Both technical and technological advances over the past few years have made laparoscopic splenectomy (LS) more feasible and acceptable. Intraoperative bleeding is the main complication and cause of conversion during LS. Different hemostatic techniques are used for vascular control. In this study, we evaluate LigaSure vessel sealing system as the sole instrument in addition to the lateral approach for achieving a safe vascular control.Eleven patients with hematological disorders of the spleen were enrolled in this 2 year study for LS at Ain Shams University Hospitals. Eight patients had idiopathic thrombocytopenic purpura (ITP), two patients with hereditary spherocytosis and one patient with Evan's syndrome.In all patients the LigaSure vessel sealing system with lateral approach was used to achieve safe vascular control. The patients were 6 females and 5 males, their age ranging between 17-23 years (Median= 20 yrs). The intraoperative blood loss, need for blood transfusion, operative time, post-operative complications and hospital stay as well as the cost were evaluated.Nine cases were successfully performed laparoscopically with two conversions due to hilar bleeding. In all but two patients (converted patients) the intra-operative blood loss was less than 100ml (range 50-100ml) with no need for blood transfusion.The operative time range was 70-100 minutes (median 85 minutes). There were no mortalities in our series. The average hospital stay was 4 days (range 3-5 days), and apart from minor wound infection, no post operative complications were recorded.Stapleless LS using LigaSure vessel sealing system with the lateral approach is a safe procedure to carry out laparoscopic splenectomy.
Background: Duloxetine is an antidepressant drug utilized for treatment of anxiety disorders and depressive disorders. This study aimed to compare the potential protective effect of Rosmarinic acid (RA) as natural antioxidant with the potential therapeutic effects of mesenchymal stem cells on treating the toxic effect of Duloxetine on the parotid gland. Material & methods: 60 male albino rats were classified into 4 groups, 15 rats in each group. The first group1 (control): negative control (group 1a) formed from 7 rats received no treatment, positive control (group 1b) formed from 8 rats received 1ml distilled water using oro-pharengeal tube for 12 weeks, group 2 (Duloxetine): received 10 mg/kg/d duloxetine dissolved in distilled water using oro-pharengeal tube for 12 weeks, group3 (Duloxetine+RA): received Duloxetine the same as Group2 and received at the same time 120 mg/kg/d Rosmarinic acid dissolved in distilled water for 12 weeks using oropharengeal tube, group4 (Duloxetine+MSCs): received Duloxetine the same as Group2 then a single injection of MSCs just after stopping of Duloxetine , In all groups animals were sacrificed after 16 weeks for histological evaluation, the parotid gland was stained with hematoxylin and eosin, and Mallory's trichrome stain. Also, Transmission electron microscope and immunohistochemistry using caspas-3 were used to examine the parotid gland. Also the level of MDA and GSH-Px level in the parotid tissue were done. Results: Examination of parotid sections in Group2 revealed inflammatory cells infiltration and massive distortion and vacuolation of serous cells, however Group3 and Group4 showed marked improvement in the histological structure of the parotid gland. Conclusion: MSCs and RA have good effect in decreasing the toxic effect of Duloxetine administration on the parotid gland with insignificant difference between the two methods.
There is much controversy about the surgical approach to esophageal carcinoma: should an extensive resection be done to optimize long term survival or should the extent of the operation be limited to obtain lower perioperative morbidity and mortality rates? Thirty-one patients with carcinoma of the lower third of the esophagus who were clinically fit for either transhiatal resection (THR) or transthoracic resection (TTR) were prospectively randomized to THR (16 patients) and TTR (15 patients). Patients of the two groups were comparable in age, sex, preoperative tumor staging, and pulmonary and cardiac risks for surgery. There was no significant difference in the operative complications among both groups. However, the amount of blood loss was significantly more in the TTR group (P <0.05), and the mean operating time was significantly longer in the TTR group (P <0.00l). There was no difference in postoperative ventilatory requirements, and mean hospital stay between the two groups. There were higher pulmonary complications in the TTR group compared to higher incidence of anastomotic leakage and unilateral vocal cord paralysis in the THR group. However the differences were not statistically significant (P >0.05). There was no 30-day mortality in the THR group but there were 2 mortalities in the TTR group from mediastinitis (1 patients) and pulmonary embolism (1 patient). The median survival rates were 19 and 16.5 months, respectively, for the THR and TTR groups (P>0.05). In conclusion, although there was no demonstrable statistical difference in results between THR and TTR approaches, the THR approach is preferred as early survival rate are better and should be considered for all cases with adenocarcinoma of the lower end of the oesophagus.
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