Reporting of the circumferential tumour margin involvement and preoperative levels of carcinoembryonic antigen as prognostic risk factors in colorectal cancer patients

Background and study aims: The two very important prognostic risk factors of colorectal cancer are circumferential tumour margin [CTM] involvement and preoperative levels of carcinoembryonic antigen [CEA]. The aim of this study is to monitor the frequency of reporting of the CTM in the postoperative pathology reports after colorectal cancer resection in addition to monitoring the frequency of reporting of preoperative levels of CEA and exploring the possibility of improving the frequency of reporting of both

Patients and methods: Reports of the CTM and preoperative level of CEA were found in 730 [664 retrospective and 66 prospective] patients with colorectal cancer. The possibility of improving the incidence of reporting was estimated by comparing the reporting frequency of both [retrospective and prospective] groups

Results: The percentage of reporting the involvement of the CTM was 46.08% and 81.81% for the retrospective group and the prospective group, respectively. The percentage of reporting the preoperative CEA levels was 40.9% and 68.7% for the retrospective and the prospective groups, respectively. There was a statistically significant difference in reporting both CTMs and the preoperative level of CEA between retrospective and prospective groups to the side of prospective group in which the p-value was <0.0001 for both groups

Conclusion: There was inadequate reporting of both the CTM involvement and preoperative levels of CEA in the retrospective patients with statistically significant improvement of this reporting in patients in the prospective group. This may point to the unawareness of the importance of both in the prognosis of colorectal cancer, which may be because both are not involved in the widely used tumour, node, metastasis [TNM] staging system

Combined coronary artery bypass grafting and surgical resection of right atrial myxoma complicated with pulmonary embolism / Cirugía combinada de bypass de arteria coronaria y resección quirúrgica de un mixoma auricular derecho complicado por una embolia pulmonar / Chirurgia combinada de bypass da artéria coronária e ressecção cirúrgica de um mixoma auricular direito complicado por uma embolia pulmonar

Although the association between right atrial myxoma and pulmonary embolism is rare, it has been recognized for many years. This condition is fatal unless surgical intervention is performed for resection of right atrial mass and pulmonary embolectomy. A 68 years old diabetic, hypertensive male patient was admitted to our hospital with severedy spnea and chest pain. An echocardiogram and pulmonary CT angiography revealed right atrial mass and pulmonary embolism. Further more, coronary angiography was done and showed a three vessels disease. Complete surgical removal of the right atrial myxoma and parts of the tumor embolectomy from the right pulmonary artery were successfully performed combined with coronary artery bypass grafting to LAD, obtuse marginal and diagonal branches. Histological examination of the primary tumor as well as the embolus confirmed the diagnosis of benign myxoma. The patientwas discharged after 15 days of his successful operation. We report this case, as it is unique because of the rarity of the combined surgery of right atrial myxoma complicated with pulmonary embolism and coronary artery bypass grafting.

Si bien la asociación entre el mixoma auricular derecho y la embolia pulmonar es poco frecuente, se conoce su existencia desde hace años. La condición es fatal salvo si se realiza una intervención quirúrgica para la resección de la masa auricular derecha y una embolectomía pulmonar. Ingresa a nuestro hospital un paciente masculino diabético e hipertenso de 68 años con disnea severa y dolor de pecho. Un ecocardiograma y una angioTac de pulmón revelan un masa auricularderecha y una embolia pulmonar. Además, la coronario angiografia realizada identifica enfermedad en tres vasos. Se realiza con éxito la resección quirúrgica completa del mixoma auricular derecho y parte de la embolectomia tumoral de la arteria pulmonar derecha junto con un bypass de la arteria coronaria a la descendente anterior, la marginal obtusa y las ramas diagonales. El examen histopatológico del tumor primario y de la embolia confirman el diagnóstico de mixoma benigno. El paciente fue dado de alta 15 días después de la exitosa operación. Publicamos este caso ya que es único porque es poco frecuente es combinar la cirugía de un mixoma auricular derecho complicado por una embolia pulmonar con una cirugía de bypass de la arteria coronaria.

