Malignant Melanoma, with emphasis on first relapse cases

Malignant melanoma is the eighth most commonly diagnosed malignancy in Nova Scotia, Canada. The incidence of and death from malignant melanoma are increasing, despite surgical resection of lesions. The risk for local recurrence after treatment is 3.2%. Our aim was to determine the characteristics of malignant melanoma and the risk for relapse in an industrial region of Nova Scotia. We performed a retrospective analysis of the records of 90% of all melanoma patients in 1999-2010 in Cape Breton, Nova Scotia [N = 100]. Data were derived from the patients' medical records kept at the Cape Breton District Health Authority. Of the 100 cases of malignant melanoma, 57 were in men and 43 were in women. Treatment consisted of local excision for 91 patients, therapeutic lymph node dissection for 5 and no treatment for 2. Relapses occurred in 16 patients [10 men, 6 women] between 2003 and 2010. Eleven of the 16 patients with relapses [69%] were alive at 1 year, four [25%] at 2 years and three [19%]] at 5 years. The majority, 80/100, of patients are still alive without malignant melanoma, while two patients are alive but with malignant melanoma. Of the 18 patients who died, eight died from malignant melanoma. We obtained a better 5-year survival rate [82%] than that reported in the literature [73%]. In Cape Breton, more men than women have malignant melanoma and are more likely to have local recurrence. The long-term survival rate after relapse was poor.

Bronchopulmonary dysplasia in ventilated neonates :incidence and risk factors

Bronchopulmonary dysplasia occurs in neonates who need supplemental oxygen at 36 weeks gestational age and those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Mechanical ventilation is an invasive life support procedure that may cause lung injury through a combination of oxygen toxicity, barotrauma, and volutrauma. Alveolar development is interrupted and parenchyma destroyed leading to emphysematous changes, decreased lung compliance, and impaired gas exchange. There is a positive correlation between ventilator settings, duration of assisted ventilation and development of BPD. The aim of the study was evaluation of the incidence of bronchopulmonary dysplasia among ventilated neonates and determination of associated risk factors. A retrospective study conducted in the Neonatal Intensive Care Unit Cairo University over the period from January 2007 to December 2008. It included 633 ventilated neonates out of 3321 total admissions [19.06%]. All data were collected from patient's records. Patients were diagnosed to have bronchopulmonary dysplasia if they needed supplemental oxygen at 36 weeks gestational age or those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Patients were classified to 2 groups: BPD group and non BPD group. Bronchopulmonary dysplasia [BPD] developed in 221633 ventilated neonates [3.48%]. Twenty of them had gestational age between [28 - 32] weeks [90.90%],14/22 were males [63.63%], 13/22 were delivered by CS [59.09%], BPD developed in 18/290 [6.2%] neonates ventilated by SIMV from start, 3/178 ventilated by NCPAP followed by SIMV [1.7%], 1/165 ventilated by NCPAP only [0.61%], with P-value 0.002 [significant]. Eleven neonates out of 22 BPD cases [50%] were discharged. Twenty one out of 285 neonates diagnosed as respiratory distress syndrome [7.4%] developed BPD. In BPD group, Mean Fraction of inspired oxygen was 60.68 +/- 16.90, compared to 33.24 +/- 21.57 in non BPD group P value < 0.001 Highly Significant [HS]. Mean PIP in BPD group was 21.94 +/- 4.22 and 21.32 +/- 5.26 non BPD group, P Value 0.63. Mean PEEP was3.94 +/- 0.24 in BPD group and3.79 +/- 0.45 in non BPD group, P value 0.17. Mean Rate was 39.29 +/- 8.27 in BPD group compared to 36.23 +/- 12.10 in non BPD group, P value 0.32. Mean Flow was 7.83 +/- 0.71 in BPD group and 7.66 +/- 0.57 in non BPD group, P Value 0.25. Mean I/E Ratio was 0.40 +/- 0.02 in BPD group and 0.38 +/- 0.03 in non BPD group, P value 0.04 [significant]. Mean birth weight in BPD group was 1.22 +/- 0.21 compared to 2.27 +/- 0.80 in non BPD group, P value <0.001 [H.S.]. Mean duration of ventilation was 35.77 +/- 4.07 days in BPD group compared to 6.36 +/- 4.07days in non BPD group, P value<0.001 [H.S]. Mean length of hospital stay was 39.36 +/- 4.58 days in BPD group compared to 8.12 +/- 5.68 days in non BPD group, P value <0.001. In conclusion; The use of NCPAP is associated with a lower incidence of BPD compared to SIMV. The least required oxygen should be delivered to minimize oxygen toxicity and reduce the incidence of chronic lung disease

