Clinical utility of abbreviated breast MRI based on diffusion tensor imaging in patients underwent breast conservative therapy.

PURPOSE: To evaluate the added value of the diffusion tensor imaging (DTI) parameters to abbreviated breast MRI protocol in differentiating recurrent breast cancer from post-operative changes in cases of breast conservative surgery (BCS). METHODS: This prospective study was approved by our institutional review board. Written informed consent was obtained in all patients. 47 female patients (mean age, 49 years; range, 32-66 years) that previously underwent breast conservative surgery with a palpable mass were included in this study (62 breast lesions). Two abbreviated MRI protocols were compared using 1.5 Tesla MRI, AB-MRI 1 (axial T1, T2, pre-contrast T1, 1st post-contrast and subtracted images) and AB-MRI 2 (same sequences plus adding DTI). In both protocols, the wash-in rate was calculated. Histopathology was used as the standard of reference. Appropriate statistical tests were used to assess sensitivity, specificity, and diagnostic accuracy for each protocol. RESULTS: The mean total acquisition time was of 6 min for AB-MRI 1 and 10 min for AB-MRI 2 protocols while the mean interpretation time was of 57.5 and 75 s, respectively. Among analyzed DTI parameters, MD (mean diffusivity) showed the highest sensitivity (96.43%) and specificity (91.18%) (P value = < 0.001). FA (fractional anisotropy), AD (axial diffusivity) and RD (radial diffusivity) showed sensitivity = (78.57%, 82.14% and 85.71%), specificity = (88.24, 85.29% and 79.41%), respectively, P value (< 0.001). CONCLUSION: DTI may be included in abbreviated MRI protocols without a significant increase in acquisition time and with the advantage of increasing specificity and clinical utility in the characterization of post-conservative breast lesions.

Fibroadenoma of the breast; incidence of malignancy and indicators for surgical intervention: An analysis of 1392 patients.

BACKGROUND: Fibroadenomas are common among young females. The size of the lesion used to be an indication for further assessment or excision. With arising of the watch and see proponents, criteria for selecting patients are important to establish. METHODS: This is a retrospective study of a prospectively maintained database where all patients having the clinical/radiological provisional diagnosis of fibroadenoma and attending our center - from January 2008 to March 2020 - were enrolled. The primary outcome was the incidence of malignancy and the secondary outcomes were the correlation of malignancy-risk with epidemiologic and radiologic criteria. RESULTS: The study enrolled 1392 patients. The mean age of the patients was 35.7 + ∕- 13.1 years. The median of the longest diameter of the detected breast lesions was 25 mm. The incidence of malignancy was 188 (13.5%). The size of the lesion measured by largest diameter was insignificant (p = 0.99), while the patients' age, marital status, and imaging criteria as measured by BIRADS score were significant (<0.001). CONCLUSION: Approaching patients with the age above 35 or with BIRADS 4 provisionally diagnosed with fibroadenomas should be cautious with biopsy and short-term follow-ups The size of the tumor alone should not be used as an indication for surgical intervention.

Brain metastatic breast cancer: Epidemiology, survival and prognosis: Single center experience / Cáncer de mama metastásico cerebral: epidemiología, supervivencia y pronóstico; experiencia en un solo centro

Introduction Breast carcinoma is the most common malignancy in women worldwide. It is also one of the most frequent causes of brain metastasis (BM). Studies have identified BM as one of the worst prognostic signs. Methods We retrospectively analyzed data from 71 patients with BM from BC with the aim of clarifying the epidemiological criteria and management in our setting. We also aimed to identify predictors of survival and factors affecting the length of the BM-free interval in our group of patients. Results All the patients were female with a mean age at diagnosis of primary cancer of 41.6 years. The most common site of BM was the parietal lobe. The BM-free interval was longer with N1 disease (in comparison to N2 and 3) and in luminal B breast cancer subtype. Survival was shorter in older patients, those with hormone receptor negative and/or HER2-neu positive disease, synchronous BM, primary tumour not removed, soft tissue/non-regional nodes concomitant metastasis, and those who did not receive palliative chemotherapy. Survival tended to be longer in patients with temporal lobe metastasis, but this result was not statistically significant. Conclusion BM is a bad prognostic sign. Large scale prospective studies are needed to further delineate its nature. (AU)

