role of non-operative management for blunt splenic injuries in regarding operative management in all ages

Non-operative management of patient with blunt splenic injuries has become a preferred mode of management for hemodynamically stable patients. The operative management of patients with blunt splenic injuries still has the major role in this study. Twenty two patients [16 males and 6 females] proved to have splenic injury were selected for operative and non-operative management, 15 patients underwent direct laparotomy, 10 splenectomy and 5 partial splenectomy. The remaining 7 patients had underwent conservative non-operative management, 2 of them need surgical intervention. Although not advocating splenectomy as the treatment of choice for the adult population, this study recommended early operative intervention with an attempt at partial splenectomy

Treatment of chronic anal fissure with isosorbide dinitrate and its cost versus open lateral sphincterotomy

Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by topical application of nitric oxide donors [isosorbide dinitrate]. This study was undertaken to compare local application of isosorbide dinitrate with lateral internal sphincterotomy. A sample of 153 patients with chronic anal fissure was allocated to treatment with sphincterotomy [69 patients] or local isosorbide dinitrate tablets [84 patients]. Patients were followed-up for one year. Common age group was 30-40 years. The healing rate was 97% in surgical group and 47.8% in medical group. The recurrence after healing in last group was 44.4%. The cost of treatment by sphincterotomy under local anesthesia is nearly equal to treatment by topical application of isosorbide dinitrate tablet. Lateral internal sphincterotomy under local anesthesia is considered the operation of choice in surgically fit patients in treatment of chronic anal fissure. Topical application of isosorbide dinitrate can be used for those who are surgically unfit or refuse operation

Conserving surgery of early breast carcinoma

Conservation surgery of the breast implies the resection of minimal volumes of diseased breast tissue to achieve control rates equivalent to those accomplished by mastectomy, it has the goal of preservation of cosmoses and function. This limited resection is followed by axillary lymph nodes clearance followed by radiation and systemic therapy in breast cancer stage 1 and II. This study included 50 female patients having carcinoma of the breast as proved by lump biopsy true cut needle or excisional biopsy, these patients were selected from all the cases of cancer breast who attended the outpatient clinic of EL-Minia University hospital and National Cancer Institute in the period from January 1998 till march 2001.The purpose of this study is to evaluate the efficacy of breast conservation surgery plus radiotherapy or radiochemotherapy for early stage breast cancer patients to determine mortality and recurrence rates and to evaluate prognostic factors for these outcomes. Locoregional recurrence was detected in 3 patients out of 50 [6 percent], distant metastases was detected in one patient to the liver after 18 months [2 percent]. As regards the overall survival 2 patients out of 50 [4 percent] died because of; one due to distant metastases to the liver and the other due to heart failure. Breast conservation therapy could be a suitable option for the Egyptian woman with early breast cancer of stage I and II and from the previous results and owing to the satisfactory documented efficacy of radiation and chemotherapy to prevent or at least delay local recurrence and the fact that 95 percent of local recurrences in the breast are salvageable with no effect on survival, are encouraging factors although a longer follow up and a large number of patients are required for more accurate results, also a regular close follow up is recommended to detect any late relapse especially in the presence of high risk factors for local recurrence