Quality of life after breast carcinoma surgery in women with operable breast cancer a comparison of three surgical procedures

Because breast conservative surgery [BCS], mastectomy alone, mastectomy with reconstruction is equally effective for treatment of early stage of breast carcinoma. Now choice of women focus on quality of life, psychosocial results and individual response following breast carcinoma surgery. The involved women in this study aged between 30:85 years [median 57.5] with newly diagnosed breast carcinoma who underwent BCS [n=25]. Mastectomy alone [n=15], Mastectomy with reconstruction [n=10]. The quality of life was assessed after diagnosis [baseline] and at 1,3,6,12,18 and 24 months after baseline by using mischel uncertainly in illness scale [MUIS], profile for mood states [POTIS] and functional assessment of cancer therapy for breast cancer [FACT-B] Women who underwent mastectomy with reconstruction had greater mood disturbance and poorer well being than women who had mastectomy alone, women who underwent BCS had more mood disturbances than women who had mastectomy alone. As regarding well being BCS and mastectomy did not differ significantly. With regard quality of life is not better in women with BCS or mastectomy with reconstruction than in women with mastectomy alone. Mastectomy with reconstruction is associated with greater mood disturbance and poorer well being

Hand disability related variables in an Egyptian female RA patients sample

The aim of the present work is to study hand affection in Rheumatoid Arthritis [RA] in an Egyptian female sample to establish a map of lesions underlying the rheumatoid hand dysfunction using clinical, laboratory and imaging techniques. This study comprised 100 adult female RA patients. They were clinically assessed for pain using visual analogue scale [VAS], joint tenderness using Ritchie Articular Index, assessment of grip strength, assessment of functional ability using Health Assessment Questionnaire [HAQ], and assessment of hand function using Sequential Occupational Dexterity Assessment score [SODA] patients were subjected to the following laboratory investigations: full blood picture, ESR, C-reactive protein concentration and rheumatoid factor. Radiological investigations included plain X-ray examination and Magnetic resonance imaging. SODA score for hand dexterity had highly significant correlations with disease duration, morning stiffness, ESR, Ritchie index, VAS, HAQ, Duke index disease activity, and hand grip [p<0.001 for all]. It was significantly higher in patients with muscle wasting, deformity and tenosynovitis of the hand, moreover, it showed highly significant correlations with X-ray score and MRI scores. SODA score for hand dexterity had highly significant correlations with clinical findings. SODA score is valuable for evaluation of hand disability and disclosure of the underlying clinical, laboratory and imaging variables in RA female patients

Prevalence of Helicobacter pylori DNA in recurrent aphthous ulcerations is predominantly. Limited to mucosa-associated lymphoid tissues of the pharynx

To determine the presence of H. pylori and, if detected, its potential prevalence in the etiology of recurrent aphthous ulcers [RAS], confined to mucosa-associated lymphoid tissues [MALTs] of the pharynx. A prospective, controlled clinical trial. The study population comprised 146 patients with recurrent multiple aphous ulcers of the oral cavity and pharynx, and 20 normal subjects, that were used as controls. Patients were assigned to [Group A, n=58] in whom the ulcers were strictly limited to the lymphoid tissues, or [Group B, n=88] in whom the ulcers were randomly distributed in the oral cavity and pharynx. H. pylori DNA was extracted from 3-mm-diameter tissue samples and PCR amplifications were performed for the 16S ribosomal RNA [rRNA] gene. In examining all the samples; Group A, 39 [68%] patients were shown to be positive for H. pylori DNA, while in Group B, 9 [10%] patients were shown to be positive for H. pylori DNA, but it was not detected in any of the 20 control samples [Chi test, P<0.001]. Our results support a possible etiological role for H. pylori in recurrent aphthous ulcerations with a characteristic distribution and affinity to mucosa-associated lymphoid tissues of the pharynx

Complications associated with the technique of pedicle screw fixation in thoracic and lumbar spine in 100 consecutive cases