Introducción El carcinoma de mama es la neoplasia maligna más común en las mujeres del mundo. Además, es una de las causas más comunes de metástasis cerebral (MC). Los estudios detectan MC como uno de los peores signos pronósticos. Métodos Analizamos retrospectivamente los datos de 71 pacientes con MC de origen mamario con el objetivo de clarificar los criterios epidemiológicos y el esquema de manejo en nuestra localidad de esta enfermedad, además de detectar predictores de supervivencia y factores que afectan la longitud del intervalo libre de MC en nuestro grupo de pacientes. Resultados Todos los pacientes fueron mujeres con una edad media de diagnóstico de cáncer primario de 41,6 años. El sitio más común de MC fue el lóbulo parietal. El intervalo libre de propagación cerebral fue más largo con la enfermedad N1 (en comparación con N2 y 3) y en el subtipo de cáncer de mama luminal B. La supervivencia fue menor en pacientes mayores, aquellos con receptores hormonales negativos y/o enfermedad HER2-neu positiva, MC sincrónica, tumor primario no extirpado, metástasis concomitantes de tejido blando nodos no regionales y aquellos que no recibieron quimioterapia paliativa. Además, aquellos con metástasis del lóbulo temporal tienden a tener una mejor supervivencia, aunque no alcanzaron significación estadística. Conclusión La MC es un mal signo pronóstico. Se necesitan estudios prospectivos a gran escala para delinear aún más su naturaleza. (AU)

Diabetic Mastopathy: Reporting an Unusual Scenario of a Rare Disease.

Diabetic mastopathy is a rare, benign breast disease that presents with fibrous breast lumps usually induced by the hyperglycemic state in diabetic patients and often associated with type 1 or 2 diabetes mellitus. Clinical and radiographic appearances are usually confusing and pathologic confirmation is essential for diagnosis mainly to rule out malignancy. However, a specialized breast pathologist often utilizes patient's history of diabetes as a guide to solve this diagnostic dilemma. We report a challenging scenario in which a case of diabetic fibrous mastopathy was pathologically identified with no previous given history of diabetes. This benign breast entity should be included in the differential diagnosis of breast lumps even without history of diabetes that may be overlooked before surgery.

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.

Short-Term Surgical Outcomes of Standard and Lateral Video Endoscopic Inguinal Lymphadenectomy: A Multinational Retrospective Study.

Background: Video endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive technique that gives superior surgical outcomes than open inguinal lymphadenectomy (IL) for treating lymph node metastasis in penile, vulvar, and skin cancers. This study compared surgical outcomes obtained with two different approaches of VEIL, standard VEIL and lateral VEIL (L-VEIL), in cancer patients. Methods: Sixty-two patients who underwent standard VEIL (n = 15) or L-VEIL (n = 47) for treatment of lymph node metastasis were evaluated retrospectively from three centers in Brazil, Egypt, and India. Primary endpoint analyzed was conversion rate to open IL in the two groups, and the secondary endpoints included operative time, estimated blood loss, nodal yield, nodal positivity, postoperative drain duration, and postoperative complications. Results: The conversion rate to open IL was higher in L-VEIL compared with VEIL group (2% vs. 0%). Significantly lesser blood loss was reported with L-VEIL compared with VEIL (mean difference: 3.63 mL; P = .01). Postoperative drain duration was significantly lower with L-VEIL (-4.34 days; P < .05) than VEIL. The L-VEIL group had a higher number of lymph nodes without infiltration (mean difference: -0.48; P = .02). Operative time, nodal yield, nodal positivity, and hospitalization duration were similar in both groups. Postoperative complications were higher in the L-VEIL versus VEIL group (35 vs. 11 cases). Lymphedema events were significantly higher with L-VEIL in comparison with VEIL (38.8% vs. 16.7%; P = .03). Among patients with penile cancer, no significant difference was observed in outcomes obtained with VEIL and L-VEIL. Conclusion: As L-VEIL and VEIL approaches lead to comparable surgical outcomes, surgeons may choose either of these as per their convenience.

