Mahmoud A. Mohammed, Sherif Mokhtar, Esraa Osama, Omar Sherif
Breast cancer is the most common type of cancer and the second leading cause of mortalities among women. Early-stage diagnosis of breast cancer increases the chances of survival, and therefore, reduces mortality rates. A national initiative was implemented in Egypt in 2019 when women above the age of 18 years were granted free screening at 3538 healthcare units, and 114 hospitals nationwide. To describe the sociodemographic factors and clinicopathological presentation of breast cancer among the patients presented to Cairo University Hospital over 5 years. We conducted a descriptive historical study at Kasr Al-Ainy Teaching Hospital of Cairo University, we retrospectively assessed all women with primary breast cancer diagnosed over 5 years during the period from the July 1, 2017 to the July 1, 2022. Data was collected from medical records, operative notes, radiology reports, and pathology reports from the database system of the Oncology Department of Cairo University Hospitals (Kasr Al-Ainy). The patient data is put into a spreadsheet that focuses on the demographic and clinicopathological characteristics of the patients (age, size of the tumor, side of breast affected, histopathology findings, imaging characteristics, immunohistochemistry, and TNM staging of breast cancer). We enrolled a total of 509 female patients who were screened for early detection of breast cancer during the past 5 years in general surgery, radio diagnosis, and oncology departments, Kasr Al-Ainy Teaching Hospital; they showed a mean age of 53.7±11.7 years and ranged between 26 and 88 years. In the current study molecular subtyping showed that 24.4% were Luminal A, 34% were Luminal B1, 19.4% were Luminal B2, 9.2% were HER2-enriched and 13% were triple-negative breast cancer subtype. We found that neoadjuvant therapy was prescribed for 190 (37.3%) patients, 36 (19%) of those patients achieved pCR, while the remaining patients had residual disease in the postoperative specimen. We concluded that in our center, Egyptian females are diagnosed with breast cancer earlier compared with developed countries; however, the current study reports approximately the same percentages of molecular subtypes, rates of pCR, and metastatic disease at the time of presentation compared with developed countries.
{"title":"Retrospective descriptive analysis of the demographic and clinicopathological presentation of breast cancer patients in Kasr Al-Ainy Hospital over 5 years","authors":"Mahmoud A. Mohammed, Sherif Mokhtar, Esraa Osama, Omar Sherif","doi":"10.4103/ejs.ejs_316_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_316_23","url":null,"abstract":"\u0000 \u0000 Breast cancer is the most common type of cancer and the second leading cause of mortalities among women. Early-stage diagnosis of breast cancer increases the chances of survival, and therefore, reduces mortality rates. A national initiative was implemented in Egypt in 2019 when women above the age of 18 years were granted free screening at 3538 healthcare units, and 114 hospitals nationwide.\u0000 \u0000 \u0000 \u0000 To describe the sociodemographic factors and clinicopathological presentation of breast cancer among the patients presented to Cairo University Hospital over 5 years.\u0000 \u0000 \u0000 \u0000 We conducted a descriptive historical study at Kasr Al-Ainy Teaching Hospital of Cairo University, we retrospectively assessed all women with primary breast cancer diagnosed over 5 years during the period from the July 1, 2017 to the July 1, 2022. Data was collected from medical records, operative notes, radiology reports, and pathology reports from the database system of the Oncology Department of Cairo University Hospitals (Kasr Al-Ainy). The patient data is put into a spreadsheet that focuses on the demographic and clinicopathological characteristics of the patients (age, size of the tumor, side of breast affected, histopathology findings, imaging characteristics, immunohistochemistry, and TNM staging of breast cancer).\u0000 \u0000 \u0000 \u0000 We enrolled a total of 509 female patients who were screened for early detection of breast cancer during the past 5 years in general surgery, radio diagnosis, and oncology departments, Kasr Al-Ainy Teaching Hospital; they showed a mean age of 53.7±11.7 years and ranged between 26 and 88 years. In the current study molecular subtyping showed that 24.4% were Luminal A, 34% were Luminal B1, 19.4% were Luminal B2, 9.2% were HER2-enriched and 13% were triple-negative breast cancer subtype. We found that neoadjuvant therapy was prescribed for 190 (37.3%) patients, 36 (19%) of those patients achieved pCR, while the remaining patients had residual disease in the postoperative specimen.\u0000 \u0000 \u0000 \u0000 We concluded that in our center, Egyptian females are diagnosed with breast cancer earlier compared with developed countries; however, the current study reports approximately the same percentages of molecular subtypes, rates of pCR, and metastatic disease at the time of presentation compared with developed countries.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140220773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Abuelnaga, Youssef Kotb, Waleed Mohamed, Hossam Elawady, Diaa Mostafa
For the initial assessment and follow-up of patients with ureteropelvic junction obstruction (UPJO), we conducted this prospective study to assess the renal parenchyma to hydronephrosis area ratio (PHAR) in conjunction with the renal scan in patients who will undergo pyeloplasty. Patients who had visited the outpatient clinic for 2 years were diagnosed with UPJO, and fit the requirements for requiring surgical intervention were chosen. Before pyeloplasty and 3 months after surgery, PHAR and a renal isotope scan were conducted concurrently. Thirty-six patients were evaluated. After the operation, 31 (86.1%) cases improved and five (13.9%) cases did not improve. There was a significant change in all parameters at 3 months postoperatively as the mean T½ has significantly decreased (25.22±2.49 vs. 17.57±3.84). Also, there was a significant increase in the mean parenchymal thickness (9.42±4.92 vs. 15.12±4.86), glomerular filtration rate of the affected kidney (34.31±3.31 vs. 48.32±6.99) split renal function (37.30±3.80 vs. 44.03 ±4.11) and PHAR (0.86±0.30 vs. 2.45±0.93) at 3 months postoperative. PHAR postoperatively shows a positive correlation with parenchymal thickness, glomerular filtration rate of the affected kidney, and renal split function, while there is a negative correlation with T½. PHAR is a potential noninvasive measure that may be evaluated during ultrasonography assessment to aid in predicting future surgical needs for UPJO and for postpyeloplasty follow-up in pediatric patients.
