Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs.

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.

A meta-analysis of the prevalence and risk of mental health problems in allergic rhinitis patients.

OBJECTIVE: Allergic rhinitis (AR), a prevalent global health concern, is increasingly recognized for its impact beyond physical symptoms, affecting mental health. This research examined the extent of AR's psychological burden and sleep disturbances. METHODS: A systematic search of four databases yielded 49 studies reporting mental health problems in 18,269,265 individuals (15,151,322 AR patients and 3,117,943 controls). The primary outcomes included all mental health problems in AR patients. Subgroup analyses based on outcome and AR severity, country, AR diagnosis, recruitment setting, and age were performed. Secondary outcomes included the risk of these problems compared to controls (healthy or without AR). RESULTS: In AR, depression (25%), anxiety (25%), stress (65%), distress (57%), suicidal thoughts (14%) and attempts (4%), poor sleep quality (48%), insomnia (36%), sleep impairment (33%), and insufficient sleep duration <7 h (59%) were prevalent. The severity of these outcomes differed significantly. Patients' country, AR diagnostic method, recruitment method/setting, and age group were significant effect modifiers. Compared to controls, AR resulted in significantly higher risk of depression, anxiety, stress, suicidal attempts and thoughts, insomnia, and sleep impairment. CONCLUSION: AR patients had significantly lower sleep duration. Mental health problems are very common among AR patients, further exacerbating their sleep quality and duration and intention to suicide.

Thyroid US-guided FNA techniques: A prospective,randomized controlled study.

BACKGROUND: Thyroid nodules are common in the general population. Ultrasonography is the most efficient diagnostic approach to evaluate thyroid nodules. The US FNAC procedure can be performed using either the short axis (perpendicular), or a long axis (parallel) approach to visualize the needle as it is advanced toward the desired nodule. The main aim of this study was to compare the percentage of non-diagnostic results between the long and short axis approach. METHODS: A prospective study that included a randomized controlled trial and was divided into two arms-the short axis and the long axis-was conducted. A total of 245 thyroid nodules were collected through the fine needle aspiration cytology, performed with ultrasound, from march 2021 to march 2022. The patient's demographic information were collected and also nodules characteristics. RESULTS: Of 245 nodules sampled, 122 were sampled with the long axis method, while 123 with the short axis method. There is not significantly less non diagnostic approach with either method compared to the other (11.5 % vs 16.3 % respectively). DISCUSSION: Previous studies came to the conclusion that the long axis method yields fewer non diagnostic samples. This study evaluated the two FNA approaches which were proceeded by the same physician who is expert in both techniques. CONCLUSION: The US FNAC performed in the long axis approach will not produce more conclusive results and less non diagnostic results (Bethesda category 1) than the short axis approach one.

Does acute isolated sphenoidal sinusitis meet the criteria of the recent acute sinusitis guidelines, EPOS2020?

INTRODUCTION: Isolated sphenoidal sinusitis (ISS) is a rare disease with non-specific symptoms and a potential for complications. Diagnosis is made clinically, endoscopically, and with imaging like CT scans or MRIs. This study aimed to evaluate if ISS meets the EPOS 2020 criteria for diagnosing acute rhinosinusitis and if new diagnostic criteria are needed. MATERIALS AND METHODS: The study analyzed 193 charts and examination records from 2000 to 2022 in patients diagnosed with isolated sphenoidal sinusitis at the Ziv Medical Center in Safed, Israel. Of the 193, 57 patients were excluded, and the remaining 136 patients were included in the final analysis. Patients were evaluated using Ear, Nose and Throat (ENT), neurological and sinonasal video endoscopy, radiological findings, demographic data, symptoms and signs, and laboratory results. All these findings were reviewed according to the EPOS 2020 acute sinusitis diagnosis criteria and were analyzed to determine if ISS symptoms and signs fulfilled them. RESULTS: The patients included 40 men and 96 women, ranging in age from 17 to 86 years (mean ± SD, 37 ± 15.2 years). A positive endoscopy and radiography were encountered in 29.4%, and headache was present in 98%; the most common type was retro-orbital headache (31%). The results showed that there is no relationship between the symptoms of isolated sphenoidal sinusitis and the criteria for diagnosing acute sinusitis according to EPOS 2020. CONCLUSION: ISS is an uncommon entity encountered in clinical practice with non-specific symptoms and a potential for complications. Therefore, the condition must be kept in mind by clinicians, and prompt diagnosis and treatment must be initiated. This kind of sinusitis does not fulfill the standard guidelines for acute sinusitis diagnosis criteria.

Local Excision Versus Total Mesorectal Excision After Favourable Response to Neoadjuvant Therapy in Low Rectal Cancer: a Multi-centre Experience.

The gold standard surgical management of curable rectal cancer is proctectomy with total mesorectal excision. Adding preoperative radiotherapy improved local control. The promising results of neoadjuvant chemoradiotherapy raised the hopes for conservative, yet oncologically safe management, probably using local excision technique. This study is a prospective comparative phase III study, where 46 rectal cancer patients were recruited from patients attending Oncology Centre of Mansoura University and Queen Alexandra Hospital Portsmouth University Hospital NHS with a median follow-up 36 months. The two recruited groups were as follows: group (A), 18 patients who underwent conventional radical surgery by TME; and group (B), 28 patients who underwent trans-anal endoscopic local excision. Patients of resectable low rectal cancer (below 10 cms from anal verge) with sphincter saving procedures were included: cT1-T3N0. The median operative time for LE was 120 min versus 300 in TME (p < 0.001), and median blood loss was 20 ml versus 100 ml in LE and TME, respectively (p < 0.001). Median hospital stay was 3.5 days versus 6.5 days (p = 0.009). No statistically significant difference in median DFS (64.2 months for LE versus 63.2 months for TME, p = 0.85) and median OS (72.9 months for LE versus 76.3 months for TME, p = 0.43). No statistically significant difference in LARS scores and QoL was observed between LE and TME (p = 0.798, p = 0.799). LE seems a good alternative to radical rectal resection in carefully selected responders to neoadjuvant therapy after thorough pre-operative evaluation, planning and patient counselling.

Evaluation of Topical Sclerosant Agents for Minimization of Postmastectomy Seroma: A Placebo-Controlled, Double-Blind, Randomized Trial.

Objective: Seroma after mastectomy is a bothersome problem. Topical sclerosants are one method used to reduce seroma. The aim of this study was to evaluate if spraying flaps before closure with doxycycline or bleomycin after total mastectomy can prevent seroma. Materials and Methods: After institutional review board approval, using a computer-based randomization program, a prospective, double-blind, placebo-controlled randomized, superiority study was conducted during the period from the first of August 2017 to the first of August 2018. IRB proposal code was MS/17.08.66 and the trial was approved at 15/8/2017. The trial is available publicly at http://www.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesisPages.aspx?fn=PublicDrawThesis&BibID=12553049. The primary outcome of the study was to assess the incidence of seroma following total mastectomy after intervention comprising spraying of skin flaps with doxycycline or bleomycin versus placebo. Patients who were candidates for total mastectomy were randomized into control, doxycycline, and bleomycin groups. The postoperative data included length of the hospital stay, pain score among the three groups, post-operative drained fluid volume, post-operative day of drain removal, complication rates including infection, flap necrosis and hematoma, the incidence of seroma and aspirated seroma volume, and total number of postoperative visits. Results: Of 125 patients, 90 were candidates for total mastectomy. Analysis of these 90 showed that the incidence of seroma was similar; 43.4%, 40% and 40% in the control, doxycycline, and bleomycin groups, respectively (p = 0.99). Furthermore, wound complication rates were similar among all groups. Conclusion: Despite improved recognition and management of risk factors, seromas remain a common clinical concern in the postoperative setting of total mastectomy. These results suggest that sclerosant agents, specifically bleomycin and doxycycline, have no utility for prevention of post mastectomy seroma.

Nipple Sparing Goldilocks Mastectomy, A New Modification of the Original Technique.

