BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is effective in the management of biliary obstruction. PTBD can be used as an alternative to endoscopic approach when it is unavailable or unsuccessful due to anatomical variations or technical difficulty. OBJECTIVES: To evaluate the success rate, complications, morbidity and mortality in patients with inoperable malignant obstructive jaundice treated with PTBD with or without stenting. SUBJECTS AND METHODS: 67 percutaneous transhepatic biliary procedures were performed for forty five selected patients with inoperable malignant extrahepatic cholestasis. In total there were 21 male (46.7%) and 24 female (53.3%) patients. The mean age was 69 years and ranged from 48-88 years. These patients were subdivided into three equal groups according to the planned drainage for internal-external drainage, external drainage or metallic stenting. Statistical analysis included Chi square test, values were considered significant when P values ≤0.05. RESULTS: The overall technical success rate was 83% while the overall therapeutic success was 86.6% with the best results (100%) reported in the group of metallic stenting. There was no procedure related mortality in the different groups. The overall immediate, early and late complications were 20%, 29% and 20% respectively, with the highest complications rate reported in the group of external drainage. The overall 30 days mortality was 26.7% with the highest incidence was reported in the group of external drainage (53.3%). CONCLUSION: PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with malignant biliary obstruction. Key Words: Percutaneous transhepatic biliary drainage- Malignant biliary obstruction- Biliary stent

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.

Objective: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. Design: In this study, data were collected prospectively in 107 patients with diabetic foot ulcer examined and followed between March 2009and March 2012 in the Diabetic clinic at Assiut university hospital and were used to evaluate potential predictors of ulcer non-healing, after a follow-up period for a maximum one year. Results : After 1 year of follow-up, 29.9% of the patients showed non-healed ulcers. Baseline predictors of ulcer non-healing in the whole study population were duration of diabetes > 10 years (P0.0001) , negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.0001) , colour changes in the foot (P0.0001) , duration of ulcer (>3 months) (P0.0001), HbA1c (> 12 %) and Texas classification class D .Older age (P0.004), presence of hypertension(P0.02) , nephropathy (P0.005) ,smoking , presence of PAD as ABI 0.9 ( P0.02) and absent pedal pulses (P0.0001) ,ulcer size (> 5 cm2) , ulcer depth grade 3, increase total white blood cell count, ,decreased serum albumin and decreased hemoglobin levels were also associated with increased risk of unhealing. Conclusions: duration of diabetes >10 years (P0.0001), negative neuropathic symptoms ( ie : loss of sensation in the foot) (P0.01), colour changes in the foot due to presence of PAD (P0.01), duration of ulcer >3 months (P0.04), HbA1c > 12 % (P0.001) and Texas classification stage D (P0.01) were considered a major independent predictors of unhealing of diabetic foot ulceration. List of abbreviation; ABI; ankle-brachial index. DFU; diabetic foot ulcer. ECG; electrocardiogram. LEA; lower extremity amputation. PAD; peripheral arterial disease. PNP; peripheral neuropathy.