Comparative study between preoperative and operative staging in endometrial cancer patients

Background: endometrial cancer is the most common gynecological cancer in developed countries and is primarily treated surgically. This study aimed to compare between preoperative findings by Vaginal U/S and MRI with postoperative pathological data regarding Endometrial thickening, Myometrial Invasion Depth and Lymph Node Metastasis

Methods: It is a prospective cohort study of 20 consecutive patients with endometrial cancer, in the Department of General Surgery at Al-Azhar University Hospitals. To assess the depth of myometrial invasion, we performed a pelvic MR. Subsequently; myometrial invasion was detected with MRI by the recognition of the disruption, whilst transvaginal sonography was performed by experienced sonographers who used a 5.0- to 7.5-MHz curvilinear-array transducer probe

Results: Our results showed that the employment of magnetic resonance imaging to detect the myocardial invasion established that the sensitivity, specificity, positive and negative predicted values of MRI was 92.3%, 76.5%, 60.0% and 96.3% subsets, respectively. US was accurate in 12 of 20 cases and overestimated the depth of invasion in 2 cases. In comparison with histopathological findings; the results of MRI images were accurate in 13 patients whilst TVUS images were accurate in 12 patients [60%] with 3 patients underestimated and two patients over estimated

Conclusion: MRI and TVUS detect myocardial invasion with accurate results that help the surgeon to make the appropriate decision. Brings to light that, MRI and TVUS perform best in the pretreatment evaluation of endometrial cancer and differentiating deep from superficial myometrial invasion

Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective: To evaluate vascular endothelial growth factor (VEGF) levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and its relation to treatment response. Methods: A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically. Twenty patients were suitable to be treated by TACE, while other 20 patients were treated with PEI. Serum VEGF levels were measured before and 1 month after each procedure by ELISA. Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound. Results: There was no significant difference between TACE and PEI groups with regard to age, sex, tumor size, response to local therapy, or VEGF and alpha-fetoprotein before and after therapy. VEGF levels after TACE were significantly higher than before TACE [(298.1 ± 123.6) pg/mL vs. (205.8 ± 307.3) pg/mL; P = 0.001]. Also, VEGF levels were significantly higher after PEI than before PEI [(333.8 ± 365.6) pg/mL vs. (245.3 ± 301.8) pg/mL; P = 0.000]. Non-responders of both groups had significantly high VEGF levels than responder's, both before [(985.0 ± 113.2) pg/mL vs. (117.1 ± 75.3) pg/mL; P < 0.001] and after therapy [(1. 330.6 ± 495.7) pg/mL vs. (171.0 ± 94.7) pg/mL; P = 0.000)]. Conclusions: Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients. Higher levels of VEGF before and after therapy were found in non-responders, suggesting that VEGF is a useful marker in predicting treatment response.

Postoperative wound infections after minor surgery: incidence and some associated risk factors

To determine the incidence of and some associated risk factors for surgical wound infections after minor surgery. Prospective cohort study included patients presenting for minor surgery at surgical clinics and offices, surgery departments at Al-Hussein and Bab El-Shaarria hospitals, Al-Azhar University, Cairo, Egypt. The study included 428 eligible patients. Relevant data were collected from participated patients using a pre-designed questionnaire. The included patients were assessed for post-operative wound infection. Overall incidence of postoperative wound infection is calculated with its 95% confidence interval. Multivariate logistic regression analyses were done to calculate the risk of postoperative wound infection with the various studied factors. The overall incidence of wound infection was occurred in 37 of the studied 428 patients [8.6%; 95% CI, 3.5%-13.8%]. Excisions from thigh [Relative risk [RR] = 2.2; 95% confidence interval [CI] = 1.3-3.6], excision of lipoma [RR= 2.2; 95% CI= 1.3-3.4] or biopsy of squamous cell carcinoma [1.8; 95% CI= 1.2-2.6], and diabetes [RR= 1.8; 95% 1.4-2.2] were independent risk factors for wound infection following minor surgery carried out in surgical clinics and offices. No risk difference was observed regarding the method of wound management. Our results indicate the high-risk groups for wound infection following minor surgery, such as people with diabetes and those undergoing excision of a non-melanocytic skin cancer or excision from a lower limb. Recognition of these groups could encourage more judicial use of prophylactic antibiotics and use of other interventions, including operating in the theatre, aimed at reducing infection rates

