Lateral trans-psoas approach to fix the lumbar spine

The present study describes a new surgical approach to fix the lumbar spine with evaluation of the prospective early outcome. In the period from October 2004 to January 2006, 10 patients with degenerative spondylolisthesis [7 females, 3 males; mean age 43.0 year] underwent lateral retroperitoneal trans-psoas approach for screws and plate fixation of the lumbar spine. All cases [2 with prior posterior surgery and 8 without] had instability at one level which was L3-4 in 2 patients and L4-5 in 8. Spinal stenosis, large disc protrusion, and L5-S1 instability were excluded from this study. Average operative time was 3.2 hours; average blood loss was 450CC, and average postoperative hospital stay was 4.3 days. Clinical and radiological outcome after one year follow-up were satisfactory in the 10 patients. Neither mortality nor massive blood loss were encountered. Complications were in the form of temporary weak painful left hip flexion in all the patients, transient ileus in 4, inadvertent lumber sympathectomy in 2, incisional hernia in 1, and mild wound infection in 1

Endoscopic assisted harvesting of the radial artery for coronary artery bypass grafting: a modified technique

The present study evaluates a minimally invasive technique for radial artery harvesting for coronary artery bypass grafting [CABG]. The decision to use the radial artery for grafting was taken by the cardiac surgeons in Cairo university hospitals. 30 patients were enrolled in this study in the period from February 2002 to August 2005. Allen's test, modified Allen's test, and duplex scanning were the preoperative measures to assess ulnar collateral circulation. A 2 incisions policy was adopted with a 14 cm tunnel inbetween. 2 nasal speculae were used as retractors, with a 30[degree] 5 mm endoscope for visualization, and a harmonic scalpel as haemostatic, dissection, and cutting instrument. In all the patients, harvested grafts ranged between 18 and 22 cm and all were usable. No hand ischemia or graft thrombosis were encountered. Complications involved one [3.3%] tunnel hematoma that was surgically evacuated, 2 cases [6.7%] with bruises in the forearm, 2 [6.7%] with minor wound infection, 2 [6.7%] with numbness of the thenar eminence, and one [3.3%] with neurogenic functional disorder of the thumb. 28 out of the 30 studied patients markedly appreciated the cosmetic outcome. The remaining 2, one had a long scare after exploration of tunnel hematoma, and the other was disappointed with the functional thumb affection

Multimodality therapy for locally advanced breast cancer

In the present study, 20 patients with locally advanced breast cancer were treated with a combined modality strategy from September 1999 to June 2002. Their age ranged from 30-65 years with a mean of 50 years. Thirteen patients were postmenopausal and seven patients were premenopausal. Fourteen cases were in stage IIIb, while six cases were in stage IIIa. A metastatic work up was done and all patients were found to be free from distant metastases before neoadjuvant chemotherapy. The patients received three cycles of different regimens of neoadjuvant chemotherapy. Fourteen patients received 5-flurouracil, adriamycin, cyclophosphamide [FAC], three patients received 5-flurouracil, epirubicin, cyclophosphamide [FEC], two patients received 5-flurouracil, novantrone, cyclophosphamide [FNC]and one patient received cyclophosphamide, methotrexate, 5-flurouacil [CMF]. 90% of the patients had partial responses to the neoadjuvant chemotherapy [the tumor decreased more than 50% of its size]; while only two patients did not respond to treatment. Modified radical mastectomy was done for all patients. Postoperatively, all patients received adjuvant treatment, radiotherapy 5000 cGY, 25 fractions, 3-4 cycles of further adjuvant chemotherapy [FAC, FEC, CMF and FNC] and hormonal treatment, tamoxifen 20 mg/day. The patients were followed up for a variable period of time ranging from 12-24 months. No local recurrence was detected in all patients. Only two patients developed distant metastasis. Disease free survival was 90%. This multimodality approach to locally advanced breast cancer rendered most of the patients disease-free and produced an excellent local control rate