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1.
Artigo em Inglês | MEDLINE | ID: mdl-31928389

RESUMO

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.

2.
Breast J ; 2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31448502

RESUMO

Dual localization of SLN in breast cancer patients using isotope & dye is the best-approved modality with limitations such as high cost of radioactive materials, complex logistic preparations & scheduling issues, especially in developing countries. We investigated the feasibility & accuracy of a novel technique for SLN localization using silver wire insertion or liquid charcoal injection guided by CT lymphography. 120 patients with clinically node-negative breast cancer were enrolled. In the test group, SLN was localized using preoperative CTLG guided injection of liquid charcoal or by placing a 3 cm silver wire. In addition, intraoperative SLN mapping was performed using methylene blue dye followed by searching for the SLN localized by both methods. In the control group, SLN was localized by the blue dye only. Feasibility, accuracy, detection rates, and number of SLNs retrieved were reported as well as matching between the LN detected with the CTLG and that detected with the dye technique. SLN could be detected in 59 out of 60 patients (98.3%) in the test group and in 54 out of 60 patients (90%) in the control group (P = .057). In self-controlled analysis of the test group comparing CTLG only to dye only was significant (P = .050). Comparing charcoal to silver wire in detection was statistically insignificant (P = .5). This novel method can offer advantages which are as follows: being more accurate than the dye alone, saving operative time, abandoning complex logistic preparations for the radioisotope, and solving the problem of timing.

3.
Anesth Essays Res ; 13(2): 334-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198256

RESUMO

Background: Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the opioids and general anesthetics' needs. This study compared the erector spinae plane (ESP) block and the pectoral plane (PECS) block effects on the opioid consumption postoperatively, stress response, fentanyl needs intraoperatively, pain scores, and incidence of complications in female patients subjected to MRM surgery. Patients and Methods: Fifty patients were allocated randomly and divided into two groups. Forty-seven patients were included in the final analysis after exclusion. ESP block group (E group, n = 24) received 20 mL of 0.25% levobupivacaine plus 0.5 µ/kg dexmedetomidine that was injected in-between erector spinae muscle and transverse process. PECS block group (P group, n = 23) received 30 mL of 0.25% levobupivacaine plus 0.5 µg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the interfascial plane and the other was 20 mL injected between the serratus anterior and the pectoralis minor. Results: Postoperative morphine consumption and stress hormone level in P group were significantly lower than E group. The pain scores and number of patients requested analgesic postoperatively showed significantly higher values in E group. Hemodynamic parameters, fentanyl needed intraoperatively and the incidence of postoperative complications recorded no significant difference between the two groups. Conclusion: The current study demonstrated that PECS block provides better quality of analgesia than ESP block in patients subjected to MRM operations.

4.
Ann Diagn Pathol ; 40: 59-65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31031216

RESUMO

BACKGROUND: Regional nodal recurrence (RNR) in patients diagnosed with papillary thyroid carcinoma (PTC) has increased. Variable immunohistochemical (IHC) markers have been studied for predicting the likelihood of PTC for recurrence. We aimed to clarify the IHC expression of p53, Ecadherin and BRAF as potential markers of RNR in PTC. METHOD: 145 (73 study group and 72 control group) patients with PTC were analyzed retrospectively between January 2010 and June 2017. Further classification to a specific histological variant was done, and IHC expression of p53, Ecadherin and BRAF was analyzed both in the primary tumor and in nodal recurrence. RESULTS: Regarding the risk of RNR, we found certain clinicopathologic features as elder age ≥55 years, tumor size >1 cm, presence of microscopic extrathyroid extension, presence of lymphovascular emboli, and conventional papillary subtype. Furthermore, IHC results for negative E-cadherin, and positive P53 and BRAF are significant risk factors, while radioactive iodine (RAI) adjuvant therapy decrease recurrence risk. CONCLUSION: We found several risk factors for RNR in PTC diagnosed patients, all of which are easily achievable in clinical settings. In this regard, we suggested that patients with specific clinicopathologic and immunohistochemical features have strict follow up for early detection of RNR as it has a great impact on their survival.


