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Small for size syndrome difficult dilemma: Lessons from 10 years single centre experience in living donor liver transplantation

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World Journal of Hepatology 2017年第21期9卷 930-944页

作者： Hany Shoreem emad hamdy Gad Hosam Soliman Osama Hegazy Sherif Saleh Hazem Zakaria Eslam Ayoub Yasmin Kamel Kalid Abouelella Tarek Ibrahim Ibrahim Marawan Hepatobiliary Surgery Department National Liver InstituteMenoufiya Univer-sity Anesthesia Department National Liver InstituteMenoufiya University

AIM To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome(SFSS) after living donor liver transplantation(LDLT). METHODS Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT(A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range(0-144 m). RESULTS SFSS was diagnosed in 20(11.5%) of our recipients. While extra-small graft [small for size graft(SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis(P = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis(P = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10(40%) SFSS vs 3/7(42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe(RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10(28.6%) SFSS vs 52/152(34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7-and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference(P = 0.00). CONCLUSION SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the mana

关键词： Living donor liver transplantation Outcome after living donor liver transplantation Small for size syndrome Small for size graft Portal inflow Venous outflow

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Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases

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World Journal of Gastroenterology 2017年第38期23卷 7025-7036页

作者： ayman el nakeeb waleed askar ehab atef ehab el hanafy ahmad m sultan tarek salah ahmed shehta mohamed el sorogy emad hamdy mohamed el hemly ahmed a el-geidi tharwat kandil mohamed el shobari talaat abd allah amgad fouad mostafa abu zeid ahmed abu el eneen nabil gad el-hak gamal el ebidy omar fathy ahmed sultan mohamed abdel wahab gastroenterology surgical center mansoura university

AIM To evaluate the evolution, trends in surgical approaches a n d r e c o n s t r u c t i o n t e c h n i q u e s, a n d i m p o r t a n t lessons learned from performing 1000 consecutive pancreaticoduodenectomies(PDs) for periampullary *** This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period(1993-2002), middle period(2003-2012), and late period(2013-2017).RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the *** Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.

关键词： Pancreaticoduodenectomy Pancreaticogastrostomy Pancreaticojejunostomy Postoperative pancreatic fistula Periampullary tumor

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Intraoperative endoscopic retrograde cholangiopancreatography: A useful tool in the hands of the hepatobiliary surgeon

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World Journal of Gastroenterology 2015年第2期21卷 609-615页

作者： Ayman El Nakeeb Ahmad M Sultan emad hamdy Ehab El Hanafy Ehab Atef Tarek Salah Ahmed A El Geidie Tharwat Kandil Mohamed El Shobari Gamal El Ebidy Gastroenterology surgical center Mansoura UniversityDaqahlia 35516Egypt

AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography(ERCP) combined with laparoscopic cholecystectomy(LC) forpatients with gall bladder stones(GS) and common bile duct stones(CBDS).METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram(TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven ***: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases(84.2%) where removal of stones were successful; passed stones in 6 cases(7.9%); short lower end stricture with small stones present in two cases(2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case(1.3%) which was treated by open hepaticojejunostomy; and one case(1.3%) was proved to be ampullary carcinoma and whipple's operation was scheduled. CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.

关键词： Obstructive jaundice Endoscopic retrograde cholang

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Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

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World Journal of Gastrointestinal Endoscopy 2016年第19期8卷 709-715页

作者： Ayman El Nakeeb Ehab El Hanafy Tarek Salah Ehab Atef Hosam Hamed Ahmad M Sultan emad hamdy Mohamed Said Ahmed A El Geidie Tharwat Kandil Mohamed El Shobari Gamal El Ebidy Gastroenterology Surgical Center Mansoura University

AIMTo detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity. METHODSThis is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected. RESULTSThe study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP. CONCLUSIONPEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

关键词： Pancreatitis Obstructive jaundice Endoscopic retrograde cholangiopancreatography

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Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy

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World Journal of Gastroenterology 2013年第41期19卷 7129-7137页

