Bevacizumab in the treatment of ovarian cancer

Despite advances in surgical cytoreduction and cytotoxic chemotherapy, ovarian cancer continues to be the leading cause of death in women with gynecologic malignancy. Our understanding of the treatment of ovarian cancer was revolutionized with the discovery of platinum- and taxane-based adjuvant chemotherapy regimens. Since that time however, overall survival has been stable. Given the above, an emphasis has been placed on exploring alternative therapeutics. Recent research efforts have improved our understanding of the molecular biology of ovarian cancer and novel targeted treatment strategies have emerged. The most studied of these agents has been the monoclonal anti-vascular endothelial growth factor antibody bevacizumab. The purpose of this review is to discuss management issues related to the treatment of ovarian cancer, with a focus on the utilization of bevacizumab, summarizing applicable clinical trials, its potential benefits, and reported adverse events

Evaluating Delay Causes for Constructing Road Projects in Saudi Arabia

In this paper, we evaluate the causes of delays in road construction projects in Saudi Arabia. The research identifies four main groups of delay causes: external factors, contractor-related factors, project management factors, and environmental factors. External factors include changes in regulations and delays in obtaining permits and approvals. Contractor-related factors include inadequate resources and poor project planning. Project management factors encompass ineffective communication and poor coordination among stakeholders. Environmental factors include adverse weather conditions and unforeseen site conditions. The study recommends measures such as improved coordination, enhanced contract management, and advanced project management techniques to mitigate these delay causes. The findings provide valuable insights for stakeholders involved in road infrastructure development in Saudi Arabia, enabling them to implement strategies for timely project delivery and improved project performance

Bow Hunter\u27s Syndrome in a Patient with a Right Hypoplastic Vertebral Artery and a Dynamically Compressible Left Vertebral Artery

This is a case report of a 48-year-old man with multiple transient ischemic attacks and a known hypoplastic right vertebral artery (VA) who presented after a syncopal event while turning his head to the left. The objective of this study is to demonstrate the necessity of proper diagnosis and management of cerebrovascular pathology including imaging and surgical intervention in patients with known anatomical anomalies. This study was conducted at Massachusetts, United States of America. Our patient\u27s history was significant for a hypoplastic right VA and a stenotic segment of the right VA at the C3-C4 junction. There was also degeneration of the C3-C4 facet on the left, with osteophyte formation compressing the VA, and a fusion of the C2-C3 segment. Imaging demonstrated obliteration of the left VA flow with head rotation to the left and subsequent reconstitution of flow in the neutral position. After consultation, the patient decided to proceed with surgical management with an anterior cervical discectomy and fusion at the level of C3-C4. Symptoms of vertebrobasilar insufficiency including syncopal episodes resolved after treatment. VA anomalies, although uncommon, are important to understand. Our patient presented with an anomalous right VA, as well as severe degenerative changes to the C2/C3 vertebrae that contributed to the development of Bow Hunter\u27s syndrome. It is essential that proper monitoring and follow-up has to be carried out in patients with abnormal cerebral vasculature to minimize the occurrence of Bow Hunter\u27s syndrome

57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve) with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64years old who underwent aortic valve replacement with homograft 14years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch

2. Minimally invasive mitral valve surgery why do you take the risks?

During recent years, minimally invasive mitral valve surgery (MIMVS) become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female), age 35±12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6±0.7. Mean ejection fraction was 50±8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%), or direct aortic cannulation (42 of 70, 25%). Aortic cross-clamp used in (66 of 70, 94.2%). Without aortic cross-clamp in (4 of 70, 5.7%), mitral valve repair has been done in (52 of 70, 74.2%), mitral valve replacement (18 of 70, 25.7%). Concomitant procedures included AF ablation (24 of 70, 34.2%), and tricuspid valve repair (33 of 70, 47.1%). No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5%) during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95±35 and 250±74min, respectively. 4 patients (5.7%) underwent reexploration for bleeding and (57 of 70, 81.4%) did not receive any blood transfusions. Six patients (8.5%) sustained face oedema. Mean length of hospital stay was 7±3.8days. 18 patients (25.7%) did not feel any interest regarding cosmotic advantage over conventional surgery. Minimally invasive mitral valve surgery is an excellent alternative to conventional mitral valve surgery in most cases however comparing to conventional mitral surgery it shows long bypass time, long cross clamp time, difficult reexploration for bleeding and multiple body incisions

Response rates for mailout survey-driven studies in patients with head and neck cancer

Background: Mailout survey studies are becoming more prevalent in the head and neck literature. The objective of this paper is to summarize response rates in patients with head and neck cancer, and to provide recommendations surrounding methodology used to design and implement mailout survey questionnaires. Methods: The results of this paper are from a study assessing the measurement properties of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) in head and neck cancer patients. A modified Dillman tailored design approach was used. Results: The methods used yielded a response rate of 80% with this patient population. Conclusion: This is a considerably higher response rate than other reports in the oncology literature. © 2010 Wiley Periodicals, Inc. Head Neck, 2010Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78489/1/21363_ftp.pd

Functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation

Background: Fractures of the ischiopubic bones, S-I joint, and sacrum are among the most common bony injuries. Various procedures are available for managing this condition. Biomechanically, internal fixation of both the posterior and anterior lesions can offer complete stability to the pelvic ring. This study aimed to assess the functional assessment of daily living activities following surgical management of young-burgess lateral compression type-II pelvic fractures with combined anterior and posterior internal fixation. Methods: This descriptive observational study was conducted at the Department of Orthopedics & Traumatology, Dhaka Medical College & Hospital, Dhaka, Bangladesh from July 2016 to June 2018. A total of 44 patients with pelvic injuries admitted to the respective department were purposively enrolled as the study population. Data analysis was performed using the MS Office tools. Results: Most patients (68.18%) continued their jobs with reduced performance, while 22.72% maintained both job and performance levels. Regarding functional assessment, 54.54% could sit pain-free, with only 13.63% experiencing discomfort. None reported painful sexual intercourse. Mobility-wise, no one was bedridden or could only walk a few meters, and 0% needed walking sticks. Additionally, 18.81% could walk for one hour with a stick, while 63.63% had a normal walking distance for their age. No limitations in walking time or distance were observed in 63.63% of cases. Conclusions: This study concludes that stabilization of LC type-II pelvic ring fractures by anterior, combined, or posterior reconstruction plate provides a good result concerning daily living activities