为了对输尿管肾盂连接处梗阻（UPJO）患者进行初步评估和随访，我们开展了这项前瞻性研究，结合肾脏扫描评估将要接受肾盂成形术的患者的肾实质与肾积水面积比（PHAR）。 研究选择了在门诊就诊 2 年、确诊为 UPJO 并符合手术治疗要求的患者。在肾盂成形术前和术后 3 个月，同时进行 PHAR 和肾同位素扫描。 对 36 名患者进行了评估。手术后，31 例（86.1%）病情好转，5 例（13.9%）病情未好转。术后 3 个月，所有参数均有明显变化，平均 T½ 显著下降（25.22±2.49 vs. 17.57±3.84）。此外，术后 3 个月时，平均肾实质厚度（9.42±4.92 vs. 15.12±4.86）、患肾肾小球滤过率（34.31±3.31 vs. 48.32±6.99）、分裂肾功能（37.30±3.80 vs. 44.03±4.11）和 PHAR（0.86±0.30 vs. 2.45±0.93）均有明显增加。术后 PHAR 与肾实质厚度、患肾肾小球滤过率和肾分裂功能呈正相关，而与 T½ 呈负相关。 PHAR 是一种潜在的无创测量指标，可在超声波检查评估期间进行评估，以帮助预测未来对 UPJO 的手术需求，并对小儿患者进行肾盂成形术后随访。
{"title":"The role of renal parenchyma to hydronephrosis area ratio in the evaluation of ureteropelvic junction obstruction in children","authors":"M. Abuelnaga, Youssef Kotb, Waleed Mohamed, Hossam Elawady, Diaa Mostafa","doi":"10.4103/ejs.ejs_320_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_320_23","url":null,"abstract":"\u0000 \u0000 For the initial assessment and follow-up of patients with ureteropelvic junction obstruction (UPJO), we conducted this prospective study to assess the renal parenchyma to hydronephrosis area ratio (PHAR) in conjunction with the renal scan in patients who will undergo pyeloplasty.\u0000 \u0000 \u0000 \u0000 Patients who had visited the outpatient clinic for 2 years were diagnosed with UPJO, and fit the requirements for requiring surgical intervention were chosen. Before pyeloplasty and 3 months after surgery, PHAR and a renal isotope scan were conducted concurrently.\u0000 \u0000 \u0000 \u0000 Thirty-six patients were evaluated. After the operation, 31 (86.1%) cases improved and five (13.9%) cases did not improve. There was a significant change in all parameters at 3 months postoperatively as the mean T½ has significantly decreased (25.22±2.49 vs. 17.57±3.84). Also, there was a significant increase in the mean parenchymal thickness (9.42±4.92 vs. 15.12±4.86), glomerular filtration rate of the affected kidney (34.31±3.31 vs. 48.32±6.99) split renal function (37.30±3.80 vs. 44.03 ±4.11) and PHAR (0.86±0.30 vs. 2.45±0.93) at 3 months postoperative. PHAR postoperatively shows a positive correlation with parenchymal thickness, glomerular filtration rate of the affected kidney, and renal split function, while there is a negative correlation with T½.\u0000 \u0000 \u0000 \u0000 PHAR is a potential noninvasive measure that may be evaluated during ultrasonography assessment to aid in predicting future surgical needs for UPJO and for postpyeloplasty follow-up in pediatric patients.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140219261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Elshazly, Ahmed Radwan, Mohmed A. Elhalim, Ahmed Moaz
This study aimed to assess the efficiency of the new modified inverted Y cleft lift procedure, utilizing an advancement flap technique with off-midline primary wound closure for patients with lower pits of the sinus near the anus. This prospective case series was conducted from September 2018 to September 2020. Forty patients with sacrococcygeal pilonidal sinus disease with lower pits near the anus presented either as new cases or recurrent cases. All patients were offered the new modified inverted Y cleft lift advancement flap procedure and were followed up for 48.5 months (range, 21–57 months). Patients were evaluated in terms of operation time, postoperative complications, recurrence rate, return-to-work time, and cosmetic satisfaction. The average age was 27.4 years (range, 16–52 years); 29 (72.5%) patients were male and 11 (27.5%) were female. The mean operating time was 25 min (range, 22–45 min) and the mean length of hospital stay was 0.8 days (range, 0.4–2 days). Primary healing occurred in 35 (87.5%) patients. Complete healing for complicated wounds (five patients) was achieved in an average of 21 (14–60) days. Two (5%) patients developed a superficial wound infection, four (10%) patients experienced a seroma, and five (12.5%) had partial dehiscence (some complications observed in the same patient). There was no case of deep infection, hematoma formation, or complete dehiscence. This series proved that the new modification inverted Y cleft lift flap reconstruction is an effective operative procedure for primary and recurrent pilonidal sinus cases with pits located very close to the anus, associated with low complication and recurrence rates. What does this paper add to the literature? This paper discusses a new modification to the modified cleft lift procedure named the inverted Y flap procedure, achieving off-midline primary wound closure in patients with a difficult situation with lower pits of the sinus very close to the anus, for pilonidal disease either primary or recurrent.