Objective: Although Goldilocks mastectomy offers good aesthetic outcomes. Removal of the nipple-areolar complex (NAC) often has a negative psychological impact. The objective of this study was to assess the feasibility and esthetic outcome of this technique with salvage of the NAC using a dermal pedicle. Materials and Methods: The study included female patients suffering from breast carcinoma with large and or ptotic breast. Patients were offered Goldilocks mastectomy. Those who were unfit for anesthesia, those with locally advanced or metastatic disease or those refusing the procedure were excluded. Results: Fifteen female patients (18 breasts) with a mean age of 51.6 years underwent Goldilocks breast reconstruction with a trial of NAC preservation. The mean body mass index was 39.1 kg/m2. More than half (56%) were cup C, while 44% were cup D. Seven cases (46.7%) showed grade II ptosis and 8 (53.3%) were grade III. The mean operative time was 168 minutes (range 130-240 minutes). NAC ischemic changes were noted in five cases; two (11%) were partial while three (17%) were total. Two cases (11%) suffered from flap loss and one of them was total. No locoregional recurrence or distant metastases were observed. Conclusion: The Goldilocks mastectomy with nipple preservation is an appealing and feasible option for a certain group of patients who have large-sized and/or ptotic breasts. Nevertheless, it is a time-consuming technique with relatively higher rates of flap and NAC complications. Further, studies are required with a larger number of cases and longer follow-up.

The Evaluation of a Cost-Effective Method for Tumour Marking Prior to Neo-Adjuvant Chemotherapy Using Silver Rods.

Objective: The lack of objective documentation of pre-neoadjuvant chemotherapy (NAC) tumour margins is a major constraint in performing safe breast conserving surgery (BCS) in patients with breast cancer. Using a novel method of marking pre-NACT tumour margins with indigenous silver wire markers, this retrospective observational study attempted to assess the feasibility of safe BCS in breast cancer patients by performing excision wide of the marked pre-NACT margins. Materials and Methods: This retrospective observational study was conducted on breast cancer patients who were attending our oncology centre between May, 2015 and April, 2022. All patients had received NAC followed by surgery as recommended by our multidisciplinary team. All the patients had a primary operable solitary breast cancer. We used radiopaque metallic rods made from silver to localize tumour margins prior to NAC. Results: Sixty-four breast cancer patients were included; none had marker-related complications. Following NAC, BCS could be easily performed in 60 patients guided by the silver markers, which were used as temporary implants and removed during surgery. Only 2 patients were seen with positive margins and were converted to mastectomy. Conclusion: Breast cancer localization using sterile silver markers before the initiation of NAC is safe, easy, inexpensive, and effective, causing no morbidity or significant pain to the patients.

Ultrasound-Guided Fine Needle Aspiration of Deep Thyroid Nodule: Is There a Correlation between the Nodule's Depth and Nondiagnostic Results?

Objective: To evaluate whether thyroid nodule depth correlates with nondiagnostic results in ultrasound-guided fine needle aspiration cytopathology. Background: Many factors correlate with nondiagnostic ultrasound-guided fine needle aspiration cytology (FNAC) results, including older age, macrocalcification, small-sized nodules, aspirin medication, and cystic portion in more than 50% of the thyroid nodules. However, there are few studies which have examined whether there is a relationship between the depth of nodules and the percentage of nondiagnostic results in cytology (Bethesda category I). We conducted this study in order to investigate if such a correlation exists. Materials and Methods: FNAC was performed on 283 thyroid nodules between January 2019 and December 2020. Cytological analyses of the nodules were reviewed and sorted as nondiagnostic and diagnostic according to the Bethesda score. Patient files and ultra sound (US) scans were reviewed for clinical information (such as age, sex, and ethnic group) and sonographic features of nodules (such as depth, size, cystic portion, type of calcification, and echogenicity) and were compared between the nondiagnostic and diagnostic nodule results. The depth of a nodule was calculated as the shortest distance from the skin to the most superficial border of the nodule in the axial plane, using our medical center's computer program, which allows reviewing all saved shots of the US scan. Results: Age, sex, and ethnicity were not significantly different between the nondiagnostic group and the diagnostic group (p > 0.05). Nodule diameter, cystic portion, calcification, and echogenicity were also not associated with the frequency of nondiagnostic results. The depth of nodules ≥9 mm was correlated with nondiagnostic US-guided FNA cytological results (OR = 2.55, p=0.018). Conclusions: Deep thyroid nodules correlated with nondiagnostic US-guided FNA cytological results. Further studies are needed for optimizing the approach to deep thyroid nodules in order to improve the efficacy of FNA in deep thyroid nodules.

