Comparative study between Alvarado score and appendicitis inflammatory response score in diagnosis of acute appendicitis

Background: The appendix is a worm like extension of caecum and for this reason has been called "vermiform appendix". Appendicitis may occur due to several reasons, such as an infection of the appendix, but the most important is the obstruction of appendiceal lumen. Acute appendicitis has remained the most common acute surgical condition of the abdomen in all ages and of course, a common disease in surgical practice. The usual picture of appendicitis is often not classical, leaving in many cases a diagnostic problem. In patients with questionable findings, the aggressive surgical approach has been "when in doubt, take it out, "and the price paid is the frequent removal of normal appendix

Aim of the Work: The aim of the work is to evaluate the appendicitis inflammatory response [AIR] score and compare its performance in predicting the risk of appendicitis to the Alvarado score

Patients and Methods: In this randomized prospective study, 100 patients with acute pain in right lower quadrant of abdomen were admitted to the surgical department of Al-Hussain University Hospital in the period from June 2017 to October 2017. All the patients had indications for appendectomy. The present study was carried out among patients suffering from acute pain in right lower quadrant of abdomen

Results: This randomized prospective study comprised 100 patients, of whom 52 were females [52%] and 48 were males [48%]. Their ages ranged from 16 to 42 years old with a mean age of 21 years. These 100 patients were presented with acute pain in right lower quadrant of abdomen. All female cases proved to be pregnant were excluded from the study. Recurrent sub-acute appendicitis were also excluded from the study. Patients with known abdominal malignancies or previous abdominal surgery were also excluded from the study

Conclusion: This prospective study comprised 100 patients with acute right iliac fossa pain for evaluation and comparing between Alvarado score and AIR score in diagnosis of acute appendicitis. The present study showed that the AIR score has a good statistical discrimination for patients with acute appendicitis and outperforms the Alvarado score

Is gastric pull-up reconcstruction still the versatile method in the surgical treatment for hypopharyngeal carcinoma

The objective of this cross sectional study was to assess the best option for reconstruction after pharyngolaryngectomy for hypopharyngeal carcinoma. The study was done in surgical oncology department. National Cancer Institute, Cairo University. The study included 131 patients with carcinoma of the hypopharynx. The results of this study showed that gastric pull-up was the suitable reconstructive option in 67.1% of cases with free jujenal flap reconstruction in 9.2%. No reconstruction teas done in 9.2% of advanced patients leaving the patient with a pharyngostome, an orostome and a tracheostomy. Pectoralis major myocutaneous flaps were used primarily for repair in 3.8% of patients, and free antrolateral thigh flap in 2.3% while primary closure was done in 8.4% of cases when conservative surgery was feasible. Postoperative morbidity was encountered in 47% of patients. The most common morbidities were pharyngeal fistula and chest infection. Local and nodal recurrence occurred in 19.1% of cases. Postoperative mortality occurred in 33% of cases. Of 81 cases there was an extrahypopharyngeal spread in 60% of them. Extension to the larynx occurred in 22% of cases, thyroid gland in 11% of cases, esophagus also in 11% of cases [all from postcricoid area], soft tissue extension in 11% of cases and oropharynx in 5% of cases. Pathological examination of nodes in cases subjected to lymph node dissection [53 cases,] revealed metastatic lymph nodes in 52.8%. Most of the cases were at advanced stage [48% of cases were stage IV and 35% of cases were stage III. Lack of sufficient safety margin was found in 15 cases [11.5%. All positive margins were less than 2 cm. According to the advanced stage of the disease at presentation, reconstruction by gastric pull-up after pharyngolaryng- esophagectomy for hypopharyngeal carcinoma is the optimal option

Giant cell tumors of long bones: a preliminary report of treatment and outcome

The present study was performed to determine whether there is a difference in the functional outcome and recurrence rate after different methods of treatment of giant-cell tumor of long bones. Thirty-four patients, 23 females and 11 males with a mean age of 26 years were treated. According to the grading system developed by Campanacci et al., three lesions were grade I, 20 lesions were grade II and 11 lesions were grade III. The follow up ranged from 12-40 months with an average of 15 months. The patients were evaluated with regard to pain, postoperative function and local recurrence. Twenty- two patients were treated by curettage, while 12 by resection. After curettage, liquid nitrogen was used in 14 patients and high speed burr only was used in 8 patients. After curettage, the cavity was filled with autograft [iliac bone chips] in 15 patients and cement in 7 patients. After wide resection, arthrodesis was performed in five patients, endoprostheses were inserted in five patients and replacement of the distal radius by an ipsilateral fibular graft for two patients. Four of the 34 patients had a local recurrence during a mean follow up period of 15 months, including three patients having recurrence after curettage and one after resection. The functional result according to Mankin's classification was excellent in 19 patients, good in seven patients, fair in four patients and failed in four patients

