Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Background: Cavity shaving (CS) entails circumferential tissue removal from residual lumpectomy cavity following tumor resection during breast conserving surgery (BCS). It could allow detection of occult multifocal breast cancer (OMFBC).Objectives: This study aimed to highlight the impact of unidentified OMFBC as essential risk factor for local recurrence after BCS. Patients and Methods: Eligible breast cancer patients for BCS and CS were prospectively enrolled. Patients with negative margins of “resected tumor specimens” were designated as group A whereas group B comprised those with positive margins. OMFBC, diagnosed in the additionally shaved margins of the “residual lumpectomy cavity” as malignant breast tissues with intervening normal areas, was investigated in both groups. The study was conducted through the period from November, 2017 to March, 2021.Results: Forty-two patients with median age of 43 years were studied. Group A included 32 patients (76.2%)compared with 10 (23.8%) in group B. Overall, OMFBC was confirmed in the additionally shaved margins in 6 (14.3%) patients. OMFBC rate was less in group A (4/32 patients, 12.5%) compared to B (2/10 patient, 20%), however the difference did not reach statistical significance. In group B, another 1 patient showed persistent positive margins without evidence of OMFBC. All 7 patients with positive CS margins (6 with OMFBC and 1 with persistent positive margin without evidence of OMFBC) had their treatment strategy switched to modified radical mastectomy. Local recurrence occurred in only one among the remaing 35 patients (2.9%) who were treated by BCS with CS. Conclusions: CS improves outcome of BCS by reducing the rate of positive margins, enabling diagnosis of occult multifocal breast cancer and reducing local recurrence

Enucleation versus standard pancreatic resection for benign lesions and borderline tumors: a comparative study

Background: Enucleation of pancreatic benign lesions and borderline tumors, compared with standard pancreatic resection, may avoid postoperative impairment of the metabolic pancreatic functions. However, its influence on postoperative morbidity and disease recurrence seems obscure. Therefore, the choice between both approaches remains controversial. Objective: To evaluate the outcome of enucleation compared with standard pancreatic resection (SPR) of pancreatic benign lesions and borderline tumors among patients presented to Sohag University Hospital. Patients and Methods: Adult patients who underwent enucleation (group A) versus standard resections (group B) of pancreatic benign lesions and borderline tumors at Sohag University Hospital (June 2017 - May 2021) were prospectively enrolled. Both surgical techniques were compared regarding their influence on postoperative metabolic functions of the pancreas, surgical complications, and disease recurrence. Results: Sixteen patients (eight per group) with comparable gender and age distribution were eligible. Group A had significantly shorter operative time, lower amounts of intra-operative blood loss and less transfusions compared to group B. Likewise, patients in group A exhibited significantly reduced severity of surgical complications, including postoperative pancreatic fistula, and required significantly shorter periods of hospital stay. The incidence of new onset diabetes mellitus and pancreatic exocrine insuffficiency were significantly lower among patients in group A compared with those in group B. During follow-up, no recurrence was found in both groups. Conclusion: It could be concluded that enucleation of pancreatic benign lesions and borderline tumors preserves pancreatic metabolic functions, reduces postoperative morbidity and confers satisfactory oncologic outcome

Closure of emergency midline laparotomy over subcutaneous closed suction drain to mitigate incisional surgical site infection, dehiscence and hernia: A prospective comparative study

Background: The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of the work was to investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery. Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to January 2021 by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were randomized according to EML incision closure technique into group A without SCSD and group B with closure of EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia. Results: Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise, the duration of hospital stay was significantly shorter among patients in group B versus those in group A. Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of duodenal ulcer in group B. After a median follow-up of 26 (range: 7 - 44) months, the protective effect of SCSD against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during closure of non-traumatic EML

Clinical outcome and prognostic factors for central neurocytoma, a study of 14 cases