Pembrolizumab as a first line therapy in a patient with extensive mucoepidermoid salivary gland carcinoma. A complete clinical, radiological and pathological response. A very specific case.

BACKGROUND: Patients with advanced salivary gland malignancies (SGCs) have few therapy options. Although results from newly published trials suggest that checkpoint inhibition may be useful in a subgroup of patients, there are no clear criteria for PD-L1 score in SGCs. Chemotherapy benefits were observed to be limited, with a dismal prognosis in unresectable and high-grade SGC. Immunotherapies have demonstrated extraordinary efficacy in a variety of cancers, including non-small cell lung cancer and malignant melanoma. Anti-PD-1 antibody pembrolizumab has been shown to have potent anti-tumor action in a number of clinical trials. CASE PRESENTATION: We report a unique case of advanced high grade mucoepidermoid carcinoma of the parotid salivary gland after Pembrolizumab treatment as a first line therapy. The tumor was downstaged as a result of the pembrolizumab treatment, allowing for a successful surgical excision with no facial nerve sacrifice and no major neoadjuvant treatment adverse effects, and the final specimen pathology was tumor-free. In these types of malignancies, a similar technique resulted in a complete response (CR) radiologically and pathologically has never been discussed before. CONCLUSIONS: In pretreated patients with high-grade salivary gland mucoepidermoid carcinoma, pembrolizumab showed good anticancer activity and provided a clinically, radiologically, and pathological response with a viable treatment choice. More research is needed to bring Pembrolizumab to the front-line of treatment. The time and duration of medication should be compared to the time required for surgery in these investigations.

Use of Thoracodorsal Artery Perforator (Tdap) Flap to Cover a Laparoscopically Harvested Omental Flap After Modified Radical Mastectomy; a Case Report.

Omental flap was introduced for breast reconstruction after mastectomy either alone or as an adjunct to prosthetic reconstruction. Laparoscopically harvested omental flap was used successfully for this issue. Most of reports had described its use after partial mastectomy, skin or nipple areola sparing mastectomies. In this case, we used the thoracodorsal artery perforator (Tdap) flap as a cover for the omental flap in a patient who underwent modified radical mastectomy. Modified radical mastectomy was done in the usual fashion. The descending branch of the thoracodorsal vessel was traced till its main perforator in an antegrade fashion. Then, the supplied skin island flap was created and rotated to cover the laparoscopically harvested omental flap that was delivered after its mobilization through a small epigastric wound from underneath the inner aspect of the lower mastectomy flap. The overall operative time was around 150 min. No blood transfusion was required. Pain score was around 6-7 in the early postoperative hours. No major complications were encountered, and the patient was discharged at the third postoperative day. The overall esthetic score was expressed as "good." To our knowledge, this is the first time to report usage of laparoscopically harvested omental flap after modified radical mastectomy with skin coverage by the thoracodorsal artery perforator (Tdap) flap. One criticism that may arise is the dual flap reconstruction; however, this method still as an alternative to the myocutaneous flaps with a reasonable operative time and minimal donor site and overall morbidities with good esthetic outcome. Modified radical mastectomy can be safely and efficiently reconstructed using a laparoscopically harvested omental flap with a cutaneous coverage using the thoracodorsal artery perforator (Tdap) flap.

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

BACKGROUND: The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma. METHODS: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year. RESULTS: Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%). CONCLUSION: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function.

A New Concept of Interval TRAM for Immediate Breast Reconstruction in Obese Women.

Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1 week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35 days. The mean total volume of blood loss was 380 ± 82.33 ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of "Interval TRAM" enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.

