mansoura, dakhlia | Egypt
Additional Specialties: proctoperiineolgy
1) End Colostomy with Smooth Muscle Grafting; A Decent Proposal for Colostomy Care. International Gastroclub Conference Budapest 1996. Proceeding – Mansoura Faculty of Medicine Conference. 1995. [Proceeding].
2) Anorectal varices : endoscopic dilemma. Surgical Endoscopy (journal of European association of endoscopic surgeon;EAES; and Intervenual Technique) JUN 1996:445-448.
3) The Effect of Somatostatin Analogue, Octrotide on The Jejunal Mucosa of Bowel Resected Albino Rat. WJS Proceeding ISW 95, 36 World Congress of Surgery. Mansoura Medical Journal Vol. 1,2:1 (1996).
4) Does The Coloanal J – Pouch Have Similar Properties to Ano-Rectum ? Benha Medical J 13,3 : 240 – 245(1996).
5) Dynamic Graciloplasty with Obturator – Pudendal Nerve Anastomsis. Is It Myth or Reality? Mansoura Faculty of Medicine, Pediatric Conference 1995, 4th Congress of Italian Society of Coloproctology Torino Italy 1996 [Proceeding].
6) The Double Stapled Technique in Low Colorectal Anastomosis Is it worthwhile ? Benha Medical J 13,43 : 255 – 265 (1996).
7) Modified Duhamel Using Linear Outer Gia 75mm vs Modified Swanson in Hirshsprings Disease. Benha Med. J 14,1:107–113 (1997).
8) Evaluation of Adult Patients with Chronic Constipation by Defecography and Colonic Transit Using Radiopaque Markers, The Egyptian Journal of Radiology & Nuc. Med. , Vol. 29, No. 2, (Dec.):529-549, 1998.
9) Gut Ischemia & Oxiditive Stress in Pneumo- Peritonium Expermintal Study Mansoura Medical J 29 , 3&4 July& October,1999.
10) The Use Of Unilateral Gluteus Maximus Muscle For The Mangment of Fecal Incontinence Following Anorectol Surgery Technique in Coloproctology 4,1 :7 – 12(2000).
11) Severe Anorectal Injuries Associated with Fracture Pelvis: Primary or Secondary Repair Panarab Association of Surgery Cairo (2001). 20th Congress of Italian Society of Surgery.
12) Evaluation of Roux En Y Gastic Bypass Procedure Operation in Management of Morbid Obesity Mans. Med J.32,3&4 2001.
13) Encopresis in Children Impact of Anxiety and Depression Symposium of Lower Gut Disorder. Mansoura Medical J. (2001).
14) Evaluation of Vertical Banded Gastroplasty Operation In Mangnent of Morbid Obesity: Study of 25 Cases Mansoura Medical J. 32 No. 3,4 July & Oct 121-135 (2001).
15) Transperineal with or without Levatoroplasty vs. Transanal Repair for Rectocele in Obst. Defecation Egyptian J. of Surgery, 21 , No. 3 , July (2002).
16) Evaluation of Different Treatment Modalites in Dukes B and C Rectal Adenocarcinoma. Medical J of Cairo Unversity (Accepted In 4/3/2002).
17) Evaluation of Overlapping anal Sphenctric Repair ( OASR ) with Internal Sphincter Imprication for Fecal Incontinence Due to Sphincteric Injury Benha Med. J. 19,2:27 2002 .
18) Research Design . Egyptian Journal of Surgery Vol. (21), No. 4 , Oct., 2002.
19) Professional Development How to Write A Research Proposal (Protocol) Eg. J Surg 21,1:2002.Professional Development Sample Size Eg. J Surg 22,2 :111-114, 2003.
20) M.Farid, H.A. Moneim. T. Mahdy. W. Omer. (2003)., "Augmented Unilateral Gluteoplasty with Fascia Lata Graft in Fecal Incontince" Tech. in Coloproctology, 7 No. April 23-28 .51)
21) How to Present A Paper at A Scientific Meeting. Egyptian J of Surgery, 23 No. 4 Oct (2004).
22) Professional Development (Handing Surgical Data Exploratry Data Analysis) EJS October 2004.
23) Nabil Dowidar, Mohamed Farid, Ahmed Hussein,Ahmed Hazem . , Jan. , 2004.,"Tips on Writing :A Scientific Paper" Egyptian Journal of Surgery Vol. (23), No. 1 .
24) Professional Development (Tips on Writing References) Egyptian Journal of Surgery Vol. (23), No. 3 , July. , 2004.
25) Fecal Fistula: What Is New? Egyptian Journal of Surgery Vol. (23), No. 4 , Oct. , 2004.