Apesar da associação entre mixoma auricular direito e embolia pulmonar ser pouco frequente, sua existência é conhecida há anos. A condição é fatal salvo se realizamos uma intervenção cirúrgica para a resecção da massa auricular direita e uma embolectomia pulmonar. Ingressa ao nosso hospital um paciente masculino diabético e hipertenso de 68 anos com dispnéia severa e dor no peito. Um ecocardiograma e um angioTAC do pulmão revelam uma massa auricular direita e uma embolia pulmonar. Além disso, a coronario angiografia realizada identifica comprometimento de três vasos. Realiza-se com êxito a resecção cirúrgica completa do mixoma auricular direito e parte da embolectomia tumoral da artéria pulmonar direita junto com um bypass da artéria coronária àdescendente anterior, a artéria obtusa marginal e os ramos diagonais. O exame histopatológico do tumor primário e da embolia confirmam o diagnóstico de mixoma benigno. O paciente recebeu alta 15 dias depois da exitosa operação. Publicamos este caso por ser único devido à pouco frequência em combinar a cirurgia de um mixoma auricular direito complicado por uma embolia pulmonar com uma cirurgia de bypass da artéria coronária.

Base catalyzed formation and ring cleavage of 2- acyl-4- alkoxycarbonyI- 4-cyano substituted cyclobexanoles

The reaction of 1, 3-diaryI-2-propen- 1 -ones [1 a, b] with ethyl cyanoacetate in absolute ethanol in the presence of a catalytic amount of KOH at 50-55°C afforded 3-aroyl-l-cyano-4-hydroxy-2,4, 6-triarylcyclohexanecarboxylates [2a,b]. Base-catalyzed ring cleavage of 2a,b in refluxing ethanolic KOH solution afforded the corresponding 3-aryl- 2-cyano-2-propenoic acid 4 along with 1 a, b. The structure of 2 was established through different spectroscopic techniques and confirmed via dehydration using thionyl chloride in refluxing pyridine afforded 3. However, reaction of la with ethyl cyanoacetate in refluxing ethanol in the presence of secondary amine [piperidine or morpholine] as a basic catalyst gave the open-chain Michael adduct 6. Treatment of the latter with ethanolic KOH solution yielded 1,5-pentanedione derivative 7. The relative configurations of 3b and 6 were determined through single crystal X-ray diffraction analysis

Gastrointestinal stromal tumors [GISTS]: clinical presentation, diagnosis, surgical treatment and its outcome

This study included 13 selected patients treated by surgical excision for lesions that proved postoperatively to be gastrointestinal stromal tumors [GISTs] by histopathological and immunohistochemistry studies. The demographic, clinical and operative reports data were collected. Eight cases were gastric GISTs, four cases were small bowel GISTs [jejunum 1 and ileum, 3] and GIST of the sigmoid colon was in one patient. Eight cases presented at the emergency department due to hematemesis [3], gastrointestinal obstruction [3], bowel perforation [1] and severe bleeding per rectum [1]. Three cases presented with a feeling of abdominal fullness and ill-defined palpable abdominal mass. Two cases were discovered incidentally during GIT endoscopy for dyspepsia. Diagnosis of GISTs was presumed on clinical basis and operative findings from gross morphological features. Complete resection [RO] was achieved for 12 tumors [92.3%]. The immunohistochemistry profile was positive for C-kit for all cases. One operative death was due to massive pulmonary embolism. Postoperative complications occurred in three [23%] as upper GIT bleeding [1], biliary gastritis [1] and wound infection [1], and one [7.69%] of ileum tumor recurrence

Laparoscopic adhesiolysis in patients with chronic abdominal pain

The present study aimed to test the hypothesis that laparoscopic adhesiolysis leads to a substantial pain relief and an improvement in the quality of life in patients with adhesions and chronic abdominal pain. Twenty-two consecutive patients with chronic abdominal pain underwent diagnostic laparoscopy and in case of adhesions, adhesiolysis was performed. In two patients, other causes were found in the abdominal cavity and were treated. Pain relief was assessed and the results were determined. Three months after adhesiolysis, 86.3% of the patients were pain-free or had less pain. The remaining 13.6% of the patients experienced no change or had more pain. Female gender and older age are associated with less pain relief. In conclusion, laparoscopic adhesiolysis can be done completely in 91.6% of patients with adhesions

Volar inlay bone graft and K-wire fixation in stable scaphoid non-union

Stable undisplaced non-united fracture of scaphoid showed an increasedincidence of displacement and angulation with subsequent radioscaphoidarthritis over longer duration of non-union. 16 patients with stable scaphoidnon-union were treated by volar inlay graft and k-wire fixation. For clinicalassessment, the wrist score of Coony et al was applied pre and postoperatively. Bone healing was obtained in 15 out of the 16 patients. Thepostoperative wrist score was significantly improved even in the 2 patientswith satisfactory preoperative assessment. The stable ununited scaphoidfractures, even with mild or no symptoms, should be treated precisely to improvethe functional status of wrist and to decrease the incidence of radioscaphoidarthritis

