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Outcomes of pancreaticoduodenectomy in elderly patients

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Hepatobiliary & Pancreatic Diseases International 2016年第4期15卷 419-427页

作者： Ayman El Nakeeb Ehab Atef Ehab El Hanafy Ali Salem Waleed Askar Helmy Ezzat ahmed Shehta Mohamed Abdel wahab Gastroenterology Surgical Center Mansoura University

BACKGROUND： Although the mortality and morbidity of pancreaticoduodenectomy（PD） have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly ***： We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age： group I（patients aged 〈60 years）, group II（those aged 60 to 69 years） and group III（those aged ≥70 years）. The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival ***： A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579（69.9%） patients in group I, 201（24.3%） in group II, and 48（5.8%） in group III. The overall incidence of complications was higher in elderly patients（25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006）. There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital ***： PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.

关键词： pancreaticoduodenectomy elderly pancreatic fistula delayed gastric emptying

Study of Aerosol Direct and Indirect Effects and Auto-conversion Processes over the West African Monsoon Region Using a Regional Climate Model

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Advances in Atmospheric Sciences 2018年第2期35卷 182-194页

作者： Zeinab SALAH ahmed SHALABY Allison L. STEINER Ashraf S. ZAKEY Ritesh GAUTAM Mohamed M. ABDEL wahab The Egyptian Meteorological Authority Cairo 11784 Egypt University of Michigan Department of Climate and Space Sciences and Engineering Ann Arbor M148109-2143 USA Centre of Studies in Resources Engineering and Interdisciplinary Program in Climate Studies Indian Institute of Technology Bombay Bombay 400076 India Cairo University Department of Astronomy Space Science and Meteorology Giza 12613 Egypt Environmental Defense Fund Washington DC 20009 USA

This study assesses the direct and indirect effects of natural and anthropogenic aerosols （e.g., black carbon and sulfate） over West and Central Africa during the West African monsoon （WAM） period （June-July-August）. We investigate the impacts of aerosols on the amount of cloudiness, the influences on the precipitation efficiency of clouds, and the associated radiative forcing （direct and indirect）. Our study includes the implementation of three new formulations of auto-conversion parameterization [namely, the Beheng （BH）, Tripoli and Cotton （TC） and Liu and Daum （R6） schemes] in RegCM4.4.1, besides the default model＇s auto-conversion scheme （Kessler）. Among the new schemes, BH reduces the precipitation wet bias by more than 50% over West Africa and achieves a bias reduction of around 25% over Central Africa. Results from detailed sensitivity experiments suggest a significant path forward in terms of addressing the long-standing issue of the characteristic wet bias in RegCM. In terms of aerosol-induced radiative forcing, the impact of the various schemes is found to vary considerably （ranging from -5 to -25 W m-2）.

关键词： aerosol, cloud West African monsoon auto-conversion RegCM

Interrelationship between Toll-like receptors and infection after orthotopic liver transplantation

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World Journal of Transplantation 2020年第6期10卷 162-172页

作者： Mahmoud El-Bendary Mustafa Naemattalah ahmed Yassen Naser Mousa Dina Elhammady ahmed M Sultan Mohamed Abdel-wahab Department of Tropical Medicine and Hepatology Faculty of MedicineMansoura UniversityMansoura 35111Egypt Department of Medical Biochemistry Faculty of MedicineMansoura UniversityMansoura 35111Egypt Gastroenterology Surgical Centre Faculty of MedicineMansoura UniversityMansoura 35111Egypt

Early microbial recognition by the innate immune system is accomplished by Toll-like receptors(TLRs),with resultant initiation of a pro-inflammatory response against infecting *** spite of presence of an abundance of Toll-like receptors on the surface of the liver,gut bacteria does not elicit an inflammatory reaction in healthy individuals due to tolerance to these TLRs,suggesting that the inflammatory responses seen in the liver are the result of breakdown of this *** orthotopic liver transplantation is often life saving in many instances,death following this procedure is most commonly due to infection that occurs in up to 80%of transplant recipients,most commonly due to microbial causes in up to 70%of cases and viral infections in 20%,while fungal infections affect only 8%of *** probability of acquiring infection following hepatic transplantation is heightened due to affection of the innate immune defense mechanisms of the host following this *** nucleotide polymorphisms of TLRs have been associated with increased likelihood of either development of post-transplant infection or eradication of infecting ***,conflicting reports from other studies reveal that prevalence of this single nucleotide polymorphism is not increased in infected patients.