26) Utility of Preoperative Serum Carcinoemberyonic Antigen in Colorectal Cancer Patients , Benha Medical Journal , Vol. 21 No. 3, Sep. 2004 .
27) Professional Development. How To Appraise an Article on Surgical Therapy. April, 2005.
28) Manometric studies, endorectal U.S and incont score after closed lateral sphenctrotomy ,convential and tailored;a randomised prospective study.EJS 24,1 2005: 36-4 .
29) Said Rateb, Nabil Dowidar, Mohamed Farid, Ahmed Hussein, Ahmed Hazem. July,2005. "How to Appraisa an article on diagnosis" , Vol.(24), No.(3),2005.
30) Nabil Dowidar, Ahmed Hazem, Said Rateb, Mohamed Farid Ahmed Hussein . July,2006. "Audit Objectives and standards , Journal of surgery", Vol.(25), No.(3), 2006.
31) Hosama El- wakeel, Hesam Abd el- Moneim , Mohamed Farid, and A.A. Gohar 14 March 2006, 7 Agust 2006," Clove Oil Cream: a new effective treatment for chronic anal fissure." International Journal of Colorectal Disease,9, 549-552.
32) Professional Development: Disclosure. EJS. July, 2006.
33) Evolution of Colorectal Cancer in Schistosomiasis. Egyptian Journal of Surgery Vol. (25), No. 4 , Oct. , 2006.
34) Professional Development How to Select an Audit Sample. Egyptian Journal of Surgery Vol. (25), No. 4 , Oct. , 2006.
35) Nabil Dowidar, Ahmed Hazem, Said Rateb, Mohamed Farid, Ahmed Hussein . April. , 2007, Making change , Vol. (26), No. (2) ,.
36) Early oral feeding VS delayed oral feeding in patients undergoing intestinal resection ,EJS.26,1 January : 33-38,2007 .
37) Nabil Dowidar, Ahmed Hazem, Said Rateb, Mohamed Farid Ahmed Hussein . Jan ,2007, Audit Design Vol.(26), No.(1) .
38) Professional Development. Audit Report, EJS.Vol.(26), No.(3), July,2007.
39) Yosses T., Mahdy T., Farid M., Latif AA.(2008 Aug); Thyroid Surgery : use of the ligasure vessel sealing system versus conventional knot tying . Int J Surg. 6(4): 323-7.EPUB.
40) Original Article. Randomized,Clinical Trial of Ligasure Haemorhoidectomy Versus Conventional "Ferguson" Haemorhoidectomy. EJS.Vol.(26), No.(3),July,2007. Technique of coloproctolgy 2009 13(3):243-6.
41) Nabil Dowidar, Ahmed Hazem, Said Rateb, Mohamed Farid Ahmed Hussein July. , 2008. " Research Misconduct-I Vol. (27), No. (3),.
42) Salehel-Awady,Ayman M.Ali,Osama Kumbwe, Sied AbdEl-Maksoud, Mohamed Farid, (2008) ."Tibial corticotomy and periosteal elevation for chronic critical lower limb ischaemia " . Acta orthopaedica belgica July(Vol;74.),
43) Ayman ElNakeeb, Amir Fikry, Waleed Omer, Elyamani Fouda, Tito El-Metwally, Hosam Ghazy, Sabry Badr, Mohamed Abu Elkhar,Salih Elawady , Hisham Abd El moniam, Waiel khafagy, Mosaad Morshed, Ramadan El lithy, Mohamed Farid,( 2008 November), "Rubber band ligation for 750 cases of symbtomatic haemorrhoids out of 2200 cases ".World Journal Gastroenterol ; 14;14(42),.
44) AymanEl-Nakeeb, Amir Fikry,Tito M.AbdEl-Hamed, El-Yamani Fouda, , Hosam Ghazy, Sabry badr, Wael Khafagy, Mohamed Farid, (2009)," Early oral feeding in patients undergoing colonic anastomosis ".International Journal of Colorectal Disease.7 (2009) 206-209 ,.
45) AymanEl-Nakeeb, Amir Fikry,Tito M.AbdEl-Hamed, El-Yamani Fouda, Saleh El- Awady, Tamer Youssef, Doaa Sherief, Mohamed Farid, (2009) "Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer " International Journal of Surgery 7 (2009) 126-129 .
46) ElAwadi S., El Nakeeb A., Youssef T., Fikry A., Abd El- Hamed TM., Ghazy H., Fouda E., Farid M., (2009),. "Laparoscopic versus open cholecystectomy in cirrhotic patients:A prospective randomized study". International Journal of Surgery 7(2009) 66-6, .