{"title":"Efficiency of the new modified inverted Y cleft lift advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease with low-lying tracts near the anus","authors":"W. Elshazly, Ahmed Radwan, Mohmed A. Elhalim, Ahmed Moaz","doi":"10.4103/ejs.ejs_322_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_322_23","url":null,"abstract":"\u0000 \u0000 This study aimed to assess the efficiency of the new modified inverted Y cleft lift procedure, utilizing an advancement flap technique with off-midline primary wound closure for patients with lower pits of the sinus near the anus.\u0000 \u0000 \u0000 \u0000 This prospective case series was conducted from September 2018 to September 2020. Forty patients with sacrococcygeal pilonidal sinus disease with lower pits near the anus presented either as new cases or recurrent cases. All patients were offered the new modified inverted Y cleft lift advancement flap procedure and were followed up for 48.5 months (range, 21–57 months). Patients were evaluated in terms of operation time, postoperative complications, recurrence rate, return-to-work time, and cosmetic satisfaction.\u0000 \u0000 \u0000 \u0000 The average age was 27.4 years (range, 16–52 years); 29 (72.5%) patients were male and 11 (27.5%) were female. The mean operating time was 25 min (range, 22–45 min) and the mean length of hospital stay was 0.8 days (range, 0.4–2 days). Primary healing occurred in 35 (87.5%) patients. Complete healing for complicated wounds (five patients) was achieved in an average of 21 (14–60) days. Two (5%) patients developed a superficial wound infection, four (10%) patients experienced a seroma, and five (12.5%) had partial dehiscence (some complications observed in the same patient). There was no case of deep infection, hematoma formation, or complete dehiscence.\u0000 \u0000 \u0000 \u0000 This series proved that the new modification inverted Y cleft lift flap reconstruction is an effective operative procedure for primary and recurrent pilonidal sinus cases with pits located very close to the anus, associated with low complication and recurrence rates.\u0000 What does this paper add to the literature?\u0000 This paper discusses a new modification to the modified cleft lift procedure named the inverted Y flap procedure, achieving off-midline primary wound closure in patients with a difficult situation with lower pits of the sinus very close to the anus, for pilonidal disease either primary or recurrent.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140212589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmoud R. M. Elsebaai, Mohamed A. H. Shehab, Dina M. Hanafy, Karim F. Abd Al Moaty
Sentinel lymph nodes biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in a considerable percentage of patients with early-stage breast cancer which was a great advance in preventing many surgical complications and enhancing their health welfare. Although there are different sentinel lymph nodes (SLNs) tracers with different identification rates, there is no agreement about the idealistic method. The study was designed to compare carbon nanoparticles and patent blue v dye regarding SLNs detection rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety in patients with early breast cancer and clinically node-negative axilla. A total of 40 patients with axillary lymph node-negative early-stage breast cancer patients were divided into two groups and subjected to carbon nanoparticles and patent blue V dye in group A and group B, respectively. Patients who were pregnant or lactating had node-positive axilla (N1-3) or metastatic breast cancer (M1) or had neoadjuvant chemotherapy were excluded. The mean age was 48.3±9.5 and 47 ±8.9, while the mean BMI of 33.3±4.8 and 32.834±4.862, the SLN detection rates were 95% and 90% in groups A and B, respectively. A total of 128 sentinel lymph nodes (SLNs) were removed from patients in the two groups (65 with Carbon Nanoparticles and 63 with patent blue dye). The mean number of SLNs was 3.4±0.7 (range, 2–5) and 3.5±1.2 (range, 2–7), mean time of SLNs detection was 13.5±4.5 (range, 7–22) and 12.7± 3.6 (range, 7–18 min) between group A and B, respectively. There is no significant difference between carbon nanoparticles and patent blue dye regarding axillary SLNs in early breast cancer regarding identification rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety with slight preference to carbon nanoparticles regarding postoperative skin staining and Egyptian market availability.