This was a prospective study done in the emergency centre of Mansoura university hospital. Ben ha university hospital and Zagazig university hospital where we reviewed the complications associated with the technique of pedicle screw fixation in 100 patients with spinal instabilities for different reasons where 520 pedicle screws were inserted by five different surgeons but with the same technique. The most common intraoperative problem was unrecognized screw misplacement [8.5% of the total screws inserted]. Fracturing of the pedicle and iatrogenic cerebrospinal fluid leak occurred in 3 patients [3%]. Neurological deficits occurred in 7% of the patients and in 4% reoperations were required. Infection occurred in 8 patients [8%] and required reoperations in 5%. Screw breakage occurred in 1.3% of the total screws inserted with no significant disabilities recorded. A careful analysis of our 100 patients shows that pedicle screw placement may be associated with significant intraoperative and postoperative complications. The intraoperative complications and inadequacies can be kept to a minimum, if attention is paid to careful planning, knowledge of anatomy and careful attention to the technique and details. Also familiarity with the technique and experience results in further diminution of morbidity as shown in our study of the first and second 50 consecutive patients

Total knee arthroplasty with unresurfaced patella

In this prospective study, we evaluated the outcome of total knee replacement without resurfacing of the patella in 97 cases. There were 55 males and 42 females. The age at the time of surgery ranged from 65 to 81 years. All patients underwent cementless total knee replacement [Profix, Smith and Nephew]. The patients were assessed, at intervals of 6 weeks, 6 months and 18 months postoperatively. The mean follow up of the last visit was 15.3 months. We used the knee society score and the patellar score for assessment. According to the final, knee society score results, the outcome was excellent in 35 cases [36.1%], good in 42 cases [43.3%], fair in 12 cases [12.4%] and poor in 8 cases [8.2%]. The patellar score was satisfactory [excellent and good] in 83 cases [85.6%] and poor in 13 cases [14.4%]. The results of total knee replacement with the implant design used in this study and routine patellar retention provided satisfactory mid-term outcome and a high degree of patient satisfaction

Three weeks external fixation followed by hip spica cast for femoral shaft fractures in older children and adolescents

There has been a recent resurgence of interest in operative stabilization of pediatric femoral shaft fractures in older juveniles and adolescents. External fixation has many advantages especially in polytraumatized patient and in open fractures. Some authors criticize external fixation if used till full union as it may cause nonunion, delayed union, and refracture after its removal. The aim of this study is to evaluate the results of three weeks external fixation for pediatric femoral shaft fractures [6-16 years] followed by hip spica till complete union. Twenty eight femoral shaft fractures in 25 patients were the material of this study. The mean age was 9 years [range 6 - 16 years], with 19 boys and 6 girls. Three patients had bilateral fractures and 3 fractures were open. Eight patients were polytraumatised, and most of fractures were diaphyseal [25 cases]. On admission immediate skin traction was applied over Thomas splint and the patients were referred for radiological examination. All the patients were listed for external fixation next morning except in three cases with open fractures where immediate external fixation was done after thorough debridment and irrigation. The orthopaedic table with traction piece was used in all patients after general anesthesia. A closed reduction or assisted closed reduction using Joy-Stick technique under image intensifier was done. A uniplanar double bar AO tubuIar external fixator with at least two pins proximal and distal to the fracture avoiding the physes was used. Post operative meticulous pin-site care, immediate active hip and knee range of motion were advised, followed by assisted crutch weight-bearing as tolerated. The average length of hospital stay was 5.6 days [range 2-16 days]. Three weeks later a hip spica was applied after removal of the fixator, and radiographs were done every 21 days till complete union. The average time for union was 9 weeks [range 6-15 weeks], with an average follow up period of 18 months [range 3-36 months]. The following complications were reported: pin-tract infection [4 cases], angulation >10 degrees in AP view [1 case] angulation >10 degrees in lateral view [3 cases], genu varum [1 case], translation [4 cases], limb-length discrepancy [6 cases], partial loss of reduction [2 cases], and residual knee fiexion deformity about 5 degrees [1 case]. In conclusion applying external fixation for a short period just enough to get the fracture stabilized by soft tissue callus give the patient all its advantages with minimal complications. Also it shortened the period of hospital stay and the cost of treatment

use of different per-cutaneous pinning techniques in management of unstable distal radius fractures

