Value of preoperative axillary ultrasonography as a useful guide to sentinel LN biopsy in clinically node negative with large sized breast carcinoma

Breast carcinoma is most'y diagnosed beyond stage I in Egyptian patients. Here, we evakiate the use of preoperative ultrasonography to predict axillary lymph nodes involvement. We speculate that preoperative ultrasonographic evaluation may be of paramount importance in the era of sentinel node biopsy. Consecutive 110 clinically node-negative breast carcinomas were ultrasonographically examined for axillary nodes using 10 MHz linear transducer The images were recorded for analysis. Descriptive statistics of morphologic features of the examined lymph node in relation to final pathology were performed. Mean age was 47.5 years. Axillary lymph nodes were pathologically invaded in 80 patients [72.7%] with an average infiltration of 4.2 nodes per axilla. Compared to pathologic find ings, gray sca'e ultrasonography was highly significant in differentiating malignant from benign tumors [p<0.001], Gray sca'e examination had a sensitivity for detecting nodal metastases of 85.0%, specificity of 63.3% and overall accuracy of 79.1%. Surgeon-performed axillary ultrasonography is a helpful adjunct to clinical examination to improve preoperative staging in clinically node negative breast cancer especially in larger-sized tumors. However if sonography is negative sentinel node biopsy should be done due to considerable percentage of false negative results

case of carotid artery secondary hemorrhage successfully managed by extra anatomic axillary-internal carotid bypass

Carotid artery rupture post oncologic Head and Neck surgery is relatively rare but potentially lethal complication. To the best of the author's knowledge, the management options are restricted to ligation and resection of the pathologic segment of the artery accepting with helplessness a potential of stroke and sometimes mortality secondary to interruption of the blood supply of the brain. A patient with recurrent tongue cancer post resection and radiofrequency ablation. Salivary leak and infection in the neck resulted in a "Blow out" of the bifurcation of the carotid artery. Bleeding was controlled by minimal digital pressure, awakening test during cross clamping of the internal carotid artery lead to neurologic deficit. An extra-anatomic bypass was constructed with the inflow from the axillary artery and the outflow at the internal carotid artery at the skull base above and separate from the infected area and the tunnel in the posterior triangle of neck away from infection. The patient suffered no neurologic deficit. The vascular exposure wounds healed uneventfully .The patient was sent to chemotherapy. Occlusion of the graft occurred silently and hence left well alone. We hope that this bypass, or perhaps any other better option, proves to offer a management option for this frustrating morbidity that carries the risk of adding a neurologic deficit to the misery of the advanced head and neck malignancy

Prevalence of HCV infection in immunocompromised children and adults: evaluation of a novel screening test

It has been recently hypothesized that the hepatitis C virus [HCV] might be involved in the pathogenesis of lymphoproliferative disorders [LPD], systemic lupus erythomatosus [SLE], nephrotic syndrome and renal failure [RF]. The aim of this study is to determine the prevalence of HCV infection among immunocompromised patients and a trial to assess the sensitivity of HCV core antigen [HCVcAg] testing as a screening method compared to PCR-RNA in these patients. The study included 75 patients with malignant lymphoproliferative disease [LPD] under long term chemotherapy including immunosuppressive therapy [30 children and 45 adults] [group II], 46 chronic renal failure patients under hemodialysis [10 children and 36 adults] [group III], 20 systemic lupus erythematosus patients [SLE] under long term immunosuppressive therapy [10 children and 10 adults], group IV and 30 nephrotic syndrome patients under long term immunosuppressive therapy [20 children and 10 adults] [group V]. Thirty healthy subjects were included as controls [group I]. HCV detection by HCV-antibodies, HCVcAg and HCV PCR were done for all patients and controls. The results showed that there was significantly increased prevalence rates of HCV infection among immunocompromised patients. Positivity was 53.33% in LPD group, 47.83% in chronic renal failure group, 45% in SLE group and 33.33% in nephrotic syndrome group. Also our results revealed that, in studied patients [children and adults], HCVcAg in comparison to PCR had diagnostic sensitivity of 100%, specificity of 98.38%, accuracy of 99%, positive predictive value of 97.53% and negative predictive value of 100%. [1] immunocompromised patients have a higher prevalence rate of HCV infection. [2] increased prevalence were significantly higher in patients with non-Hodgkin's lymphoma [NHL], membranoproliferative glomerulonephritis [MPGN] and with the increased duration of hemodialysis in patients with chronic renal failure. [3] HCV infection may play an important role as a risk factor in both lymphoproliferative disorders, and clinical pattern of SLE. [4] HCVcAg maybe considered as an alternative to HCV-RNA assay in screening of HCV infection

Squamous cell carcinoma of the retromolar trigone; surgical treatment and reconstruction by the pedicled buccal fat pad flap

Objectives: Retromolar trigone carcinoma is uncommon but notorious for poor prognosis. We reviewed our experience with primary surgery followed by postoperative radiation therapy or radiochemotherapy to determine the impact of our treatment protocol on the patients' outcome

Patients and Methods: Between May 2001 and April 2005. 23 patients with RMT squamous cell carcinoma were treated in Surgical Oncology Department, Mansoura University Hospitals, Egypt. Surgical excision of the primary tumor and ipsilateral neck dissection was performed in all patients. Reconstruction was accomplished by the pedicled buccal fat pad flap [12 cases] or temporoparietal fascial flap [11 patients]. Patients were followed up for 4-48 months [mean 29 months]. There were 3 patients stage I, 11 stage II, 7 stage III, and 2 stage IV

Results: Posterior marginal mandibulectomy was performed in 11 cases and segmental madibulectomy in 4 cases. Maxillectomy was done in 8 cases. Pathologic reports confirmed mandibular bone invasion in 8 cases [34.7%] and maxillary bone invasion in 7 cases [30.4%]. Metastatic disease was found in 60.9% of ipsilateral neck nodes. Occult metastasis was demonstrated in 38.5% of clinically NO necks. The 3- year locoregional control rate was 73.9% and the overall 3-year survival rate was 69.5%

Conclusion: Squamous cell carcinomas of RMT are aggressive tumors. Posterior marginal mandibulectomy instead of routine mandibular resections and reconstruction by the pedicled buccal fat pad are two steps that made surgical treatment easier without compromise of the oncologic safety