Risk of aggression and criminal behaviour among adolescents living in Alexandria governorate, Egypt

Adolescent risk-taking and aggressive behaviours are among the most visible forms of violence in society. A study was carried out to identify the prevalence and risk factors for aggression, violence and criminal behaviour among adolescents in Alexandria, Egypt. Using multistage, cluster sampling of families from all health districts in Alexandria, the mothers of 783 adolescents aged 11-19 years answered an Arabic version of the Mentor Research Institute screening questionnaire. Overall 26.9% of adolescents were assessed to be at high risk and 20.2% at extremely high risk of aggression and criminal behaviour. Living in urban/slum areas, male sex, low level of parents' education/occupation, exposure to violence within the family and changes in behaviour of any family member were associated with risk of aggression/violence. In multivariate analysis, the significant independent variables were adolescents' sex, presence of behavioural changes in the family, violence against brothers and sisters and substance abuse by any family member

Prevalence and determinants of condom utilization among people living with HIV/AIDS in Egypt

Condoms are an integral part of HIV/AIDS prevention, yet their use is affected by several factors. The purpose of this study was to determine the prevalence of condom use and the psychological and behavioural determinants among people living with HIV/AIDS in Egypt. Focus group discussions were used to develop the study tool [questionnaire interview] geared towards eliciting knowledge, attitudes and beliefs about condoms among 338 confirmed HIV-positive persons attending fixed voluntary counselling and testing centres in 8 governorates in Egypt. The prevalence of condom use was 45.0% in regular sexual relations and only 18.1% in casual relations. The determinants of condom use were: type of partner, serostatus of partner, antiretroviral intake, beliefs and attitudes towards condom use and to HIV infection. The study shows that special efforts need to be made to change the attitudes of people living with HIV/AIDS towards condom use

Incidence, treatment and visual outcomes of non-infectious keratitis as a postoperative complication of laser-assisted in-situ keratomileusis [LASIK]

To study the incidence, treatment, and visual outcomes of Non-Infectious Keratitis as a Postoperative Complication of Laser in-Situ Keratomileusis [LASIK]. The files of 3500 post-LASIK patients [6326 eyes] were reviewed for the development of Non-Infectious Keratitis. Incidence, management regimens, and final best spectacle corrected visual acuity [BSCVA] were reported. Post-LASIK Non-Infectious Keratitis was diagnosed in 149 eyes [2.35%]. The Keratitis was classified as diffuse lamellar keratitis [DLK] in 89 eyes [1.4%] and 60 eyes [0.94%] as localized debris-related Keratitis [LDK]. The occurrence of post-LASIK Non-Infectious Keratitis was 2.35%, with DLK being the common diagnosis overall, with 92.6% of patients achieving < 20/20 BSCVA. The best way for prevention of DLK is to eliminate defined predisposing factors for DLK. Close follow-up during the early postoperative period

Dilemma of bilateral versus unilateral neck exploration in management of primary hyperparathyroidism

There is still a considerable discussion about whether focal unilateral or bilateral neck exploration should be used in patients with primary sporadic hyperparathyroidism because of improved preoperative localization tests and intraoperative parathyroid hormone assay. Making sense of applying these new technologies is difficult and poses the question. Is limited parathyroid surgery better surgery?. Most clinicians deduce that limited surgery is better only if the success rate is equivalent to bilateral exploration. The aim of this study was to find out if there is an advantage in unilateral neck exploration over the standard bilateral neck exploration for parathyroid surgery. This is a prospective non-randomized clinical study which had been conducted in the period between October 1996 and January 2004 on 29 patients with a diagnosis of primary hyperparathyroidism divide into two groups. Group I: Fourteen patients [4M and 10F] that had bilateral neck exploration. Group II: Fifteen patients [5M and 10F] that underwent unilateral neck exploration. All patients had preoperative clinical and biochemical assessment, ultrasound, CT of the neck and sestamibi scanning [for those patients considered candidates for unilateral neck exploration]. All patients were seen on follow-up visits after 1 week, 1 month, 3 months, 6 months and then yearly. There was no statistically significant difference in preoperative serum calcium level or serum parathyroid hormone level between the two groups [p>0.5]. Median operative time was 105 minutes [range 95-180 minutes] in group I compared to 90 minutes [range 80-155 minutes] in group II [p value<0.5; significant]. Only one patient [7.2%] had postoperative hypocalcaemia in group 1. One patient [7.2%] had recurrence in group! compared with two patients [13%] in group II [p value>0.5, non-significant]. No patient had recurrent laryngeal nerve paralysis or permanent hypocalcaemia in either group. There was no statistically significant difference between group I and II patients in postoperative histopathological findings. In group II three patients [20%] required conversion to bilateral neck exploration; one patient had [7%] multiple adenomas and two patients bad hyperplasia [13%]. Bilateral neck exploration for surgery for primary hyperparathyroidism is as safe as unilateral neck exploration and has higher cure rates. It also avoids the costs of preoperative and intra-operative localization scans and techniques. In hospitals where intra-operative localization methods are not available; the conventional neck exploration for primary hyperparathyroidism should be considered the method of choice