在相当一部分早期乳腺癌患者中，前哨淋巴结活检（SLNB）已经取代了腋窝淋巴结清扫术（ALND），这在预防许多手术并发症和提高患者健康水平方面是一大进步。虽然有不同的前哨淋巴结（SLNs）示踪剂，其识别率也不同，但对于理想的方法却没有一致的看法。 本研究旨在比较碳纳米粒子和专利蓝 v 染料对早期乳腺癌和临床结节阴性腋窝患者的前哨淋巴结检测率、前哨淋巴结数量、检测时间、转移性前哨淋巴结、成本和安全性的影响。 研究人员将 40 名腋窝淋巴结阴性的早期乳腺癌患者分为两组，A 组和 B 组分别使用碳纳米粒子和专利蓝 V 染料。排除妊娠期、哺乳期、腋窝淋巴结阳性（N1-3）、转移性乳腺癌（M1）或接受过新辅助化疗的患者。 A组和B组的平均年龄分别为（48.3±9.5）岁和（47±8.9）岁，平均体重指数分别为（33.3±4.8）和（32.834±4.862），SLN检出率分别为95%和90%。两组患者共切除了 128 个前哨淋巴结（SLN）（65 个使用碳纳米粒子，63 个使用专利蓝染料）。A 组和 B 组的 SLN 平均数量分别为 3.4±0.7（范围，2-5）和 3.5±1.2（范围，2-7），SLN 平均检测时间分别为 13.5±4.5（范围，7-22）和 12.7±3.6（范围，7-18 分钟）。 在早期乳腺癌腋窝SLNs的识别率、SLNs数量、检测时间、转移性SLNs、成本和安全性方面，碳纳米粒子和专利蓝染料没有明显差异，而在术后皮肤染色和埃及市场供应方面，碳纳米粒子略胜一筹。
{"title":"Carbon nanoparticles versus patent blue dye for detection of sentinel lymph node in patients with early breast cancer","authors":"Mahmoud R. M. Elsebaai, Mohamed A. H. Shehab, Dina M. Hanafy, Karim F. Abd Al Moaty","doi":"10.4103/ejs.ejs_311_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_311_23","url":null,"abstract":"\u0000 \u0000 Sentinel lymph nodes biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in a considerable percentage of patients with early-stage breast cancer which was a great advance in preventing many surgical complications and enhancing their health welfare. Although there are different sentinel lymph nodes (SLNs) tracers with different identification rates, there is no agreement about the idealistic method.\u0000 \u0000 \u0000 \u0000 The study was designed to compare carbon nanoparticles and patent blue v dye regarding SLNs detection rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety in patients with early breast cancer and clinically node-negative axilla.\u0000 \u0000 \u0000 \u0000 A total of 40 patients with axillary lymph node-negative early-stage breast cancer patients were divided into two groups and subjected to carbon nanoparticles and patent blue V dye in group A and group B, respectively. Patients who were pregnant or lactating had node-positive axilla (N1-3) or metastatic breast cancer (M1) or had neoadjuvant chemotherapy were excluded.\u0000 \u0000 \u0000 \u0000 The mean age was 48.3±9.5 and 47 ±8.9, while the mean BMI of 33.3±4.8 and 32.834±4.862, the SLN detection rates were 95% and 90% in groups A and B, respectively. A total of 128 sentinel lymph nodes (SLNs) were removed from patients in the two groups (65 with Carbon Nanoparticles and 63 with patent blue dye). The mean number of SLNs was 3.4±0.7 (range, 2–5) and 3.5±1.2 (range, 2–7), mean time of SLNs detection was 13.5±4.5 (range, 7–22) and 12.7± 3.6 (range, 7–18 min) between group A and B, respectively.\u0000 \u0000 \u0000 \u0000 There is no significant difference between carbon nanoparticles and patent blue dye regarding axillary SLNs in early breast cancer regarding identification rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety with slight preference to carbon nanoparticles regarding postoperative skin staining and Egyptian market availability.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140213053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. M. Salama, Mohamed I. Abuelnasr, Enas M. Sweed, A. Nawar
In conservative breast surgery, a larger volume of resected breast tissue is associated with a poorer cosmetic outcomes. Therefore, the introduction of ultrasonography in the excision of palpable breast cancer aims to minimize the excision of healthy tissue ensuring oncologically safe excision, and hence, a better cosmetic outcome compared with palpation-guided surgery (PGS). To compare ultrasound-guided surgery (UGS) for palpable breast cancer with PGS in terms of safety margin, re-excision rate, and cosmetic outcome. This is a prospective, randomized, controlled study conducted on 79 female patients with early palpable breast cancer. Patients were randomized to undergo either UGS or PGS. The mean distance between the tumor and the resection margin, re-excision rate, operative time, cosmetic outcome, and patient satisfaction were assessed. Data management and statistical analysis were done using SPSS, version 28. Quantitative data were assessed for normality using the Shapiro–Wilk test and direct data visualization methods. According to normality, quantitative data were summarized as means and SDs. Categorical data were summarized as numbers and percentages. Quantitative data were compared between the studied groups using independent t test. Categorical data were compared using the χ 2 test. Multivariate logistic regression analysis was done to predict good to excellent patient satisfaction. All statistical tests were two-sided. P values less than 0.05 were considered significant. The UGS group showed significantly higher excellent panel evaluation (48.7 vs. 22.5%, P=0.028) and patient satisfaction (61.5 vs. 30%). The UGS group demonstrated significantly longer operative time but significantly lower re-resection rate and distance from tumor to resection margin (0.62±0.16 vs. 1.72±0.35 cm, P<0.001). The predictors of the outcomes were tumor T stage (T2 stages associated with less satisfaction), tumor to resection margin distance (the more distance the less satisfaction), and ultrasound use. The UGS proves to be superior to PGS as it significantly decreases re-excision rates and improves overall cosmetic outcome and patient satisfaction.