Extended lymphadenectomy to the lower paraortic nodes during radical cystectomy

Evaluation of the diagnostic, prognostic and possible therapeutic role of extended lymphadenectomy to lower para-aortic area in operable bladder cancer patients. One hundred and nine patients were subjected to the procedure in the National Cancer Institute, Cairo University, and in Minea Oncology Center, Ministry of Health by the same group of surgeons, during the period from September 2000 to March 2003. The lymph nodes dissected were labeled to the following groups: perivesical, lymph node of Cloquet, external iliac, internal iliac and obturator, common iliac and paraortic groups both right and left. These nodes were subjected with the primary tumor to serial sectioning for histopathologic examination. Preoperatively, all patients were subjected to routine laboratory investigations. In addition to cystoscopy, biopsy and histopathologic examination, bone scan, chest X-Ray and computerized tomography with IV. contrast examination for the abdomen and pelvis were done for clinical staging of the disease. 34.4% of the node positive patients have been found to harbor the disease in the para-aortic lymph nodes above the common iliac bifurcation. Obturator, external iliac, internal iliac, para-aortic, common iliac, perivesical and lymph node of Cloquet are the higher incidence groups of positive lymph nodes sequentially. The clinical and C.T. staging are inaccurate methods of diagnosis due to high overall error in up to 70.6% of patients. There is no higher incidence of morbidity, mortality, operative time or intraoperative blood loss related to the addition of lower para-aortic dissection to the routine radical cystectomy. Extension of lymphadenectomy to include the lower para-aortic area in addition to the standard pelvic lymphadenectomy during radical cystectomy for bladder cancer is a more accurate technique for diagnosis and staging of bladder cancer patients and it may help in determining the benefit of adjuvant chemotherapy +/- radiotherapy. By itself, it gives a better recurrence-free survival rate without adding higher morbidity or mortality than the standard pelvic lymphadenectomy

randomized controlled trial of psychosocial counselling for first-time IVF couples

Of this study was to evaluate pre-IVF counselling using self report questionnaire on couples. The acceptability of counselling, perception of help and effects on anxiety and depression were considered. The study included 423 consecutive childless Arabic couples preparing for their first IVF. Randomization was carried out through sealed envelopes attributing participants to counselled and non-counselled groups and was accepted by 300 couples. Another 42 couples refused randomization because they wanted counselling and 81 couples because they did not. Questionnaires including the State-Trait Anxiety Inventory, the Beck Depression Inventory and assessments of help were answered by couples before IVF and counselling, and after the IVF outcome result. Counselling was accepted by 81% [342/423] of couples. There was no significant effect of counselling on anxiety and depression scores which were within normal ranges at both times. Counselling provided help for 86% [225/261] of initially non-demanding subjects and 96% [81/84] of those initially requesting a session. Help was noted in areas of psychological assistance, technical explanations and discussing relationships. This model of routine counselling provides an acceptable form of psychological assistance for pre-IVF couples

Surgical management of posterior mediastinal tumors with intraspinal extention

In this study, ten patients with posterior mediastinal tumors were subjected to thorough clinical and radiological examination including CT and MRI chest and thoracic spine to determine the site of the tumor and the extent of invasion of the thoracic vertebral bodies and/or their neural arches. Preoperative CT guided biopsy was done for all cases to identify the tumor pathology. The patients were followed up for a period ranging from 7 to 24 months for local or distant recurrence, spinal stability, neurological functions and the need for adjuvant therapy. Anterior approach [posterolateral thoracotomy] was done in seven patients, posterior approach was done in one case and combined anterior and posterior approaches were done in two cases. Total corpectomy alone was done in seven cases. Combined corpectomy and laminectomy were done in two cases and laminectomy alone in one case. In nine cases, dorsal spine was fixed anteriorly by instrumentation [Z-plate and screws] and iliac crest bone graft [eight cases] or isobone [one case]. In one case, fixation was done by posterolateral plates and screws and intertransverse bony fusion. All cases of fixation showed sound bony fusion. Nine cases were improved neurologically and only one case did not improve postoperatively

Evaluation of risk factors associated with recurrent cesarean section morbidity: a suggested score

This prospective study included 1000 women undergoing cesarean section [CS] under general anesthesia. They were divided into two groups. Group 1 [control group] included 500 patients, who underwent CS for the first time. Group 2 [study group] included 500 patients who had one or more previous CS. Simple scoring system was developed to record the possible risk factors related to CS morbidity. There were six significant preoperative risk factors [high parity, preterm delivery, placenta praevia, antepartum hemorrhage, medical disorders and bad general condition]. There were five highly significant risk factors related to intra-operative morbidity [high parity, placenta praevia, intra-peritoneal adhesions, low experienced surgeon and preterm gestational age] and five risk factors related to previous CS operation [previous three or more CS, previous CS at rural hospital or private clinic, previous upper segment CS, previous complicated CS and tender previous scar]. Eleven factors related to postoperative morbidity were more significant in the repeated CS group. The incidence of overall morbidities was significantly more in the repeated CS group. Total postoperative morbidity was highly significant starting from previous 4 or more CS. Risk factors related to intra-operative morbidity were used to develop a mortality scoring system. Based on a summation of logistic coefficient corresponding to individual risk factors, a scoring system was suggested, which can help in the prediction of CS morbidity. Further prospective evaluation of this scoring system would be helpful to confirm the usefulness and practicality of this system

Seromuscular vascularized ileal loop patch for the repair of radiation induced vesico-vaginal fistula after radical hysterectomy for cervical carcinoma

The use of Vascularized pedicled seromuscular Heal loop patch as a well Vascularized interposition tissue flap, between bladder and vaginal walls for repair of radiation induced vesico-vaginal fistula -was studied on nine patients from the period of April 2000 till January 2003 in the national cancer institute. Those patients were referred to the surgical department with adiagnosed vesico-vaginal fistula, that developed after completion of an external beam and intracavitary radiotherapy post hysterectomy for cervical carcinoma. Through transabdominal, Transvesical approach, with stinting of the ureters during dissection of the fistulous tract, an ileal loop flap is mobilized with its mesenteric blood supply to become technically amenable for enforcement of the repair or reconstruction of the deficient vesical wall after excision of the scarred fistulous tract simulating cystoplasty technique. The outcome of this approach and flap technique showed successful healing of all fistulae in all patients, without complications either post operatively or during follow up. This study recommended the use of seromascular Vascularized Heal loop patch for the repair of radiation induced vesico-vaginal fistula after radical hysterectomies