Multimodality therapy for locally advanced breast cancer

In the present study, 20 patients with locally advanced breast cancer were treated with a combined modality strategy from September 1999 to June 2002. Their age ranged from 30-65 years with a mean of 50 years. Thirteen patients were postmenopausal and seven patients were premenopausal. Fourteen cases were in stage IIIb, while six cases were in stage IIIa. A metastatic work up was done and all patients were found to be free from distant metastases before neoadjuvant chemotherapy. The patients received three cycles of different regimens of neoadjuvant chemotherapy. Fourteen patients received 5-flurouracil, adriamycin, cyclophosphamide [FAC], three patients received 5-flurouracil, epirubicin, cyclophosphamide [FEC], two patients received 5-flurouracil, novantrone, cyclophosphamide [FNC]and one patient received cyclophosphamide, methotrexate, 5-flurouacil [CMF]. 90% of the patients had partial responses to the neoadjuvant chemotherapy [the tumor decreased more than 50% of its size]; while only two patients did not respond to treatment. Modified radical mastectomy was done for all patients. Postoperatively, all patients received adjuvant treatment, radiotherapy 5000 cGY, 25 fractions, 3-4 cycles of further adjuvant chemotherapy [FAC, FEC, CMF and FNC] and hormonal treatment, tamoxifen 20 mg/day. The patients were followed up for a variable period of time ranging from 12-24 months. No local recurrence was detected in all patients. Only two patients developed distant metastasis. Disease free survival was 90%. This multimodality approach to locally advanced breast cancer rendered most of the patients disease-free and produced an excellent local control rate

Evaluation of two types of fibrin sealants as a haemostatic agent in the management of hepatic injuries: an experimental comparative study in an animal model

The present study was carried out on 40 female albino rabbits [1 kilogram in weight] in the animal laboratory of the National Cancer Institute. General anaesthesia was administered to all rabbits. The abdomen was entered through an upper midline incision and the liver was exposed. The scalpel was used to inflict a 2 cm long wound in the liver parenchyma deep enough but short of the posterior Glisson's capsule. The rabbits were divided into 2 equal Groups; in group [1] fibrin glue made from platelets and bovine thrombin was applied to the hepatic tear; while in group [2] fibrin glue made from platelets and human thrombin was applied to the liver tear. The time needed to achieve haemostasis was recorded in each group. Both types of fibrin sealants were successful to achieve haemostasis well as healing of the liver tear. However, the time needed to achieve haemostasis was significantly shorter in group [1] [bovine thrombin group]. It was concluded that both agents could be an attractive solution in the management of hepatic injuries especially in the modern era of surgical laparoscopy

Comparison of continuous inflow occlusion, intermittent inflow occlusion and ischemic preconditionning: an experimental study on murine liver

The present study was carried out on 40 white female rats classified into four groups, 10 rats in each group. In the first group, a continuous vascular inflow occlusion for 30 minutes was carried out using microvascular clamps. In the second group, a continuous vascular inflow occlusion for 60 minutes was carried out. In the third group, intermittent vascular inflow occlusion for 60 minutes was carried out [15 minutes clamping and 5 minutes reperfusion for 3 successive cycles]. In the fourth group, ischemic preconditioning was carried out [10 minutes clamping and 15 minutes reperfusion, followed by continuous clamping for 60 minutes]. In all groups, these different ischemic protocols were followed by two-hour reperfusion. The ischemia-reperfusion injurious effects were assessed in the liver specimens using light microscopy as well as electron microscopy. Apoptosis, as a marker of ischemia-reperfusion injury, was evaluated in the liver specimens stained with specific TUNEL staining. The continuous inflow occlusion for 60 minutes is associated with a highly significant degree of hepatic parenchymal damage compared with the other groups

Cervical lympho-venous shunt versus denver shunt in management of intractable ascites [analysis of 170 cases]

The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results