Internal hemipelvectomy, a limb saving procedure, NCI experience

Treatment of primary malignant tumors involving the pelvic girdle traditionally necessitated the sacrifice of a healthy lower extremity. Internal hemipelvectomy offers a safe alternative to this problem. With careful selection, the lower limb can be salvaged with acceptable function and hip stability. This study comprised 40 patients with malignant tumors of the pelvic bone treated by different types of internal hemipelvectomy at the National Cancer Institute [NCI], Cairo University in the period extending from 1996 to 2005. According to the location and extent of their tumors, they were ascribed to one of three groups. Group A included 28 patients who underwent type I hemipelvectomy [iliac bone resection], Group B included 8 patients who underwent type I+II hemipelvectomy [iliac and peri-acetabular resection] and group C included 4 patients who underwent type III hemipelvectomy [pubic bone resection]. The mean age for groups A, B and C was 35 +/- 11.9, 39 +/- 17.8 and 33.5 +/- 13 years; respectively. The study comprised 14 patients with Ewing's sarcoma, 12 patients with chondrosarcoma, 6 patients with osteosarcoma, 4 patients with giant cell tumor, 2 patients with aneurysmal bone cysts and 2 patients with malignant fibrous histocytoma. Neoadjuvant chemotherapy was given to 11 patients and 7 received preoperative chemotherapy and radiotherapy; whereas 22 patients received no neoadjuvant treatment. The mean +/- SD duration of the surgical procedure was 2.67 +/- 0.32 hours and the mean +/- SD intra-operative blood loss was 1323 +/- 233 ml. The difference between groups A, B, and C was statistically significant [p <0.05]. Intra-operative complications were encountered in 9 patients where 5 patients had various nerve injuries, 2 patients had vascular injury and 2 had bladder injury. In the postoperative period, 4 patients developed deep vein thrombosis, 7 showed wound infection, 3 had deep pelvic infection and 2 developed hematuria secondary to intra-operative bladder injury. Upon evaluation of the functional results obtained, 50% of the patients were judged to have good results and 30% had fair results and ambulation aids could be discarded after 6-8 months. The remaining 20%, who had undergone type I+II hemipelvectomy, demonstrated a poor functional result in the form of flail hip. At a median follow-up of 18 months, 70% of the patients were alive and free of disease, 17.5% were alive with loco-regional recurrence and 5 died; 3 from lung metastases and 2 of unrelated causes. Internal hemipelvectomy can achieve limb salvage in most cases of pelvic tumors without compromise to surgical margins, local control or survival rates. Functional results obtained with this technique were quite satisfactory when the hip joint could be preserved

Lower urinary tract reconstruction following radical cystectomy using ileal neobladder with studor technique; 3 years experience

Between April 1997 and March 2000, 29 men underwent lower urinary tract reconstruction by means of the ileal neobladder of Studor with a modification. All operations were done after radical cystectomy for bladder carcinoma. The median age was 48.5 years. There was 2 perioperative deaths with an operative mortality rate of [6.8%]. The early complication rate for issues indirectly related to the neobladder was [13.7%] compared to a [34.4%] directly neobladder-related complication rate. Neobladder-related late complications have been acceptable including urinary retention [11.1%], metabolic acidosis [7.4%]. Through March 2000, [11.1%] of the patients died of metabolic disease and [3.7%] of unrelated medical problem. Eight patients [29.6%] suffered pelvic recurrence. Diurnal continence was achieved in 85.2%, while the nocturnal continence rate was 48.1%. Two patients [7.4%] required intermittent catheterization because of inability to void. The median neobladder capacity was 447 ml. The upper tract remained stable in [59.2%] of the patients, improved in [11.1%]. Dilatation either unilateral or bilateral occured in [29.6%] of the patients; however, the renal function remained good in [18.1%] and impaired in [11.1%]

Organochlorine residues in adipose breast tissues and risk of breast cancer in Egyptian females

Exposure to environmental estrogen such as organochlorine pesticides and industrial chemicals has been proposed as a cause of increasing rates of breast cancer. To test this hypothesis 0.2-1 gm of breast adipose tissue was biopsied from 150 Egyptian females seen for evaluation of a palpable breast mass at the National Cancer Institute, Cairo University in the period from September 1995 to September 1997. Data on established risk factors for breast cancer were obtained by standard questionnaires. Mammary infiltrating carcinoma was diagnosed in 58 females [cases] while benign breast disease was diagnosed in 92 females [controls]. Elevated levels of organochlorine compounds were found in fat samples from women with cancer compared with those who had benign breast disease reaching a statistically significant difference for DDE, beta HCH and heptachlor [P < 0.05]. When comparing organochlorine levels according to estrogen receptor status [ER], the mean adipose tissue levels in ER-positive cases were significantly higher than ER-negative cases as regards DDE, beta HCH and heptachlor [P < 0.05]. Exposure to high levels of DDE was associated with significant higher risk of breast cancer [Odd ratio adjusted for age and BMI] was 6.8 increased to 8.8 when estrogen receptor status entered into the model. In conclusion: The present work support but not prove the hypothesis that exposure to 2,2-bis [p-chlorophenyl] 1,1,1, trichloroethane [DDT] increases the risk of breast cancer among Egyptian females