{"title":"A comparative study on the cosmetic outcomes of ultrasound-guided versus palpation-guided conservative breast surgery in patients with early palpable breast cancer","authors":"A. M. Salama, Mohamed I. Abuelnasr, Enas M. Sweed, A. Nawar","doi":"10.4103/ejs.ejs_308_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_308_23","url":null,"abstract":"\u0000 \u0000 In conservative breast surgery, a larger volume of resected breast tissue is associated with a poorer cosmetic outcomes. Therefore, the introduction of ultrasonography in the excision of palpable breast cancer aims to minimize the excision of healthy tissue ensuring oncologically safe excision, and hence, a better cosmetic outcome compared with palpation-guided surgery (PGS).\u0000 \u0000 \u0000 \u0000 To compare ultrasound-guided surgery (UGS) for palpable breast cancer with PGS in terms of safety margin, re-excision rate, and cosmetic outcome.\u0000 \u0000 \u0000 \u0000 This is a prospective, randomized, controlled study conducted on 79 female patients with early palpable breast cancer. Patients were randomized to undergo either UGS or PGS. The mean distance between the tumor and the resection margin, re-excision rate, operative time, cosmetic outcome, and patient satisfaction were assessed.\u0000 \u0000 \u0000 \u0000 Data management and statistical analysis were done using SPSS, version 28. Quantitative data were assessed for normality using the Shapiro–Wilk test and direct data visualization methods. According to normality, quantitative data were summarized as means and SDs. Categorical data were summarized as numbers and percentages. Quantitative data were compared between the studied groups using independent t test. Categorical data were compared using the χ\u0000 2 test. Multivariate logistic regression analysis was done to predict good to excellent patient satisfaction. All statistical tests were two-sided. P values less than 0.05 were considered significant.\u0000 \u0000 \u0000 \u0000 The UGS group showed significantly higher excellent panel evaluation (48.7 vs. 22.5%, P=0.028) and patient satisfaction (61.5 vs. 30%). The UGS group demonstrated significantly longer operative time but significantly lower re-resection rate and distance from tumor to resection margin (0.62±0.16 vs. 1.72±0.35 cm, P<0.001). The predictors of the outcomes were tumor T stage (T2 stages associated with less satisfaction), tumor to resection margin distance (the more distance the less satisfaction), and ultrasound use.\u0000 \u0000 \u0000 \u0000 The UGS proves to be superior to PGS as it significantly decreases re-excision rates and improves overall cosmetic outcome and patient satisfaction.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140217864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast conservative therapy (BCT) includes conservative breast surgery (CBS) with adjuvant radiotherapy and is now considered a standard treatment for early-stage breast cancer to achieve survival with acceptable aesthetic outcomes. Management of multiple ipsilateral breast cancer (MIBC) is a challenge, since the choice of optimal surgical procedures is controversial. Recently, many breast surgeons have advocated CBS is technically feasible to safely excise MIBC in selected cases. This study aimed to evaluate the outcome of MIBC patients who received CBS with special attention on local control and recurrence. This retrospective study was carried out on 90 patients at Al Azhar University Hospital and Ain Shams University Hospitals between January 2021 and January 2023. The majority of patients 85 (94.4%) had two foci of disease while five (5.5%) patients had three foci. The distance between the lesions ranges between 0.5 and 6.5 cm. The most common type of CBS was wide local excision en bloc resection of all lesions with normal tissue in between was done in 85 (94.4%) patients and five (5.5%) patients had two separate incisions leaving normal tissue in between. Clear margins were reported in 79 (87.7%) patients. 15 (5.5%) patients had different pathological lesion types (heterogeneous). One patient had a recurrence and another had distant metastases. With good patient selection, there is no difference between CBS and mastectomy in the management of MIBC. CBS is oncological safe provided that an adequate excision with clear margins followed by whole-breast radiation therapy and adjuvant systemic therapy.
{"title":"Evaluation of the impact of breast-conserving surgery on cancer outcomes of multiple (multifocal or multicentric) ipsilateral breast cancer","authors":"Mohamed F. Abdelfattah, Yasmine H. Elzohery","doi":"10.4103/ejs.ejs_291_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_291_23","url":null,"abstract":"\u0000 \u0000 Breast conservative therapy (BCT) includes conservative breast surgery (CBS) with adjuvant radiotherapy and is now considered a standard treatment for early-stage breast cancer to achieve survival with acceptable aesthetic outcomes.\u0000 Management of multiple ipsilateral breast cancer (MIBC) is a challenge, since the choice of optimal surgical procedures is controversial. Recently, many breast surgeons have advocated CBS is technically feasible to safely excise MIBC in selected cases.\u0000 \u0000 \u0000 \u0000 This study aimed to evaluate the outcome of MIBC patients who received CBS with special attention on local control and recurrence.\u0000 \u0000 \u0000 \u0000 This retrospective study was carried out on 90 patients at Al Azhar University Hospital and Ain Shams University Hospitals between January 2021 and January 2023.\u0000 \u0000 \u0000 \u0000 The majority of patients 85 (94.4%) had two foci of disease while five (5.5%) patients had three foci. The distance between the lesions ranges between 0.5 and 6.5 cm. The most common type of CBS was wide local excision en bloc resection of all lesions with normal tissue in between was done in 85 (94.4%) patients and five (5.5%) patients had two separate incisions leaving normal tissue in between. Clear margins were reported in 79 (87.7%) patients. 15 (5.5%) patients had different pathological lesion types (heterogeneous). One patient had a recurrence and another had distant metastases.\u0000 \u0000 \u0000 \u0000 With good patient selection, there is no difference between CBS and mastectomy in the management of MIBC. CBS is oncological safe provided that an adequate excision with clear margins followed by whole-breast radiation therapy and adjuvant systemic therapy.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140215867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nasr Al-Qadasi, Yehia Al Syaghi, Raddad AL-Fakih, Abdullah Al-Ashwal