47) Farid M., El-Monem HA., Omar W., El Nakeeb A., Fikry A., Youssef T., Youssef M., Ghazy H., Fouda E., El Metwally T., Khafagy W., Ahmed S., El- Awady S, Morshed M., El-Lithy R.,. (2009) " Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients " International Journal of Colorectal Disease24:327-334., .
48) Saleh El-Awady, Lithy R., Morshed M., KhafagyW., Abd Monem H. Waleed Omer. Badr S., El- Nakeeb A., Ghazy H., El- Yamany M., Metually T., Mohamed El- Armar.MD. Mohamed Farid M.D. (2009), "Utility of serum preoperative Carcinoemberyonic Antigen in Colorectal Cancer Patients " the Hepato-Gstroentrology Journal 56:361-366.,
49) "Maximus Muscle Flap in treatment of end stage fecal Incontinence " Of Techniques in Coloprctology 2009 .
50) Mohamed Farid , Tamer Yossef, Tarek Mahdy, Waleed Omer, Hesham Abdul Moneim, Ayman El-Nakeeb, Mohamed Yossef . 2009 Mar, Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus.Int j Colorectal Dis. 24(3): 327-34., .
51) Khafagy W., El- Nakeeb A., Fouda E., Omer W., Elhak NG., Farid M., Elshobaky M., 2009 Jul-Aug; Conventional haemorrhoidectomy, stapled haemorrhoidectomy, Doppler guided haemorrhoidectomy artery ligation; post operative pain and anorectal manometric assessment. Hepatogastroenterology. 56(93):1010-5.61- 58- 58- .
52) Farid M., El- Nakeeb A., Youssef M., Omer W., Fouda E., Youssef T., Thabet W., Elmoneum HA., Khafagy W., 2009 Sep; Idiopathic hyertensive anal canal : a place of internal sphincterotomy. J Gastrointest Surg. 13(9): 1607-13.
53) Mohammed Farid, M.D. Amir Fikry, M.D., Ayman El Nakeeb, M.D., Elyamani Fouda, M.D.,Tito Elmetwally, M.D., Mohamed Yosef, M.D.,and waleed Omer,M.D., 15 July 2009 , Clinical Impacts of Oral Gastrografin Follow-Through in AdhesiveSmall Bowel Obstruction (SBO) Journal of Surgical Research,1-7(2009), 15 July 2009 154 No.2.
54) Farid M, Youssef M, El Nakeeb A, Fikry A, El Awady S, Morshed M. Comparative study of the house advancement flap, rhomboid flap, and y-v anoplasty in treatment of anal stenosis: a prospective randomized study. Dis Colon Rectum. 2010 May;53(5):790-7.
55) Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M. Treatment of Anal Fistulas by Partial Rectal Wall Advancement Flap or Mucosal Advancement Flap: A Prospective Randomized Study. Int J Surg. 2010 Apr 10.
56) El Nakeeb A, Askar W, El Lithy R, Farid M. Clipless laparoscopic cholecystectomy using the Harmonic scalpel for cirrhotic patients: a prospective randomized study. Surg Endosc. 2010 Apr 8
57) Farid M, Madbouly KM, Hussein A, Mahdy T, Moneim HA, Omar W., 2010 Apr. Randomized controlled trial between perineal and anal repairs of rebnctocele in obstructed defecation. World J Surg. 2010 Apr;34(4):822-9.
58) Elbanna HG, Abbas AM, Zalata K, Farid M, Ghanum W, Youssef M, Thabet WM, El Awady S, El-Sattar MH. 2010, Effects of ovarian failure on submucosal collagen and blood vessels of the anal canal in postmenopausal women.Int J Colorectal Dis. 2010 Apr;25(4):477-83.
59) Madbouly KM, Hussein A, Omar W, Farid M.,Jun., 2010 , Regenerated oxidized cellulose reinforcement of low rectal anastomosis: do we still need diversion?Dis Colon Rectum. 2010 Jun;53(6):889-95.
60) Faried M, El Nakeeb A, Youssef M, Omar W, El Monem HA. 2010 May Comparative Study between Surgical and Non-surgical Treatment of Anismus in Patients with Symptoms of Obstructed Defecation: A Prospective Randomized Study . J Gastrointest Surg. 2010 May 25 14:1235-1243 .
61) Elymani Fouda , Ayman El- Nakeeb , Alaa Magdy , Enas A. Hammed , Gamal Othman , Mohamed Farid , 2010, Early Detection of Anastomotic Leakage After Elective Low Anterior Resection , J Gastrointest Surg, 27 October 2010 .