Clinico-pathological study of intra-mammary lymph nodes in breast cancer

Axillary lymph node status considered the most significant factor for breast cancer outcome and treatment decision are based on the presence or absence of nodal disease. Intramammary lymph nodes [IMLNs] can be a site of regional spread. Is this a marker for more aggressive disease. This prospective study has been completed on 30 patients with [IMLNS] of breast cancer at the surgical oncology unit Al-Azhar University from February 2000 to February 2008. Their age ranged from 27 to 90 years with an average of 55 years in positive intramammary lymph nodes and their age ranged from 38 to 92 years with an average of 62 years in negative intramammary lymph node. Intramammary lymph nodes were identified in 30 breast cancer patients, with metastatic spread in 10 patients and benign IMLNs described in 20 patients. Patients without intramammary lymph nodes were excluded in this study. Positive intramammary lymph nodes were associated with more aggressive disease, including higher rates of invasive versus non invasive cancer [10% ductal carcinoma - in - situ [DCIS] with positive IMLNs versus 25% with negative IMLNs]. Lymphovascular invasion [60% vs 10%] and a higher rate of axillary lymph node involvement [75% vs. Patient with positive IMLNs were also more likely to undergo mastectomy [80% vs. 55%]. IMLNs metastasis is a marker for disease severity, recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLNs is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection-preoperative mammography and lymphoscientigraphy help identified these extra-axillary metastases

Diagnostic significance of trans-vaginal ultrasonography for pre-operative evaluation of stress urinary incontinence in females

The Aim of this work is to demonstrate the dynamic relationships, of the urinary bladder, urethra, urethrovesical junction, and symphysis pubis during stress and to assess the reproducibility of trans-vaginal ultrasonography [TVUS] for preoperative evaluation of stress urinary incontinence in females, together with evaluation of its diagnostic value compared to urodynamic findings. This study was conducted on 97 female patients including 71 patients with clinically diagnosed stress urinary incontinence [SUI] as group [A] for comparison with 26 patients with no urological complaints as control group [B]. All patients underwent complete history and physical examination, laboratory investigations, urodynamic evaluation especially valsalva leak point pressure [VLPP], and trans-vaginal ultrasonography [TVUS]. Patients of group [A] were further subdivided into two sub groups [GI and GII] according to the results of VLPP. GI and GII included 47 and 24 patients with VLPP above and below 60 cm H[2O] respectively. Statistical analysis of seven transvaginal ultrasonic anatomical parameters that include measurement of bladder symphysis distance [BS], rotational angle [RA], bladder neck mobility [BNM], bladder neck vertical descend [BNVD], BN funneling [BNF], BN position [BNP], and posterior urethrovesical angle [PUVA], was done in both study groups at rest and during strain together with correlation of these 7 parameters and urodynamic VLPP findings. A highly statistically significant difference was found in all the seven parameters measured by TVUS in group [A] when compared to control group B and in each patient of the two groups during both phases at rest and during strain [p <0.001]. There is a significant high positive correlation between TVUS parameters and VLPP findings. The sensitivity and specificity of TVUS in detecting SUI were 92.9% and 92.31% respectively when compared to 83.09% and 84.61% of urodynamics. Positive and negative predictive values of TVUS are 97.1%, and 82.7%, respectively. The over all accuracy of TVUS was 92.8% compared to 83.50% of urodynamics. TVUS is a simple minimally invasive endosonographic technique that provides opportunity to combine anatomic and functional views of the urinal bladder and urethra compared to other radiological method. The patients avoiding catheterization hazards, exposures to radiation, and the sophistication of multi-channel urodynamic evaluation, readily accept it. TVUS not only can be considered as a significant reliable tool for diagnosing and classifying [SUI] but also of prognostic value in predicting better successful surgical outcomes with proper choice of the surgery type according to each type of SUI. We strongly believe that TVUS is a technique that deserves to be supported for further applications