Laser therapy in superficial bladder tumors: technique, results and complications

Fifty-two patients with superficial transitional cell carcinoma were randomized to receive either Nd:YAG laser therapy [25 patients] or transurethral resection [27 patients]. Local tumor recurrence at the same site of the original tumor occurred in 12% of patients treated with laser therapy compared with 56% of those treated by transurethral resection. There was no significant difference as regards remote recurrence in both groups. These findings were corroborated even after stratification according to stage and grade, which agreed with a number of published reports. In addition, the Nd:YAG laser was associated with a smaller incidence of treatment-related morbidity. Nevertheless, the high cost of setting up and maintaining a laser unit precludes recommending it except in the setting of a large tertiary referral center

Effect of cardio-pulmonary bypass [CPB] on renal functions in open heart surgery

A group of 60 patients undergoing open heart surgery were selected from Zagazig University and National Heart Institute from 1994 to 1996 to evaluate the effect of cardiopulmonary bypass [CBP] on renal functions, the patients were selected from 20-40 years old and had normal pre-operative renal functional reserve. Aortic valve replacement was done for 25 [41.7%] patients, mitral valve replacement for 13 [21. 7%] patients, mitral valve replacement and tricuspid repair for 13 [21.8%] patients, double valve replacement for 7 [11.7%] patients, double valve replacement with tricuspid repair for 5 [8.3%] patients and closure of ASD was done for 2 [3.3%]. Renal impairment was observed in 13 [21.7%] patients. It was mild moderate i.e serum creatinine from 1.6-5 mg/dL in 11 [I8.3%] patients while it was severe renal impairment i.e serum creatinine> 5 mg/dl in 2 [3.3%] patients two patients required peritoneal dialysis one of them recovered after 35 days while the other died after 10 days. Two deaths occurred in this series one died from cardiac cause [pump failure] intraoperativeIy and the other died from renal failure at the 10th post-operative day. We found that, prolonged cardiopulmonary bypass time, hypotension, oliguria and low cardiac output during open heart surgery correlate with development of renal impairment post-operatively. Although severe renal failure was uncommon complication after open heart surgery, its occurrence carried a grave prognosis

CT-guided percutaneous cutting needle biopsy in diagnosis of diffuse pleural thickening

Diffuse pleural thickening may be caused by a variety of inflammatory and malignant processes and differentiation on the basis of clinical findings can be extremely difficult. Computed tomography [CT], however is an excellent modality with which to examine the pleura and chest wall and has been used to differentiate between malignant and benign causes but has a limited sensitivity. So we are always in need of tissue biopsy. To assess the diagnostic yield of computed tomography CT guided percutaneous needle biopsy of diffuse pleural thickening, 25 patients with diffuse pleural thickening based on CT criteria described by Lynch et al. were taken in this study from Cardiothoracic Department Zagazig University Hospital from 1993 to 1995.Sufficient pleural tissue for histological diagnosis were obtained in 23 biopsied cases with a correct histological diagnosis comparison to the results of operative tissue biopsy, made in 21 of 23 biopsies. There were 2 false negative biopsies and 2 inadequate specimens. So, the specificity of CT -guided needle biopsy was 92% and 84% respectively with minimal complications. We conclude that CT guided needle biopsy in combination with CT criteria are very useful as a first line of diagnosis in diffuse pleural thickening