It is critical to categorize pressure ulcers at different stages to establish effective treatment plans. Debridement and excision of the underlying bursa and implicated bone tissue, followed by tissue covering, are the basic surgical procedures. This research examines patient characteristics, results, and complications, reporting on our experience treating pressure ulcers. All the 25 individuals had a total of 39 pressure ulcers treated. The sacral ulcer was the most common. Three-quarters of the cases were related to pressure ulcer formation in hospitals. Debridement, primary repair, skin grafts, V-Y fasciocutaneous flap, transverse lumbar fasciocutaneous flap, V-Y tensor fascia lata flap, inferior gluteal rotational myocutaneous flap, and V-Y gluteal myocutaneous flap were among the available treatment options. Complications happened in 19%. Most of the time, pressure ulcers may be prevented with adequate understanding of their etiology and appropriate patient treatment for those who are at risk. Given the frequency of complications, recurrence, and new ulcers, treatment of individuals with pressure ulcers requires multidisciplinary involvement as well as family involvement. For the best prognosis and appropriate closure of the ulcer, complications and risk factors such as poor hygiene, anemia, diabetes, infection, and hypoalbuminemia should be avoided. In the medical sector as a whole, pressure sores are a prevalent issue. The pelvic girdle pressure points appear to be the focus of most sores. Medical personnel who are in charge of patient monitoring must be knowledgeable about the main risk factors.
{"title":"A clinical study of surgical management of pelvic girdle pressure sores: a three-year experience","authors":"Nasr Al-Qadasi, Yehia Al Syaghi, Raddad AL-Fakih, Abdullah Al-Ashwal","doi":"10.4103/ejs.ejs_293_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_293_23","url":null,"abstract":"\u0000 \u0000 It is critical to categorize pressure ulcers at different stages to establish effective treatment plans. Debridement and excision of the underlying bursa and implicated bone tissue, followed by tissue covering, are the basic surgical procedures. This research examines patient characteristics, results, and complications, reporting on our experience treating pressure ulcers.\u0000 \u0000 \u0000 \u0000 All the 25 individuals had a total of 39 pressure ulcers treated. The sacral ulcer was the most common. Three-quarters of the cases were related to pressure ulcer formation in hospitals. Debridement, primary repair, skin grafts, V-Y fasciocutaneous flap, transverse lumbar fasciocutaneous flap, V-Y tensor fascia lata flap, inferior gluteal rotational myocutaneous flap, and V-Y gluteal myocutaneous flap were among the available treatment options.\u0000 \u0000 \u0000 \u0000 Complications happened in 19%. Most of the time, pressure ulcers may be prevented with adequate understanding of their etiology and appropriate patient treatment for those who are at risk. Given the frequency of complications, recurrence, and new ulcers, treatment of individuals with pressure ulcers requires multidisciplinary involvement as well as family involvement. For the best prognosis and appropriate closure of the ulcer, complications and risk factors such as poor hygiene, anemia, diabetes, infection, and hypoalbuminemia should be avoided.\u0000 \u0000 \u0000 \u0000 In the medical sector as a whole, pressure sores are a prevalent issue. The pelvic girdle pressure points appear to be the focus of most sores. Medical personnel who are in charge of patient monitoring must be knowledgeable about the main risk factors.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140217208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ehab Loutfy, Hatem Elgohary, Mahmoud E. Elkashlan, Mohamed G. Abdelrahman, Wael Omar
Hemorrhoids are one of the most commonly presented diagnoses of colorectal diseases. This study aimed to evaluate and compare the outcomes of laser hemorrhoidoplasty (LHP) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grades III and IV hemorrhoids, focusing on some postoperative complications. A randomized, controlled, clinical trial involving 34 patients with grades III and IV hemorrhoids was conducted at the General Surgery Department, Faculty of Medicine, Helwan University, from June 2022 to March 2023. Ethical considerations were adhered to, and patients provided informed consent. The groups underwent either LHP or HSH, and comprehensive patient information was collected, including demographics and preoperative assessments. Postoperative care and follow-up evaluations assessed outcomes such as pain, bleeding, discharge, wound healing, incontinence, recurrence, and stenosis. Demographic distribution was similar between the LHP and HSH groups, with comparable operative times. Postoperative bleeding did not significantly differ between groups. HSH was associated with more early discharge, longer wound healing times, and significantly higher postoperative pain levels up to the third week. No significant differences were observed in stenosis, incontinence, or recurrence between the two groups. Both HSH and LHP techniques were found to be safe and effective for managing hemorrhoids. LHP demonstrated advantages, including lower postoperative pain levels, reduced seromucous discharge, and faster wound healing compared with HSH. These findings provide valuable insights for clinicians in optimizing patient care during the management of hemorrhoids.
