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Background: Gastric cancer is the third most common type of cancer worldwide. Gastric cancer has a 15% to 20% 5-year overall survival rate, even if the disease just affects the stomach wall. The prognosis is favorable if tumors and their precursors are discovered early on. The current study intended to enhance the prognosis of patients suffering from early-stage stomach cancer. Methods: In this study, 24 patients with stomach cancer who attended to Zagazig University Hospitals' outpatient clinic were included. Every patient underwent a complete medical history, a general examination, and an abdominal examination that included PR and PV. Laboratory tests were performed. Along with gastroscopy and biopsies, all patients also underwent CT, ultrasonography, and CXR scans. Results: There were six women and eighteen men in the study. The distal portion of the stomach was the site of malignancy in all 100 cancer patients under study. A statistically significant correlation was not observed between the sex of the cancer cases under study and either the age distribution or the tumor site. Conclusions: Laparoscopic distal gastrectomy is a safe and effective treatment that offers advantages over open conventional gastrectomy for treating stomach cancer. These advantages include a lower risk of intraoperative blood loss and overall consequences. [ABSTRACT FROM AUTHOR]

Background: One of the most frequently performed surgical procedures worldwide is the laparoscopic cholecystectomy (LC). There is a need to assess numerous factors that may lead to conversion from laparoscopic to open surgery in the case of complicated laparoscopic cholecystectomy. Objective: The aim of the current study was to evaluate the risk factors and predictive models for open surgery (CTO), and surgical quality outcome measures. Patients and methods: This is a prospective observational study was conducted at General Surgery Department, Faculty of Medicine, Zagazig University. A total of 56 patients with symptomatic gall bladder disease were included. Surgical quality outcome were estimated. Results: Male gender was found to be a highly significant factor for predicting of difficult laparoscopic cholecystectomy (DLC) (P=0.026). Also, older age was found to be a significant factor for predicting DLC. Obesity was found to be a significant predictive factor of difficulty in LC. History of previous ERCP was a significant factor for prediction of difficulty as history was positive in 7 (6.7%) patients and 6 (85.7%) patients of them had difficulty during operation. Preoperative ultasonographic findings of thickened gallbladder wall; it was highly significant predictive factor for difficult LC (P=0.005). In this series presence of a thick GB wall may make grasping and manipulation of GB difficult gallstones size; it was a significant predictive factor for difficult LC (P=0.001). The duration of operation was found to be significant factor for predicting difficulty. Conclusion: Pre-operative ultrasound is without a doubt a good predictor of DLC in the majority of instances and should be used as a screening tool, However to predict the challenging LC, greater attention must be given to demographic data, the patient's medical history, and the clinical evaluation. [ABSTRACT FROM AUTHOR]

Background: With the rise of laparoscopic surgery, there have been reports of blunt trauma situations where a laparoscopic approach was used, particularly for partial splenectomies. However, the evidence has not yet met acceptable criteria. This study aimed to evaluate the safety, feasibility, and outcome of laparoscopic splenectomy in patients with blunt splenic injury. Patients and methods: This clinical trial study was carried out in Zagazig University hospital including 30 patients with splenic injuries caused by blunt abdominal trauma who were admitted to the Emergency Department of Zagazig University hospitals during the period from March 2020 to September 2020 to evaluate the feasibility and outcome of laparoscopic splenectomy in patients with blunt splenic injury. The diagnosis of splenic injury caused by blunt splenic trauma was confirmed on basis of Radiological investigations and Laboratory investigations. Results: in this study, Only 2 cases 6.7% converted to open. Overall complication founded in 4 cases with 13.3%. Conclusion: Laparoscopic Splenectomy was safe and technically feasible when applied carefully to patients with blunt abdominal trauma, decreasing the hospitalization time and postoperative ICU stay. [ABSTRACT FROM AUTHOR]

In this paper, we introduce a new technique, called the direct power series method to solve several types of time-fractional partial differential equations and systems, in terms of the Caputo derivative. We illustrate the method with a simple algorithm that can be used to solve different types of time-fractional partial problems. We introduce a new theorem to explain the required substitutions of the proposed method. In addition, convergence analysis conditions of the method are given. Furthermore, some different illustrative examples of time-fractional partial differential equations and systems are discussed to show the applicability and simplicity of the new approach. [ABSTRACT FROM AUTHOR]