作者： Ayman El Nakeeb Ahmad M Sultan Tarek Salah Mohamed El Hemaly emad hamdy Ali Salem Ahmed Moneer Rami Said Ahmed AbuEleneen Mostafa Abu Zeid Talaat Abdallah Mohamed Abdel Wahab Gastroenterology surgical center Mansoura UniversityMansoura 35516Egypt

AIM:To elucidate surgical outcomes of pancreaticoduodenectomy(PD)in patients with liver ***:We studied retrospectively all patients who underwent PD in our centre between January 2002and December *** A comprised patients with cirrhotic livers,and Group B comprised patients with non-cirrhotic *** cirrhotic patients had ChildPugh classes A and B(patient’s score less than 8).Preoperative demographic data,intra-operative data and postoperative details were *** primary outcome measure was hospital mortality *** outcomes analysed included duration of the operation,postoperative hospital stay,postoperative morbidity and survival ***:Only 67/442 patients(15.2%)had cirrhotic *** blood loss and blood transfusion were significantly higher in group A(P=0.0001).The mean surgical time in group A was significantly longer than that in group B(P=0.0001).Wound complications(P=0.02),internal haemorrhage(P=0.05),pancreatic fistula(P=0.02)and hospital mortality(P=0.0001)were significantly higher in the cirrhotic *** stay was significantly longer in group A(P=0.03).The median survival was 19 mo in group A and 24 mo in group *** hypertension(PHT)was present in 16/67 cases of cirrhosis(23.9%).The intraoperative blood loss and blood transfusion were significantly higher in patients with PHT(P=0.001).Postoperative morbidity(0.07)and hospital mortality(P=0.007)were higher in cirrhotic patients with ***:Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver *** is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis;therefore,it is only recommended in patients with Child A cirrhosis without portal hypertension.

关键词： Periampullary tumour Liver cirrhosis Portal hypertension Pancreaticoduodenectomy

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Theoretical-period characteristics of frame buildings designed under variable levels of seismicity and allowable-drift

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Earthquake Engineering and Engineering Vibration 2020年第3期19卷 669-681页

作者： hamdy Abou-Elfath emad Elhout Structural Engineering Department Faculty of EngineeringAlexandria UniversityAlexandria 21544Egypt Higher Institute of Engineering and Technology King-MarriottAlexandriaEgypt

Period equations provided by seismic codes are generally derived by calibration with recorded period data of buildings located in high seismicity *** period-equations do not account for either the design level of seismicity or the permissible limit of lateral *** designed under high level of seismicity are expected to display higher stiffness and shorter periods than buildings designed under low-to-medium seismicity *** addition,buildings designed with high level of permissible lateral-drift are expected to display lower stiffness and longer periods than buildings designed with low level of permissible *** this study,the theoretical fundamental-periods of an ensemble of regular reinforced concrete(RC)and steel moment-resisting frame(MRF)buildings having 3-,6-,9-and 12-stories and designed with various levels of seismicity and permissible lateral-drift are *** obtained outcome indicates the sensitivity of the MRF theoretical-periods to the design seismicity and the permissible *** results also indicate the need for modifying the current period equations to realistically account for the variations in the design seismicity and allowable lateral-drift of MRF buildings.

关键词： concrete frame stiffness

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How does epidemiological and clinicopathological features affect survival after gastrectomy for gastric cancer patientssingle Egyptian center experience

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World Journal of Gastrointestinal Surgery 2016年第6期8卷 444-451页

作者： Ehab El Hanafy Ayman El Nakeeb Helmy Ezzat emad hamdy Ehab Atif Tharwat Kandil Amgad Fouad Mohamed Abdel Wahab Ahmed Monier Gastroenterology Surgical Center Mansoura University

