Prognostic indicator of dermal backflow detected by SPECT-Lymphoscintigraphy in breast cancer patients

Lymph node in breast cancer is of clinical significance in determining the disease stage, appropriate therapy and predicting the outcome of patients. Lymphoscintigraphy is essential for preoperative Sentinel Lymph Node [SLN] identification in breast cancer; it provides the surgeon with a roadmap of lymphatic drainage and the location of SLN. SLN are normally easily detected by lymphoscintigraphy most of the time.We report a case of right breast cancer for sentinel node mapping at mastectomy. Planar lymphoscintigraphy images showed tracer dispersion around the injection site with nonvisualization of SLN while SPECT/CT delineated the SLN and identified the initial breast tracer dispersion to be localized dermal activity, indicating dermal lymphatic backflow

Esophageal transit time scintigraphy in the assessment of the esophagus motility

The esophagus is 25 cm long muscular tube, which acts as a passage of food from the mouth to the stomach

Many diseases affect the esophagus, which may affect its morphology and function. Hence, several diagnostic modalities are used to assess the esophagus abnormalities, such as endoscopy, manometry, barium contrast studies and gastroesophageal scintigraphy studies

Gastroesophageal scintigraphy is a simple, non-invasive and well-tolerated method used to assess mainly the upper GI tract motility

We present a case of gastroesophageal adenocarcinoma where an esophageal scintigraphy was performed to assess the esophageal motility

effects of L-thyroxin replacement therapy on bone mineral and body composition in hypothyroid children

This study aimed to detect the effects of L-T4 treatment on bone mineral and body composition in hypothyroid children, Thirty five hypothyroid patients [10 males and 25 females], mean age was 11.57 +/- 5.06 yr. Twenty six children of matched age and sex served as controls, Dual energy X-ray absorptiometry [DXA] was done to detect the bone mineral density [BMD], bone mineral content [BMC] and Z score at lumbar and femur neck regions. Body composition was also studied by DXA. Serum calcium, phosphorus, osteocalcin, osteoprotegrin and urinary deoxypyridinoline were measured. No significant differences were detected in lumbar Z score [-0.19 +/- 0.65] and femur Z score [-0.16 +/- 0.57] compared to controls [-0.33 +/- 0.75] and [-0.21 +/- 0.53] respectively. BMD and BMC are not significantly different from controls. No significant difference was detected between cases and controls as regard body composition. Positive correlation was detected between BMD and age [r 0.857, P<0.01], and with the period of treatment [r=0.766, P<0.01]. Positive correlation was existed between BMD and total body fat [r=0.693, P<0.01], and with abdominal fat [r=0.667, P<0.01]. L-T4 treatment in hypothyroid children doesn't alter bone metabolism and body composition

effects of hypothermic versus normothermic cardiopulmonary bypass on hepatic blood flow

To explore Trans-esophageal Echo [TEE] as a monitoring device for hepatic blood flow during cardiac1 surgery and to correlate between the hepatic venous blood flow measurements and the liver function tests during normothermic and hypothermic cardiopulmonary bypass. Forty patients scheduled for cardiac surgery were randomly divided into 2 groups: group 1 [Gl] undergoing normothermic cardiopulmonary bypass [CPB] and group 2 [G2] undergoing hypothermic CPB. Serum AST, ALT, billirubin and hyalurinic acid levels were measured before, during and 6 hours after the bypass. During these same phases, TEE was used to measure both cardiac index [Cl] and middle hepatic vein blood flow. During CPB there were no significant differences in demographic data, AST, ALT or billirubin levels between the 2 groups. There was, however, a significant increase [P<0.001], in both groups, in serum hyalurinic acid levels during CBP in relation to the baseline and in Cl 6 hours after bypass in relation to pre and intra bypass phases. The middle hepatic venous blood flow was significantly higher amongst Gl patients six hours following the procedure in relation to the pre and intra bypass phases, whereas G2 patients showed a significant decrease in middle hepatic venous flow during the bypass followed by a significant increase 6 hours after the procedure in relation to the baseline. Hepatic venous blood flow is reduced significantly more during hypothermic bypass than during normothermic bypass. This may cause disturbances in sinusoidal endothelial cell [SEC] function. However, this change may be well tolerated by the healthy liver. Multiplan TEE may be used to monitor hepatic blood flow during CPB

Laparoscopic nissen fundoplication for gastroesophageal reflux disease

Laparoscopic antireflux surgery is the standard treatment for gastroesophageal reflux disease [GERD] in western countries. This study is to examine the effectiveness and our results with laparoscopic antireflux surgery. Between July 2001 and November 2004, 23 patients were included in this study to undergo laparoscopic Nissen fundoplication [LNF]. We examined the following 3 parameters pre- and postopertively: patients symptoms, barium swallow and endoscopic findings in symptomatic patients. Also the operation time, intraoperative complications and postoperative complications were evaluated. Laparoscopic NF was successfully completed in 20 patients with 3 patients requiring conversion to open. The mean operative time was 175 minutes and the mean hospital stay was 2.4 days. There were 4 [17%] intraoperative complications 3 of which required conversion to open. There were 8 postoperative complications in 6 patients [30%]. The patients were followed for 36 months with a mean of 15 months. Seventeen patient 85% had substantial improvement of their symptoms and needed no proton pump inhibitors drugs. Three patients 15% require occasional medications and 3 patients did not improve. Laparoscopic Nissen fundoplication is an effective and durable treatment for gastresophageal reflux disease

