safe radiotherapy in patients with implanted cardiac pacemaker

Radiotherapy to cancer patients having implanted cardiac pacemakers [ICPs] is challenging decision. The literature reported serious life threatening complications secondary to ICP malfunction. As the number of patients with ICPs requiring radiation therapy is on rise, it is recommended that cardiologist, physicist and radiation oncologist be aware of the potential risks to ICPs and their prevention. Most of radiotherapy centers do not have internal policy and procedures [IPPs] to handle cancer patients with ICP receiving radiation. This article reported three radiotherapy courses in two cancer patients with ICP treated at our center. The Pub med and cochrane database were searched for the potential hazards and effects of radiotherapy on patients having ICPs. The reviewed literature showed that modern multi-programmable pacemakers are very sensitive to radiation therapy in comparison old generation pacemakers. The radiation therapy candestroy ICP or at least can affect its function. There is no safe radiation threshold for ionizing radiation, however it is not contraindicated. Megavoltage radiation can be safely delivered to patients with cardiac pacemakers provided direct irradiation of pacemakers is avoided, adequate monitoring is required during and after irradiation and the dose to the pacemaker generator should be kept below 2 Gy. Close follow-up with cardiologists and a pacemaker clinic is essential. Radiotherapy departments should have their own protocols in place for cancer patients with ICPs

Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study

Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy [LC] feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy [OC] versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group [55 patients] and LC group [55 patients]. There was no operative mortatity. In LC group 4[7.33%] patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group [96.13+17.35m vs. 76.13+15.12] P<0.05, associated with significantly higher intraoperative bleeding in OC group [P<0.01], necessitatating blood transfusions to 7 [12.72%] patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group [6+1.74 days vs. 1.87+1.11 days] P<0.01 with low postoperative morbidity. LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that pf patients without cirrhosis. However, it offers lower morbidity, shorter operative time, early resume dieting with less need for blood transfusion and reducing hospital stay than OC.

Effect of helicobacter pylori eradication on ulcer healing and recurrence after simple closure of perforated duodenal ulcer

Helicobacter pylori [H.Pylori] plays a fundamental role in the causation of duodenal ulcer. This study was conducted to elucidate the prevalence of H.Pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H.Pylori prevent ulcer recurrence following simple repair of the perforation. Eighty three patients admitted with perforated duodenal ulcer, only seventy seven patients treated with simple closure included in our study. Sixty five patients [84.4%] who had H.Pylori infection were randomly divided into triple therapy group [34 patients] and alone group [31patients]. Follow up endoscopy was performed at 8 w, 16 w and 1 year to show the ulcer healing and determine H.Pylori. The eradication of H.Pylori was significantly higher in triple therapy group than omeprazole alone group [at 8 weeks 91.2% vs. 22.6% respectively]. Initial healing of ulcer was significantly better in eradication group and after one year the difference in ulcer recurrence between the two groups was statistically significant [2[6.1%] in eradication group vs. 8 [29.6%] in omeprazole alone group P=0.001]. H.Pylori was present at a high ratio in patients with duodenal ulcer perforation. Eradication of H.Pylori after simple closure of a perforated duodenal ulcer reduces the incidence of recurrence ulcer

Evaluation of long term results of distal urethral advancement and glanuloplasty for the repair of distal hypospadm

Distal hypospadias represents the most common male genital malformation. Many surgical procedures had been practiced for repair of distal hypospadias, and only few reports had follow up more than one year, The objective of this study was to evaluate the long term results of distal hypospadias repair using distal urethral advancement and glanuloplasty technique. This study comprised 87 patients admitted to the Surgical Department, Mansoura University Hospital with the diagnosis of distal hypospadias and underwent surgical repair using distal urethral advancement and glanuloplasty technique. Their mean a.ge was 6.7 [+4.6] range 2-20 years, and the mean follow up was 48.3 [range 12-78] months. Good outcome was achieved in 79 [90.8%] patients, and complications occurred in only 8 [9.20%] patients including urethral fistula in 2 [2.30%] meatal stenosis in 3 [3.45%], meatal retraction in 1 [1.15%], and poor cosmetic results in 2 [2.30%] patients. We concluded that long-term follow up confirms the validity of this procedure with good outcome and low complication rate