Laparoscopic management of ovarian mature cystic teratomas

To evaluate the safety and efficacy of laparoscopic management of dermoid cysts, to present some guidelines, and to avoid possible complications that may occur from cyst spillage. A retrospective review of twenty-four women, who underwent laparoscopic surgery for dermoid cysts. Cases were recruited during the period from March 2002 to May 2005 at Shatby University Maternity Hospital, using special technique during laparoscopic removal of dermoid cysts. All patients were counseled for the procedure and informed consent was obtained to do laparoscopic management. In 24 women aged 18 to 38 years, thirteen patients [54.2%] had unilateral cysts, while eleven patients [45.8%] had bilateral cysts. The size of the dermoid cysts ranged from one to ten centimeters, mean cyst diameter was, 4.7 +/- 2.9 cm, and all these cysts removed via the use of endobag. The chief complaint was chronic pelvic pain in 11 patients [45.8%], irregular menstrual cycles in 4 cases [16.7%], one case [4.2%] presented with acute abdomen and torsion, while 8 cases [33.3%] were asymptomatic and discovered incidentally during routine ultrasound examination. All patients underwent operative laparoscopic cystectomy of the dermoid cysts. During the cyst extraction, spillage occurred in 4 cases [16.6%], and none developed chemical peritonitis. Operative time for dermoid cyst removal was 103 +/- 30 minutes. There were no intraoperative or postoperative complications, and no conversion to laparatomy. Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure

Assessment of a guideline for management of hepatocellular carcinoma [HCC] in Egyptian patients

HCC is the commonest liver malignancy all over the world including in Egypt. Many classification system for management of HCC have been proposed but none of them is implemented worldwide. In this work we propose a guideline for management of HCC which is suitable for the Egyptian patient. The suggested guideline of management includes assessment of four areas: The general clinical status of the patient, the liver status, the tumor status and options of therapy which are suitable for Egyptian circumstances. In one center, this design was prospectively applied on 79 patients who presented with HCC. The HCC patients showed that: Two [2.86%] had non-cirrhotic liver parenchyma, while all the rest had cirrhosis: 7 [10.0%] early stage or Child's A [one early and 6 late Child's A], 28 [40.0%] intermediate stage [Child's B] and 33 [47.14%] terminal end stage [Child's C]. Therapy was applied according to the suggested guideline as follows: surgical resection for four patients [5.71%], radio frequency ablation [RFA] for 6 [8.57%], percutaneous ethanol injection [PEI] for 39 [55.71%], selective arterial chemoembolization for 2 [2.86%], chemotherapy for 6 [5.57%] and symptomatic therapy for 13 [18.75%] patients. After two years of follow up: Fourty four [62.9%] were still living, 20 [28.6%] died while 6 [8.6%] were missed to follow up. Recurrence of HCC was found in 21 [30.0%] cases. The liver status progressed from Child's A to B in four cases out of 7 [57.1%] and from Child's B to C in 24 cases out of 28 [85.71%] within one year. The prognosis of the disease depended on many factors on top of which was the liver functional reserve. Most Egyptian patients with HCC present in a late stage of cirrhosis thus with a bad prognosis as predicted from their clinical status, the liver condition and the tumor status. The progress of the underlying liver disease is more rapid when HCC appears. PEI is a good option of therapy. The predictive factors of good prognosis and improvement in this study were HBV infection and the Child's class. Although the mortality rate was still high [28.5%], but the cost of therapy was reduced due to application of the suggested guideline system. This guideline is simple, easy to apply, covers most HCC presentations, is flexible and may be changed [updated] according to progress in technology, resources of therapeutics, skills of the operators and the patient's presentation. Thus other Egyptian centers can apply this guideline in management of HCC, reevaluating and updating it