Distribution patterns of natural radionuclides and rare earth elements in marine sediments from the Red Sea, Egypt.

The present study was conducted to study the compositional trends of rare earth elements (REEs), Th, and U in marine sediment samples in terms of distribution patterns, anomalies, and indicator ratios. For this purpose, a total of 32 marine sediment samples were collected from 12 coastal areas of the Egyptian Red Sea and analyzed using instrumental neutron activation (INAA) and inductively coupled plasma mass spectrometry (ICP-MS) analytical techniques. The analyses investigated 14 REEs, Th, and U. The results revealed that the contents of REE, light REE (LREE), and heavy REE (HREE) are 47.6, 38.7, and 8.3 mg/kg, respectively, whereas the concentration of Th and U is determined as 2.15 and 2.23 mg/kg, respectively. Indicator ratios were calculated, and inter-correlation elements with Th and U were constructed. Multivariate statistics were implemented on the data and GIS technology to construct the distribution patterns of REE, Th, and U along the Egyptian coast of the Red Sea. The obtained results were compared with the corresponding values published in literature to show a good matching. There is a significant enrichment of LREE relative to HREE, a reduced ratio of Th/U, a weak positive anomaly of Eu/Eu*, and a slight positive Ce anomaly is noticed. Among the 12 studied areas, one area, Sharm El-Bahari, located in the middle of the coast, shows peak values of REE, Th, and U relative to the other areas. However, it still shows a good agreement with the results published in the literature.

Feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy.

The aim of the study is to evaluate the feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy (LNSRH). The post-operative bladder catheterisation period of 30 patients who underwent LNSRH at two institutes in Egypt and Italy were prospectively evaluated with postoperative drainage of the bladder through a Foley catheter for two days without performing bladder-training exercise. The median duration for postoperative bladder catheterisation was 3.5 (3-5) days. Within the fifth postoperative day, 82.7% had a PVR urine volume less than 100 ml. None of the patients had PVR urine more than 100 ml more than 10 days after the operation with no need for self-catheterisation. These results support early postoperative bladder catheter removal without prior bladder-training exercises following LNSRH. IMPACT STATEMENT What is already known on this subject? Bladder-training exercise was used routinely following radical hysterectomy (RH) operations before bladder catheter removal. Only two studies reported that these exercises could be omitted, but one study was done on both laparoscopic and open RH patients and the other did not show whether the operation was nerve-sparing and whether it was done by laparoscopy or open technique. What the results of this study add? This study's results support early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing RH. What the implications are of these findings for clinical practice and/or further research? Excluding the unnecessary procedure of bladder training, which is time- and effort-consuming, after the operation.

Etiologic and Clinicopathological Correlates of Gastric Carcinoma in the Egyptian Delta.

We aimed at evaluation of the clinicoepidemiologic data of patients with gastric carcinoma in the Egyptian Delta as regards the etiologic factors, behavior, presenting symptoms, and tumor location, grade, and stage with highlighting of the treatment modalities, survival, and prognostic factors. Three hundred cases with gastric carcinoma were enrolled, diagnosed, and treated in a tertiary oncology center in the Egyptian Delta. Data were collected as regards the etiology, presenting symptoms, family history, comorbid conditions, treatment modalities, responses, recurrences, and survival outcomes. Univariate and multivariate analyses were done to correlate the different clinicopathologic factors with the overall and disease-free survivals. Male to female ratio was 2:1. The median age was 43 years. The main tumor location was in the gastric body. Pain was the commonest presenting symptom (36%). Most of the cases were stage IV (42.0%). Only 49% of cases were operable. On multivariate analysis, age more than 60 years, performance status 3-4, high grade, diffuse type, T4 lesions, N2 and N3, and the presence of metastasis were independently associated with worse OS. We report a clinic-epidemiologic study of gastric carcinoma in the Egyptian delta; the age at presentation was a decade earlier than that recorded in the USA and Europe; most of the cases were sporadic, located mostly at the body. Most of the cases were presented at stage IV with poor response to neoadjuvant therapy with a poorer overall survival than that recorded in the USA and Europe.

