Evaluation of harmonic scalpel [SH] in thyroid surgery: a prospective randomized study

The harmonic scalpel [HS] using mechanical vibration rather than high temperature has been widely used in laparoscopic surgery and is documented to be safe and fast for cutting and coagulating tissues. We studied whether the use of [HS] could have advantages in thyroid surgery compared to conventional thyroidectomy. Our study was a prospective randomized trial of thyroidectomies performed for benign thyroid diseases between March 2004 and August 2005 in Cairo University Hospital. Patients were randomized into 2 groups: group A [n=50] underwent thyroidectomy using HS and group B [n=50] with the conventional technique, clamp and tie and electrocautery. The outcome measures in this study included operative time; postoperative drainage; hospital stay; and procedure complications including recurrent laryngeal nerve injury RLN as well as hypoparathyroidism. The two groups were similar in age and sex. Mean -+SD operative time was shorter in the SH group compared with the conventional group for both hemithyroidectomy [61- +6vs 78- + /10 minutes] and subtotal thyroidectomy [86- +2Ovs 101-+ / 6minutes]. The difference was statistically significant. There were no statistically differences between the two groups regarding transient postoperative complications. There was no mortality in both groups and no intraoperative complications or postoperative definitive sequelae. We concluded that the use of HS is safe in thyroidectomy: it does not reduce or increase operative morbidity but has a clear advantage of reducing operative time by almost 30 minutes. These results my have implications for significant hospital cost saving. By shortening operative anesthesia time the use of HS might accelerate postoperative recovery. Further studies are needed to show the cost-effectiveness of both techniques

Evaluation of percutaneous intratumoral injection of p53 gene in the treatment of inoperable hepatocellular carcinoma as compared to alcohol injection

P53 is a tumour suppressor gene on chromosome 17 P. Alterations [deletion or mutation] within the coding sequences of the gene are among the most frequent genetic changes detected in human neoplasm. The use of gene therapy in some tumours is a new trend nowadays which carries many hopes for the future treatment of these tumors. This modality of treatment utilizes transfer vectors [plasmid, virus,] for delivering certain genes into malignant cells to induce tumour suppression. Injection of P53 intratumoral [I.T] in Hepatocellular Carcinoma [H.C.C.] is an example of this therapy. The aim of this study is to compare the effect of intratumoral injection of P 53 to that achieved with alcohol injection in cases of H.C.C. In a prospective study, eleven consecutive patients, diagnosed as H.C.C., were subjected to I.T injection of alcohol [Group I] and another eleven patients were subjected to I.T P 53 injection [Group II]. The results show that alcohol injection has superior results in treating H.C.C. over P 53 injection