RESUMO
BACKGROUND: After malaria, schistosomiasis is the second most prevalent tropical disease. The prevalence of oviposition in CNS of infected persons varies from 0.3 to 30%. The conus medullaris is a primary site of schistosomiasis, either granulomatous or acute necrotizing myelitis. OBJECTIVE: To report the clinical, radiological, and laboratory results of spinal cord schistosomiasis (SCS) and to design proper therapeutic regimens. MATERIALS AND METHODS: Seventeen patients (13 males and four females) with SCS were enrolled between 1994 and 2009 at Mansoura University Hospitals. Their median age at diagnosis was 19 years (13-30 years). Independent neurological, radiological, and laboratory assessments were performed for both groups, excluding pathological confirmation that was done earlier in eight patients (Group 1). In the group 2 (nine patients), indirect hemagglutination (IHA) test for bilharziasis in blood and cerebrospinal fluid (CSF) was performed. Higher positive titer in CSF than serum indicated SCS plus induction of antibilharzial and corticosteroid protocols for 12 months with a three-year follow-up. RESULTS: Rate of neurological symptoms of granulomatous intramedullary cord lesion was assessed independently in 16 cases and acute paraparesis in one case. All patients in group 2 had positive IHA against Schistosoma mansoni with median CSF and serum ranges 1/640 and 1/320, respectively. Seven patients (41.18%) had complete recovery, eight patients (47.06%) showed partial recovery, and no response was reported in two patients (11.76%) (P = 0.005). There was no recorded mortality in the current registry. CONCLUSIONS: Rapid diagnosis of SCS with early medical therapies for 12 months is a crucial tool to complete recovery.
RESUMO
PURPOSE: The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages. PATIENTS AND METHODS: This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done (19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction). Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only. RESULTS: Perioperative mortality was 8.3% (2/24). No patient reported reflux symptoms or showed endoscopic findings of reflux esophagitis in the subdiaphragmatic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight. CONCLUSIONS: Ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention.
RESUMO
BACKGROUND: The diagnosis of thyroid carcinoma during the course of lobectomy for a dominant nodule occasionally cannot be rendered on the basis of frozen section. Once the diagnosis of carcinoma is made, the question of completion thyroidectomy arises. PATIENTS AND METHODS: During a period of 3 years, 28 patients diagnosed with well-differentiated thyroid cancer (WDTC), and operated upon with less than total thyroidectomy, were admitted to our department. Patients had no clinical or radiological evidence of any residual disease at the time of admission. All were submitted for total thyroidectomy. RESULTS: There were 7 men and 21 women (1:3), and the average age was 38.6+/-1.3 years (range, 20 to 62 years). The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 2 patients (7.1 %), permanent hypoparathyroidism in 1 patient (3.5%), there was no recurrent laryngeal nerve palsy, there were haematoma in 2 patients, and seroma in 1 patient. Completion thyroidectomy resulted in detecting 9 patients (32.1%) having residual disease that was not clinically manifest. CONCLUSION: Although many surgeons advocate total or near-total thyroidectomy for differentiated thyroid carcinoma, some of these surgeons hesitate to complete thyroidectomy after lobectomy for thyroid nodule when there is no clinical evidence to suggest bilateral disease, for fear of added morbidity to the patients. However, as demonstrated in this study, completion thyroidectomy was shown to be a fairly safe procedure, which carries a low incidence of complications. It also facilitates further management and follow-up with radioactive iodine. The decision to perform completion thyroidectomy for WDTC should be based on the patient's risk category, and not on a concern for risk of complications from the second procedure.