关键词： Toll like receptors Infection Liver transplantation Cirrhosis Immunity Orthotopic

Formation of Trihalomethanes during Seawater Chlorination

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Journal of Environmental Protection 2010年第4期1卷 456-465页

作者： ahmed Abdel-wahab ahmed Khodary Nasr Bensalah 不详

The use of seawater for industrial cooling is a vital technology that poses some of the most profound environmental impact on the water quality in the Arabian Gulf. Biocide (chlorine) is added to the seawater to control biofouling of the cooling system. This added chlorine reacts with bromide and other chemicals naturally exist in the water to form a wide range of oxidants. Regrettably, reactions between the residual oxidants and natural organic matter in the water lead to formation of toxic halogenated organic compounds that have detrimental effects on the environment when they are discharged into the Gulf. This paper describes the formation of trihalomethanes (THMs) in seawater cooling systems. Results of kinetic experiments have shown that concentrations of THMs increased rapidly with time during the first half hour. Chlorination of seawater has shown significant increase in total THMs (TTHMs) and in bromoform concentrations. Rapid decrease of UV absorbance at 254 nm was also observed during seawater chlorination which is indicative of natural organic matter degradation into small organic molecules including THMs and other by-products. The increase in chlorine dose was accompanied with an increase in TTHMs and bromoform concentrations. Linear relationships between total chlorine concentration and both final TTHMs and bromoform concentrations were established. First order exponential decay and exponential associate functions were developed to correlate chlorine dose with formed THMs.

关键词： Chlorination by-Products Seawater Cooling Biocides Trihalomethane Bromoform

Functional evaluation of the filtering bleb by ultrasound biomicroscopy after trabeculectomy with mitomycin C

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International Journal of Ophthalmology(English edition) 2018年第2期11卷 245-250页

作者： Ali Abbas El Salhy Rabab Mohamed Elseht ahmed Fekry AI Maria Saied Mohamed Abd El-wahab Shalaby Tarek Ragaee Hossein Kafr EL Sheikh Ophthalmology Hospital Health MinistryKafr EL Sheikh 33511Egypt Department of Ophthalmology Tanta UniversityTanta 31511Egypt

AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.

关键词： filtering bleb bleb reflectivity sub-scleral tract ultrasound biomicroscopy sclerotomy site

Tailored pancreatic reconstruction after pancreaticoduodenectomy: a single-center experience of 892 cases

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 528-536页

作者： Ayman El Nakeeb Ahmad M Sultan Ehab Atef Ali Salem Mostaffa Abu Zeid ahmed Abu El Eneen Gamal El Ebidy Mohamed Abdel wahab Gastroenterology Surgical Center Mansoura UniversityMansoura 35516 Egypt

BACKGROUND: Pancreatic reconstruction following pancreaticoduodenectomy(PD) is still debatable even for pancreatic surgeons. Ideally, pancreatic reconstruction after PD should reduce the risk of postoperative pancreatic fistula(POPF) and its severity if developed with preservation of both exocrine and endocrine pancreatic functions. It must be tailored to control the morbidity linked to the type of *** study was to show the best type of pancreatic reconstruction according to the characters of pancreatic stump. METHODS: We studied all patients who underwent PD in our center from January 1993 to December 2015. Patients were categorized into three groups depending on the presence of risk factors of postoperative complications: low-risk group(absent risk factor), moderate-risk group(presence of one risk factor) and high-risk group(presence of two or more risk factors). RESULTS: A total of 892 patients underwent PD for resection of periampullary tumor. BMI >25 kg/m~2, cirrhotic liver, soft pancreas, pancreatic duct diameter <3 mm, and pancreatic duct location from posterior edge <3 mm are risk variables for development of postoperative complications. POPF developed in 128(14.3%) patients. Delayed gastric emptying occurred in 164(18.4%) patients, biliary leakage developed in 65(7.3%) and pancreatitis presented in 20(2.2%). POPF in low-, moderate-and high-risk groups were 26(8.3%), 65(15.7%) and 37(22.7%) patients, respectively. Postoperative morbidity and mortality were significantly lower with pancreaticogastrostomy(PG) in high-risk group, while pancreaticojejunostomy(PJ) decreases incidence of postoperative steatorrhea in all groups. CONCLUSIONS: Selection of proper pancreatic reconstruction according to the risk factors of patients may reduce POPF and postoperative complications and mortality. PG is superior to PJ as regards short-term outcomes in high-risk group but PJ provides better pancreatic function in all groups and therefore, PJ is superior in l

关键词： periampullary tumor pancreaticogastrostomy pancreaticojejunostomy pancreaticoduodenectomy postoperative pancreatic fistula