New closed technique in treatment of pilonidal sinus

Although many methods of surgical and non-surgical approaches for treatment of pilonidal sinus [PNS] have been proposed, an optimal treatment modality has not been achieved yet. In the case of pilonidal sinus treated with primary intention surgery, the uneventful healing is still difficult to obtain as indirectly proven by the number of different procedures. The aim of this study was to determine the advantages of adding an antibiotic carrier [Septocoll, septomycin] in the closed method technique after primary excision of the PNS. This randomized controlled prospective study included one hundred sixty-four consecutive patients who had primary or recurrent pilonidal sinus. These patients were treated by excision of the pilonidal sinus and primary closure. They were divided into 2 groups each included 82 patients: For Group I an antibiotic carrier [Septocolll] was introduced into the resulted cavity after excision of the PNS before skin closure. For Group II no antibiotic carrier was used and the cavity was closed directly. For group I: There was no operative mortality. Seventy-two patients [88%] had complete healing by the end of the study and were asymptomatic. Sixty six patients [80%] had healing by primary intention and in 16 patients [20%], the wounds healed by secondary intention. Fourteen patients [17%] developed postoperative prolonged pain. Ten patients [12%] developed recurrence. Mean length of hospital stay was 2.2 days [range Ito 3 days]. For group II: There was no operative mortality. Forty-nine patients [60%] had complete healing by the end of the study and were asymptomatic. Forty-six patients [56%] had healing by primary intention and in 36 patients [44%], the wounds healed by secondary intention. Thirty-three patients [40%] developed recurrence. Eighteen patients [21%] developed postoperative prolonged pain. Mean length of hospital stay was 3.1 days [range hto4 days]. Wide excision and primary closure by tension sutures after application of antibiotic carrier in the cavity is associated with short postoperative hospital stay, low morbidity, and low recurrence rate. It can be performed for managing primary or recurrent, clean or infected pilonidal sinuses with good long-term results

Sentinel node mapping in colorectal cancer: is it worth the effort?

Background: Lymphatic mapping [LM] with sentinel node [SN] biopsy is an interesting recent development in surgical oncology. This approach has the potential of accurately identifying the first lymph node [or nodes] that drain primary tumors. These nodes are the most likely to harbor metastatic or micrometastatic disease. Sentinel node mapping and the pathologic search for micrometastasis may therefore increase the accuracy of the pathologic staging, which may alter the further management and the prognosis

Aim of the Study: To evaluate the usefulness of intra-operative in-vivo and ex-vivo sentinel node mapping in colorectal cancer [CRC] resections, and its effect combined with selected pathologic focus node examination on upstaging of CRC and consequent therapeutic strategies

Patients and Methods: Twenty- nine [after exclusion of six] patients with CRC were enrolled in a study of lymph mapping [LM] with peritumoral and submucosal injection of isosulfan blue dye. In-vivo LM was undertaken intraoperatively during colon resection in 23 patients. Ex-vivo LM was done after specimen removal in 6 patients [1 rectosigmoid and 5 extraperitoneal low rectal carcinoma]. All nodes wereexamined with hematoxylin and eosin [H and E] staining; in addition, negative sentinel lymph nodes [SNs] for metastasis with H and E were multi-sectioned and examined by immunohistochemical staining with cytokeratin[CK-lHC]