Stridor as the First Presentation of Metastatic Breast Cancer that Was Managed with Chemotherapy: a Case Report.

Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a case of metastatic breast cancer to the deep cervical lymph nodes that caused stridor due to compression of the recurrent laryngeal nerve which was diagnosed by indirect laryngoscopy. After full investigations, urgent chemotherapy was started and it showed a dramatic response with disappearance of the lymph node after two cycles with resolution of the stridor. This report also highlights the association of other metastatic sites with this higher level of neck nodal metastases of breast cancer.

Assessment of anthropogenic and geogenic impacts on marine sediments along the coastal areas of Egyptian Red Sea.

The present study was conducted to assess the possible impacts of human activities and naturally occurring on the marine sediments, to test for anomalous enrichments in metals. A total of 32 marine sediments samples collected from 12 coastal areas of the Egyptian Red Sea analyzed using different analytical techniques. The analysis explored 43 elements for the marine sediments. Principal component analysis and multivariate statistics were implemented on the data. The extent of pollution was quantified for selected 6 pollutants using the geoaccumulation indices (Igeo), enrichment factor (EF), metal pollution index (MPI), contamination factor (Cf), and degree of contamination factor (Cd). The associated risk using potential ecological risk factor (PER), and risk index (RI) was calculated. The data was interpolated using ArcGIS technology to construct the spatial distribution maps of the selected 6 pollutants along the coastal areas of the Egyptian Red Sea. The data was normalized and the peak values were observed for Ca (13.6%) >Na (1.9%) > Mg (1.6%) >Br (41.1 ppm). The obtained findings were compared with other local and regional data shows that the metal enrichment in studied areas is in line and anomalous enrichments in metals were not evidenced. Even though out of 12 studied areas 2 areas viz., Sharam El-Bahari in the middle of the coast and downwards to the southern Marsa Hemira area found to have peak values of metals, however still show a good agreement with results with other data. Moderate enriched sediments with Cr were noticed. It could be stated that comparison of the gained data from this study with others clearly indicates that nearly the metal concentrations were in the natural unpolluted sediments range.

Absence of Neck Scars With Total Endoscopic Submandibular Sialadenectomy Using a Chest Wall Approach: A New Technique.

INTRODUCTION: This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic submandibular sialadenectomy through a chest wall approach without the creation of any neck incisions. METHODS: Four patients with benign submandibular gland lesions underwent a total endoscopic submandibular sialadenectomy through a chest wall approach using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). RESULTS: The operative time ranged from 140 to 170 minutes. Conversion to the open technique was only necessary in one case with good visualization of the facial vein and artery, marginal mandibular and lingual nerve. No significant perioperative complications were encountered. All patients were discharged on the third postoperative day, and they were satisfied with the cosmetic outcome. CONCLUSION: Total endoscopic submandibular sialadenectomy through a chest wall approach is technically feasible and safe with satisfactory cosmetic results. It may be a valid alternative to conventional surgery when performed in select patients. The absence of neck scars and the ability to avoid potential nerve injuries are the most obvious advantages of this innovative technique.

Role of Hepatic Resection for HCC in the era of Transplantation; an Experience of Two Tertiary Egyptian Centers.

The surgical treatments of hepatocellular carcinoma (HCC) in a cirrhotic liver include both hepatic resection and liver transplant. While the liver transplant is considered as a golden therapy, it has some obstacles including shortage of organs especially living donors, economic circumstances, and the progression of a tumor while waiting for the transplant so the second choice which is resection should have a role. In this study, 84 patients with HCC (who were legible for transplant according to Milan and extended selection criteria) were enrolled for hepatic resection. The outcome including complication and the oncologic outcome was evaluated. We followed our patients for 15 months as a median follow-up (range from 3 to 50 months); we noticed 10 tumor relapse (11.7%) and seven lost (8.3%). We also noticed no recurrence. Patients' overall survival showed a median of 15 and 50 months, respectively. We can conclude that there is reasonability for HR as an effective optional treatment for patients with HCC who are legible for transplant particularly for patients with a Child-A scoring.