Outcome of thoracolumbar burst fractures: decompression, pedicle screw fixation and posterolateral fusion

A total of 29 patients with unstable [according to Denis classification] thoracolumbar burst injury underwent transpedicular spinal instrumentation using the SAS screw-rod system. We were able to follow-up 23 patients for more than 6 months. The 23 patients [13 males and 10 females] with mean age 33.30 +/- 10.18 years [range 19-56 years] presented with severe back pain. Four patients with complete neural injury 14 patients with partial neural injury, and 5 without neurological deficit Surgery consisted of either indirect or direct neural decompression, internal fixation, and autogenous iliac bone grafting. Annulotaxis was performed in patients with complete injury [n=4] and those with canal compromise more than <40% [n=10]. Transpedicular decompression was performed for other patients. A total of 92 pedicle screws were placed in 20 patients with one unstable motion segment and 3 patients with two unstable motion segments. All patients were submitted for routine clinical and radiographic follow-up including CT-scan. Mechanical stability was maintained through the follow-up in all patients with fusion rate of 87%. All screw purchases were satisfactory but 5 [94.57%]. Mean kyphus deformity reduced from 20.09 +/- 9.77 to 11.26 +/- . 6.25 degrees postoperative. Mean canal compromise corrected from 36.30 +/- 23.44% to 11.74 +/- 5.56% postoperative. No operative mortality, wound infection, or necessity for reoperation were reported. All patients with partial neural injury improved at least one Frankel grade. Those with complete neural injury as well as those without neurological deficit remain unchanged. Morbidity included two isolated nerve root deficits one transient and one permanent. Pedicle screw-rod fixation allows early mobilisation, short segment fixation. and preservation of adjacent motion segments. It offers high biomechanical stability with high fusion rate. The technique is dem and ing and meticulous nevertheless it is associated with minimum morbidity in trained h and s

Unreamed interlocking nail versus external fixator in the management of open tibial fractures, a randomized trial

Thirty-four patients with open tibial fractures [OTF] were treated by either unreamed interlocking tibial nail [UITN] or external fixator. Cases were randomized to both treatment protocols on alternate basis. The mean age was 36 years, with 28 males and 6 females. Exclusion criteria included children, associated injuries of the knees, ankles, and tarsus and type I soft tissue injuries. The average interval from injury to operation was 8 hours. There were 17 cases in external fixation group and 17 cases in UITN group. The patients were followed for an average of fifteen months. The results of UITN in the treatment of open tibial fractures were superior to external fixation with shorter time of union, better alignment, lower infection rate and shorter wound healing time

Solitary rectal ulcer syndrome: a limited clinical experience using sucralfate enemas and modified levatorplasty technique

A limited clinical experience with eleven cases of the rare solitary rectal ulcer syndrome [S.R.U.S.] was presented. Sucralfate enemas were successful in healing the ulcer in 3 out of 5 patients [60% success], while the modified levatorplasty was successful in healing of the ulcer in 7 out of 8 patients [including the two failures from the sucral fate group] [i.e. 87.5% success rate]. The remaining patient is symptom free despite the endoscopic evidence of persistence of the ulcer, though smaller in size [i.e. 2 cms versus 7 cms in diameter preoperatively]

Management of congenital nasolacrimal duct obstruction

In a prospective study, patients presented to EL Maghraby Eye Center with congenital nasolacrimal duct obstruction underwent culture and sensitivity of conjunctival swabs. A total of 68 patients [28 males and 40 females] were treated over one year period. The average age of presentation was 5.8 months with a range of 2-12 months. Cultures of conjunctival swabs revealed hemophilus influenza in 24 cases, Staphylococcus aureus in 12 cases, Pneumococci in 10 cases, Staphylococcus epidermis in 8 cases, Pseudomonas pyocyaneous in 4 cases and Branhamella catarrhalis in 4 cases. The main management was simple massage of the tear sac with cotton tipped applicator 4 times daily in addition to instillation of antibiotic eye drops according to the sensitivity results. Chloramphenicol was shown to be active against the pathogens detected in nearly 50% of the cases. So we recommend chloramphenicol to be the initial treatment in case of congenital nasolacrimal duct obstruction

Comparative study of Aswad operation for entropion trichiasis

A comparative study off Aswad operation and other operations for entropion trichiasis was done in 240 cases. The results with Aswad operation were excellent in cicatricial entropion trichiasis of both upper and lower lid either primary or recurrent compared with other operations. Many cosmotic advantages were recorded especially in the lower lid