Results: SNs were successfully identified in 27/29 patients [93%][at least one SN was identified]. SNs were not identified in 2 cases; one case of very low rectal cancer and the other one was a locally advanced rectosigmoid colonic cancer. LM .demonstrated primary lymphatic drainage to SNs outside the margins of conventionally surgical planned resections in 2 cases [7%] and guided multiple sections and histochemical staining that identified occult micrometastases in 3 of the SN negative patients [11%]. Upstaging was thus achieved in 5 cases [18%] using mapping and focus nodal examination. Overall, the specificity and the negative predictive value in this series were 100% and 67%, respectively, whereas the sensitivity and positive predictive value were 89% and 78% respectively. There was a significant positive correlation between the tumor T stage and lymph node metastases [P< 0.001]

Conclusion: Sentinel node mapping is easy to do intraoperatively during colorectal resections. Ex-vivo LM can be applied when in- vivo techniques are unsuccessful and could beuseful for rectal carcinoma. LM techniques appear to improve staging accuracy in CRC through detection of more node metastases as well as guiding the use of sophisticated histopathologic studies to search for occult nodal micrornetastases. It may demonstrate an unexpected pattern of lymphatic drainage requiring modification of the conventional resection

Breast cancer: clinical and pathological study of simulated quadrantectomy after mastectomy

This work aimed to study the safety of conservative breast surgery and define the high risk factors for recurrence. A simulated quadrantectomy after mastectomy was done in 50 female patients with stage I or II breast cancer [diagnosed by minimal tissue volume biopsy] and both the quadrantectomy and the other remaining breast tissue were histopathologically examined. Multifocality was found in 42% of the patients and multicentricity was found in 32%. There was a statistically significant correlation between multifocality and multicentricity and the grossly non-circumscribed subareolar tumors, tumors with necrosis and tumors with extensive in situ carcinoma [EIC]. It was concluded that breast cancers with extensive intraduct component, tumor necrosis, non-circumscribed or subareolar tumors are high risk factors for local recurrence after conservative breast surgery

Differences between colorectal cancer in Egypt and the Western prototype

This study aimed to review patients with colorectal cancer presented to a general surgery unit with special interest in coloproctology in Ain-Shams University concentrating on the differences between the pattern of the disease in Egypt and western countries. The study is a six-year retrospective review of one hundred and fifty-five patients with colorectal cancer. The results showed that 38% of the tumors occurred in patients less than 40 years and only 15% of patients were above 60 years of age. 3% of the tumors were Dukes A and 58% were Dukes C. 6% of the tumors were irresectable, 36% of the resections were palliative and 29% of curative operations entailed massive resection of nearby organ or tissue. Synchronous adenomas were present in 5.2% of patients and bilharziasis in 3.2%. At a mean follow up of 52 months, 58% of curative resection patients had recurrence, 38% died of their disease or secondary to its treatment and 42% were alive and disease free

One year general surgical experience in a well-established day surgery unit

In the present time, financial problems are increasing due to the overpopulation and the increasing costs of medical services. Different types of Day Surgery Units [DSU] have been described to allow better use of hospital resources. To review the general surgical results of the DSU in El-Salam Hospital, Yemen. This study is partly retrospective [from January to June 1997], and partly prospective [from July to December 1997]. The study included all the general surgical patients [n. 577, 438 males and 139 females] operated upon in the Day Surgery Unit [DSU], El-Salam hospital, Yemen from January to December 1997. The mean age was 38 [range 3/12 - 80]. During this year 577 operations were done in 130 surgical sessions [4.4 patient per cession]. The anaesthetic techniques employed were general in 426 patients [73.8 per cent] and regional in 151 patients [26.2 per cent]. Operations included: 196 inguino-scrotal swellings, 43 ventral wall hernia, 84 anal surgery, 62 minor genito-urinary surgery, and 192 other operations. Forty six patients [7.9 per cent] needed admission to the hospital from the day surgery unit. Twenty six patients [4.5 per cent] presented after discharge with postoperative complications, 11[1.9%] whom presented at the emergency department but only 3 required re-admission. The present study proved that the results of this ambulatory surgery unit were satisfactory and encouraging to continue working In this project with only few functional changes