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.

Laparoscopic colorectal cancer resection with natural orifice specimen extraction: a prospective study / Ressecção laparoscópica do câncer colorretal com extração de espécime em orifício natural: um estudo prospectivo

ABSTRACT Introduction: Laparoscopic colorectal resection is more and more being employed in the daily oncology practice. Natural orifice techniques to obviate the need for a specimen extraction incision are evolving. Materials and methods: We studied transanal and transvaginal specimen extraction after laparoscopic colorectal resections prospectively in 16 patients. Results: The technique was successfully implemented in 75% of the cases. The site of the tumour and the patient age were the significant predictors of the technique success. Conclusion: The technique is reproducible and can be more widely adopted.

RESUMO Introdução: A ressecção colorretal laparoscópica está sendo cada vez mais empregada na prática diária de oncologia. Observa-se uma evolução nas técnicas que usam orifícios naturais de modo a evitar a necessidade de uma incisão para extração de espécimes. Materiais e métodos: O estudo avaliou prospectivamente a extração transanal e transvaginal de espécimes após ressecções colorretais laparoscópicas em 16 pacientes. Resultados: A técnica foi implementada com sucesso em 75% dos casos. A localização do tumor e a idade do paciente foram preditores significativos de sucesso da técnica. Conclusão: A técnica é reprodutível e pode ser mais amplamente adotada.

Transanal Total Mesorectal Excision for Rectal Cancer: Short Term Outcomes from Two Centers.

BACKGROUND: Rectal cancer is now an increasing problem in both developed and developing countries. In the last 7 years, minimally invasive surgery for this disease has entered a new era of transanal resection with/without laparoscopic assistance. MATERIALS AND METHODS: We present here a prospective study done in Egypt (probably the earliest experience) and Spain on the feasibility of hybrid NOTES in rectal cancer. RESULTS: From September 2015 till November 2017, 18 cases underwent transanal total mesorectal excision with no detected mortality and with morbidities in 44% of cases, from which 5 were class III on Clavien-Dindo scale requiring intervention. Good quality total mesorectal excision was obtained in more than three quarters of our patients. CONCLUSIONS: In our experience, the technique was technically demanding with a long learning curve; however, the short term results were very good in alliance with other few similar reports.

Predictors for local recurrence and distant metastasis of mucinous colorectal adenocarcinoma.

BACKGROUND: Mucinous adenocarcinoma (MA) is a unique subtype of colorectal carcinoma. Although some investigators considered MA a predictor for poor prognosis, predictors for poor clinical outcome of MA were not elucidated. The present study aimed to investigate the predictors for local recurrence and distant metastasis of MA. METHODS: This was a retrospective review of patients with MA who underwent operation with curative intent. Variables included patient and tumor characteristics, TNM stage, investigations, details of surgery, and postoperative outcomes, including local recurrence and distant metastasis. Univariate and multivariate regression analyses were performed to determine the risk factors for local and systemic disease recurrence. RESULTS: A total of 106 patients (83 male) of a mean age of 51.5 years were included; 62% of patients had colonic tumors, and 38% had rectal tumors; 77% and 58% of colonic and rectal cancers, respectively, were T3-T4 tumors. There were no lymph node metastases in 61% of colonic tumors and 55% of rectal tumors. Local recurrence occurred in 15 patients (14%) and distant metastasis in 9 (9%). Predictors for local recurrence were age (odds ratio [OR]: 1.04; P = .04), female sex (OR: 4.5; P = .01), rectal tumors (OR: 3.73; P = .02), and T4 tumors (OR: 10.9; P = 0.03). Predictors for distant metastasis were age (OR: 1.1; P = .016), local recurrence (OR: 24.28; P < .0001), and T4 tumors (OR: 19.3; P = .049). CONCLUSION: Patients' age, female sex, and T4 tumors were significant predictors for local recurrence and distant metastasis. Rectal tumors had a greater likelihood for regional recurrence than colonic tumors. Local recurrence was an independent risk factor for distant metastasis.

Outcome of Patients with Cervical and Vaginal Stump Carcinomas Treated with More Conservative Surgical Approaches: a 9-Year Experience of a Tertiary Oncology Center.