{"title":"Laser hemorrhoidoplasty procedure versus harmonic scalpel hemorrhoidectomy: a comparative study for the treatment of grades III and IV hemorrhoids","authors":"Ehab Loutfy, Hatem Elgohary, Mahmoud E. Elkashlan, Mohamed G. Abdelrahman, Wael Omar","doi":"10.4103/ejs.ejs_325_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_325_23","url":null,"abstract":"\u0000 \u0000 Hemorrhoids are one of the most commonly presented diagnoses of colorectal diseases. This study aimed to evaluate and compare the outcomes of laser hemorrhoidoplasty (LHP) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grades III and IV hemorrhoids, focusing on some postoperative complications.\u0000 \u0000 \u0000 \u0000 A randomized, controlled, clinical trial involving 34 patients with grades III and IV hemorrhoids was conducted at the General Surgery Department, Faculty of Medicine, Helwan University, from June 2022 to March 2023. Ethical considerations were adhered to, and patients provided informed consent. The groups underwent either LHP or HSH, and comprehensive patient information was collected, including demographics and preoperative assessments. Postoperative care and follow-up evaluations assessed outcomes such as pain, bleeding, discharge, wound healing, incontinence, recurrence, and stenosis.\u0000 \u0000 \u0000 \u0000 Demographic distribution was similar between the LHP and HSH groups, with comparable operative times. Postoperative bleeding did not significantly differ between groups. HSH was associated with more early discharge, longer wound healing times, and significantly higher postoperative pain levels up to the third week. No significant differences were observed in stenosis, incontinence, or recurrence between the two groups.\u0000 \u0000 \u0000 \u0000 Both HSH and LHP techniques were found to be safe and effective for managing hemorrhoids. LHP demonstrated advantages, including lower postoperative pain levels, reduced seromucous discharge, and faster wound healing compared with HSH. These findings provide valuable insights for clinicians in optimizing patient care during the management of hemorrhoids.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140220127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tamer E. Abd-Allah, Mostafa S. M. Abdelbary, Mina G. Zekri, Karim S. M. El-Awady
Due to the global burden of varicose veins (VVs) and the impact on the quality of life (QoL) of patients, it is essential to search for better treatment modalities. The main objective of this research was to compare the efficacy, safety, and impact on the QoL of endovenous microwave ablation (EMA) and endovenous laser ablation (EVLA) for the management of varicose veins of the great saphenous vein (GSV). A comparative, multicenter, single-blinded, parallel randomized controlled study conducted on 340 patients confirmed to have primary VVs of the GSV who were further randomized into two groups. The study group (n=170) received EMA, and the control group (n=170) received EVLA. Both the study group and the control group were comparable with regard to their baseline characteristics (P values > 0.05). The study group and the control group were comparable with regard to the limb affected (P=0.184). Only 14.7% and 10.0% of the study group and the control group have both limbs affected. Both the study group and the control group were comparable with regard to CEAP classification (P=0. 068). The study group and the control group were significantly different with regard to operating time (P<0.001). The operating time is less in the study group than in the control group. The median (IQR) and the mean±SD of the operating time was 7 (4) and 8.7±4.1 min in the study (microwave) group and 9 (5) and 10±3.9 min in the control group. Also, the study group and the control group showed 100% success at the 1-week evaluation as none of the cases in both groups suffered recanalization. At 6-month evaluation, only 1 case in the study group and 2 cases of the control group experienced recanalization; however, the difference is not significant (P=0.537). At the 12-month evaluation, the study group and the control group showed 100% success as none of the cases in both groups suffered recanalization. QoL is better in the study group than the control group at 6 months Aberdeen score (P=< 0.001). The median IQR and the mean±SD of the postoperative Aberdeen score were 9 (2.7) and 9.3±1.7 in the study (microwave) group and 10.8 (3.4) and 10.8±1.8 in the control group. Moreover, the study group and the control group were comparable (P values > 0.05) with regard to adverse events except for paresthesia (P-value = 0.025). About 11.2% of the control group experienced paresthesia versus only 2.9% of the study group. In conclusion, EMA has a lower operating time than EVLA. EMA is as effective as EVLA for treating VVS of the GSV. EMA has fewer adverse events than EVLA. EMA has better QoL than EVLA ablation. However, the choice of treatment should be based on individual patient characteristics and the expertise of the treating physician.