Assuntos
Antígenos CD/metabolismo , Caderinas/metabolismo , Proteínas Proto-Oncogênicas B-raf/metabolismo , Câncer Papilífero da Tireoide/metabolismo , Neoplasias da Glândula Tireoide/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia
5.
Eur J Radiol ; 111: 76-80, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30691669

RESUMO

AIM OF THE WORK: To investigate mean diffusivity (MD) and fractional anisotropy (FA) measured by diffusion tensor imaging (DTI) as complementary tools to differentiate recurrent breast cancer from post-operative changes in patients with breast-conserving surgery (BCS). PATIENTS AND METHODS: Prospective study was conducted upon 30 patients with BCS that underwent DTI and dynamic contrast MR imaging. DTI was performed using an axial two-dimensional spin-echo echo-planar imaging sequence. The MD and FA of the lesions were calculated by 2 observers. A single pixel seed isotropic region of interest was placed in the solid part of the tumor on the axial color FA map guided by an enhanced part of the tumor. The final diagnosis was done by biopsy for all patients. RESULTS: The pathological examination proved to be recurrent breast cancer (n = 13) and post-operative changes (n = 17). Recurrent breast cancer had significantly lower MD (P = 0.001, 0.001) and higher FA (P = 0.003, 0.02) than in post-operative changes for both observers respectively. At ROC curve analysis of MD, the AUC was 0.86 and 0.85 by both observers. The threshed MD was (0.86, 0.85 × 10-3 mm2/s) used for differentiation between entities revealed sensitivity (76.9%, 92.3%), specificity (82.4%, 64.7%) and accuracy (80%, 76.7%) of both observers respectively. At ROC curve analysis of FA, the AUC was 0.82 and 0.75 by both observers. The threshold FA (0.82, 0.75) was used for differentiation between entities revealed sensitivity (92.3%, 76.9%), specificity (70.6%, 70.6%) and accuracy of (80.0%, 73.3%) of both observers respectively. There was a strong positive correlation of MD (r = 0.86) and FA (r = 0.73) of both observers. Combined analysis of FA and MD used for differentiation between entities had AUC (0.90, 0.88) revealed sensitivity (92.3%, 92.3%), specificity (82.4%, 70.6%) and accuracy of (86.7%, 80.0%) for both observers respectively. CONCLUSIONS: Combined analysis of MD and FA of DTI may play an important role as a non-invasive method for differentiation recurrent breast cancer from post-operative changes in patients with BCS.


Assuntos
Neoplasias da Mama/patologia , Imagem de Tensor de Difusão , Mastectomia Segmentar , Recidiva Local de Neoplasia/patologia , Adulto , Anisotropia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Período Pós-Operatório , Estudos Prospectivos , Curva ROC
6.
Surg Laparosc Endosc Percutan Tech ; 28(6): 366-370, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30260917

RESUMO

INTRODUCTION: Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes. METHODS: This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed. RESULTS: There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA. CONCLUSIONS: Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.


Assuntos
Endoscopia/métodos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Biópsia por Agulha Fina , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Mama , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/psicologia , Contratura/etiologia , Contratura/psicologia , Transtornos de Deglutição/etiologia , Estética/psicologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Parestesia/etiologia , Parestesia/psicologia , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Parede Torácica , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/psicologia , Tireoidectomia/psicologia , Resultado do Tratamento
7.
Urology ; 107: 103-106, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28456539

RESUMO

OBJECTIVE: To evaluate the role of preoperative testicular shear wave elastography (SWE) in the prediction of improvement of semen analysis parameters after subinguinal microsurgical varicocele ligation in patients with primary infertility and clinically detectable varicocele. PATIENTS AND METHODS: Testicular SWE before the surgical intervention was done. Forty-eight patients were scheduled for subinguinal microsurgical varicocele ligation as a treatment option. Computer-assisted semen analysis was repeated 6 months after the intervention. RESULTS: At a cutoff value of 4.5 kPa, the stiffness index had a sensitivity of 86.4% and a specificity of 84.2% for semen parameter improvement after varicocelectomy. Correlation between different parameters of semen analysis and SWE showed a statistically significant negative correlation between SWE stiffness index and both sperm count (million/mL) and total motility. On the other hand, a nonsignificant negative correlation was found between SWE stiffness index and percentage of normal form. CONCLUSION: Testicular SWE is a good test that can be used in the assessment of male infertility with clinically detectable varicocele, and its results may predict semen parameter improvement after varicocelectomy. Further studies on a larger number of patients are needed to verify our results.