The surgical management of stump carcinoma includes the gold standard pelvic exenteration and more conservative approaches. This study aimed to investigate the outcome among a cohort of vaginal and cervical stump carcinomas that were treated with an intent of organ preservation. This is a prospective study of 60 patients with a biopsy confirmed stump carcinomas at a tertiary care oncology center in Egypt. The demographic, surgical, and pathological data were collected and patients underwent radical surgery with an intent of organ preservation guided by margin negativity. The pathologic data were correlated with the postoperative mortality. Correlation coefficients were calculated for simple correlation and regression analysis was used to investigate the independent predictors of survival. Pelvic exenteration was conducted in 30/60 (50%), while wide local excision with safety margins was possible in 26/60 (43%) and in two cases, resection was precluded. Mean hospital stay in days was 19 ± 9 (range 4-61). Overall operative morbidity was 83.3% (50/60). Perioperative mortality was 6.7% (4/60). Five-year disease-free survival was 40% (24/60). Five-year overall survival was 50% (30/60). The resection margin status and the perioperative therapy were independent prognostic factors of DFS (p = 0.003 and 0.02, respectively. Only the resection margin status was significantly associated with overall survival (p = 0.009). There was no increased mortality with introduction of more conservative surgical approaches. The resection margin status is the most important determinant of recurrence free and overall survivals.

Lateral Versus Anterior Approach Laparoscopic Splenectomy: A Randomized-controlled Study.

PURPOSE OF THE STUDY: The study compares prospectively the hospital stay and postoperative complications of anterior (ALS) versus lateral (LLS) approach for laparoscopic splenectomy. MATERIALS AND METHODS: Between September 2011 and April 2015, 94 patients with splenomegaly were referred to the surgical unit in the Oncology Center of Mansoura University, Egypt. Only 80 patients with splenomegaly <30 cm underwent an open-label randomized allocation into 2 equal parallel groups. Indications were hematological in 52 patients (65%) and malignant splenic conditions in 28 patients (35%). Two patients younger than 18 years, 4 patients with splenomegaly >30 cm, and 8 patients with associated surgical comorbidities were excluded. Three days' hospital stay reduction with LLS was suggested with a power of 80% and P-value of 0.05. RESULTS: The mean hospital stay was significantly shorter (P=0.001) after LLS. Laparoscopic splenectomy was completed in 68 patients (85%). Twelve patients (15%) required open splenectomy with no difference between groups. The operation time was significantly shorter in LLS (P=0.013). Blood loss (P=0.057) and blood transfusion (P=0.376) showed no difference between the two groups. The times until resumption of oral intake (P=0.019) and drain removal (P=0.011) were statistically shorter in LLS. CONCLUSIONS: LLS is more safe and feasible with shorter hospital stay compared with ALS.

Impact of liver cirrhosis due to chronic hepatitis C viral infection on the outcome of ovarian cancer: a prospective study.

BACKGROUND: This study was designed to investigate the impact of liver cirrhosis due to chronic hepatitis C virus (HCV) infection on the disease-free and overall survival of ovarian cancer patients undergoing a standard primary operation followed by standard chemotherapy. Attainment of the operative goals, intra- and postoperative events, possible complications under chemotherapy necessitating the termination of treatment, and the impact of ovarian cancer treatment on liver function were assessed. METHODS: This was a prospective observational study that included only patients with primary epithelial ovarian cancer. Only patients with Child-Turcotte-Pugh classification class A disease were recruited. Patients were divided into two groups according to whether they had liver cirrhosis. All the patients underwent primary debulking surgery followed by 6 cycles of chemotherapy, and were followed-up for 24 months after chemotherapy was completed. RESULTS: We recruited 77 patients, 19 of whom had liver cirrhosis. There were no significant differences between patients with or without liver cirrhosis with respect to tumor stage, histopathological type, tumor grade, or optimal operative debulking. There was no registered liver dysfunction-related mortality in the follow-up period, and there were no statistically significant differences between the groups with respect to disease-free or overall survival (p = 0.719 and p = 0.524, respectively). CONCLUSION: From the results of this study, we conclude that compensated liver cirrhosis (Child-Turcotte-Pugh class A) due to chronic HCV infection affects neither the disease-free nor the overall survival of ovarian cancer patients, regardless of their stage. This study shows that it is possible to treat ovarian cancer patients with cirrhosis caused by HCV infection the same as any other patient; treatment does not have to be adjusted as long as the patients have Class A disease.