impact of ante-natal maternal depression on pregnancy outcomes

Ante-natal depression has received little attention in the literature, it may go undiagnosed because of a focus on maternal and fetal well-being and the attribution of complaints to the physical and hormonal changes associated with pregnancy. Therefore, this study aimed to investigate the impact of ante-natal depression on pregnancy outcomes. An exploratory prospective study done on subjects of 220 pregnant women in their last trimester during their antenatal visit at EL-Shatby Maternity Hospital, the subjects are interviewed individually throughout a period of six months from January to June 2008. A structured questionnaire, Mood/ depression assessment questioner and Beck Inventory Depression scale are used for data collection. The results showed that 38.6% of the study subjects had no depression during their pregnancies, while the rest of them who represented the larger proportion had depression with varying degree [mild 22.3%, moderate 22.7% and severe 16.4%]. A significant association was found between ante-natal maternal depression and adverse pregnancy outcomes such as cesarean section, premature labor and low birth weight babies. The study concluded that antenatal depression is a common problem with prevalence probably higher than that reported in literature. Woman's socio-demographic characteristics including, age, level of education, her past history of marital conflicts, domestic violence, history of miscarriages, and complications in previous pregnancies are some of the significant risk factors for ante-natal depression. Ante-natal depression also leads to a high risk of adverse obstetric and neonatal outcomes

Gender: does it have a role in blood pressure in Caucasians with well-controlled type 2 diabetes?

Blood pressures are increased in type 2 diabetics presenting an enhanced risk of myocardial infarction and subsequent death. It is controversial whether males have a greater risk of myocardial infarction and resultant death in type 2 diabetes. The purpose of this study was to review the literature regarding gender in blood pressure and to test the hypothesis that there would be gender inequality in blood pressure in well-controlled Caucasian type 2 diabetics in Cape Breton, Nova Scotia resulting in at least one gender exceeding the Canadian Diabetes Association [CDA] guidelines for systolic and/or diastolic pressures. Blood pressure were done by sphygmomanometry and using a stethoscope. This study revealed statistically identical blood pressures in males and females which were above the CDA guidelines for systolic and diastolic pressures. It is concluded that neither males nor females as a population in this study are meeting the CDA guidelines for systolic or diastolic pressures and as such may well be at greater risk of myocardial infarction than if they were meeting these CDA guidelines. Ultimately it will have to be determined what approaches are suitable in bringing blood pressures to clinical target endpoints and what role gender may play in these approaches to management of hypertension in type 2 diabetics. However, this was only a very small study and a much larger one would answer whether there is gender inequality in blood pressure among persons with well-controlled type 2 diabetes

Gender: does it have a role in bleeding time in Caucasians with well controlled type 2 diabetes?

Bleeding times are decreased in type 2 diabetics presenting an enhanced risk of myocardial infarction and subsequent death. It is controversial whether males have a greater risk of myocardial infarction and resultant death in type 2 diabetes. The purpose of this study was to review the literature regarding gender in bleeding time and to test the hypothesis that there would be gender inequality in bleeding time in well-controlled Caucasian Type 2 diabetics in Cape Breton, Nova Scotia. This study revealed significantly shorter bleeding times in males. Thus it may be that males should be more aggressively treated to increase bleeding time and hence to more equitably manage the risk of myocardial infarction and subsequent death. Ultimately it will have to be determined what bleeding time thresholds are suitable for intervention and indeed what the most appropriate intervention is at each threshold and what role gender may play in these features in type 2 diabetics. However, this was only a very small study and a much larger one would answer whether there is gender inequality in bleeding time among persons with well-controlled type 2 diabetes

Gender: does it have role has a role in glycaemic control in Caucasians with well-controlled type 2 diabetes?

