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1.
EMJ-Emirates Medical Journal. 2005; 23 (1): 41-4
in English | IMEMR | ID: emr-70664

ABSTRACT

Finding microscopically positive margins after breast lumpectomy is generally an indication for re-excision. However many re-excision results are inaccurate or negative, thus not contributing to disease control but may increase patient morbidity. This study attempts to re-evaluate our experience if mastectomies were justified in positive or close margins and to set standard guidelines in the management. A 14 year review operative and histopathology records for the period from 1990-2004 was conducted. All breast specimens reports with positive or close margins which underwent further re-excisions were reviewed. The total identified number was 127, size ranged between 3-5 cm on gross specimen measurement. those reported with positive margins excisions were 75, while those with close margin reports were 52 patients. All patients underwent re-excision in the form of either mastectomy or wide local excision based on the surgeon's preference. The histopathology tissue review revealed positive re-excisions in 67 [52.7%] while 60 [47.2%] patients were negative residual tumour, out of these 40 were previously reported with close margins and 20 of the with positive margins. Of the negative re-excisions 27 patients underwent mastectomy which was considerd an over treatment for these young patients. In conclusion surgical margins remain the best predictor of residual disease in the breast though they are occasionally inaccurate. Mastectomy may be the only option in some cases to eradicate the disease yet it should be reserved for those with locally advanced disease, multi-focal or high grade tumours


Subject(s)
Humans , Female , Breast Neoplasms/pathology , Biopsy , Breast Neoplasms/diagnosis , Mastectomy/methods
2.
New Egyptian Journal of Medicine [The]. 2005; 32 (Supp. 3): 54-66
in English | IMEMR | ID: emr-73854

ABSTRACT

Ischemia reperfusion injury [IRI] is a multifactorial process that may be the main underlying factor in critical phases faced during and after liver transplantation. This work evaluates the effect of methylprednisolone [MP] and prostaglandin El [PGE1] on IRI of the liver of dogs at the ultrastructural level together with the assessment of soluble P-and E- selectin levels. Three groups of dogs [9 each] were subjected to 60 min ischemia followed by 30 min reperfusion with the appropriate solution according to the group. Group I, the control untreated group was flushed with Ringer's solution, group II was administered 10 mg/kg MP 24 hours before the procedure and with induction of anaesthesia, and group III was flushed with PGE1 in Ringer's solution at a rate of 0.02 microg/kg/min. Liver specimens were collected before ischemia, after ischemia and after reperfusion and were processed for the preparation of ultrathin sections for electron microscopic examination. Corresponding venous blood samples were harvested, centrifuged and serum was processed for the estimation of soluble P-and E- selectins by enzyme immunoassay, together with alanine and aspartate aminotransferases. Electron microscopic [EM] examination of liver ultrathin sections revealed that the morphological structure of hepatocytes and endothelial lining of hepatic sinusoids were well preserved in the group treated with PGE1. Hepatic ultrastructure was much altered in MP treated group showing necrotic and degenerative changes. The control untreated group disclosed bleb formation of hepatocytic membrane with increased leukocyte infiltration. Soluble P-and E- selectin levels were significantly elevated in the control group, near to pre-ischemic level in PGE1 group and showed a persistent elevation in MP group. Serum transaminases [AST and ALT] were significantly elevated in both control and MP groups as compared to their corresponding pre-ischemic levels. Yet, in PGE1 group, their values were comparable to the pre-ischemic ones. This work confirms the hepatoprotective effect of PGE1 in IR injury. The PGE1 impact on preserving the subcellular structure of hepatic sinusoids is crucial and may be mainly attributed to its biological properties. We presume that P-and E- selectins are greatly implicated in the mechanism of IR and may be an important therapeutic target by specific monoclonal antibodies


Subject(s)
Animals , Liver , Methylprednisolone/pharmacology , Alprostadil/pharmacology , Dogs , P-Selectin , E-Selectin , Microscopy, Electron , Protective Agents , Liver Function Tests , Reperfusion Injury
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