Preputial glanuloplasty for an apical meatus in second-stage hypospadias repair

This work aimed to study the possibility of achieving a truly apical meatus by minor technical modification of the second-stage Denis-Browne hypospadias repair. It included 76 hypospadias aged 7 months to 25 years, with an average age of 6.3 years, who already had a penile curvature correction procedure done. They were then operated upon by a preputial glanuloplasty, the author's modification of the second-stage Denis-Browne hypospadias repair, mobilizing and suturing the lateral skin flaps to the very tip, of the glans. A truly apical meatus was achieved in 43 patients [56.6%] and overall fair to excellent results were obtained in 95% of cases. Failure, necessitating re-do surgery for the distal part of the neo-urethra, occurred in only 4 patients. Preputial glanuloplasty adds only a few minutes to the total operating time. It does not cause additional complications and achieves satisfactory anatomical and functional results. It is to be recommended when a Denis-Browne procedure is to be performed

Thyroid haematoma: clinico-ultrasonographic correlation and treatment

Ultrasound examination using a linear real-time scanner was done for 12 patients with thyroid hematoma, 2 acute, 2 subacute, and 8 chronic. No patient was on anticoagulant therapy and all had platelet counts and prothrombin time within normal. The ultrasonographic appearance of the thyroid hematoma varied depending on the age of the hemorrhage. Acute hematoma was echogenic. Subacute hematoma showed a mixed pattern with echogenic and echo-free areas. Early large-sized chronic hematoma showed few scattered echoes or septations, otherwise chronic hematoma gave an echoefree cystic pattern. All subacute and chronic hematomas showed deep echo enhancement. Ultrasonography was used to substantiate the clinical examination and both showed complete resolution of the hamatomas in all patients, without resort to any form of intervention, after a maximum period of 8 weeks

relative frequency and characteristics of mucinous adenocarcinoma of the stomach and intestines at the NCIC

Five hundred and thirty two cases of mucinous adenocarcinoma of the stomach and intestines were reviewed from the records of the N.C.I.C. during 14 years [1976 to 1989] to analyze their relative frequency and other available data. The overall percentage of mucinous adenocarcinomas to total carcinoma over the study period was 25.8%, the yearly percentage was found to have decreased since 1985 compared to previous years [1976 to 1984]. Over two-thirds of the cases were in their third to decade and the male to female ratio was 1.95 to 1. About 87% of the cases presented with a malignant single primary tumour without evidence of direct or metastatic spread but the percentage of metastic tumour as an initial presentation was over double that in the non-mucinous cases. the rectum was the commonest site affected [61.3%] and, in addition to its junctional zones, the rectosigmoid and anorectal junctions, it had the highest percentage of mucinous adenocarcinoma t total carcinoma cases [over 30%]. This study confirmed that gastrointestinal mucinous adenocarcinoma is the more likely to be in an adanced stage on presentation. The study forms a basis, with its georpagical distribution data, for the estimation of the incidence and prevalence of gastrointestinal mucious adenocarcinoma in Egypt, using mathematical models. A plea is made for the adherence to W.H.O. criteria used for the histological typing of these tumours

Relative frequency of gastrointestinal signet-ring cell carcinoma at the NCIC

Thirty-nine cases of S.R.C.C. of the stomach and intestines were reviewed from the records of the N.C.I.C. during 14 years [1976 to 1989] to analyze their relative frequency. Of the cases occurred in the last five years. Twenty-two cases were males and 17 were females; a male predominance of 1.3 to 1. In gastric case the numbers of males and females were equal. Over five-sixths of the cases [84.6%] were in their fourth to sixth decades with an overall mean age of 44.2 years. That for gastric cases was greater by about four year [48 years]. The stomach was the commonest site affected [66.7%] and next was the rectum [20.5%]. Similarly, the highest percentage of S.R.C.C. to total carcinoma occurred in the stomach [9.5%]. In the large intestine this was 0.63%. Since S.R.C.C. of the gastrointestinal tract is distinct histopathologically from reputation, it should always be classified separately from the latter tumour

Efficiency of the modified technique of PGA mesh small intestinal sling in the prevention of radiation-induced small bowel injury