Safety of repair of large parastomal hernias using a prosthetic mesh in the sub lay position

Background: The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias

Methods: Thirty-two patients [20 males and 12 females] with a mean age of 56 years [range 52-69 years] with paracolostomy hernias in the period from September 1997 to September 2004 were included in this study. All the patients are assessed preoperatively and treated surgically by midline approach and a prosthetic mesh in the sublay position in a plane between the peritoneum and transversus abdominal muscle. The mean follow up of our patients was 4.5 years [range 6months-6 years]

Results: The mean duration of the operation was 150 minutes. The mean size of the mesh used was 15 x 30 cm. Their were no major intra operative complications. Four major postoperative complications developed. Small adhesive bowel obstruction, two patients developed severe wound infection and one patient developed pulmonary embolism the mean follow up period was 4.5 years [range 6 months - 6 years]. The overall recurrence rate verified by clinical and ultra sonographic examination is nearly 10%. Moreover two patients developed incisional hernia who had no problem with their old scar

Conclusion: it is our opinion that the use of a polypropylene mesh extraperitoneally in the sublay position for treatment of large paracolostomy hernias avoids the high recurrence rate seen with local repair or relocation of the stoma, avoids the complications seen with the intraperitoneal placement of the mesh and furthermore allows the possibility of repair of other fascial defects whether related to the mid line or not with safety, with no major intra operative complications, with no major wound Infection that warrants mesh removal and accepted low recurrence rates

Pulmonary hypertension in patients with chronic renal failure: the role of parathormone and pulmonary calcification

Cardiovascular complications especially coronary artery disease are considered to be a major cause of mortality in patients with chronic renal failure [CRF] on regular hemodialysis. Abnormal technetium-m99 methylene diphosphonate [99mTc-MDP] lung uptake was reported in 61% of patients with CRF on regular hemodialysis in the presence of normal chest radiographs indicating the presence of pulmonary calcifications. Pulmonary calcification was reported to be a possible cause for the development of pulmonary hypertension [PH] in patients with CRF on regular hemodialysis. 51 patients [28 males and 23 females] who had end stage renal disease and were on regular hemodialysis. Those patients were divided according to the presence of pulmonary hypertension by echo-Doppler study into: Group 1: 15 patients [5 males and 10 females] with a mean age of 43.5 +/- 9.8 years who had pulmonary hypertension and subjected to 99m Tc-MDP. Group II: 15 patients [10 males and 5 females] with a mean age of 40.3 +/- 10.9 years without pulmonary hypertension. Also, those patients were subjected to 99m Tc-MD and were considered as a control group. Group III: 21 patients [15 males 6 females] with a mean age of 3g9 +/- 11.0 years without pulmonary hypertension but were not subjected to 99m Tc-MDP scan. All patients were subjected to full clinical evaluation, chest X ray and well standardized 12 leads ECO. Laboratory investigations included BUN, creatinine, calcium [Ca], phosphorus [Ph], alkaline phosphatase [ALK], hemoglobin [Rb] ,complete lipid profile, and intact molecule parathormone hormone [PTH]. Echo-Doppler study was performed mainly for estimation of the pulmonary artery systolic pressure [PASP]. Only patients in groups I and IT were subjected to 99m techn MDP scan. Twenty patients from 30 patients [66.6%] had positive 99m Tc-MDP lung uptake. There was no significant difference between patients with positive or negative 99m Tc-MDP lung uptake regarding the duration of dialysis, the serum level of Ca, Ph, ALK, Rb, cholesterol, triglyceride and PTH .15 patients [29.47%] had pulmonary hypertension [The mean value of PASP was 45.2 +/- 6.7 Hg]. There was no significant difference regarding the mean value of PASP in patients with positive or negative 99m Tc-MDP lung uptake .The mean value of PASP in patients with positive 99m Tc-MDP was 33.9 +/- 11.8 mmHg vs 36.5 +/- 11.8 mmHg in patients with negative 99m Tc-MDP lung uptake [p=0.3]. This study demonstrated that 66.6% of patients with CRF and on regular hemodialysis had pulmonary calcifications. There was no significant difference between patients with or without pulmonary calcifications regarding serum Ca, Ph, ALK, Hb, cholesterol, triglyceride and PTH. There was no correlation between pulmonary calcifications and pulmonary hypertension. The mechanism of pulmonary hypertension is uncertain and other factors rather than pulmonary calcifications and hyperparathyroidism should be considered

Pancreatic tumor resectability: spiral CT, surgical and pathological assessment

Resectability of pancreatic tumors can be difficult to assess. The initial investigations [abdominal ultrasonography and; conventional C.T.scans] may fail to assess the resectability of pancreatic tumors in up to 30% of cases. The aim of this retrospective study was to evaluate the accuracy of spiral computed tomography [C.T.] in assessing the resectability of small pancreatic ductal adenocarcinoma and; to correlate the C.T findings with histopathologic and surgical findings. Spiral C.T. scans were obtained in fifteen patients who underwent surgery for potentially resectable pancreatic adenocarcinoma. C.T. findings were correlated with surgically assessed extent of tumor and pathological findings. Twelve patients had resection of the tumor with pancreaticoduodenectomy operation Three patients proved during operation inoperable due to the presence of small [< 1 cm] hepatic metastatic deposits [2 patients] and peritoneal and omental seedling in one patient. We concluded that thin-section helical CT is a useful application in the diagnostic imaging of pancreatic tumor and in determining tumor resectability