Approach to surgical management of carotid body tumor and our experience at Assiut University Hospital

Carotid body tumor [CBT] is a rare neoplasm, which typically presents as a slow growing, painless neck mass found along the anterior border of the sternocleidomastoid muscle. This tumor is generally benign but possesses aggressive resection remains a surgical challenge traditionally associated with a 15-30% incidence of cranial nerve injury. To present our experience at Assiut University Hospital regarding surgery of CBT and the use of preoperative embolization and mandibulotomy in large sized tumors. The study was performed on 18 cases with CBT, 5 females and 13 males with a mean age of 40 years. Clinical and radiological diagnosis was recorded. Angiography was done in 17 cases for confirmation of CBT diagnosis and its extent, evaluation of carotid arteries and for preoperative emobilization. One case due to some technical difficulties was evaluated by spiral CT angiography. Patients were classified according to the tumor size and Shamblin classification. Preoperative imobilization to decrease the tumor vascularity and the intraoperative blood loss, was done. Patients were subjected to surgical removal of the tumor through anterior longitudinal approach to the carotid system not later than 4 days after the embolization to avoid the inflammatory phase and the development of any collaterals. Paramedian mandibulotomy was done in cases with very large tumore. Patttients presented with painless swelling, local tenderness, bruit, difficulty with swallowing, and hoarseness. Preoperative embolizaiton for large cases decreases the tumor vascularity by [25% to 45%][as documented by post embolization films. The average blood replacement was one unit. There were no deaths and complications were recorded in 44.4% of patients as vascular complications [legation of external carotid artery, simple repair of internal carotid artery, and repair of internal carotid artery with interposition of vein graft] or neurological complications as cerebrovascular stroke, injury of vagus, hypoglossal and marginal mandibular nerves. All cases were confirmed histologically as benign paragangliomas. CBT should be taken in considerations in all lateral neck masses. Angiograhy is very helpful in making the diagnosis. Preoperative embolizaiton decreases the tumor size, the vascularity and facilitates the subsequent surgery. Paramedian mandibulotomy provided a wide exposure, in cases with large sized tumors. Early detection and resection of smaller tumors ultimately reduced the risk of complications

Perianal submucosal ethanolamine oleate injection assisted abdominal suture rectopexy: a new technique for treatment of rectal prolapse in adults

This study was done on 51 adults with rectal prolapse to evaluate the ethanolamine oleate solution injection assisted by suture rectopexy in complete prolapse and alone in partial prolapse. It included 32 patients with complete rectal prolapse, 8 males and 24 females with age range from 20 to 64 years. After full mobilization of the rectum, four-non-absorbable sutures [Prolene sutures, No. 0] were used to fix it to the periosteum of the promontory of the sacrum. A spinal needle attached to an injection syringe was inserted through the skin just outside the mucocutaneous junction. Using a guiding finger in the rectum, the needle was passed through the perianal skin for about 10 cm above the anal verge. Then injection of ethanolamine oleate solution was done in the submucosal plain while we withdrew the needle outside. The injection was repeated in four quadrants at 6, 9, 12, 3 o'clock. Then the rectum was lightly packed with a gauze, which was removed at the following defecation. The results were very encouraging regarding: a] Prolapse management, all patients were cured of their prolapse with no recurrence after follow up period ranged from 16 to 36 months, b] Continence regain, in grade 3 incontinence, 83.5% got full continence and the incidence was 100% in grade 2 and c] No constipation occurred which is a major complication of abdominal rectopexy. Injection alone was done in 19 patients with partial rectal prolapse [6 males and 13 females] with 68.4% success from the first trial and 10.5% success after the second injection. On conclusion, ethanolamine oleate solution injection is safe, effective and cheap method for treatment of partial rectal prolapse and assists abdominal rectopexy in complete prolapse