Phase II study on the use of intraoperative radiotherapy in early breast cancer

To report our early experience using the Intrabeam radiotherapy delivery system for intraoperative radiotherapy [IORT] in early breast cancer. This is a prospective phase 2 study carried out at the Department of Surgery and Radiology, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from December 2010 to November 2012. Females eligible for breast-conserving surgery with biopsy-proven invasive duct carcinoma, and with a mass of 3 cm, with lymphovascular invasion, multifocal lesion, extensive intraductal carcinoma, and positive nodes. Early and late toxicity were recorded using the Radiation Therapy Oncology Group [RTOG] criteria. Forty-five patients were included with a median age of 54 [range: 27-79 years]. Thirty-six cases [80%] had tumor <3 cm in diameter, and 36 [67%] have pathologically negative axillary lymph node metastases. None of the patients developed delayed wound healing, postoperative infection requiring intravenous antibiotic, or breast seroma requiring aspiration. Sixteen [36%] received EBRT after IORT. Twelve patients developed radiologically proved fat necrosis. The IORT for early stage breast cancer patients using the Intrabeam delivery system was easily implemented in our center with an acceptable toxicity profile and cosmetic outcome

Suspected acute appendicitis in female patients. Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia

To determine the negative appendectomy rate; utilization, accuracy of Alvarado scale, ultrasound [US], computed tomography [CT] in diagnosis of acute appendicitis. Hospital records of 124 female patients admitted for suspicious of acute appendicitis from January 2003 - January 2004 to the Emergency Department [ED] at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia were reviewed retrospectively. We reviewed the age of patients, clinical presentation, Alvarado scale, US, CT, histopathological diagnosis of appendicular specimen. A total of 124 female patients aged 6-64 years were presented to ED with right iliac fossa pain. Of the total, 103 patients have appendectomies [83.1%], 21 [16.9%] patients underwent conservative treatment. Prevalence of advanced appendicitis was 13.7% and negative appendectomy rate was 27.2%. Accuracy rate of appendicitis with Alvarado scale was 67.7%, US was 57.9%, CT was 66.7%. Postoperative complications were found in 2.4%. Positive correlation was found between advanced cases and Alvarado scale [r=0.338], and hospital stay duration [r=0.250, p<0.01]. Clinical findings and experience remain of major importance in appendicitis-diagnosis. When appendicitis appears with atypical presentations, it remains a clinical challenge. In such cases, laboratory and imaging investigation may be useful in establishing a correct diagnosis. Alvarado scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis especially for junior surgeons