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Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Surgical technique and equipment have been evolved to overcome technical limitations, making LLR safe and feasible. Surgeons develop skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Patients and methods In this prospective randomized study, a comparison between laparoscopic and open resection was done to compare short-term results regarding intraoperative details, postoperative management, and complications. This study was conducted on 30 patients with hepatocellular carcinoma (HCC): 15 (50%) patients were treated by LLR (group A), whereas the other 15 (50%) patients were treated by open liver resection (group B). Results Regarding the demographic data, the presence of past history of medical condition, and the preoperative laboratory results, no statistically significant difference was found. The mean operative time has a statistically significant difference between the two groups, with decreased operative time in the laparoscopic group (P<0.001). