case of diaphragmatic hernia

Congenital diaphragmatic hernia is a rare condition addressed in the medical literature as a surgical problem. It is usually a disorder of the newborns, equally occurring in males and females. There are 3 basic types of congenital diaphragmatic hernia: the posterolateral Bochdalek hernia, the anterior Morgagni hernia, and the hiatus hernia. This is a presentation of a newborn with congenital diaphragmatic hernia and a favorable outcome after surgical repair

Pathologic pattern of invasive bladder carcinoma: impact of bilharziasis

To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Between April 2002 and October 2006, 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department, Cairo, Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type, stage, grade and gross features in addition to lymph node involvement were particularly noted. Bilharzial bladder pathology [lesions or ova] was present in 105 [70.9%] of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma [TCC] in 84 [56.7%], squamous cell carcinoma [SCC] in 51 [34.5%], adenocarcinoma in 9 [6.1%] and anaplastic tumor in 4 [2.7%] of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23%, pT3 in 70.9% and pT4a involving the prostate or seminal vesicles in 6.1%. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 [48.6%] and high grade in 76 [51.4%] specimens. Regional lymph node involvement was detected in 31 [20.9%] specimens irrespective of bilharzial infestation. Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3, low-grade SCC and commonly appears as an ulcerative, bulky, fungating or verrucous mass. On the other hand, bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

Monopolar electrocautery, an alternative novel method of hemostasis during radical cystectomy: preliminary report

During radical cystectomy, local hemostasis is a critical factor for surgical success. It can be accomplished with a variety of techniques including mechanical compression, ligatures, auterization and laser. The aim of this work was to evaluate monopolar electrocautery alone for achieving hemostasis during radical cystectomy. In this prospective study 30 patients were scheduled for radical cystectomy over a period of 2 years at Al-Azhar University Hospitals using monopolar electrocautery as the only hemostatic tool. The parameters studied were: operative time, estimated blood loss and incidence of complications. The data were analyzed clinically and statistically. Monopolar electrocautery as the only hemostatic tool during radical cystectomy resulted in a short operative time [35 +/- 5 minutes]. The mean estimated blood loss was 150 +/- 50 ml. Intraoperative bleeding was encountered in 2 patients only and they received blood transfusion. The overall post-operative early [within the fi rst month] complication rate was low [13.3%] and all complications were managed conservatively. Monopolar electrocauterization is a safe method for achieving hemostasis during radical cystectomy, with a signifi cantly short operative time, low cost, low blood loss, a low cystectomy-related complication rate and a short hospital stay

Injuries encountered during rigid ureteroscopy in training centers

Objective: To analyze the peroperative injuries encountered during ureterorenoscopy [URS] in two training centers in Egypt over a four-month period

Patients and Methods: A prospective computerized database of 88 patients [38 males and 50 females] who underwent URS at two urologic university training centers [Al-Azhar University Hospital, Cairo and Assiut University Hospital, Assiut, Egypt] between July and October 2003 was analyzed. The procedures were elective in all cases. The indication for URS, the state of the ureter, associated pathologies, intraoperative injuries encountered and their management were recorded for analysis

Results: All but seven patients were operated for therapeutic indications, mainly stone disease and ureteric strictures. Peroperative injuries were encountered in 14 patients [15.9%] with the commonest type being mucosal laceration [57%] followed by minor ureteric perforations. Major injuries in the form of ureteric avulsion, laceration and extravasation were noted in 2% of the cases. The procedure was associated with inadvertent bladder or urethral injury in three patients. In all cases the diagnosis of the ureteric injury was prompt and confirmed by intraoperative ureterography. Treatment was started immediately

Conclusion: URS, although an important tool in the management of upper tract pathology, is an invasive procedure, especially for therapeutic indications. It may result in significant complications that may jeopardize the integrity of the concerned renal unit. Recent technology in the design of ureteroscopes and their accessories may minimize injuries, especially if applied in teaching hospitals where the learning curve of URS is a demanding task

Patient satisfaction with health care services provided at the family medicine clinic at Jordan University Hospital