Type 2 diabetes is costly to manage and thus it is important to know if management of blood glucose and HbA[1C] are meeting clinical targets in both men and women. There is conflicting published data on the gender equality of blood glucose and HbA[1C] management in type 2 diabetics. The purpose of this work was to review the literature on gender equality in blood glucose management and to test the hypothesis that management of blood glucose and HbA[1C] would meet clinical targets in Cape Breton, Nova Scotia, irrespective of gender in well controlled Caucasian type 2 diabetic patients. Fasting serum insulin and insulin sensitivity levels were determined in order to assist in the explanation of the glucose and HbA[1C] results in people with diabetes. Patients were asked to give a fasting blood sample on each of two occasions three months apart. There were no differences between males and females in each of fasting serum glucose [FSG] and HbA[1C] levels as well as fasting serum insulin concentrations and in insulin sensitivity at visit 1 or 2. However, each of FSG and HbA[1C] levels were slightly higher than clinical targets. Modestly elevated serum insulin and lower insulin sensitivity were consistent with the FSG and HbA[1C] levels. This contrasts with some of the existing literature pointing out the need for a much larger study to be done in Cape Breton. It is concluded that blood glucose management among people with well controlled type 2 diabetes in Cape Breton, Nova Scotia may be close to clinical targets irrespective of gender. A further lowering of HbA[1C] and FSG may be in order. However, this was only a very small study and a much larger one would answer whether there is gender equality in FSG and HbA[1C] among persons with well controlled type 2 diabetes on Cape Breton Island

Laparoscopic treatment of common bile duct stones: [single stage] laparoscopic approach to cholelithiasis and choledocholithiasis

Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance. There are several disadvantages to ERCP including the additional invasiveness of endoscopic procedures, moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES [endoscopic sphincterotomy]. Peroperative real time cholangiography has the advantage of addressing choledocholithiasis with a single procedure LCBDE [Laparoscopic Common Bile Duct Exploration] while leaving the sphincter of Oddi anatomically intact without added morbidity. The choice of treatment between immediate laparoscopic common bile duct exploration, open exploration of CBD and transsphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and examine the biliary ductal system by laparoscopic intra-operative cholangiography [IOC] during laparoscopic cholecystectomy [LC]. The aim was to visualize the ductal anatomy and any anomalies on filling with contrast [to avoid biliary injury], detect any CBD stones and assess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Intraoperative cholangiography was performed for 302 patients underwent LC for chronic calcular cholecystitis [CCC] in Benha University Hospital from Dec. 1999 to Jan 2004. Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patients [11.3%] were harbouring silent CBD stones managed immediately for CBD clearance. LCBDE was feasible in 23/31 cases who had choledecholithiasis [74.2%], while 8 patients needed conversion to open choledochotomy. 28 patients [9.3%] had preoperative ERCP, endoscopic sphincterotomy [ES], stone retrieval Operative cholangiography during LC proved residual stones in CBD in 2 of them [7.1%] and were treated by open choledochotomy. LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choledocholithiasis as a [one step] procedure

Direct versus nonrefluxing ureteroileal anastomosis in ileal neobladder

Does the theoretical benefit of reflux prevention in low-pressure bladder substitutions outweigh the potentially high rate of anastomotic stricture? Over 6 years, 120 renal units in 60 patients were reimplanted in orthotopic ileal neobladder following radical cystectomy. They were classified into 3 groups: 60 renal units were reimplanted by direct end to side technique, 30 units by extramural serous lined technique and 30units by Le Duc technique. Pre and postoperative bacteriologic study, blood chemistry, IVU, renal isotope scanning and postoperative micturating pouchogram were done in all cases after 3, 6months and then annually for 6-60months [mean, 36months].The following data were recorded in the 3 groups respectively: Rate of anastomotic stricture; 1.66%, 13.33% and 26.66%. Reflux; 15%, 3.33% and 6.66%.Upper tract dilation; 11.66%, 13.33% and 30%.Significant decrease in GFR; 11.66%, 13.33% and 30%.Azotemia; 3.33%, 6.66% and 13.33%. Asymptomatic bacteriurea; 26.66%, 20% and 20%.Pyelonephritis; 6.66%, 6.66% and 10%.Upper tract stone formation; 1.66%, zero and 3.33%. Nonrefluxing methods of ureteroileal anastomosis resulted in statistically significant higher rate of anastomotic stricture and upper tract dilation than direct end to side anastomosis. This is a high cost for any theoretical benefits of preventing pyelonephritis, azotemia or stone formation. In low-pressure bladder substitutions, direct ureteroileal anastomosis may be the technique of choice as it preserves kidney function and morphology, simple and time saving technique