AIM:To investigate the clinicopathological features and the significance of different prognostic factors which predict surgical overall survival in patients with gastric ***:This retrospective study includes 80 patients diagnosed and treated at gastroenterology surgical center,Mansoura University,Egypt between February 2009 to February *** factors were assessed by cox proportional hazard ***:There were 57 male and 23 *** median age was 57 years(24-83).One,3 and 5 years survival rates were 71%,69% and 46% *** median survival was 69.96 *** the follow-up period,13 patients died(16%).Hospital morbidity was reported in 10 patients(12.5%).The median number of lymph nodes removed was 22(4-41).Lymph node(LN) involvement was found in 91% of *** R0 resection,depth of wall invasion,LN involvement and the number(> 15) of retrieved LN,LN ratio and tumor differentiation predict *** multivariable analysis,tumor differentiation,curability of resection and a number of resected LN superior to 15 were found to beindependent prognostic ***:Surgery remains the cornerstone of *** differentiation,curability of resection and a number of resected LN superior to 15 were found to be independent prognostic *** LN dissection does not increase the morbidity or mortality rate but markedly improves long term survival.

关键词： Cancer stomach Prognostic factors Lymph node metastasis Recurrence after gastrectomy Lymph node ratio

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Involved Nodal Radiotherapy vs. Involved Field Radiotherapy after Chemotherapy in the Treatment of Early Stage Hodgkin’s Lymphoma

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Journal of Cancer Therapy 2013年第1期4卷 271-279页

作者： hamdy M. Zwam emad E. Habib Mustafa E. AL-Daly Clinical Oncology Department Faculty of Medicine Cairo University Cairo Egypt

Aim of work: This study is a prospective randomized trial aiming to investigate whether radiotherapy volume can be reduced without loss of efficacy from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) after four cycles of ABVD chemotherapy in the treatment of early stage Hodgkin’s lymphoma. Patients and Methods: Between September 2009 and January 2012, all patients with newly diagnosed early-stage favorable and unfavorable Hodgkin’s lymphoma attending to the Clinical Oncology department of Cairo University, faculty of medicine were enrolled into this study after a written consent was obtained from those cases enrolled. Patients were assigned to receive (ABVD) for four cycles followed by randomization for radiotherapy into two arms one arm of 30 Gy INRT +/– 6 Gy to residual disease or another arm of 30 Gy IFRT +/– 6 Gy to residual disease. Results: 35 patients were enrolled in this study: 16 patients in the INRT arm and 19 patients in the IFRT arm. The median observation time was 25 months. The overall survival for all eligible patients was 97% and freedom from treatment failure was 85.7%. Survival rates at the end of the study revealed no differences between INRT and IFRT arms. Also, in terms of complete remission post radiotherapy (14 versus 15), relapse (1 versus 4), and death (0 versus 1) respectively the outcome was similar in both arms. As regard acute and sub-acute toxicities no significant difference could be detected between both arms except that IFRT arm was associated with a higher incidence of radiation pneumonitis (4 versus 1 patient). Conclusion: Radiotherapy volume size reduction from IFRT to INRT after ABVD chemotherapy for four cycles produces similar results and less toxicity in patients with early-stage Hodgkin’s lymphoma especially in patients with mediastinal disease.

关键词： Hodgkin’s Lymphoma Nodal Radiotherapy Field Radiotherapy

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T-Helper I Cell/T-Helper 2 Cell Balance with Anti Inflammatory Therapy in Partly Controlled Asthmatic Children

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Journal of Life Sciences 2012年第11期6卷 1206-1213页

作者： Gamal Abdel Naser Yamamah Hala hamdy Shaaban emad Ezzat Salama Nevine El Helaly Solaf Kamel Elham Mostafa Pediatrics Department National Research Center (NRC) Cairo 12622 Egypt Pediatrics Department Faculty of Medicine Cairo University Cairo 11562 Egypt Clinical and Chemical Pathology Department National Research Center Cairo 12622 Egypt