Background: Since they’re rare, the intraventricular neoplasms “central neurocytoma” best management got diverse, and mystifying.Aim of the work: to assess outcome for patients with central neurocytoma and value of specific factors like tumor size, surgical resection extent, atypia, and concomitant other modality of treatments by radiotherapy in their survival.Patients & methods: 14 patients (8 males, 6 females) were managed surgically between 2012 and 2016. They were assessed clinically, radiologically and their outcome in relation to selected factors.Results: Median age at diagnosis was 28.3 years in average (range 16–58). Median follow-up was 32.2 months.we lost 2 cases to follow-up in post-operative period. Six patients had recurrent of neurocytoma tumours.Five patients (35.7 %) obtained gross total resections (GTR) while 9 patients (64.2 %) had subtotal resections (STR). Two STR patients (14.2 %) received dose of radiation post operatively that significantly enhanced overall PFS (p =0.047). our series data propose that radiation therapy following (STR) usually increase (PFS). Two patients proved to have atypical neurocytoma by pathological reports died at 2.3 and 10.2 months after the microsurgical procedures. MIB-1 tagging index higher than 4 % is an indicator for poor outcome. We used Kaplan–Meier beside Cox proportional hazards methods in determining the Progression-free survival (PFS) in our study.Conclusion: the extent of surgical resection may improve the neurological condition but not the survival, Atypia was the most important factor determine the recurrence & survival while radiotherapy improve the survival quietly

Efficacy of electromyography and nerve conduction velocity monitoring in surgical management of terminal lipoma in children

Background: the prognosis of Terminal lipomas is better than that of other sites and pathology especially their management nowadays became clearer with better surgical outcome due to advancement of surgical tools and neurophysiology study. Objective: to assess the outcome of excision of terminal lipomyelomeningocele and reconstruction of the neural tube. Methods: From 2002 to 2016, 32 cases of terminal lipomyelomeningocele in Mansoura university hospital, insurance hospital and El Ahrar specialized center, the age of the cases ranged between 10 days and 4,3 years underwent surgical management of total or near-total lipoma excision and neural tube reformation with minimum follow up of 6 months. Results: according to system which applied to show the success of the operations, Of the 32 patients, 9 cases represent (28.1%) showed total excision of the lipoma; 17 patients represent (53.1%) had 25 mm3 of lipoma or less and 6 patients represent (18.75%) had 26 mm3 of fat or more. The neurological and urological complications was about 25%, while other complications like cerebrospinal fluid leak, wound disruption and infection was 9.4%. The surgical morbidity was comparable with the published papers. Conclusion: the excision of terminal lipomyelomeningocele and recreation of the neural tube by monitoring throughout EMG & NCV with low surgical morbidity and better results than leaving them without management or surgical interference without neurophysiological monitoring.Key words: terminal lipomyelomeningocele, lipoma, Reconstruction of neural placode. Abbreviations: DREZ, dorsal root entry zone; MRI, magnetic resonance imaging, CSF, cerebrospinal fluid

Scaffold Repurposing Reveals New Nanomolar Phosphodiesterase Type 5 (PDE5) Inhibitors Based on Pyridopyrazinone Scaffold: Investigation of In Vitro and In Silico Properties

Inhibition of PDE5 results in elevation of cGMP leading to vascular relaxation and reduction in the systemic blood pressure. Therefore, PDE5 inhibitors are used as antihypertensive and antianginal agents in addition to their major use as male erectile dysfunction treatments. Previously, we developed a novel series of 34 pyridopyrazinone derivatives as anticancer agents (series A–H). Herein, a multi-step in silico approach was preliminary conducted to evaluate the predicted PDE5 inhibitory activity, followed by an in vitro biological evaluation over the enzymatic level and a detailed SAR study. The designed 2D-QSAR model which was carried out to predict the IC50 of the tested compounds revealed series B, D, E and G with nanomolar range of IC50 values (6.00–81.56 nM). A further docking simulation model was performed to investigate the binding modes within the active site of PDE5. Interestingly, most of the tested compounds showed almost the same binding modes of that of reported PDE5 inhibitors. To validate the in silico results, an in vitro enzymatic assay over PDE5 enzyme was performed for a number of the promising candidates with different substitutions. Both series E and G exhibited a potent inhibitory activity (IC50 = 18.13–41.41 nM). Compound 11b (series G, oxadiazole-based derivatives with terminal 4-NO2 substituted phenyl ring and rigid linker) was the most potent analogue with IC50 value of 18.13 nM. Structure–activity relationship (SAR) data attained for various substitutions were rationalized. Furthermore, a molecular dynamic simulation gave insights into the inhibitory activity of the most active compound (11b). Accordingly, this report presents a successful scaffold repurposing approach that reveals compound 11b as a highly potent nanomolar PDE5 inhibitor worthy of further investigation