ABSTRACT
Aim: Lymphorrhea and seroma formation are disabling and serious complications of axillary lymphadenectomy. The role of octreotide in control of post axillary dissection lymphorrhea will be assessed in this study
Methods: Fifty female patients with cancer breast of different stages were subjected for modified radical mastectomy and divided into two groups; the first group was given octreotide [Sandostatin, Novartis Pharma AG, Basie, Switzerland] 0.1 mg subcutaneous 18 hours for 7 days, the other group was the control group. Both groups were evaluated for amount and duration of lymphorrhea as well as infection and hematoma formation
Results: A significant difference in the amount and duration of lymphorrhea between the two groups was observed [P = 0.0003]. In the first 8 days, the mean amount of lymphorrhea was 145.0 +/- 45.8 cc per day and mean duration of drainage was 27.0 +/- 7.59 days in control group. In the treatment group, the mean amount of lymphorrhea was 104.0 +/- 29 cc per day and the mean duration of drainage was 12.7 +/- 6.74 days
Conclusion: Octreotide could be used successfully for control of post-axillary lymphadenectomy lymphorrhea and this may lower the incidence of lymphedema and lymphosarcoma
ABSTRACT
Aim: the management of fistula in-ano has been based on digital examination and operative findings. This study was conducted to asses the diagnostic accuracy of magnetic resonance imaging [MRI] with endorectal coil in perianal fistula
Patients and Methods: twenty patients with anal fistula were classified into two groups. The first one included those who had primary fistula [10 patients] and the second included those with recurrent fistula [10 patients]. All patients underwent preoperative MR imaging using endorectal coil. The findings were compared to examination under anesthesia [ELIA] and final surgical findings
Results: comparing MRI with operative data [EUA and final surgical results]; in the first group with simple fistula, MR imaging showed additional information than examination under anesthesia in only one patient [10%] and did not diagnose one fistulous tract at all. 111 the second group, MRI detected 8 internal openings correctly and one opening was missed. MRI added information than EUA in 6 patients, its fallacies was noted in 2 patients
Conclusion: MRI with endorectal coil could be very useful and reliable in defining fistula anatomy, assessing relationship with anal sphincter, identifying secondary extensions [particularly horseshoe tracts] and planning surgical strategy
ABSTRACT
Aim: laparoscopic cholecystectomy gives rise to a very complicated issue concerning the use of antimicrobial prophylaxis. The role of antibiotic prophylaxis in elective laparoscopic cholecystectomy and the relation between post-operative septic complication and bile microbiology will be assessed in this study
Patients and methods: 64 patients were included in the study and divided into two groups; group A: [29 patients] received antibiotic prophylaxis [cefotaxime] and group B [35 patients] received 100m1 isotonic saline [placebo]. Bile sampling and culture was taken for all cases and the patients' were followed up for incidence of sepsis where the wounds were swapped and cultured
Results: bile sampling and culture revealed no growth in 41 cases [64.1%] [19 in-group A and 22 in-group B]. Postoperative infection developed in two cases of group A and in three cases of group, B. Incidence of wound infection was significantly related to incidence of GB perforation [p < 0.0001]. Swabbing of infected wounds and collections revealed infecting organisms other than that detected in bile culture except in one case of group B
Conclusion: there is no relation between bile microbiology and postoperative infection, so, antibiotic prophylaxis is to be used in high-risk patients and in patients suspected to have difficult operation and GB perforation
ABSTRACT
Aim: was to compare the technique and the postoperative continence state of Swenson's operation with its Wang's modification
Methods: 25 cases underwent a resectional surgery over 2.5 years. 13 underwent Wang's modification while Swenson's operation was performed for 12 cases. Mean age at operation was 16 months [2 months to 5 years]
Results: Wang's operation had superior results than Swenson operation regarding postoperative soiling [P= 0.027] that occurred in 6 cases after Swenson operation and in only one case after Wang's operation while anastomotic leak occurred in one case of each group. Further, Wang's operation group had postoperative resting and squeeze pressures of 49.82 +/- .31 mmHg and 90.83.80 mmHg respectively; both are significantly higher than those recorded in Swenson operation group: 40.82.30, 78.0 +/- 7.21 respectively [P= 0.0001]
Conclusion: Wang's modification of Swenson's operation represents a proper management of the internal anal sphincter during resectional surgery for HD through preservation of the anterior rectal wall and splitting its posterior wall with formation of heart shaped anastomosis
ABSTRACT
Background and Aim: the usefulness of preoperative Carcinoembryonic antigen [CEA] in colorectal cancer [CRC] remains unsettled as regards its role in management and follow up of CRC patients. Efficacy of basal CEA in the diagnosis, prognosis, follow up and therapy of CRC patients will be assessed in this study
Patients and Methods: 200 CRC patients and 100 persons as a healthy control were included in the study. Basal CEA was done before resection. Postoperative Dukes' staging was adopted. Routine follow up and CEA estimation were done
Results: the mean CEA in CRC patients [17.3 ng% +/- 1.67] was significantly higher than control [3.41 ng% +/- 1.1]. A significant association between mean basal CEA and Dukes' classes was evident [it was 7.8, 12.7, 25.8 ng% for Dukes' A, B, C]. The validity of basal CEA in primary CRC diagnosis was highly positive, with higher efficacy in advanced disease detection and negative exclusion power for DFS prediction. Basal CEA was a discriminant factor in prognosis. DFT and DFS were higher in patients with CEA
Conclusion: the preoperative CEA identifies subsets with favourable, indolent and uneven biological behaviour [ 15 ng %]. With conventional staging, it forms strong prognostic tool that supplies practice guideline for follow up and therapy