Laparoscopic transabdominal preperitoneal procedure versus lichtenstein repair in treatment of recurrent inguinal hernia

This study was designed to compare an open tension-free technique [Lichtenstein repair] with a laparoscopic transabdominal preperitoneal hernia repair [TAPP]. In the period between January 2004 and May 2005, 36 patients presented with recurrent inguinal hernias admitted to General Surgery Department at Mansoura University Hospitals. All patients were males and subjected to careful history taking, clinical examination and investigations, they were divided into two groups, group A included 20 patients with 20 recurrent inguinal hernia were treated by open technique [Lichtenstein] and group B included 16 patients were managed by laparoscopic technique. Follow up was done after 1 week, 6week, 3months, 6 months and one year. 20 patients were treated by open technique and 16 patients were treated by laparoscopic method. No major complications were found in both techniques apart from one recurrence in the laparoscopic group [1 year after surgery]. There were difference in operative time between the two methods with favor to open technique [P< 0.05]. Laparoscopy is of great benefit in treatment of recurrent inguinal hernia due to less postoperative pain, early return to work, it still of limited applications in this field due to its serious complications. High cost and experience needed by surgeon to elicit this type of surgery. This makes conventional open technique more applicable for those patients

Vascular thoracic outlet compression syndrome

The aim of this study was to describe our experience with the surgical treatment of arterial and venous thoracic outlet syndrome. This prospective study included 25 patients with vascular compression at thoracic outlet area. They were admitted to Vascular Surgery Unit, Mansoura University Hospital during the period from July 2004 to July 2007. Patients were classified into two main groups. Group I [arterial thoracic outlet syndrome, n = 16]. Group II [venous thoracic outlet syndrome, n = 9]. The operations of arterial reconstruction were worthwhile for all patients with excellent results in 11 patients [84.6%], only 2 patients [15.4%] developed early postoperative thrombosis which was managed by transbrachial thrombectomy. The success rate of surgical interference for venous non-thrombotic patients was 100% while conservative treatment of thrombotic patients showed success in 4 patients [57%] and failure in 3 patients [43%]. In patients with vascular compression, resection of the first rib, resection of cervical rib, scalenectomy and neurolysis of the brachial plexus are recommended in addition to vascular reconstruction. Our experience using the supraclauicular approach indicate that this is a safe route with good results and minimal risk to the patients health

Hormone replacement therapy and risk of breast cancer

To determine the effect of different types and formulations of hormone replacement therapy [HRT] on the risk of breast cancer in postmenopausal women at Mansoura University Hospitals. This study was conducted in Obstetrics and Gynaecology, General Surgery and Oncology and Nuclear Medicine Departments, Faculty of Medicine, Mansoura University from January 2005 to June 2008. The study group included 210 cases of postmenopausal women ranging in age from 50-70 years with breast cancer for whom surgical interventions were done according to the stage. The study group were matched with '0 cases representing control group. The rate of breast cancer was Increased with the use of opposed estrogens in oral form [adjusted relative risk "RR" 1.1; 95% confidence interval "CI" 1.31-1.42] and injectable [RR 1.1; 95% CI 0.86-1.20]. The rate of breast cancer was not increased among users of unopposed estrogens [RR 0.96; 95% CI 0.86-1.09] or of progestins only [RR 0.86; 95% CI 0.85-1.12]. Oral etstrogen-progestin combinations appear to be associated with an increased breast cancer risk while estrogens alone and progestins are not

Induction chemotherapy followed by chemo-radiotherapy versus concurrent chemo-radiotherapy in advanced head and neck carcinomas