The authors aimed to assess Thl （T-helper cell 1）/Th2 （T-helper cell 2） balance, through evaluation of serum IFN-γ （interferon gamma） and IL-4 （interleukin 4）, during asthma exacerbation and study the effect of anti inflammatory therapy. A randomized prospective case-control study was designed. The sludy included 30 asthmatic patients, aging 8-14 years. All were diagnosed as partly controlled asthmatics. Twenty, age and sex matched, healthy children were included in the study as control group All participants were subjected to medical history, clinical examination, pulmonary function testing, eosinophilic blood counting, estimation of serum interleukine-4 and interferon gamma. Patients were treated for 6 weeks with 2 different anti inflammatory drugs. All methods were then repeated for follow up. IL-4 serum level was significantly higher in subjects with partly controlled asthma than in control subjects （P = 0.01）, and then in asthmatic patients after therapy （P = 0.0000）, while IFN-）, serum level was significantly lower in subjects with partly controlled asthma than in control subjects （P = 0.01）, and than in asthmatic patients after therapy （P = 0.0000）. Interferon gamma showed a significant negative correlation with IL-4 among the healthy control group （r = -0.559, P = 0.010）. Both LTA （leukotriene antagonist） and ICS （inhaled corticosteroids） therapy lead to significant improvement, but there were no statistically significant differences （P 〉 0.05） between them as regard the pulmonary functions and the laboratory evaluating parameters. Both serum levels of IL-4 and IFN-γ, could be used as a reliable inflammatory biomarker for the evaluation and follow up of asthmatic patients.

关键词： Thl Th2 IFN-γ IL-4 partly controlled asthma LTA ICS.

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Value of Different Diagnostic Markers in Spontaneous Bacterial Peritonitis in HCV Egyptian Cirrhotic Patients

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Open Journal of Gastroenterology 2015年第9期5卷 119-128页

作者： emad M. El Motasem Ahmed A. Heikal Hemmat E. El Haddad Ahmed hamdy Rasha M. Abdel Samie Heba Sharaf El Din Internal Medicine Department Faculty of Medicine Cairo University Cairo Egypt Clinical and Chemical Pathology Department Faculty of Medicine Cairo University Cairo Egypt

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening infection occurring in 8% - 30% of ascitic cirrhotic patients;different laboratory diagnostics play a pivotal role for rapid and effective management of SBP patients. Polymorphonuclear leucocytic (PMNLs) count in Ascitic fluid (AF) is the mainstay for the diagnosis, whereas the diagnostic role of alternative biomarkers is rather controversial. In many studies, serum lipopolysaccharide binding protein (LBP) was elevated and Complement 3 (C3) level was significantly consumed in AF of SBP patients. Objectives: To evaluate the diagnostic value of serum LBP and AF C3 in HCV-cirrhotics with SBP in relation to other well-established serum and AF markers. Patients and Methods: One hundred and twenty patients with HCV-cirrhosis and ascites were enrolled and consented: 50 patients with non-SBP ascites in group A and 70 ascitic patients diagnosed with SBP according to clinical suspicion and PMLs count in AF ≥ 250 cells/mm3 in group B in addition to 15 healthy individuals considered as a control group. Serum LBP, CBC, kidney and liver function tests, CRP, fasting and 2 h PP blood glucose and HCV antibodies were measured. AF samples were sent for C3 level, culture, PMNLs count, LDH, CRP, total proteins and albumin. Results: In patients with SBP, the level of serum LBP was not significantly high (p > 0.05) with best cut off value at 0.4500 and poor AUC (<0.6) with low sensitivity and specificity (53.3% & 57.7%, respectively). AF C3 was significantly reduced in AF (p < 0.001) with best cut off value at 144.2 and almost excellent AUC (0.889) with good sensitivity and specificity (82% & 84%, respectively). AF culture showed significant difference between both patients groups (p < 0.05) but with low sensitivity (33.3%). Serum and AF CRP and AF PMNLs count were of high significance in SBP diagnosis (p < 0.001). Conclusion: Serum LBP level showed low significance while AF C3 was significantly reduced in patients

关键词： Spontaneous Bacterial Peritonitis-Serum Lipopolysaccharide Binding Protein-Ascitic Fluid Complement 3-C-Reactive Protein-Ascitic Fluid Culture

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