Results evaluating the efficiency of the modified technique of PGA abdominal MeSH in the prevention of RISBI are reported in 19 patients and controls showed no statistically significant difference [P > 0.05]. Details of the radiotherapy dosage showed that placement of the PGA MeSH allowed tumoricidal doses above standard to be used safely, where felt necessary [3 rectal carcinoma cases], even when combined with adjuvant chemotherapy. The control group; [total 20 patients] who similarly had postoperative pelvic radiotherapy but in whom the PGA MeSH was not used. None of the cases with implanted PGA MeSH suffered from radiation sickness or diarrhoea as opposed to the control group. In the latter, radiation sickness occurred in 19 patients [95%] in 7 of which it was severe [grade 3] and diarrhoea, as a manifestation of RISBI occurred in 17 patients [85%] in 4 of which it was severe [grade 3]. The advantages of PGA MeSH implantation by the modified technique are enumerated. PGA MeSH small intestinal sling deserves recognition as the procedure of choice in the prevention of RISBI following surgery for pelvic malignancies

Absorbable polyglycolic acid mesh abdominal diaphragm as a small intestinal suspender for postoperative pelvic irradiation

Twenty-one patients with locally advanced pelvic malignancies were operated upon. Sixteen had radical and 5 non-radical acid MeSH style. 2 positioned as a small intestinal sling at L4. Two patients died postoperatively from uraemia and pulmonary embolism. There was no morbidity related to placement of the MeSH or to the potential space below it. Radiation dosage above standard was used. Average follow- up period was 18 months. Barium follow through studies done before and after radiotherapy and at 6 months postoperatively showed that the MeSH had prevented small bowel descent into the pelvis throughout the period of irradiation. Thereafter, the MeSH was absorbed. Presence of the MeSH diaphragm was successful in preventing irradiation injury of the small intestine. No such manifestations occurred in the MeSH group as opposed to a control group of 20 patients. Routine use of the MeSH is recommended with radical or palliative surgery for pelvic malignancies whenever postoperative radiotherapy is contemplated

Has the incidence of gastrointestinal mucinous adenocarcinoma changed in Egypt? Phase 1 [study at the NCIC]

Five hundred and thirty two cases of mucinous adenocarcinoma of the stomach and intestines were reviewed from the records of the N.C.I.C. over a period of 14 years [1976 to 1989] to reveal any change in their incidence by time. The yearly distribution, the yearly sex distribution and the yearly age distribution of the cases, according to topography, showed no impressive trend. The yearly percentage of mucinous adenocarcinomas to total gastrointestinal carcinomas was found to have decreased since 1985 compared to previous years. This decrease was essentially due to gastric and colonic cases. Thus, it may be worthwhile to consider colonic mucinous adenocarcinoma separately from rectal and anal cases. A plea is made for a well- maintained National Tumor Registry and for a long-term multi-center national survey [phase 2 of the study]

Can all fibroadenomas be removed by a circumareolar incision? 1-Subcutaneous approach for peripheral fibroadenomas of the breast

Thirty-five peripheral fibroadenomas of the breast occurred in 32 females, 14 to 43 years old. The size of the fibroadenomas averaged 2.5 cm. Feasibility of removal of these outlying fibroadenomas by a circumareolar incision, for its cosmetic excellence, was investigated. All peripheral fibroadenomas studied could be removed after creating a subcutaneous tunnel from the carcinoma incision to the site of the fibroadenoma. Drains were not used. There was no morbidity from infection or haematoma formation and the cosmetic results were excellent. The maximum follow-up period was 29 months and the average was three months. This technique gives an excellent cosmetic result and is advised in all cases where the diagnosis is not in doubt either on clinical grounds or by needle aspiration cytology

Relative frequency of gastrointestinal malignancies at the NCIC during 14 years [1976-1989]

2339 gastrointestinal malignancy cases were reviewed from the records of the NCIC during 14 years [1976 to 1989] to analyze their relative frequency. There was a general trend of increase in the number of cases over the years but this was not uniform. The greatest number of cases were in their sixth decade and the male to female ratio was 1.75 to 1. About 90% of the cases presented with a malignant single primary tumour without evidence of direct or metastatic spread. The rectum was the commonest site affected [49.7%]. Carcinomas formed 90.4% of the tumours, sarcomas 9.5% and mesotheliomas 0.1%. The commonest tumour was adenocarcinoma followed by mucoid carcinoma, together forming 76.3% of malignancies, next came squamous cell carcinoma and malignant lymphoma [5.9% each]. This study forms a basis for the analysis of the relative frequency of the individual types of gastrointestinal carcinomas and sarcomas. Mathematical models can be used to obtain estimates of the incidence and prevalence data of gastrointestinal malignancies in Egypt from the presented material with its geographical distribution data