62) S.A. Mohmoud, W.Omar and M. Farid 2010, Transanal repair fortreament of rectocelein obstructed defaecation : manual or stapled . J Colorectal disease.
Tibial corticotomy and periosteal elevation induce angiogenesis in chronic critical limb ischaemia.
Acta Orthop Belg. 2008 Dec;74(6):823-30.
El-Awady S, Ali AM, Kumber O, El-Maksoud SA, Fareed M.
Department of Surgery, Mansoura University, Mansoura, Egypt.
Corticotomy and periosteal elevation as a surgical procedure for management of chronic critical limb ischaemia is a relatively new technique. The current study aimed at assessing its safety, efficiency and cost/benefit ratio. The procedure was performed in 36patients. Preoperative documentation for age, sex, co-morbidities, ankle systolic pressure, and magnetic resonance contrast angiography was obtained. Early results included evaluation of skin perfusion. Late results involved assessment of wound healing, which was documented with photographs and was graded (healed, healing, resistant, recurrent), pain (intermittent claudication and pain at rest), Kelkar score, procedure morbidity, patient satisfaction and quality of life. Mean age was 68.03 +/- 5.5 years; 23 patients were males (63.9%) and 13 females (36.1%). Twenty (55.6%) patients had ankle systolic pressure < 50 xss=removed xss=removed p=0.001). p=0.001). p=0.001). p=0.001). p=0.001). P=0.04. P=0.001), xss=removed xss=removed P?=?0.001). P?=?0.01). P?=?0.03). xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed> 0.05) whereas, in positive ER and PR, inflammatory cells and collagen I were significantly increased and submucosal blood vessels were significantly decreased in postmenopausal women relative to menstruating women (P < 0 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed or =5> 5 ng% as they had DFS (33.75%) and DFT (18.48 months). (6) Basal CEA above 15 ng% had a significant shift in the cumulative hazard of recurrence.
The CEA is a metastasis potentiator. The high serum CEA in CRC screening programs should be considered a marker of malignancy especially in patients with appropriate symptoms. The preop CEA in CRC patients identifies subsets with favorable, indolent and uneven biological behavior (< or or =15> 15 ng% respectively). Moreover, the addition of preop CEA level to conventional staging forms a strong prognostic tool and supplies adopted practice guideline initiative for follow up and therapy in CRC.
[PubMed - indexed for MEDLINE]
Idiopathic hypertensive anal canal: a place of internal sphincterotomy.
J Gastrointest Surg. 2009 Sep;13(9):1607-13. Epub 2009 Jun 11.
Farid M, El Nakeeb A, Youssef M, Omar W, Fouda E, Youssef T, Thabet W, Elmoneum HA, Khafagy W.
Mansoura University Hospital, Mansoura, Egypt.
Hypertensive anal canal is frequently known to be associated with the presence of anal fissure. Based on clinical experience, we hypothesized that idiopathic anal sphincter hypertonia was a condition equivalent to anal fissure, and therefore, it could be treated the same way.
PATIENT AND METHODS:
Sixty-three patients complaining of anal pain without any anal pathology and ten healthy volunteers were examined. All patients underwent clinical evaluation, neurological examination, anorectal manometry, and measurement of pudendal nerve terminal motor latency. All patients with hypertensive anal canal were randomized into three groups. Group I (surgical group) underwent closed lateral sphincterotomy (LS), group II using nitroglycerine ointment (GTN), and group III received injection of botulinum toxin in internal sphincter. Post-procedures data were recorded at follow-up period.
The mean resting anal pressure (MRAP) was significantly higher in the patient group (114.6 +/- 7.4 mmHg) than control group (72.5 +/- 6.6 mmHg, P < 0.001). Anal pain is the main presenting symptoms aggravated by defecation and not relived by analgesics or local anesthetics. After LS, pain visual analogue scale decreased significantly at follow-up period than after chemical sphincterotomy using GTN or BTX (P = 0.001). There was a significant decrease in MRAP postoperatively from 114.6 +/- 7.4 to 70.8 +/- 5.5 mmHg than after using GTN or BTX (P = 0.03).
Idiopathic hypertensive anal canal is a fact and already exists presented by anal pain aggravated by defecation. It can be managed safely by closed lateral sphincterotomy, but chemical sphincterotomy had a minor role in its management.
[PubMed - indexed for MEDLINE]
Early oral feeding in patients undergoing elective colonic anastomosis.
Int J Surg. 2009 Jun;7(3):206-9. Epub 2009 Mar 28.
El Nakeeb A, Fikry A, El Metwally T, Fouda E, Youssef M, Ghazy H, Badr S, Khafagy W, Farid M.
