efficacy of ranibizumab in the treatment of macular edema secondary to central retinal vein occlusion [CRVO]

Purpose: To evaluate the effect of 3 consecutive intravitreal injections of ranibizumab [Lucentis] on visual acuity [VA] and central macular thickness [CMT] for central retinal vein occlusion [CRVO] induced macular edema. Study design: Our study was a prospective interventional case series

Patients and Methods: Twenty eyes of 19 consecutive patients diagnosed as CRVO-related macular edema [eight perfused, twelve ischemic CRVO] treated with 3 monthly intravitreal injections of ranibizumab at presentation as a monotherapy. Follow up visits were scheduled on the first, third and sixth months post-injections. Main outcome measures included mean changes in BCVA and CMI as measured by OCT

Results: The mean time from diagnosis until injection was 20 days. The mean BCVA of 0.03 +/- 0.03 [2/60] at baseline improved to a mean BCVA of 0.07 +/- 0.02 [5/60] six months after the last injection [final outcome], which was statistically significant [p<0.05] .Eleven eyes showed improved visual acuity [ 55%], 8 eyes [40%] had a stable visual acuity and 1 eye [5%] had worse visual acuity compared with baseline. A mean CMT of 679 um +/- 198 at baseline was improved to a mean CMT of 411 um +/- 158 six months after the last injection [final outcome], which was statistically significant [p<0.001]. The improvement in BCVA was superior in perfused CRVO compared to ischemic CRVO No ocular or systemic side-effects were noted

Conclusion: Intravitreal injection of ranibizurnab has shown promising results in VA improvement and decrease in CMT in patients with macular edema associated with CRVO especially the perfused form. However, long term results need to be further investigated

Imprint cytology versus immunohistochemistry of sentinel lymph nodes in berast cancer with clinically negative axilla

The success of sentinel lymph node [SLN] biopsy in determining axillary lymph node status necessitates an accurate and rapid method for intraoperative examination of the nodes. The aim of this study was to evaluate the feasibility and accuracy of immunohistochemistry [IHC] of touch imprints in detecting axillary nodal metastasis. Sentinel lymph node biopsy was performed in 50 patients with clinical T1-2 No breast cancer. After harvesting, the SLN were bisected, imprinted and subjected to IHC. Results were compared with those of routine hematoxylin and eosin [H and E] and IHC examination of the same node. The SLN was the only site of metastasis in 15 patients [37.25%]. IHC staining of the imprinted SLNs is more accurate than H and E imprint or paraffin sections H and E and IHC stained. Immunohistochemistry was capable to detect micrometastasis in 4 paraffin sections of SLN. IHC of touch imprint is feasible and provide reliable results for intraoperative evaluation of SLN in patients with breast cancer. It is also more sensitive for detection of micrometastasis in paraffin sections

Application of prolene hernia system in the management of adult umbilical hernia

This study included 20 patients with adult umbilical hernia, admitted in the surgery department Assiut University Hospital in the period between September 2002 and September 2004, 19 females and one male, their ages ranged from 29 to 54 years with mean age 44.6 their average weight was 65.2kg [range from 52 kg to 80 kg], and the average height was 158 cm [range from154 to 163 cm]. Through sub-umbilical smile incision, the sac and the contents were dissected and then restored into the abdominal cavity, the peritoneum was dissected off posterior rectus sheath to accommodate the Oval layer of the Prolence Hernia System without suturing, the defect was narrowed snugly around the connecting cylinder by absorbable interrupted sutures, the circular layer was then fixed to the anterior rectus sheath as onlay mesh by 4 to 6 prolene No [0] stitches. Closure of the skin and subcutaneous tisse with suction drain was done. Prophylactic antibiotic was instituted [3 does only]. Suction drain was removed after 1-2 days. Patient was discharged 3-6 days after the operation. After a mean period of follow up of one year, no recurrence was recorded. We concluded that prosthetic hernioplasty in the treatment of adult umbilical hernia is satisfactory and we recommend the use of Prolene Hernia System "PHS" as it has no recurrence [0%] with low morbidity

Abdominal wound disruption: a retrospective study

The occurrence of abdominal wound dehiscence is studied in a group of patients including 2205 patients treated via laparotomy over a period from June 1987 to Sept. 1991 in the Department of General Surgery; Assiut University Hospital. The incidence, age, sex, primary disease which required surgery, operations performed, preoperative and postoperative factors, of disruption, morbidity and mortality, have been analysed. The incidence of dehiscence was 2.2% [50 cases], the average age was 50 years and the condition occurred more frequently in males than females, the ratio being 1.27:1. Factors predisposing to abdominal wound disruption in our patients were; wound sepsis in 35 patients, distension in 29 patients, anaemia and malnutrition in 13 patients. The indication for the original operation in patients with dehiscence was emergent in 28 patients [56%] and elective in 22 [44%]. Right paramedian incision was used in 38 patients [76%]. Left paramedianin 9 patients [18%], and midline incision in 3 cases [6%]. Disruption occurred most commonly in the second postoperative week: 20 cases [40%] in the ninth postoperative day, 15 cases [30%] in the tenth day; 7 patients [14%] in the eighth day and 8 cases [16%] in the 5th to 7th day. No cases were recorded before the fifth or after the tenth postoperative days. After repair 38 patients [75%] recovered uneventfully and 12 patients [25%] died. We noticed that 8 out of the 12 died patients proved to have advanced malignant diseases