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Assessment of Sentinel Lymph Node Biopsy in Colon Cancer and Its Impact on Staging
Emad Hokkam
,
Soliman El-Kammash
,
Amr Abdelaziz
,
Sherif Farrag
,
Hamada Fathy
,
Ahmed Gomaa
Issue: Volume 4, Issue 2-1, March 2016
Pages: 36-40
Received: 26 October 2015
Accepted: 26 October 2015
Published: 23 February 2016
DOI:
10.11648/j.js.s.2016040201.18
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Abstract: Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application of adjuvant therapy. The aim of this study is to determine the feasibility of sentinel lymph node technique and its effect on staging of the disease. Methods: A total number of forty five patients with primary colon cancer (T1-3, any N, M0) were enrolled in the study. They were subjected to appropriate colonic resection based on the anatomic location of the tumor. A combined method of lymphatic mapping using technetium 99mTc -labeled sulfur colloid and patent blue was performed. After few minutes of injecting the tracers, the colon and its mesentery were examined for any blue-stained glands and areas of high radioactivity using a hand-held gamma probe. After colonic resection, the sentinel lymph node(s) and non-sentinel lymph nodes were sent for H&E staining. Positive sentinel lymph node(s) underwent no further analysis while negative nodes were submitted for immunohistochemical staining. Results: Sentinel lymph node(s) were successfully identified in 43 patients (95.6%) with a mean of 1.7 node/patient. The false negative rate is 7.1%, Sensitivity is 92.9%, specificity is 100%, negative predictive value is 88.2% and positive predictive value is 100%. Detailed focused examination using the immunohistochemical staining discovered 4 more positive patients who were supposed to be negative by the ordinary H&E staining resulting in upstaging rate of 9.3% among the whole study group and 21% among the negative-nodes patients. Conclusion: Sentinel lymph node mapping is a feasible technique with a relatively high identification rate. It can upstage some patients who will get benefit from further adjuvant chemotherapy resulting in reduced recurrence and better prognosis.
Abstract: Background: Missed nodal metastases during resection for colon cancer or missed occult metastases during pathological examination leads to down staging of the disease and increase the recurrence rate. The sentinel lymph node is a technique used to properly detect nodal metastases hence improving staging accuracy with subsequent proper application o...
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Umbilical Reconstruction as an Adjuvant Procedure After Umbilical Hernia Repair or Midline Abdominal Incision
Issue: Volume 4, Issue 2-1, March 2016
Pages: 31-35
Received: 13 October 2015
Accepted: 14 October 2015
Published: 27 January 2016
DOI:
10.11648/j.js.s.2016040201.17
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Abstract: Introduction: Umbilicus construction is usually needed post umbilical or Para umbilical hernia repair and in some techniques the umbilicus needs reconstruction after exploratory laparotomy. There are many techniques for umbilical reconstruction and the common objective of all these techniques is to mention umbilicus that looks natural in terms of location, size and depth. And avoid ischemic necrosis of the edges of the umbilicus flap. The author in this study described a new and simple technique for umbilical reconstruction. Patients and methods: The present study included 50 cases who were subjected to anterior abdominal wall incision (umbilical, Para umbilical or midline incision) Crimean Medical Academy named after S.I. Georgievsky Crimean Federal University named after V.I. Vernadsk Russia in department of general and gastrointestinal surgery. The study started from January 2012 to may 2015. End points: The primary end point of the study was the aesthetic appearance of the new umbilicus and the second end point was patient satisfaction of the operative outcome. Results: Over 50 cases of midline abdominal incision we performed reconstruction of the umbilicus with a new and simple technique. There were 40 females and 10 males with age ranging from 28 to 52 years with the mean value as 40 ± 7.35 years. Conclusion: The technique for reconstruction of the umbilicus presented in the present study is a simple technique without complications, with long term success and good aesthetic appearance. The new constructed umbilicus exhibits appropriate features of both depth and size and avoids the appearance of scarring and secondary stenosis or necrosis.
Abstract: Introduction: Umbilicus construction is usually needed post umbilical or Para umbilical hernia repair and in some techniques the umbilicus needs reconstruction after exploratory laparotomy. There are many techniques for umbilical reconstruction and the common objective of all these techniques is to mention umbilicus that looks natural in terms of l...
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Conservative Treatment Versus Appendectomy for Acute Uncomplicated Appendicitis
Emad Hokkam
,
Abdelaziz Gonna
,
Aly Saber
,
Ossama Zakaria
,
Abdulhameed Alhazmi
Issue: Volume 4, Issue 2-1, March 2016
Pages: 27-30
Received: 11 October 2015
Accepted: 12 October 2015
Published: 27 January 2016
DOI:
10.11648/j.js.s.2016040201.16
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Abstract: Background: For more than 100 years, surgeons have been successfully performing appendectomy to treat acute appendicitis. However; there is recent trend to shift towards a more conservative approach. This work aimed to assess the non- operative management in the treatment of acute uncomplicated appendicitis. Methods: One hundred and sixteen patients with uncomplicated acute appendicitis were enrolled into the study. They were divided into two groups (Group A & Group B). Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. All patients were evaluated at hospital discharge, at 30-days and at a median follow-up on year. The primary outcome was the success rate of the non-operative management. Secondary outcomes were the difference of length of hospitalization, time to return to normal activity, and quality-of-life measures between both groups. Results: The success rate of non-operative strategy was 93.3% (42 of 45) at hospital discharge, 88.8% (40 of 45) at 30-days and 82.2% (37 of 45) at a median follow-up of one year. Patients in Group A have a significantly shorter time to return to normal activities. They reported higher quality of life scores. The length of hospitalization was significantly shorter in Group B. Conclusion: Giving intravenous antibiotics to some patients with uncomplicated acute appendicitis instead of having them undergo surgery may be safe and effective.