Evaluation of the Quilting Technique for Reduction of Postmastectomy Seroma: A Randomized Controlled Study.

Background. Postmastectomy seroma causes patients' discomfort, delays starting the adjuvant therapy, and may increase the possibility of surgical site infection. Objective. To evaluate quilting of the mastectomy flaps with obliteration of the axillary space in reducing postmastectomy seroma. Methods. A randomized controlled study was carried out among 120 females who were candidates for mastectomy and axillary clearance. The intervention group (N = 60) with quilting and the control group without quilting. All patients were followed up routinely for immediate and late complications. Results. There were no significant differences between the two groups as regards the demographic characteristics, postoperative pathological finding, and the immediate postoperative complications. The incidence of seroma was significantly lower in the intervention group compared with the control group (20% versus 78.3%, P < 0.001). Additionally, the intervention group had a shorter duration till seroma resolution (9 days versus 11 days, P < 0.001) and a smaller volume of drainage (710 mL versus 1160 mL, P < 0.001) compared with the control group. Conclusion. The use of mastectomy with quilting of flaps and obliteration of the axillary space is an efficient method to significantly reduce the postoperative seroma in addition to significantly reducing the duration and volume of wound drainage. Therefore we recommend quilting of flaps as a routine step at the end of any mastectomy.

Axillary lymph nodes metastasis in a patient with recurrent papillary thyroid cancer: a case report.

INTRODUCTION: Thyroid cancer is the most common endocrine malignancy; the most common type of thyroid cancer is papillary thyroid cancer which accounts for approximately 90% of all thyroid cancers. Previously defined prognostic factors of papillary thyroid cancer include age, gender, tumor size, extrathyroidal extension, and distant metastasis. Cervical lymph node metastases are very common in patients with papillary thyroid cancer. Although papillary thyroid cancer has an excellent prognosis, lymphatic spread is associated with an increased risk of locoregional recurrence. Axillary metastasis is not a common finding in the classic type of papillary carcinoma; hence, a limited number of case reports have described the exceptional and rare metastatic spread of papillary thyroid carcinomas to the axilla. CASE PRESENTATION: We report a case of metastatic axillary lymphadenopathy in a 61-year-old Egyptian man with a recurrent papillary thyroid cancer. He had a history of total thyroidectomy with right radical neck dissection 18 months ago. He presented to our cancer clinic at the Oncology Centre -Mansoura University with recurrent mass at the right lower parotid region, left cervical lymphadenopathy and left axillary lymphadenopathy. Removal of the recurrent right intraparotid mass, left comprehensive neck dissection and left axillary dissection were performed and the postoperative pathology report showed infiltration of the cervical and axillary lymph nodes by metastatic papillary thyroid cancer. CONCLUSIONS: Axillary lymph node enlargement in a patient with papillary thyroid cancer should be considered metastatic from thyroid until proved otherwise. Careful thorough examination of patients with recurrent thyroid cancer is essential to address any unusual metastasis.

Pharyngoesophageal reconstruction after resection of hypopharyngeal carcinoma: a new algorithm after analysis of 142 cases.

BACKGROUND: The aim of this study is to define an algorithm for the choice of reconstructive method for defects after laryngo-pharyngo-esophagectomy for hypopharyngeal carcinoma. METHODS: One hundred and forty two cases of hypopharyngeal carcinoma were included and operated on by either partial pharyngectomy, total pharyngectomy or esophagectomy. The reconstructive method was tailored according to the resected segment. RESULTS: Pectoralis flap was used in 48 cases, free jejunal flap in 28 cases, augmented colon bypass in 4 cases, gastric pull up in 32 cases and gastric tube in 30 cases. Mean hospital stay was 12 days. Mortality rate was 10.6% and morbidity rate was 31.7%. Total flap failure occurred in 3 cases of free flap and one case of pectoralis flap. There were 23 cases of early fistula. Late stricture occurred in 19 cases, being highest with myocutaneous flap (early fistula 12/50 and late stricture 13/50). CONCLUSION: Free jejunal flap was the flap of choice for reconstruction when the safety margin is still above the clavicle. In cases with added esophagectomy, we recommend gastric tube as a method of choice for reconstruction.

