Voice changes after thyroidectomy: role of external laryngeal nerve

To evaluate a technique to protect the external laryngeal nerve during thyroidectomy.Randomized controlled trial. Patients randomized into group A or B using closed envelops method. Alexandria university hospital is a teaching hospital. It is the referral center serving seven million people. Forty four consecutive patients admitted to Alexandria university hospital for thyroidectomy. Fourpatients had voice abnormalities on preoperative voice analysis. They were excluded. All patients underwent thyroidectomy. Group A had conventional mass ligature of the superior poleof thyroid gland while group B had individual ligation of the branches of the superior thyroid artery afteridentification of the external laryngeal nerve whenever possible. Abnormal readings on postoperative voice analysis and abnormal electromyogram of thecricothyroid muscles. Observers performing voice analysis tests were blinded as regards patient group. Postoperativeelectromyography of the cricothyroid revealed signs of nerve injury in five patients of group A but none in groupB. Multi-dimensional voice program, fundamental frequency range, fundamental frequency and maximum pressurelevel all showed significant postoperative change in group A but not of those in group B [level of confidence95%].Identification of external laryngeal nerve and/or ligation of the terminal branches of the superiorthyroid vessels seems to help prevent external laryngeal nerve injury

Correlation of estrogen and progesterone receptors with Histopathologic features in human breast cancer

Some of the pathological features of mammary carcinoma, considered to be of possible prognostic significance, were compared with hormone receptor status of the primary tumor. No significant correlation was found in relation to tumor size, tumor type, or degree of lymphocytic infiltration. On the other h and, grade II tumors were more frequently receptor positive, with higher receptor concentration, than the poorly differentiated grade III tumors [P <0.05]. Node-negative patients exhibited more frequently receptor positive tumors and higher nuclear estrogen receptor concentration than those with axillary lymph node metastases [P <0.05]. Moreover, with increasing amounts of elastosis, with absent or minimal tumor necrosis, there was a significant increase in receptor positive tumors [P <0.05]. Hormone receptor analysis is therefore most valuable to the clinician, as a prognostic factor, when considered with other factors including pathology

use of Latissimus dorsi myocutaneous flap in the treatment of axillary hidradenitis suppurativa

Hidradenitis suppurativa is a troublesome disease, refractory to conservative treatment and need complete excision of the axillary skin leaving a big raw area which needs reconstruction. Latissimus dorsi myocutaneous flap was used to reconstruct the axillary defect after total excision of the lesion in 7 patients [4 cases were bilateral], with satisfactory results in the 11 flaps

study of the results of sapheno spermatic anastomosis in the treatment of primary varicocele

Vascular drainage of the pampiniform plexus into the great saphenous vein was done in 15 male patients with varicocele. Most patients with varicocele present during the third decade of life. 14 patients presented with left sided varicocele while only one patient presented with right side varicocele. Varicocele is a common cause of male infertility and associated with abnormal semen quality in most cases. The vascular anastomosis used was end to side in majority, 2/3 of the cases and side to side in 1/3 of cases. Cremasteric venous affection was apparent in 3/5 of cases either pure or combined with the spermatic venous plexus. Shunt occlusion occurred in 3 cases which was the cause of recurrence. The shunt operation improves semen parameter with an excellent result with motility and count