Abstract: Background: For more than 100 years, surgeons have been successfully performing appendectomy to treat acute appendicitis. However; there is recent trend to shift towards a more conservative approach. This work aimed to assess the non- operative management in the treatment of acute uncomplicated appendicitis. Methods: One hundred and sixteen patient...
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Age - Related Gastric Changes
Aly Saber
,
Emad K. Bayumi
Issue: Volume 4, Issue 2-1, March 2016
Pages: 20-26
Received: 17 October 2015
Accepted: 18 October 2015
Published: 13 January 2016
DOI:
10.11648/j.js.s.2016040201.15
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Abstract: Aging is a universal process with progressive loss of function accompanied by decreasing fertility and increasing mortality and disability. There are several mechanisms to underlie the primary aging process and probably contribute to age-related changes in adaptive responses. These mechanisms are oxidative stress, mitochondrial theory, telomeres and cellular senescence, apoptosis and genetic mechanism. There are many physiological changes with aging process including blood pressure, temperature, fever, and composition of body fluids. Age-related changes in bioavailability may be secondary to changes in absorption or gut wall and hepatic metabolism. The stomach lining's capacity to resist damage decreases with age due to alteration of the gastric defense mechanisms and decreased mucosal blood flow. Normal aging is associated with age-related changes in motor function of the various parts of the gastrointestinal tract such as transit time and gastric emptying. The incidence of many gastrointestinal dysfunctions increases with advancing age that is associated with alterations in the structural and functional integrity of the gastrointestinal tract. The structural changes include mucosa, muscular coat and blood flow. The clinical significance of functional and structural gastric changes may all impact upon gastrointestinal adverse effects and how older people tolerate medicines. Understanding how the upper gastrointestinal tract changes with advancing age could allow interventions that lead to more appropriate prescribing for older people, potentially reduce adverse effects, increase compliance with treatment regimens, and may allow older people to take medications that they would not otherwise tolerate.
Abstract: Aging is a universal process with progressive loss of function accompanied by decreasing fertility and increasing mortality and disability. There are several mechanisms to underlie the primary aging process and probably contribute to age-related changes in adaptive responses. These mechanisms are oxidative stress, mitochondrial theory, telomeres an...
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Patients Satisfaction and Outcome of Fistulotomy Versus Fistulectomy for Low Anal Fistula
Issue: Volume 4, Issue 2-1, March 2016
Pages: 15-19
Received: 12 October 2015
Accepted: 13 October 2015
Published: 13 January 2016
DOI:
10.11648/j.js.s.2016040201.14
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Abstract: Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally, fistulectomy is an adequate surgical procedure for the treatment of a simple or low transsphincteric fistula while others reported that fistulotomy continues to have excellent results. Patients and Methods: This study represented parallel prospective randomized clinical trial where 200 patients were divided randomly into two main groups; A and B. Group A patients were subjected to fistulotomy and those of group B were subjected to fistulectomy for low anal fistulae. The study included all patients having low anal fistulae complicating perianal abscesses. Patients with high fistulae and patients with multiple external openings were excluded. The primary end point was anal incontinence and the secondary end points were time off from work, postoperative pain, wound discharge, wound healing and patients’ satisfaction. Results: The mean operative time, time taken for wound discharge to cease and time taken for complete healing was significantly less in patients of group A. Regarding the occurrence of fecal incontinence, no permanent cases were reported in our series but temporary incontinence was observed in 2 patients in fistulotomy group while in fistulectomy group there were 4 patients. Therefore, the overall patient satisfaction mean values were 90.6 ± 8.87and 85.6 ± 13.2 for patients in group A and B respectively with statistically insignificant distribution. Conclusion: Fistulotomy could be used as a primary treatment of low anal fistula as being safe and simple to perform with good patient’s satisfaction as regard postoperative pain and outcome.
Abstract: Introduction: Anal fistulae are still negatively influencing the patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Although a number of surgical techniques have been proposed to treat this condition, there is still no single ideal technique for the treatment of this disease. Generally...