Psychiatric morbidity among Egyptian breast cancer patients and their partners and its impact on surgical decision-making.

INTRODUCTION: Psychiatric morbidities, especially cases of anxiety and depression, are prevalent among breast cancer patients and their partners. PATIENTS AND METHODS: Fifty-four early diagnosed breast cancer patients and their partners were compared with 50 healthy couples to assess psychiatric morbidity and the impact of various factors upon patients' surgical choice. RESULTS: It was found that 18.5%, 22.2%, and 3.7% of husbands had generalized anxiety disorder, major depressive disorder, and panic disorder, respectively. It was also found that 38.8%, 29.6%, and 9.2% of the patients had major depressive disorder, generalized anxiety disorder, and panic disorder, respectively. Depression and anxiety scores were high in both partners in love-based, well-adjusted marriages, within the middle socioeconomic class, and among educated couples. Among the well-known factors related to surgical treatment choice (age, parity, tumor size, pathology, grade, lymph node status), only age and psychological morbidity (in the patients and their partners) had a significant impact on treatment choice. CONCLUSION: Patients of middle socioeconomic class, the well educated, and those in love-based marriages had a higher likelihood of suffering different types of psychological morbidities and were more likely to choose breast conservation or reconstruction than mastectomy.

Therapeutic reduction mammoplasty in large-breasted women with cancer using superior and superomedial pedicles.

BACKGROUND: Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants. METHODS: Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm. RESULTS: The age of the patients ranged from 36 to 58 (median 43) years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%), good in 15 (30%) patients, and fair in three patients (6%). The follow-up period was 8-36 (mean 20) months, with no local recurrence or systemic metastasis. CONCLUSION: Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.

Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection?

BACKGROUND: Reconstruction of large scalp defects after tumor resection is a challenging problem. We aimed at putting an algorithm for reconstruction of those defects. METHODS: Forty-two patients with scalp malignancies were enrolled in this study. Tumors were resected to a 1 cm negative margin and defects were reconstructed according to their size and to patient general condition. RESULTS: No peri-operative mortality was encountered. Usage of free flaps was superior in cosmoses and function with an acceptable rate of complications. CONCLUSION: for scalp defects wider than 100 cm2, the best tool of reconstruction is free flaps. Pedicled distant flaps are reserved if free flaps are not feasible or failed. Split thickness skin grafts are cosmetically inferior and not suitable for recurrent and irradiated tumours and better reserved for patients who cannot tolerate major operations.

Continent catheterizable umbilical low-pressure intestinal pouch with split ileal end seromuscular anti-reflux technique.

BACKGROUND: Cosmesis, better function, and stomal stricture avoidance are important issues in constructing continent urinary abdominal stomas for bladder cancer patients when orthotopic urinary diversion is not feasible. This study aims to evaluate the outcome of continent catheterizable umbilical low-pressure intestinal pouch incorporating a new split ileal end anti-reflux technique. METHODS: Twenty-three patients underwent a continent umbilical low-pressure intestinal pouch incorporating a new seromuscular antireflux technique (split ileal end) after radical cystectomy when orthotopic reconstruction was not feasible. Mean operative time was 210 min (130 min for radical cystectomy and 80 min for reconstruction of the pouch). The mean follow-up after surgery was 18 mo (range 6-30 mo). RESULTS: The most common early postoperative complications were urinary leak that occurred in nine patients: seven were conservatively managed and two by re-exploration. Late postoperative complications occurred in eight patients, of whom three developed stomal stenosis and treated successfully with repeated dilatation. Thirteen patients were totally continent, seven were fairly continent, and only two were poorly continent. CONCLUSIONS: The functional results with this catheterizable umbilical low pressure intestinal pouch incorporating our new anti-reflux technique were satisfactory with better cosmesis.