The aim of this study was to compare the result of application of induction chemotherapy followed by chemo-irradiation for treating locally advanced head and neck carcinoma in comparison with the former standard of concurrent chemo-irradiation. Between 2003 and 2006 we treated 74 patients with unrespectable [stage III and IV head and neck] cancer by two different protocols. The sequential protocol [Arm I], started with two courses of neoadjuvant chemotherapy [cisplatin + continuous infusions 5- fluorouracil [5-FU]], followed by a course of chemo-irradiation using conventional fractionation up to 70 Gy. The concomitant protocol [Arm II], Patients were given Cisplatin 100 mg/m[2] [D1, D22, D43]; concomitantly with a course of radiotherapy up to 70 Gy in conventional fractionation; Results from the two groups were compared. Patient and tumor characteristics were balanced [arm I=33, arm II =31 pts.]. Mean radiation dose achieved [66.3 Gy Vs. 69.6 Gy, p=0.001], response rates were [85% Vs. 88% for primary, p=0.4 and 79% Vs. 85% for lymph nodes, p=0.1]. Local control [LC; 33.5% Vs. 53.5%, p=0.04], was significantly lower in the sequential group, and overall survival [23% Vs. 38%, p=0.3] after 3 years. Acute toxicities grades III and IV predominate in the sequential group while late toxicity was similar in both groups. Concomitant chemo-irradiations is more effective in treating head and neck tumors than induction chemotherapy followed by chemo-irradiation, resulting in better local control and a trend towards improved survival

Helicobacter pylori: does it play a role in pathogenesis of acute appendicitis

The exact aetiology of acute appendicitis remains uncertain but an infective origin has been proposed. It was postulated that helicobacter pylori infection could cause mucosa associated lymphoid tissue hypertrophy in the appendix to the extent that under certain conditions luminal obstruction and acute appendicitis might occur. This study was done to confirm whether helicobacter pylori forms part of the microenvironment of the appendix and whether it play a role in the pathogenesis of acute appendicitis. This study was performed on 62 patients with acute appendicitis ranging in age from 8 to 42 years. There were 39 females and 23 males. All patients subjected to open appendicectomy, fresh specimens from the appendix was taken and cultured on blood agar and subjected to urease test. Other specimens was subjected to histopathological examination. Pathological grading of the appendicitis was performed according to the depth of inflammatory infiltrate. 10 ml of blood was drawn from all patients for serological assessment of helicobacter pylori. Fifty patients had a pathological appendix [80.6%] with different grades of inflammation. The appendix was histologically normal in 12 patients [19.3%]. Forty-two cases [67.7%] were sero negative in whom the appendix was inflamed in 33 cases [78.6%]. Twenty cases [32.3%] were seropositive in whom the appendix was inflamed in 1 7 cases [85%]. Multiple organisms were grown on all plates and 7 biopsies were positive for urease activity. There was no evidence of helicobacter pylori in any sample on histological examination. We have concluded that helicobater pylori does not colonize the appendix and is unlikely to be a pathogenic stimulus for appendicitis. However, downstream effect of gastroduodenal infestation might induce immunological effect

External spermatic vein ligation improves the outcome of varicocele surgery: fact or fiction

Internal spermatic vein is the major route of testicular venous drainage However, Surgical failure after varicocelectomy is mostly due to persistent incompetent collaterals distal to the site of ligation of internal spermatic vein and the most important collaterals is the external spermatic vein. The aim of this study was to estimate the incidence of external spermatic vein in infertile patients and to evaluate the results of inguinal varicocelectomy with combined ligation of both internal and external spermatic veins. Eighty inguinal varicocelectomies were performed on 45 infertile patients with varicocele ranging in age from 20-40 years. There were 15 fertile control patients undergoing inguinal herniorrhaphy. There were 35 patients with bilateral varicocele and 10 patients with isolated left sided varicocele [Thirty-Seven patients with primary infertility and 8 patients with secondary infertility]. Grade 2 varicocele was the commonest one [52.5%]. External spermatic veins were detected in 57 varicocelectomies [71.25%]. Improvement in semen parameters was detected postoperatively. Pregnancy occurred in 14 cases [31%] on follow up period of one year after surgery. Subclinical recurrence of varicocele occurred in 3 patients [6.6%]. Vaginal hydrocele occurred in 2 patients [4.4%]. Among control group external spermatic vein was detected only in 2 patients [13.3%]. External spermatic vein is commonly found in patients with varicocele and its ligation during inguinal varicocelectomy improves the results of surgery. So, careful searching for this vein and its ligation is advised