Assuntos
Infertilidade Masculina/cirurgia , Sêmen/diagnóstico por imagem , Motilidade Espermática/fisiologia , Testículo/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adulto , Diagnóstico por Computador , Seguimentos , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Ligadura , Masculino , Microcirurgia/métodos , Reprodutibilidade dos Testes , Fatores de Tempo , Varicocele/complicações , Varicocele/diagnóstico
8.
J Surg Case Rep ; 2017(12): rjx248, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29302307

RESUMO

Fibromatosis is a benign tumor that rarely affects the breast and is an unusual site for its occurrence. Whilst the definite etiology of breast fibromatosis is unclear, it may present itself following surgical trauma or silicone implant. Wide local excision with adequate safety margins is considered the standard of care. We review three cases of breast fibromatosis who were presented to and operated in the Oncology center, Mansoura universty (between April 2014 and August 2016). Two of these cases underwent wide local excision and primary closure of the defect whilst the other one was reshaped by mini latismuss dorsi flap.

9.
Hepatogastroenterology ; 61(134): 1748-55, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25436374

RESUMO

BACKGROUND/AIMS: Pancreatic head cancer is considered to have the worst prognosis of the periampullary carcinomas. The clinicopathological features of uncinate process pancreatic cancer are poorly published. METHODOLOGY: We retrospectively studied patients who underwent pancreaticodudenectomy (PD) for pancreatic head adenocarcinoma. This study included three groups of patients. Group A patients with pure pancreatic head carcinoma (PPHC), group B patients with combined head and uncinate process carcinoma (CPHUC) and group C patients with pure uncinate process carcinoma (PUPC). Preoperative, intraoperative and postoperative variables were collected. RESULTS: The study included 157 patients. Jaundice was the most common presenting symptoms in PPHC and CPHUC. Abdominal pain was the most common presenting symptoms in PUPC. The mean common bile duct (CBD) and pancreatic duct diameters were significantly smallest in PUPC group (P=0.0001). The venous invasion was significantly observed more in PUPC group and vascular resection was done in 50% of cases. The number of patients with microscopically residual tumor was significantly highest in PUPC group after PD than in other two groups (P=0.001). Recurrence rate occurred in 54.2% in PUPC group, 34.8% in CPHUC group and 22.7% in PPUC group after PD (P=0.007). The median survival was 19 months in PPHC groups, 16 months in CPHUC group, 14 months in PUPC group (P= 0.02). CONCLUSIONS: PUPC presented with abdominal pain with more vascular infiltration. The recurrence rate was common after PD for uncinate process carcinoma especially locoregional recurrence and the overall survival rate was found to be lower for PUPC.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Feminino , Humanos , Icterícia/etiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasia Residual , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Arab J Urol ; 10(2): 143-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26558017

RESUMO

OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is the standard management for large and/or complex urolithiasis, but the standard patient position for PCNL is undecided. With the patient prone PCNL has several drawbacks, while when supine, as described previously, PCNL has mechanical limitations. We describe a modification that aims to overcome these limitations and provide easy access comparable to that in the prone position. PATIENTS AND METHODS: This prospective study was carried out at the Urology Department, Zagazig University, Egypt, from October 2008 to March 2011, and included 78 patients (48 men and 30 women). First the patient was placed supine and then in the 'flank-free modified' supine position. The distance between the last rib and the iliac crest in the posterior axillary line was measured in both positions. RESULTS: The mean age of the patients was 40.8 years, the mean (SD) stone diameter was 3.4 (0.7) cm, the number of right/left stones was 34/44, and mean body mass index was 28.8 kg/m(2). The mean (SD) increase in the distance between the last rib and the iliac crest in the posterior axillary line in the flank free modified supine position vs. the previous supine position was 12 (0.8) mm. CONCLUSION: The flank-free modified supine position increases the distance between the last rib and the iliac crest, and, together with the absence of a cushion under the flank, provides ample space for puncture, dilatation, multiple tracts and manoeuvrability of the system with the nephroscope.

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