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Effect of Combination of Acapella Device and Breathing Exercises on Treatment of Pulmonary Complications After Upper Abdominal Surgeries
Nesma M. Allam
,
Mohammed M. Khalaf
,
Wael N. Thabet
,
Zizi M. Ibrahim
Issue: Volume 4, Issue 2-1, March 2016
Pages: 10-14
Received: 21 October 2015
Accepted: 4 November 2015
Published: 14 December 2015
DOI:
10.11648/j.js.s.2016040201.13
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Abstract: Introduction: Background. Upper abdominal surgery alters postoperative pulmonary function, as observed by impairment of lung volumes such as total lung capacity, vital capacity. Impaired clearance of sputum results in a vicious cycle of colonization and infection of bronchi with pathogenic organisms, dilation of bronchi and further production of sputum. The aim was to investigate the effect of combination of Acapella device and breathing exercises on treatment of post operative pulmonary complications after upper abdominal surgeries. Subjects and methods: Sixty patients underwent upper abdominal surgery were assigned randomly into two equal groups; their ages ranged from 20-50 years. The study group received breathing exercises, Acapella device and traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). Control group received traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). All groups received three sessions per week for four successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure pulmonary function: Forced vital capacity (FVC) and Forced expiratory volume in one second (FEV1) using electronic spirometer. Results: Post treatment results showed that there was a significant improvement difference in FVC and FEV1 in both groups in favor of the study group. Percentage of improvement of FVC in the study group was 42.28%, while it was 16.31%in the control group. Percentage of improvement of FEV1 in the study group was 49.05%, while it was 20.79%in the control group. Conclusion: Combination of Acapella device and breathing exercises were considered to be an effective modality for treatment of postoperative pulmonary complications and removal of secretions after upper abdominal surgeries.
Abstract: Introduction: Background. Upper abdominal surgery alters postoperative pulmonary function, as observed by impairment of lung volumes such as total lung capacity, vital capacity. Impaired clearance of sputum results in a vicious cycle of colonization and infection of bronchi with pathogenic organisms, dilation of bronchi and further production of sp...
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Prevalence of Hyperkalemia in Type 2 Diabetics Treated with Inhibitors of the Renin-Angiotensin-Aldosterone System: A Multicenter Study
Abeer Al Saweer
,
Reda Othman
Issue: Volume 4, Issue 2-1, March 2016
Pages: 4-9
Received: 13 October 2015
Accepted: 14 October 2015
Published: 30 November 2015
DOI:
10.11648/j.js.s.2016040201.12
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Abstract: Background and Aim: Hyperkalemia is a common risk among patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors, especially diabetics. The aim of this study was to measure the prevalence of hyperkalemia among patients with type-2 diabetics treated with ARBs and/or ACEIs, and compare them with controls. Subjects and methods: This study was carried out in four primary health care centers in Bahrain using a comparative ex-post-facto cross-sectional design with a control group. It included 305 type-2 diabetes patients in these settings. They were categorized into four groups: A) controls not on RAAS medications; B) ARB alone; C) ACE Inhibitors alone; D) combination of both. Data were collected from medical records. The study protocol was approved by the research committee in the Ministry of Health in the Kingdom of Bahrain. Results: The prevalence of hyperkalemia among those on ACE inhibitor and/or ARB medications was 16.51% (95% CI: 11.84 – 22.12%), while severe hyperkalemia was 1.38% (95% CI: 0.28 – 3.97%). The patients in the group taking both ARB and ACE inhibitor medications had significantly higher level of serum potassium but better control of their Fasting Blood Sugar (FBS) compared to the other 3 groups. In multivariate analysis, the medication group was not a statistically significant predictor of hyperkalemia. Conclusion: A combined ACEi/ARB therapy may pose a higher risk of increased serum potassium compared with mono-treatment or control. Hence, caution should be exercised especially in those with advanced kidney disease, heart failure, on renal replacement therapy, on potassium sparing diuretics.
Abstract: Background and Aim: Hyperkalemia is a common risk among patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors, especially diabetics. The aim of this study was to measure the prevalence of hyperkalemia among patients with type-2 diabetics treated with ARBs and/or ACEIs, and compare them with controls. Subjects and methods: Thi...
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Acute Appendicitis Presented as a Cause of Sigmoid Colon Obstruction: A Case Report
Adel R. Al-Masry
,
Ifrat Bakirov
,
Aly Saber
,
Junaid Hassan
Issue: Volume 4, Issue 2-1, March 2016
Pages: 1-3
Received: 11 October 2015
Accepted: 12 October 2015
Published: 30 November 2015
DOI:
10.11648/j.js.s.2016040201.11
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Abstract: Background: Acute appendicitis is a common surgical problem. However, the diagnosis is often overlooked when it presents as a bowel obstruction. Case presentation: In this report we present a case of elderly patient presented with bowel obstruction and radiological signs of sigmoid colon volvulus. Although there were no accurate manifested signs of acute appendicitis it was the real cause of acute large bowl obstruction. The patient was successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery. Conclusion: Acute appendicitis should be considered in the differential diagnosis of patients with large bowel obstruction.
Abstract: Background: Acute appendicitis is a common surgical problem. However, the diagnosis is often overlooked when it presents as a bowel obstruction. Case presentation: In this report we present a case of elderly patient presented with bowel obstruction and radiological signs of sigmoid colon volvulus. Although there were no accurate manifested signs of...
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