Interval De-Bulking surgery in advanced stage ovarian cancer

Primary de-hulking surgery, a crucial step in the management of epithelial ovarian cancer, is not always possible in patients with advanced stage disease [stage Ill to IV]. In some circumstances, surgery may have been attempted but generally does not yield good results with residual tumor masses> 1-2 cm [so called suboptimal therapy]. Induction or neo-adjuvant chemotherapy followed by interval dehulking surgery [IDS] may have an alternative role in this setting. To study the results of interval de-bulking surgery [IDS] in patients treated for 'unresectable' advanced stage ovarian cancer compared with primary dc-hulking surgery [PDS] followed by chemotherapy. Our study includes a group of 20 patients who underwent IDS and were matched to a control group of 20 patients treated with PDS. Optimal cytoreductive surgery was achieved in 18 patients [90%]. The rates of post-operative morbidity, blood transfusion andmedian length of hospitalization were significantly reduced in the study [IDS] group, but survival did not diffec n both groups. Interval de-bulkrng surgery [IDS] in patients with advanced stage ovarian cancer gives the same survival advantage as primary de-bulking surgery [PDS], but it is better tolerated, and with better quality of life

Breast conserving-surgery after neoadjuvant chemotherapy for locally advanced breast cancer

Tumor down-staging by preoperative neoadjuvant chemotherapy in patients with locally advanced breast tumors allows breast conservation in women who were previously candidates for mastectomy. However, lumpectorny success in such cases cannot be fully achieved. The aim of this study was to create a quantitative tool for preoperative evaluation of the success of breast conservation in such patients. The study population included 57 consecutive patients with stage II and III breast cancer who were designated for lumpectomy. All patients received neoadjuvant therapy. Breast-conserving surgery was offered in accordance with clinical and esthetic criteria. Demographic details and clinical, imaging, and pathologic information were collected from medical files. Three factors were found to be the main predictors for successful breast conservation: absence of diffuse micro-calcifications as seen in the pretreatment mammogram, a post-chemotherapy tumor size of<25 mm and the existence of a circumscribed lesion on mammography. Breast conservation after neoadjuvant chemotherapy is feasible in most patients with locally advanced breast cancer. For surgical planning, tumor characteristics and response to neoadjuvant chemotherapy should be taken into account. Improved breast-imaging modalities are necessary to improve detection of residual disease after neoadjuvant chemotherapy, especially when breast cancer is of lobular invasive histology. Margin assessment by intraoperative frozen-section analysis is helpful to avoid reoperation. To achieve an optimal result, an interdisciplinary surgical approach is important: The use of these criteria as a basis for decision on the type of surgery may decrease the performance of unnecessary procedures

Synthesis of thiaphosphetane, thiadiphosphetane and thiazadiphosphetidine derivatives from the reaction of phosphacumulenes, phosphallene and phosphinimine with Lawesson's reagent

The active phosphacumulene ylides namely, N-phenylimino-[2], 2-oxo- [4] or 2-thioxo-vinylidenetriphenylphosphorane [6] are nucleophilic reagents which can be considered as versatile synthons for the synthesis of new heterocycles. They react with Lawesson's reagent [1] to give the corresponding thiaphosphetane derivatives 3, 5 and 7 respectively, which constitute an important class of heterocyclic compounds with medicinal and biological importance. On the other hand, Lawesson's reagent [1] can be converted by reaction with the active heteroallylic phosphonium ylide, hexaphenylcarbodiphosphorane [8], into the thiadiphosphetane 9. When the phosphinimine 10 reacts with Lawesson's reagent [1], the thiazadiphosphetidine 11 was obtained

Factors influencing the success of family planning services in El Menia and Assuit governorates Egypt

Family planning is an added value to the health and weli-being of women, children, families, and communities and a key component of reproductive health services. The objectives of this study are to identify the cultural, social and environmental determinants associated with under utility of family planning services and assess women satisfaction towards the quality of family planning services. The study was carried out in two governorates El Menia and Assuit, in each governorate 10 primary health care units were selected, live of them have already got the golden star in quality of family planning service recently. The study was conducted during the period January 2004 to May 2004. The subjects of this study included; 300 women who attended the family planning services during the study period, 20 physicians, 20 nurses and 20 social workers [Raedat], who are working in the selected 20 primary health care units. The result revealed that there were no significant differences between the two groups as regards duration of marriage and the number of living children. The rate of illiteracy was around 54% in both groups. Considering the educational status of the husbands there was a significant difference between the two groups. 64% of physicians in PHCs with golden star used explanatory tools during discussion with clients compared to 43.3% in the second group. This difference was statistically significant [p<0.01]. The results pointed out that physicians were the first contact as mentioned by 20.7% of women in the first group compared to 10% in the second group this difference was statistically significant [p<0.05]. General examination was performed in 91.3% for women in the first group compared to 73.3% for women in the second group this difference was statistically significant [p<0.01]. The overall patient satisfaction rate was the same in both groups [87.8% per patient in the first group and 87.3% in the second group]. The study concluded from the results of interview and focus group discussions that reasons for distinguishing PHCs with golden stars relatively to those without golden stars may be attributed to many factors including the lower illiteracy rate of the husbands, the relatively lack of desire of the women to have more children in the next two years, the near distance of the PHCs to the houses, seeing the physicians on the first contact to the PHCs and using tools for explaining the contraceptive methods