This descriptive study aimed to: 1. Determine patients' satisfaction with the services provided at the family medicine clinic at Jordan University Hospital. 2. Identify reasons why clients select the family medicine clinic as the place to receive health care at the hospital. 3. Evaluate the extent to which patients' characteristics including demography and reason for attending the clinic, affect their satisfaction with care. All patients visiting the family medicine clinic at Jordan University Hospital, at the time of the study, were asked to participate after gaining their verbal approval. The study sample consisted of 668 patients. A questionnaire- interview, developed by the researchers to measure the study variables, was administered to patients on an individual basis in the waiting room. The patients were interviewed at two points; before they see their doctor to collect demographic information and at the end of the visit to measure their satisfaction with the complete cycle of care they have just received at the clinic. The results of the study indicated a general satisfaction of the patients with the health care services rendered to them. The highest satisfaction was in relation to nursing services [M=4.56] followed by the clinic [M=4.40] and the least satisfaction was with their physicians [M=4.12]. In relation to the clinic environment and support services, the patients reflected the highest satisfaction with the receptionists' behavior [M=5.05] and time needed to bring their files from the record-keeping department [M=5.17]. The least satisfaction was in relation to the convenience of the waiting area and drugs dispense services. The results also showed that the reasons why clients select family medicine clinic were first because they do not need a previous appointment followed by the availability of good doctors. The study findings indicated significant relationship between patients' characteristics and their general satisfaction except for the reason for choosing the FMC

Clinical prognostic factors in patients with advanced stage of prostate cancer

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer

Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy [either castration or total androgen blockade [TAB]]. All pre- and post- treatment data records were evaluated with respect to patient age, prostate and tumor size, tumor grade, stage, PSA, alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early [12 months after treatment] or late [over all follow-up visits until the last visit or death]. Descriptive statistics, student T test, multivariate and Kaplan Meier's curve were used for data analysis

Results: Within 12 months of treatment 70% of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age, tumor stage, the number of bone lesions, serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome [p= 0.0015, 0.002, 0.001, 0.0002 and 0.028, respectively], while the pre-treatment PSA serum level, tumor grade and the type of hormonal treatment used [either castration or TAB] were no predictors of patient outcome [p= 0.18, 0.82 and 0.47, respectively]. Importantly, the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status [p=0.001 and 0.028, respectively]. The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 [51.6%] had overall disease progression during a mean of 59.4 months, while mortality was reported in 118 cases [53.2%] in the course of a mean of 59.9 months

Conclusion: The pre-treatment patient age, tumor stage, serum alkaline and acid phosphatase, as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However, a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB

Transurethral microwave thermotherapy versus sham treatment: early report of a randomized double-blind study

Transurethral microwave thermotherapy [TUMT] for the management of clinical BPH has recently been introduced and investigated in a number of centres. A prospective double-blind randomized study was designed to evaluate the extent of any placebo response. The inclusion criteria were a total Madsen score > 8, a Qmax

Learning curve of ureterorenoscopy for stones

The learning experience of URS in the first 155 patients [165 ureteral units] was evaluated as a therapeutic modality for stone retrieval. Using the rigid ureteroscope under flouroscopic control [in most of cases]; the overall success rate was [83.3%] [137 units], being successful on the first session in [74.5%] [123 units] and on the second session in [8.4%] [14 units], while the rest of units [13.3%] [23 units] respresent our failure rate. The highest success rate goes with the intramural stone 9 [90%]; pelvic stones 100 [85%]; while the iliac stones constituted 18 [75%] and lumbar stones 10 [55.5%]. Sorting our group chronologically we could not have a real rising curve for the first 50-60 units, but the actual rise was noticed in the subsequent 105 ureteral units. Complications reported in early procedures were in [60%] of units in comparison to [41%] in the subsequent ureteral units. We think that this relatively unsafe procedure is still a mandatory skill for every urologist to learn. Careful preoperative assessment of the ureteropyelogram, staging of the procedure; if impaction and/or stricture, antegrade approach for proximal stones, employing U.L whenever needed to avoid forcible manipulations, keeping the guide wire intraluminal all the time, close observations and follow up in the early postoperative week and thinking about the final status of the ureter rather than getting the stone out" are all among the most essential recommendations that should be considered thoroughly so as to minimise the drawbacks of the procedure