Problem of living liver donation in the absence of deceased liver transplantation program:Mansoura experience

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World Journal of Gastroenterology 2014年第37期20卷 13607-13614页

作者： Mohamed Abdel wahab Hosam Hamed Tarek Salah Waleed Elsarraf Mohamed Elshobary ahmed Mohamed Sultan ahmed Shehta Omar Fathy Helmy Ezzat Amr Yassen Mohamed Elmorshedi Mohamed Elsaadany Usama Shiha Gatrointestinal Surgery Liver Transplantation Unit Gastrointestinal Surgical Center Mansoura University Daqahlia 35516 Egypt Anesthesia Intensive Care Department Gastrointestinal Surgical Center Mansoura Faculty of Medicine Mansoura University Daqahlia 35516 Egypt Internal Medicine Department Mansoura Faculty of Medicine Mansoura University Daqahlia 35516 Egypt Radiology Department Gastrointestinal Surgical Center Mansoura University Daqahlia 35516 Egypt

We report our experience with potential donors for living donor liver transplantation(LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors(n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion(n = 792).Most of the transplant candidates(82.3%) had an experience with more than one excluded donor(median = 3). Some recipients travelled abroad for a deceased donor transplant(n = 12) and some died before finding a suitable donor(n = 14). The evaluation of an excluded donor is a time-consuming process(median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD(range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.

关键词： Living donor Liver transplantation Excluded donors Deceased donor Liver disease

Water Requirements of Sugar Beet Beta vulgaris under Heavy Cracking Clay Soils

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Journal of Agricultural Science and Technology(B) 2012年第8期2卷 865-874页

作者： Abdelhadi Abdel wahab ahmed Ali Salih Arabian Gulf University Desert and Arid Zones Sciences Program College of Graduate Studies Manamah Kingdom of Bahrain

Crop coefficients （Kc） of sugar beet were determined for accurate calculation of water requirements （CWR） and better irrigation water management. Three irrigation treatments were used during two seasons to measure actual crop water use （ETc） under no soil stress treatment using gravimetric sampling. In the second season （SS）, the method was modified to target 8 temporal points during crop growth for smooth calculation of ETc under sufficient moisture supply to avoid the distortion that was created by the continuous gravimetric sampling after, before and during each irrigation cycle on the experimental plots. Water was stopped when each targeted sampling point was reached using large plots where intensive sampling continues until the crop reaches severe water stress or permanent wilting point （PWP）. The actual crop water use was extracted from the soil moisture depletion curve which allowed the identification of two clear segments. The first segment indicated crop water use during no water stress while the change of the slope indicated the beginning of the water stress. The reference crop evapotranspiration （ET0） was determined on daily basis using appropriate weather data that coincides with the ETc measurement and consequently the crop Kc were calculated. The results showed that the method used during the SS is easy and provides a better understanding of actual crop water use and better estimation of crop Kc. The calculated 10-day Kc values for sugar beet under heavy cracking clay soil conditions were： 0.46, 0.49, 0.53 and 0.60; for the initial stage： 0.69, 0.78, 0.88 and 0.97; for the development stage： 1.05, 1.11, 1.13, 1.11 and 1.04; for mid-season stage and for late season stage： 0.92, 0.74 and 0.60. Yield and other sugar related parameters were also presented for the two seasons.

关键词： Sugar beet crop water requirements cracking clay gravimetric sampling.

Surgical Excision of Placenta with Lower Uterine Segment as a Conservative Management in a Case of Placenta Accreta: A Case Report

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Open Journal of Obstetrics and Gynecology 2018年第1期8卷 63-68页

作者： ahmed Sherif Abdel Hamid Abdel wahab Mohamed Mohamed Yaseen Department of Obstetrics & Gynecology Ain-Shams University Cairo Egypt Department of Urology Ain-Shams University Cairo Egypt

Introduction: Placenta accreta is due to invasive placental implantation. It is diagnosed when there is failure of delivery of a retained placenta. This is usually complicated by massive intrapartum hemorrhage that ends by hysterectomy. Case: We report a case of conservative management in a case of placenta accreta involving an elliptical shape incision of the lower segment with removal of placenta with underlying lower uterine segment in a stable patient desiring future fertility. Conclusion: Conservative management may be valid in carefully selected cases of placenta accreta diagnosed pre-operatively in tertiary hospitals with availability of blood-bank and multi-disciplinary approach.

关键词： Placenta Accreta Conservative Management Elliptical Incision Cystostomy