In this research, a hybrid method, entitled the Laplace Residual Power Series technique, is adapted to find series solutions to a time-fractional model of Navier-Stokes equations in the sense of Caputo derivative. We employ the proposed method to construct analytical solutions to the target problem using the idea of the Laplace transform and the residual function with the concept of limit at infinity. A simple modification of the suggested method is presented to deal easily with the nonlinear terms constructed on the properties of the power series. Three interesting examples are solved and compared with the exact solutions to test the reliability, simplicity, and capacity of the presented method of solving systems of fractional partial differential equations. The results indicate that the used technique is a simple approach for solving nonlinear fractional differential equations since it depends only on the residual functions and the concept of the limit at infinity without needing differentiation or other complex computations. [ABSTRACT FROM AUTHOR]

Background: In conjunction with the diagnosis,, an effective initial resuscitation should be done, and a management plan should be established. It should be noted that delayed presentation, hemodynamic instability, and preexisting co-morbidities necessitates aggressive resuscitation prior to surgery and close perioperative monitoring; to minimize the subsequent morbidity and mortality related to the condition, proper management plan regarding the treatment options of the perforation alone or addition of an ulcer definitive surgery should be addressed to each patient according to his condition. Conservative treatment is known as the Taylor method and consists of nasogastric aspiration, antibiotics, IV fluids, and Helicobacter pylori triple therapy. In 1946 Taylor presented the first series of successfully outcome of conservatively treated patients with perforated peptic ulcer, based on the theory that effective gastric decompression and continuous drainage will enhance self-healing. The idea for conservative treatment came from Crisp who in 1843 noted that perforations of the stomach were filled up by adhesions to the surrounding viscera which prevented leakage from the stomach into the peritoneum. But still there is an ongoing debate whether perforated peptic ulcer generally needs to be operated on or not. Many techniques have been described in the literature for the surgical treatment of perforated peptic ulcers starting from simple closure of the perforation with an omental patch, using an omental plug, a falciform ligament patch, a serosal jejunal patch and even proceeding to resection of perforation bearing duodenum and the antrum in the form of a partial gastrectomy with either a Billorth I or Billorth II anastomosis for larger perforations. Most of these techniques can be achieved using the open or the laparoscopic approaches. [ABSTRACT FROM AUTHOR]

This randomised controlled trial aimed to compare the effect of early and delayed pushing during the second stage of labour in women with occipitoposterior (OP) malposition. It included 184 nulliparous women with OP position randomised to early pushing in which women were allowed to push within one hour after full cervical dilatation or delayed pushing in which women were asked not to push for maximum of three hours or start pushing when the vertex was visible. The primary outcome was successful vaginal delivery. The rate of spontaneous vaginal delivery was significantly higher in the early pushing group (80.4 vs. 60.9%, p=.004) while the rate of instrumental vaginal delivery (30.4 vs. 15.4%) and CS (8.7 vs. 4.3%) was significantly higher in the delayed pushing group. Women in the delayed pushing group showed a significantly longer duration of the second stage (129.4 ± 7.5 vs. 61.6 ± 15.3 minutes, p<.001) and shorter duration of pushing (219.8 ± 74.8 vs. 693.9 ± 145.2 seconds, p<.001).The rate of 2nd and 3rd degree perineal lacerations (19.6 and 13% vs. 5.4 and 8.7% respectively, p=.013) and vaginal tears (41.3 vs. 8.7%, p<.001) was significantly higher in the early pushing group. We concluded that early pushing during the second stage of labour is associated with higher rates of spontaneous vaginal delivery and vaginal and perineal lacerations. Clinical trial registration NCT03121274. What is already known on this subject? Occipitoposterior malposition is common during delivery especially in primigravida and is associated with higher rates of instrumental delivery and caesarean section. It can be managed through early or delayed pushing. What the results of this study add? Early pushing is associated with higher rates of spontaneous vaginal delivery, perineal and vaginal tears, shorter duration of second stage of labour, shorter duration of pushing, lower rates of both instrumental vaginal delivery and caesarean section. What the implications are of these findings for clinical practice and/or further research? Early pushing during the second stage of labour is associated with higher rates of spontaneous vaginal delivery and vaginal and perineal lacerations in women with OP malposition and should be tried and not delaying the pushing. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal abscesses continue to be a major source of morbidity and mortality in today's surgical practice. Localized intra-abdominal abscesses usually tend to form in relation to the affected viscus. A proper diagnosis and abscess localization are mandatory for prompt treatment. Laparoscopic drainage for a massive intra-abdominal abscess is minimally invasive, enabling exploration of the abdominal cavity without the use of a wide incision. Aim: To evaluate the outcome of laparoscopic management of abdominal abscesses not amenable to percutaneous or transrectal CT guided or ultrasound US-guided drainage. Results and conclusion: Laparoscopic drainage was a feasible, safe, and effective therapeutic modality for pelvic-abdominal abscesses. Laparoscopic drainage is a minimally invasive procedure with low PO morbidities. [ABSTRACT FROM AUTHOR]

