Virtual colonoscopy-comparison with optical colonoscopy for the detection of colonic space- occupying lesions

This prospective study was performed on 20 consecutive patients with suspected or known colonic neoplasia to evaluate the sensitivity and accuracy of a new virtual colonoscopy technique for the detection of colorectal lesions in comparison with optical [conventional] colonoscopy as the standard of reference. They were 12 males and 8 females with age ranging between 48-72 years and mean age of 56.3 years. All patients were subjected to a thorough history and clinical examination, routine laboratory tests and abdominal ultrasonography. After standard bowel preparation, all patients underwent a non-contrast helical CT scan of the abdomen and pelvis followed by conventional colonoscopy in the same day. The images of CT colonography were reconstructed into a virtual colonoscopy [VC] presentation and compared with subsequent conventional colonoscopy in a blinded manner. Conventional colonoscopy identified 22 polyps 5 mm or greater in 12 patients, and no polyps were detected in 8 patients. Virtual colonoscopy correctly identified 5 polyps of 9 polyps 5-9 mm in size, and 11 of 13 lesions greater than or equal to 10 mm in diameter. Per-patient findings of VC for lesions 5-9 mm were; sensitivity 55.6%, specificity 81.8%, positive predictive value 71.4%, negative predictive value 69.2%, over all accuracy 70% and for lesions greater than or equal to 10 mm were; sensitivity 91.7%, specificity 87.5%, positive predictive value 91.7%, negative predictive value 87.5%, over all accuracy 90%. It could he concluded that VC is feasible and has excellent sensitivity and specificity for detection of colorectal lesions 10 mm and larger and provide another effective complement for the diagnosis and screening

Modified radical mastectomy or quadrantecomy and axillary clearance for management of early breast cancer

For the most part, surgery for patients with breast cancer is the first treatment. The surgical management has undergone extensive transitions over the past century. Breast conserving surgery [BCS] is a treatment modality for early-stage breast cancer that causes less physical disfigurement and psychological trauma to the patient. This study has been carried out to compare modified radical mastectomy [25 patients [group 1]] and quadrantectomy with axillary clearance [25 patients [group 2]], for 50 patients with stage I and stage II breast cancer. There were no statistical differences between both groups, regarding age, menstrual history, history of contraceptive pills, parity status, family history, tumour site as well as histopathological findings. Postoperative wound edge ischaemia was found in 3 [12%] of patients in group 1. Wound seroma occurred in 5 [20%] of patients in group 1 and 2 [8%] of patients in group 2. Wound infection occurred in 4 [60%] patients in group 1 and 2 [8%] of patients in group 2. Parasthesia and wound numbness occurred in 8 [24%] patients in group 1 and 3 [12%] of patients in group 2. There were no cases of upper limb oedema in this study. Regarding to cosmetic results in group 2, 15 patients [60%] showed excellent results, 7 [28%] showed good results; 3 [12%] showed fair results and no patients showed poor results. There were no postoperative recurrence or death from breast cancer during the follow up period [30 months] in our patients. Since breast conservation surgery yielded results similar to mastectomy, its use should be extended

Management and prognosis of primary and recurrent retroperitoneal soft tissue sarcoma

Retroperitoneal sarcomas are rare tumor accounting for appn3xinately 15% of all soft tissue sarcomas. Surgical resection of localized tumors with gross and microscopically negative margins remains the standard of care. However, because retroperitoneal soft tissue sarcoma are frequently large and locally advanced, resections are often incomplete resulting in local recurrence, investigators are evaluating combined modality therapies to improve local control and disease specific survival. The aim in this study is to evaluate the result of surgical treatment and long-term outcome of patients with retroperitoneal soft tissue sarcoma [RSTS]. Between April 2002 and January 2007, 34 patients [15 males and 19 females; mean age 56 years, range 25-77 years], were evaluated complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins. Twenty-eight out of 34 patients [82%] [15 were affected by primary retroperitoneal soft tissue sarcoma and 13 by recurrent retroperitoneal soft tissue sarcoma] underwent surgical exploration, twenty-three patients had grossly and microscopically complete resection [3 having grossly incomplete resection and the two patients with grossly complete resection have histologically involved resection margin]. Twenty-one out of 28 patients [75%] underwent removal of contiguous intra-abdominal organs. Peroperative mortality was nil, and morbidity occurred in six cases only [21%]. High tumor grade results a significant variable for worse suryival in all 28patients [100% 3 years survival for low grade versus 0% for high grade, P = 0.004]. Amongst completely resected patients only histologic grade and peroperative blood transfusion affected disease free survival [P= 0.04 and P = 0.05 respectively5. In conclusion, an aggressive surgical approach in both primary and recurrent RPS is associated with long-term survival

Anorectal pressure changes following milligan morgan haemorrhoidectomy

Milligan Morgan haemorrhoidectomy [1937] together with many anorectal surgery my lead to an immediate or long term postoperative complications including bleeding, incontinence to flatus, mucous, liquid stool and solid stool. Manometric study of the anal canal is an index of the resistance of sphincter to the passage of faeces. For this study 30 patients complaining of 3[rd] and 4[th] degree noncomplicated piles with no other associated diseases admitted to Al-Azhar University Hospitals and other hospitals were the material of this study. There were, 24 males and 6 females. Their ages ranged from 21-50 years old. Pre-and post-haemorrhoidectomy manometric study was done for all patients and the results were recorded. From our study we can conclude that Milligan Morgan haemorrhoidectomy induces a complete resolution of typical manometric alterations of the disease and that the excision of anal cushions is responsibles only of mild and transient alteration of continence

Comparative study of subinguinal microscopic varicocelectomy and laparoscopic varicocele ligation

This study was carried out to compare the operative time, post-operative complications and semen analysis between subinguinal microscopic varicocelectomy [SMV] and laparoscopic varicocele ligation [LVL]. A total of 60 subfertile patients with varicocele, were assigned into two groups according to the method of treatment. Groups 1 included 30 patients treated by subinguinal microscopic varicocelectomy and group 2 included 30 patients treated by laparoscopic varicocele ligation. There were no difference between both groups as regard age, site of affection, symptoms and grade of varicocele. The mean operative time was significantly shorter among patients with LVL and therefore decreased the cost of the operation [P < 0.5]; there is no difference between the two groups as regarding to the duration of hospital stay, time off work and the duration of post-operative analgesic use. Post-operative semen analysis showed a significant increase in the density and motility and a significant reduction in the percentage of abnormal forms in the two groups. The recurrence rate at follow up was reported among patients of SMV [6.7%] and hydrocele formation was reported among patients of LVL [6.7%]. It is concluded that, LVL resulted in significant shorter operative time and lower incidence of recurrence compared with SMV