Mansoura University Hospital, General Surgery Department, Mansoura, Egypt. email@example.com
This study assesses the safety outcome of early oral feeding and reports on the factors affecting early postoperative feeding after colorectal procedures.
PATIENTS AND METHODS:
Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis and were then randomized into two groups. The early feeding group began fluids on the first postoperative day while the regular feeding group was managed in the traditional way - nothing by mouth until the resolution of ileus.
The majority of patients (75%) tolerated the early feeding. The times to first passage of flatus (3.3+/-0.9 days vs 4.2+/-1.2 days) and stool (4.1+/-1.2 days vs 4.9+/-1.2 days) were significantly quicker in group 1. Hospital stay was also significantly shorter in the early feeding group (6.2+/-0.2 days vs 6.9+/-0.5 days). Operative time and amount of blood loss had an impact on the tolerability of early feeding while age, gender, type of operation and previous abdominal operation had no such impact.
Early oral feeding after colorectal surgery is safe and tolerated by the majority of patients. Operative time and amount of blood loss do, however, have an impact on the tolerability of early feeding.
[PubMed - indexed for MEDLINE]
Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer.
Int J Surg. 2009 Apr;7(2):126-9. Epub 2008 Dec 6.
El-Nakeeb A, Fikry A, Abd El-Hamed TM, Fouda el Y, El Awady S, Youssef T, Sherief D, Farid M.
Mansoura University Hospital, General Surgery Department, Dep. 8, Egypt. firstname.lastname@example.org
This study was conducted to elucidate the prevalence of Helicobacter pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H. pylori prevent ulcer recurrence following simple repair of the perforation.
PATIENTS AND METHOD:
Eighty-three patients with perforated duodenal ulcer (68 males); mean age was 47.8 years+/-7.2. Antral mucosal biopsies (to determine the status of HP by rapid urease test, culture and histological examination/staining) were obtained during laparotomy by passing a biopsy forceps through the perforation site. H. pylori positive patients who had undergone patch repair were randomized into the eradication group who received amoxicillin, metranidazole plus omperazole and the control group was given omeprazole alone. Follow-up endoscopy and antral biopsies were performed at 8 weeks, 16 weeks and 1 year to show ulcer healing and determine H. pylori state.
Of 77 patients in the study, 65 patients (84.8%) had H. pylori. These patients were randomly divided into the triple therapy group (34 patients) and the control group (31 patients). Eradication of H. pylori was significantly higher in the triple therapy group than the control group and initial ulcer healing was significantly better in the eradication group. After 1 year, ulcer recurrence was (6.1%) in the eradication group vs. (29.6%) in the control group (P=0.001).
H. pylori was present in a high proportion of patients with duodenal ulcer perforation. Eradication of H. pylori after simple closure of a perforated duodenal ulcer reduced the incidence of recurrent ulcer.
[PubMed - indexed for MEDLINE]
Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus.
Int J Colorectal Dis. 2009 Mar;24(3):327-34. Epub 2008 Nov 29.
Farid M, Youssef T, Mahdy T, Omar W, Moneim HA, El Nakeeb A, Youssef M.
Mansoura Faculty of Medicine, Mansoura, Egypt.
The objective of this study was to compare the results of partial division of puborectalis (PDPR) versus local botulinum toxin type A (BTX-A) injection in treating patients with anismus.
PATIENTS AND METHODS:
This prospective randomized study included 30 male patients suffering from anismus. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and electromyography. Patients were randomized into: group I which included 15 patients who were injected with BTX-A and group II which included 15 patients who underwent bilateral PDPR. Follow-up was conducted for about 1 year. Improvement was considered when patients returned to their normal habits.
BTX-A injection achieved initial success in 13 patients (86.7%). However, long-term success persisted only in six patients (40%). This was in contrast to PDPR which achieved initial success in all patients (100%) with a long-term success in ten patients (66.6%). Recurrence was observed in seven patients (53.8%) and five patients (33.4%) following BTX-A injection and PDPR, respectively. Minor degrees of incontinence were confronted in two patients (13.3%) following PDPR.
BTX-A injection seems to be successful for temporary treatment of anismus.
[PubMed - indexed for MEDLINE]
Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study.
Int J Surg. 2009 Feb;7(1):66-9. Epub 2008 Oct 26.
El-Awadi S, El-Nakeeb A, Youssef T, Fikry A, Abd El-Hamed TM, Ghazy H, Foda E, Farid M.
Mansoura Faculty of Medicine, Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis.
A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients).
There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13+17.35 min versus 76.13+15.12) P<0.05, associated with significantly higher intraoperative bleeding in OC group (P<0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18 h in LC group which is significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group (6+1.74 days versus 1.87+1.11 days) P<0.01 with low postoperative morbidity.
LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.
[PubMed - indexed for MEDLINE]
Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients.
Int J Colorectal Dis. 2009 Jan;24(1):115-20. Epub 2008 Aug 22.
Farid M, El Monem HA, Omar W, El Nakeeb A, Fikry A, Youssef T, Yousef M, Ghazy H, Fouda E, El Metwally T, Khafagy W, Ahmed S, El Awady S, Morshed M, El Lithy R.
General Surgery Department, Dep. 8 and Colorectal Unit, Mansoura University Hospital, Mansoura, Egypt.
Anismus is a significant cause of chronic constipation. This study came to revive the results of BFB training and BTX-A injection in the treatment of anismus patients.
MATERIALS AND METHODS:
Forty-eight patients with anismus (33 women; mean age 39.6 +/- 15.9) were included in this study. All patients fulfilled Rome II criteria for functional constipation. All patients underwent anorectal manometry, balloon expulsion test, defecography, and electromyography (EMG) activity of the EAS. All patients had non-relaxing puborectalis muscle. The patients were randomized into two groups. Group I patients received biofeedback therapy, two times per week for about 1 month. Group II patients were injected with BTX-A. Follow-up was conducted weekly in the first month then monthly for about 1 year.
In the BFB training group, three patients quit before the end of sessions with no improvement; initial improvement was recorded in 12 patients (50%) while long-term success was recorded in six patients (25%). In the BTX-A group, clinical improvement was recorded in 17 patients (70.83%), but the improvement persisted only in eight patients (33.3%). There is a significant difference between BTX-A group and BFB group regarding the initial success, but this significant difference disappeared at the end of follow-up. Manometric relaxation was achieved significantly post-BFB and post-BTX-A injection with no significant difference between the two groups.
Biofeedback training has a limited therapeutic effect on patients suffering from anismus. BTX-A injection seems to be successful for temporary treatment of anismus.
[PubMed - indexed for MEDLINE]
American Journal of Medicine and Medical Sciences
p-ISSN: 2165-901X e-ISSN: 2165-9036
2011; 1(1): 7-14
Pro-Angiogenic Mediators as Targets for Chemotherapy of Colorectal Carcinoma
N. M. Abdel-Hamid 1, M. Farid 2, A. Eldemeri 3, M. Atwa 4, N. Anbar 5
1Nabil Mohie Abdel-Hamid, Departments of Biochemistry, College of Pharmacy, Minia University
2Mohamed Farid, General Surgery
3Ahmed Hasan Eldemiri, Medical Oncology
4Mohamed Atwa, Clinical Pathology, Faculty of 2,3,4 Medicine
5Nahla Hamed Anbar, Emergency Hospital, Mansoura University, Egypt
Correspondence to: N. M. Abdel-Hamid , Nabil Mohie Abdel-Hamid, Departments of Biochemistry, College of Pharmacy, Minia University.
Copyright © 2012 Scientific & Academic Publishing. All Rights Reserved.
Purpose Angiogenesis and chronic inflammation are codependent in pathogenesis of colorectal carcinoma (CRC). We aim to assess whether vascular endothelial growth factor (VEGF), nitric oxide (NO) and total lipase (TL) activity being contributors to angiogenesis, are targets for CRC chemotherapy. Methods we enrolled 60 subjects, 20 volunteers (10 males and 10 females) were assigned as control (group I). Forty CRC patients, 20 locally advanced (group II), subjected to surgery and chemotherapy (5-fluorouracil (5-FU, 425 mg/m2) plus leucovorin (LV, 20 mg/m2), IV, daily for 5 consecutive days, repeated every 3 to 5 weeks for 6 courses). The other 20 patients, were metastatic, (group III), followed up, given only adjuvant chemotherapy. Results Serum carcino embryonic antigen (CEA), cancer antigen (CA19.9), VEGF, NO concentrations and TL activity were significantly elevated in CRC compared to control and in Gp III compared to Gp II patients, but were down-regulated by chemotherapy. VEGF, NO and TL helped in diagnosis and follow up of CRC, although they were not returned to reference intervals. In conclusion, the response to chemotherapy of VEGF, NO and TL substantiates an anti-angiogenic potential in controlling CRC. AFP level was not changed in secondary metastatic hepatocellular carcinoma (HCC), seemingly, it rises only in primary HCCs.
Keywords: Angiogenesis, Chemotherapy, CRC, Metastasis, NO, Total lipase, VEGF
Cite this paper: N. M. Abdel-Hamid , M. Farid , A. Eldemeri , M. Atwa , N. Anbar , "Pro-Angiogenic Mediators as Targets for Chemotherapy of Colorectal Carcinoma", American Journal of Medicine and Medical Sciences, Vol. 1 No. 1, 2011, pp. 7-14. doi: 10.5923/j.ajmms.20110101.02.