Background: Abdominal compartment syndrome (ACS) is a severe illness seen in critically ill patients. It may be under recognized because it primarily affects patients who are already quite ill. We aimed to to estimate the incidence of ACS in patients with AP in early stage and to evaluate intraabdominal pressure (IAP) as a marker of severity in acute pancreatitis and to ascertain the relationship between IAP and development of complications in patients with severe acute pancreatitis (SAP). Patients and methods: This prospective study was conducted in General Surgery Department, Faculty of Medicine, ZagazigUniversity on 18 patients with AP admitted to the Surgical Intensive Care Unit (SICU). All patients were recruited into two groups according to IAP determined during the first week after admission. Patients with IAP ≥ 20mmHg were assigned in IAH group, and patients with IAP < 20mmHg in normal IAP group. Results: APACHE was distributed as 3.94±1.35 as 50% were 71> (low) and 50% were <71 (high). About 72.2% of studied group had no morbidity and 27.8% had comorbidities as 2 cases with HTN and 3 cases had DM, regard previous surgery only 5 cases had history of surgery. Lipase level was distributed as Lipase mean of 959.72±103.58 with rang (800-1200). ACS cases were significantly associated with longer hospital stay also with Bleeding, Septic shock and Mortality. Conclusion: IAH and ACS are common finding in patients admitted to the ICU with severe acute pancreatitis. IAH may worsen the severe acute pancreatitis. Early recognition of this potentially treatable aggravating condition may lead to earlier intervention and hopefully improve the outcome. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal abscesses remain a major cause of morbidity and mortality. Intra-abdominal abscesses that are localized usually arise in connection to the damaged viscus. For timely treatment, a correct diagnosis and abscess localization are required. Laparoscopic draining of a large intra-abdominal abscess is a minimally invasive procedure that allows exploration of the abdominal cavity without a large incision. Aim: This study aimed to to evaluate the outcome of laparoscopic management of abdominal abscesses not amenable to percutaneous or transrectal CT guided or ultrasound US-guided drainage. Patients and Methods: This prospective study included 24 patients presenting with clinical and radiological manifestations of lower abdominal intraperitoneal abscesses at General Surgery Department, Zagazig University, Egypt. This study was conducted through the period from Feb 2021 to Aug 2021. Results: Our analysis showed that mean operative time was 97.2 ± 12.3 min, mean intraoperative blood loss volume was 176.5 ± 62.7 ml and 19 cases needed blood transfusion. The VAS score of preoperative pain decreased from 6.9 pre-operative to 5 immediate post-operative and 0.3 at 24 hr post-operative. Conclusion: For pelvic-abdominal abscesses, laparoscopic drainage proved a realistic, safe, and effective treatment option. Laparoscopic drainage is a minimally invasive treatment with few postoperative complications. [ABSTRACT FROM AUTHOR]

