Conserving surgery of early breast carcinoma

Conservation surgery of the breast implies the resection of minimal volumes of diseased breast tissue to achieve control rates equivalent to those accomplished by mastectomy, it has the goal of preservation of cosmoses and function. This limited resection is followed by axillary lymph nodes clearance followed by radiation and systemic therapy in breast cancer stage 1 and II. This study included 50 female patients having carcinoma of the breast as proved by lump biopsy true cut needle or excisional biopsy, these patients were selected from all the cases of cancer breast who attended the outpatient clinic of EL-Minia University hospital and National Cancer Institute in the period from January 1998 till march 2001.The purpose of this study is to evaluate the efficacy of breast conservation surgery plus radiotherapy or radiochemotherapy for early stage breast cancer patients to determine mortality and recurrence rates and to evaluate prognostic factors for these outcomes. Locoregional recurrence was detected in 3 patients out of 50 [6 percent], distant metastases was detected in one patient to the liver after 18 months [2 percent]. As regards the overall survival 2 patients out of 50 [4 percent] died because of; one due to distant metastases to the liver and the other due to heart failure. Breast conservation therapy could be a suitable option for the Egyptian woman with early breast cancer of stage I and II and from the previous results and owing to the satisfactory documented efficacy of radiation and chemotherapy to prevent or at least delay local recurrence and the fact that 95 percent of local recurrences in the breast are salvageable with no effect on survival, are encouraging factors although a longer follow up and a large number of patients are required for more accurate results, also a regular close follow up is recommended to detect any late relapse especially in the presence of high risk factors for local recurrence

Primary adenocarcinoma of third and fourth portions of the duodenum segmental resection vs pancreaticoduodenectomy

The author report four cases of distal duodenal adenocarcinoma, a rare malignant disease with, a poor 5 year survival. The behaviour of these particular tumors has not been addressed in detail in the literature. To evaluate this issue, 4 cases of distal duodenal adnocarcinoma were encountered over a period of three years. Two of them underwent segmental resection of the duodenum and the other two underwent pancreaticoduodonectomy. No peri-operative death occurred in the two groups. One of the two patients who underwent cephalic pancreaticoduodonectomy died after 6 weeks of surgery of pancreatic fistula and the other patient died of metastatic disease. The two patients who underwent segmental resection are alive without evidence of the disease. The survival of patients with adenocarcinomna of the distal duodenum is surprisingly good and segmental resection is the procedure of choice

Staged amputation in diabetic infective gangrene of lower extremity

Primary wound closure with reduced rate of infection could be assured by the staged amputation technique although it entails additional operations. To evaluate this issue 28 patients with diabetic wet gangrene of the foot where allocated to have either a one stage amputation [group A. 13 patients] or staged amputation [group B, 15 patients]. All patients had an intraoperative cultures from the foot and deep muscles to determine the presence of bacteria at the site of initial amputation. In group A definitive Syme, below or above-knee amputation where utilized while in group B we started with either Ray, transmetatarsal or open ankle amputation to be followed by definitive transmetatarsal closed Syme, or below knee amputation respectively. While six patients in group A had wound complications, none for group B patients had such complications in definitive amputation wounds. The staged amputations showed an excellent durability and none of the patients required a revision to a higher level. while in group A three patients required such a revision to a higher level. None of the group A patients had their ankle joint preserved while none of group B patients lost their knee joint. The staged amputation can be a very gratifying technique that could end up with a more conservative amputation even offered to elderly diabetic patients