2. Materials and methods
2.3. Statistical analysis
2.4. Ethical approval
Colorectal cancer (CRC) is one of the major causes of cancer death worldwide, accounting for more than 150000 new cases, 55000 deaths in the United States and more than100000 mortalities per year in Europe. The incidence of CRC in Egypt ranges from 2 to 6%.There is an increasing risk among those who have first degree relatives with CRC, constituting up to 20% of all patients with CRC.The degree of personal risk relates to family history and age of affected relatives. Increased age was associated with increased risk of advanced colonic neoplasia. Moreover, excessive weight and abdominal obesity were found to be risk indicators in men and women. Generally, women have more favorable prognosis than men. The relation between gender and survival from CRC was complex and appeared to be related to differences in tumor stage and therapeutic modality.Treatment of CRC is greatly dependent on onset and stage of the disease. It always ranges from (1) surgical management by removal of the primarytumor with adequate safety margin, (2) treatment of the draining lymphatics, and (3) restoration of function. Appropriate adjuvant therapies can enhance local control, reduce systemic recurrence and increase organ preservation. Approximately 6% to 10% of rectal cancers are locally advanced and require extensive surgery for complete tumor extirpation.
Chemotherapy is usually prescribed to eradicate micrometastasis sensitive to cytotoxic therapy. The standard treatment of metastatic colorectal cancer is a combination of 5-fluorouracil/folinic acid with irinotecan or oxaliplatin-based chemotherapy. 5-flourouracil (5-FU) is given to patients with Dukes B, C stage in combination with radiotherapy to secure local recurrence and distant metastasis. Metastasis of CRC to other extracolonic organs, especially liver is always faced among patients with long standing disease. Diagnosis of metastasis is made by both histological and serological investigations. Alpha fetoprotein (AFP) is always used to pursue or exclude hepatic metastasis. AFP is a normal fetal serum protein synthesized by the liver, yolk sac and falls to an undetectable level after birth. The primary malignancies associated with AFP elevations are HCC, linked with chronic infections as hepatitis B and C viruses and with cirrhosis from various causes. AFP elevation is common in Africa, where HCC is endemic, and is useful in screening purposes. It can be used to determine the most appropriate treatment for liver cancer and to follow patients after curative surgery or other treatment. AFP is elevated in testicular germ cell tumors containing embryonal or endodermal sinus elements. It is a definitive positive marker in indicating relapse or response to treatment. Tumor angiogenesis is the proliferation of a network of blood vessels that penetrate into cancerous growths, supplying nutrients, oxygen and removing waste products. It starts concomitantly with cancerous tumor cells sending signals to surrounding normal host tissue. This signaling activates certain genes in host tissue, in turn, make proteins to encourage growth of new vessels.
However, controllable angiogenesis occurs in healthy body for healing wounds and restoring blood flow to tissues after injury. In females, angiogenesis also occurs during the monthly reproductive cycle to rebuild the uterus lining, to mature the egg during ovulation and during pregnancy to build placenta, favoring maternal- fetal circulation. Trials to inhibit angiogenesis as means of controlling growth and spread of cancer cells began before 39 yr ago. Numerous angiogenic growth factors were targeted with modern drugs and have been identified in large bowel tumors. These included, vascular endothelial growth factor (VEGF), platelet-derived endothelial cell growth factor (PD-ECGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), insulin-like growth factors (IGFs), angiogenin, thrombospondin, angiopoeitins, and integrins .
Binding to VEGF receptor-2 (VEGFR-2) starts a tyrosine kinase signaling cascade that stimulates NO expression. Inducible nitric oxide synthase (iNOS) is an enzyme catalyzes NO production, found to be over-expressed in chronic inflammatory diseases and various types of cancer. NO is an important regulatory molecule in inflammatory response, cancer development and endogenous mutagenenesis[18,19], angiogenic factor, an enhancer of protooncogene expression[21,22] and an inhibitor of apoptosis. Lipase is a water-soluble enzyme that catalyzes the hydrolysis of ester bonds in water insoluble, lipid substrates. It exerts dual functionality: anti-inflammatory, through enhancing remnant lipoprotein catabolism and pro-inflammatory through alteration in lipid metabolism and induction of inflammatory cytokines. It was implicated in colorectal carcinogenesis, being engaged in mucosal lipid metabolism. Thus, lipase activity was reported to be increased in the colorectal mucosa affecting lipid metabolism within the tumor tissue. Angiogenesis is a target of some new drugs used as adjuvant for chemotherapy. These drugs may be expensive, or in many developing countries, not yet utilized, and conventional chemotherapies still the cornerstone in cancer management in public hospitals. Most studies on angiogenesis relied on VEGF. NO and lipase are always missing among angiogenic stimulators in most -if not all- studies on angiogenesis inhibition.