Forty -five patients with unstable distal radius fractures [DRFs] were treated by different techniques of per-cutaneous pinning between 1997-2000. The mean age was 46.8 years. At follow-up, all patients were assessed subjectively, objectively and radiographically. Over all results at a mean follow-up of 26.3 months [range 8-34 months] were excellent and good in 71.12%. The radiological results of the treatment group were comparable to the radiological anatomy of the normal contralateral wrist with regards to volar tilt [average. 10.6 degrees]; ulnar tilt [average 18.5 degrees]; radial shift [average 16.9 mm] and radial height [average 11.6 mm]. The final radiologic scoring were excellent and good in 82.22%. A total complication rate of 29% was recorded. Restoration of the radial length, reduction of the volar tilt and restoration of articular congruity did prove critical for a final favorable outcome

Coloid cysts: endoscopic VS. microsurgical treatment

Twenty patients with colloid cysts of the third ventricle had operative procedures for excision in the period from October 1995 to October 2000 [5 years]. Ten cases had microneurosurgical excision [7 cases via transcallosal-transventricular approach and 3 cases via transcortical-transventricular approach]. The other ten [10] patients had transcortical endoscopic excision. There was 12 men and 8 women, and the age of patients ranged from 12-60 years [mean 38.5]. The most common clinical symptoms of both groups included headache [in all patients], diplopia, syncope, ataxia, vertigo, memory deficits and seizure. Papilloedema was present in the majority of cases [70%]. All survived patients had follow-up ranged from 6 months to 36 months [mean 22.5 months]. The results of this study revealed that endoscopic removal of colloid cyst is promising technique that saves the operative and recovery time and decreases the risks of complications

Traumatic posterior fossa extradural hematoma: observations on a series of 17 cases and a review of the literature

Seventeen patients with posterior fossa extradural hematoma were managed at Zagazig University Hospital between January 1995 and December 2000, accounted 2.9% of all cranial epidural hematomas. The mean age was 23.1 years, with 7 children and 10 adults. Impaired conscious level was noted in 14 patients [82.4%]. None of the patients had localizing cerebellar signs. Occipital soft tissue injury in 14 patients [82.4%]. Fall from height was the causative trauma in 7 patients [41.0%]. Delayed appearance of the hematoma was noted in only one patient [5.9%]. Occipital fissure fracture was found in 15 patients [88.2%], supratentorial extension in 9 patients [52.9%,], hydrocephalus in 6 patients [35.3%] and supratentorial associated injuries in 6 patients [35.3%]. Surgery was performed on 14 patients [82.4%]. Good recovery was noted in 12 patients [70.6%], severe disability in one patient [5.9%,] and death in 4 patients [23.5%]. Patients

Foramen magnum menningiomas: a report of 14 patients

This is a retrospective analysis of 14 patients with foramen magnum meningiomas over 12 years. Two types were encountered: craniospinal type [64.3%] and spinocranial type [35.7%]. The mean age was 51.8 years with 9 women. The clinical features were vague and bizard. Misdiagnosis and incorrect surgical intervention were common. Hemiparesis or quadriparesis were found in all patients, dysesthesias in 50%, C2 sensory hypoalgesia in 35.7% and cranial nerve dysfunction in 28.6%. MRl was the diagnostic procedure in all cases. Meningiomas were of large size in 81.4%. Partial transcondylar approach was used in 3 patients, retromastoid approach in 6 patients. Gross total tumor resection was possible in 43%, while operative complications occurred in 57%. On conclusion: the patients got benefit from surgery with good functional recovery in 50% without perioperative deaths [P < 0.005]