Background& Aim: Several treatment forms have been utilized to remove the pain following laparoscopic cholecystectomy (LC), including nonsteroidal anti-inflammatory drugs, opioids and local anaesthetics, however none has elucidated harmonious effectiveness. So, this study aimed to estimate the effectiveness of intraperitoneal (IP) lidocaine with tenoxicam on relieving the pain and bowel recovery post LC. Methods: A prospective clinical trial was performed in the General Surgery department, Zagazig University Hospitals, Egypt, between March 2019-March 2020. Such study was done on 126 patients suffered from chronic calcular cholecystitis categorized into two groups: Group (A): patients underwent LC without IP lidocaine or tenoxicam and Group (B): patients underwent LC with IP lidocaine and tenoxicam. Results: There was no significant variations among both groups concerning demographic and clinical characteristics. Furthermore, there was no significant variations concerning operation time or anesthesia time. Pain control satisfaction score (PCSS) was significantly higher in Group B. Visual analogue scale (VAS) was significantly lower at Group B from two-six hours with no significant variation at eight & 12 hours at rest or movement. The time of 1st demanded analgesia was earlier in Group A and total analgesia dosage was significantly higher between Group A. Group B was significantly shorter concerning bowel sound/h, oral intake/h, ambulation/h, and hospital stay/day. The shoulder pain and nausea were significantly correlating with Group A and also vomit was higher in Group A but not statistically significant. Conclusions: IP lidocaine with tenoxicam administration is a viable alternative when seeking to alleviate postoperative pain among patients undergoing LC. [ABSTRACT FROM AUTHOR]

Purpose: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS and determines blood loss during CS. We aimed to compare manual removal versus spontaneous delivery of the placenta at CS. Methods: In a randomized controlled trial, 574 women admitted for primary or repeat elective CS were randomized into two groups. In group A, the placenta was manually removed, whereas in group B, the placenta was left for spontaneous delivery. Blood loss, operative and postoperative data were recorded. Results: Blood loss was 875.2 ± 524.2 ml in group A versus 731.8 ± 426.7 ml in group B (p = .001), with a significant drop in postoperative HB (p = .015) and HCT (p = .031). In group A, odds ratios for blood loss (>1000 ml), HB drop (> 4g/dl), postpartum hemorrhage and blood transfusion were 2.581, 2.850, 2.614 and 1.665, respectively. However, the total operative time (p = .326), duration of hospital stay (p = .916) and intensive care unit (ICU) admission (p = .453) were not statistically different between the two groups. Conclusions: Manual removal of the placenta at CS is associated with a higher risk of blood loss, postpartum hemorrhage and blood transfusion, with no decrease in operative time. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the prevalence of placenta accrete (PA) among those with placenta implanted over cesarean section (CS) scar and to evaluate the accuracy of Doppler ultrasound in diagnosis.Methods: A cross-sectional study included 100 patients with placenta previa (PP) anterior with at least one previous CS. Ultrasound and color Doppler were done to all participants and correlated with operative findings.Results: There was a significant difference between accrete and non-accrete group regarding maternal age (32.6 ± 5.01 versus 29.14 ± 4.89), and a highly significant difference regarding the postoperative hemoglobin (6.71 ± 1.156 versus 8.41 ± 1.257) and the number of previous CSs (p <.001). The abnormal Doppler findings showed a highly significant difference between the two groups as loss of retroplacental clear zone (87.3% versus 10.8%), intraplacental lacunae (93.7% versus 37.8%), hypervascularity in uterine bladder interface (47.6% versus 5.4%), and blood vessels invading myometrium (82.5% versus 18.9%) (p < .001). The sensitivity, specificity, PPV, NPV, and accuracy of loss of retroplacental clear were 87.3%, 89.19%, 93.2%, 80.49%, and 88%; intraplacental lacunae were 93.65%, 62.16%, 80.82%, 85.19%, and 82%; hypervascularity in uterine bladder interface were 47.62%, 94.59%, 93.75%, 51.47%, and 65%; dilated vessels over peripheral subplacental zone were 82.54%, 81.08%, 88.14%, 73.17%, and 82%, respectively. There was a highly significant difference between the two groups regarding surgical management with cesarean hysterectomy, occurrence of bladder injury, the need for intraoperative, and postoperative blood transfusion, ICU admission (p < .001).Conclusion: The use of ultrasound together with the color Doppler allowed for better prediction of placental invasion of the myometrium prior to obstetrical intervention to improve the maternal and the fetal outcome. [ABSTRACT FROM AUTHOR]