Chest wall reconstruction after excision of primary malignant chest wall tumours: experience of Mansoura University

In this study we present the combined experience of the surgical oncology, general surgery and the cardiothoracic surgery teams in radical treatment of chest wall tumours including the different methods of chest wall reconstruction after excision of the tumours, and the short-term follow-up of those patients regarding clinical, cosmetic and functional state of respiratory dynamics after surgery. 45 patients were operated upon for chest wall tumours [CWT]. Patients were classified into 3 groups: [1] Group 1: including 15 patients for whom no skeletal reconstruction was done. [2] Group 2: including 15 patients, for whom skeletal reconstruction was done by Methyl methacrylate bone cement embedded in double layer of marlex mesh. [3] Group 3: including 15 patients, for whom skeletal reconstruction was done by Marlex mesh alone. There were 3 patients who required postoperative ventilation in group I, none in group II, and one patient required postoperative ventilation in group III, all of them could be weaned from ventilation within 12 hours. 3 patients developed mild paradoxical respiratory movements in group I, none in group II and one patient in group III due to chest wall instability. All the myocutaneous flaps were viable at the time of discharge. All patients expressed satisfaction with the cosmetic results. There was one case of soft tissue infection in group I, one case of infection of the mesh in group II and another patient in group III. They responded to local drainage and antibiotic treatment. We conclude that proper reconstruction of the bony cage and soft tissue covering is possible after wide excision of the tumours, with the aid of a variable number of prosthetic materials and muscle flaps. Satisfactory results regarding tumour recurrence, cosmetic appearance, clinical state, and respiratory functions of the patients after operations were obtained

Percutaneous catheter drainage of liver abscesses

Imaging-guided percutaneous catheter drainage of hepatic abscesses [PAD] was done in 39 patients. Amebic liver abscesses were diagnosed in 18 patients, where 17 patients had pyogenic liver abscesses and 4 patients had indeterminate abscesses. Right lobe abscesses were seen in 32 patients and left lobe abscesses were seen in 7 patients. PAD was successful in 36 patients [92.3%], emergency laparotomy was indicated in one case who developed clinical signs of peritonitis and in two cases the condition deteriorated due to insufficient catheter drainage with C.T. evidence of persistent abscess cavity and both were drained by open surgery. 1- year follow up was available for all patients with no reported abscess recurrence. Complications developed in 4 cases [10.3%] in the form of bacteraemia [3 cases] and pneumothorax [one case]. The catheter drainage time ranged from 3 to 35 days [mean = 16 days]. PAD of hepatic abscesses is an effective, relatively safe and permanent therapeutic method. It can be used as a safe alternative to surgery, except of there is an underlying liver disease