{"title":"Microwave versus endovenous laser in great saphenous vein ablation: a randomized controlled clinical study","authors":"Tamer E. Abd-Allah, Mostafa S. M. Abdelbary, Mina G. Zekri, Karim S. M. El-Awady","doi":"10.4103/ejs.ejs_300_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_300_23","url":null,"abstract":"\u0000 \u0000 Due to the global burden of varicose veins (VVs) and the impact on the quality of life (QoL) of patients, it is essential to search for better treatment modalities.\u0000 \u0000 \u0000 \u0000 The main objective of this research was to compare the efficacy, safety, and impact on the QoL of endovenous microwave ablation (EMA) and endovenous laser ablation (EVLA) for the management of varicose veins of the great saphenous vein (GSV).\u0000 \u0000 \u0000 \u0000 A comparative, multicenter, single-blinded, parallel randomized controlled study conducted on 340 patients confirmed to have primary VVs of the GSV who were further randomized into two groups. The study group (n=170) received EMA, and the control group (n=170) received EVLA.\u0000 \u0000 \u0000 \u0000 Both the study group and the control group were comparable with regard to their baseline characteristics (P values > 0.05). The study group and the control group were comparable with regard to the limb affected (P=0.184). Only 14.7% and 10.0% of the study group and the control group have both limbs affected. Both the study group and the control group were comparable with regard to CEAP classification (P=0. 068). The study group and the control group were significantly different with regard to operating time (P<0.001).\u0000 The operating time is less in the study group than in the control group. The median (IQR) and the mean±SD of the operating time was 7 (4) and 8.7±4.1 min in the study (microwave) group and 9 (5) and 10±3.9 min in the control group. Also, the study group and the control group showed 100% success at the 1-week evaluation as none of the cases in both groups suffered recanalization. At 6-month evaluation, only 1 case in the study group and 2 cases of the control group experienced recanalization; however, the difference is not significant (P=0.537). At the 12-month evaluation, the study group and the control group showed 100% success as none of the cases in both groups suffered recanalization.\u0000 QoL is better in the study group than the control group at 6 months Aberdeen score (P=< 0.001). The median IQR and the mean±SD of the postoperative Aberdeen score were 9 (2.7) and 9.3±1.7 in the study (microwave) group and 10.8 (3.4) and 10.8±1.8 in the control group. Moreover, the study group and the control group were comparable (P values > 0.05) with regard to adverse events except for paresthesia (P-value = 0.025). About 11.2% of the control group experienced paresthesia versus only 2.9% of the study group.\u0000 \u0000 \u0000 \u0000 In conclusion, EMA has a lower operating time than EVLA. EMA is as effective as EVLA for treating VVS of the GSV. EMA has fewer adverse events than EVLA. EMA has better QoL than EVLA ablation. However, the choice of treatment should be based on individual patient characteristics and the expertise of the treating physician.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140215798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saad S. Alhanafy, Mahmoud Shaheen, Ahmed B. Alanazi, Alaa A. Elsisy, R. Seddik, M. Alabassy
To evaluate the association of timing for cholecystectomy with clinical outcomes in patients with gallstone pancreatitis (GSP). Patients with mild GSP who undergo cholecystectomy sooner rather than later tend to have shorter hospital stays. From October 2019 to January 2023, the number of adult hospitalizations at Menoufia University Hospitals due to GSP was recorded. We classified patients into early (operated on within 2 days of admission) as well as late (operated on over 2 days after admission) groups based on when they had laparoscopic cholecystectomy. The date of cholecystectomy was then correlated with nonhome discharge, postoperative hospital length of stay, and readmission rate within a month of discharge using multivariable logistic and linear regression. An estimated 129 patients were admitted with acute GSP, and 25.6% of those admissions were classified as belonging to the early cohort. The remaining admissions were classified as belonging to the late cohort. After taking into account potential confounding factors, a late cholecystectomy was found to be linked with a greater risk of significant adverse outcomes [adjusted odds ratio 1.40, 95% confidence interval (CI): 1.24–1.51]. Also, participants in the late cohort had a greater chance of being readmitted within 30 days (adjusted odds ratio 1.12, 95% CI: 1.03–1.23) and nonhome discharge (adjusted odds ratio 1.41, 95% CI: 1.29–1.53). Cholecystectomy that was performed after 2 days of admission for mild GSP was associated with increased major adverse events and 30-day readmissions, in addition to nonhome discharge.
{"title":"Rationale of on admission surgical intervention on outcomes after cholecystectomy for mild gallstone pancreatitis","authors":"Saad S. Alhanafy, Mahmoud Shaheen, Ahmed B. Alanazi, Alaa A. Elsisy, R. Seddik, M. Alabassy","doi":"10.4103/ejs.ejs_310_23","DOIUrl":"https://doi.org/10.4103/ejs.ejs_310_23","url":null,"abstract":"\u0000 \u0000 To evaluate the association of timing for cholecystectomy with clinical outcomes in patients with gallstone pancreatitis (GSP).\u0000 \u0000 \u0000 \u0000 Patients with mild GSP who undergo cholecystectomy sooner rather than later tend to have shorter hospital stays.\u0000 \u0000 \u0000 \u0000 From October 2019 to January 2023, the number of adult hospitalizations at Menoufia University Hospitals due to GSP was recorded. We classified patients into early (operated on within 2 days of admission) as well as late (operated on over 2 days after admission) groups based on when they had laparoscopic cholecystectomy. The date of cholecystectomy was then correlated with nonhome discharge, postoperative hospital length of stay, and readmission rate within a month of discharge using multivariable logistic and linear regression.\u0000 \u0000 \u0000 \u0000 An estimated 129 patients were admitted with acute GSP, and 25.6% of those admissions were classified as belonging to the early cohort. The remaining admissions were classified as belonging to the late cohort. After taking into account potential confounding factors, a late cholecystectomy was found to be linked with a greater risk of significant adverse outcomes [adjusted odds ratio 1.40, 95% confidence interval (CI): 1.24–1.51]. Also, participants in the late cohort had a greater chance of being readmitted within 30 days (adjusted odds ratio 1.12, 95% CI: 1.03–1.23) and nonhome discharge (adjusted odds ratio 1.41, 95% CI: 1.29–1.53).\u0000 \u0000 \u0000 \u0000 Cholecystectomy that was performed after 2 days of admission for mild GSP was associated with increased major adverse events and 30-day readmissions, in addition to nonhome discharge.\u0000","PeriodicalId":22550,"journal":{"name":"The Egyptian Journal of Surgery","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140213801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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