Outcome after total mesorectal excision in the management of rectal experience of 150 patients

To assess oncological outcomes including local recurrence and cancer-specific survival as well as functional outcomes including urinary and sexual functions in 150 cases of rectal cancer underwent total mesorectal excision [TME]. Patients with mid or low rectal cancer underwent TME with preservation of autonomic pelvic plexus. Oncological and functional outcomes were prospectively recorded and analyzed. A total of 150 patients of middle and lower rectal cancer underwent either APR or LAR with total mesorectal excision and pelvic nerve preservation between 1997 and 2007 were collected. Anastmotic leak was the commonest complication [16.6%]. Isolated local pelvic recurrence was 10.6%.The 5-year overall survival and cancer-specific survival rale were 45% and 52% respectively. All patients could void urine spontaneously and no patient became incontinent or went on chronic retention requiring catheterization. Postoperative urodynamics revealed normal mean maximal urinary flow rate and voided volume in 90% of patients. Erection was possible in 93%; penetration ability was possible in 69 patients [80%]. Doppler US was normal on both sides in 80%. Advances in rectal cancer surgical techniques allows improving overall survival and quality of life through local control and preservation of sphincter, sexual and urinary function

first two vancomycin resistant staphylococcus aureus isolates in mansoura university hospital; epidemiology and antimicrobial study

Staphylococcus aureus, a major cause of potentially life threatening infections acquired in health care and community settings, has developed resistance to most classes of antimicrobial agents with dramatic increase in the number of health care associated infections due to methicillin resistant S. aureus [MRSA]. During the period of our study 974 S. aureus strains were isolated from different types of infections in different wards of Mansoura University Hospitals [MUH], 530 [54.4%] isolates were methicillin sensitive S. aureus [MSSA] and 444 [45.6%] isolates were MRSA. Simplified population analysis of MRSA strains revealed, 27 [6.08%] heterogeneous vancomycin intermediate sensitive S. aureus [hVISA], 12 [2.70%] vancomycin intermediate sensitive S. aureus [VISA], while 2 [0.45%] isolates were vancomycin resistant S. aureus [VRSA]. hVISA strains were isolated from different infections, mainly from blood stream infections [29.63%] and infected skin ulcers and bedsores [29.63%], where the 12 VISA strains were isolated from infected skin ulcers and bedsores [41.66%], infected surgical wounds [41.66%] and lower respiratory tract infections [16.67]. The 2 VRSA isolates were isolated from blood stream infection [one case] and an infected bedsore [the other case]. One of the 2 VRSA cases was isolated from children hospital and the other one was isolated from medical wards. Minimal inhibitory concentration [MIC] of different antimicrobial agents for S. aureus with diminished sensitivity to vancomycin was done by microdilution method revealing a significant difference in resistance among VISA, hVISA and VRSA with vancomycin, linzolide, meropenem. Time kill study of different antibiotics for VRSA isolates showed that, vancomycin exhibited no kill activity at 1X MIC, but killing activity was achieved only at 2X and 4X. Other tested antibiotics were significantly had killing activity more than vancomycin at concentration of 1X MIC. Daptomycin, quinipristin/dalfopristin, tigecyclin, meropenem, ciprofloxacin, and erythromycin were significantly had killing activity more than linezolide at concentration of 1X MIC. In conclusion, the first two identified VRSA isolates from children hospital and medical wards still susceptible to some antibiotics which are not used widely such as, daptomycin, quinipristin/dalfopristin and tigecyclin, also hVISA and VISA had antimicrobial susceptibility pattern similar to VRSA isolates

Anticoagulation and dental implant surgery: should the anticoagulation regimen be altered?

Purpose: This study was performed to assess whether the patients receiving oral anticoagulant and require dental implant surgery need to alter the anticoagulation regimen during implant installation or not?

Materials and Methods: Thirteen patients receiving oral anticoagulant due to cardiovascular problems in need for oral rehabilitation using dental implants, were divided into two groups according to their international normalize ratio [INR]. In group [I] 6 patients their INR value 2 to >3 and in group [II] 7 patients their INR value <3 up to 4. In all patients implant insertion was performed under local anesthesia using 3% mepivacaine hydrochloride with levonordefrin 1:20,000

Results: None of the patients had any immediate postoperative bleeding, in group [II] 2 patients has postoperative bleeding that required treatment using local measure, compared to one case of group [I], with no statistically significant difference [P> 0.05]. Except only 1 implant in group [II]. All implants inserted were osseointegrated and subsequently incorporated in prosthetic reconstructions

Conclusions: Based on the results of this study alteration of the oral anticoagulant regimen prior dental implant surgery is not necessary