The present work aimed at studying the contribution of angiogenesis in CRC pathogenesis, recurrence and metastasis among groups from Mansura city, staged according to Duke’s principle. In addition, exploring a possible effect of common chemotherapy on angiogenesis, depending on three relevant parameters, serum VEGF and NO and total lipase levels (TL), to monitor CRC progression along with carcinoembryonic antigen (CEA), carbohydrate (carcinogenic) antigen (CA 19.9) and AFP serum levels as diagnostic and prognosticators. Tissue samples from both colon and liver were examined before surgical intervention for cancer staging.
2. Materials and methods
This study was carried on 60 subjects; 40 patients with histopathologically confirmed CRC (classified into 2 groups, 20 patients (stages B & C) according to Dukes' staging, 11 males and 9 females of age range 41.2 ± 12.9 years (mean ± SD, assigned as locally advanced CRC (Group II). Patients of this group were subjected to elective surgery and adjuvant chemotherapy. The third group, assigned as metastatic (group III), consisted of 20 CRC patients of stage D, 10 males and 10 females, their mean age was 48.3 ± 11.2 years, patients of this group were followed up and given only adjuvant chemotherapy, adapted according to Mayo Clinic regime (5-fluorouracil, 425 mg/m2 plus leucovorin 20 mg/m2, by rapid IV bolus, daily for 5 consecutive days every 3 to 4 weeks , repeated for 6 courses. Body surface area (BSA) in m2 was calculated from the following formula:
BSA = (W 0.425 x H 0.725) x 0.007184.
(W) represents weight in kilograms and (H), height in centimeters[29,30].The studied parameters were compared to that of normal control (group I), consisted of 20 volunteers (10 males and 10 females, of mean age, 49.4±18.2 years, from volunteer nursing staff), at Surgery and Nuclear Medicine Departments, Mansoura University Hospitals, Egypt, between January 2007 and January 2009. Written consents were taken from all participants. Thorough history including age, sex, rectal bleeding, abdominal distention, constipation, special habits, history of previous colorectal disease or surgery, clinical examination and manifestations of intestinal obstruction, general, abdomino-pelvic and rectal examination were done. Barium enema, abdominal ultrasound and preoperative colonoscopy, biopsy for histological examination were achieved for differential diagnosis and Dukes' staging, were conducted. These information were archived in patient files at the Department Registration Office. Among the studied CRC groups, male to female ratio was 54.3% / 45.7%. Fasting blood samples were withdrawn from patients and control, separated sera were kept for assays. Participated patients shown as post-treatment subjects, others, changed setting of follow-up. Figures show the clinical findings of presented cases, (Figure 1-3), in addition to histological examination of both colon and liver of the selected groups before surgical intervention (Figure 4):
Histological examination of pre-operative tissue samples were done after hematoxylin and eosin (H&E) staining. Serum CEA and CA19.9 were determined by automatic Roche Elecsys 2010, Switzerland, based on electrochemically generated chemiluminiscence. AFP was determined by Sandwich ELISA, Boehringer, Germany. Serum VEGF level was made by Sandwich enzyme immunoassay technique (R & D Systems Inc., MN, USA) according to the method of Sheng et al.. Nitric Oxide (NO) was assayed by colorimetric method using kit group of Oxis International Inc, Portland, OR, USA, according to the method of Miranda et. al,. Serum total lipase activity was determined by kits purchased from Genzyme Diagnostic, Inc, Canada and the manufacturer's instructions were followed.
?Figure 1. Clinical data of CRC patients. Numbers of recruited patients (Proximal colon: 10, Distal colon:15, Rectum:15), percentages are among each group .
?Figure 2. Pathological forms among CRC patients.
?Figure 3. Duckes stages of CRC patients.
?Figure 4. Histological staging of CRC patients, showing both locally advanced and metastatic invasion among studied cases.
2.3. Statistical analysis
The data were expressed as mean ± SD. Statistical significance was examined by one-way analysis of variance (ANOVA) using SPSS program. P values less than 0.05 were assumed to be statistically significant.
2.4. Ethical approval
Ethical approval for the study was obtained from Mansura University Research Ethics Committee.
Histological examination showed malignant alterations in colon tissue and graded as B1 (lymph n
Primary Affiliation: Mansoura University - mansoura, dakhlia , Egypt
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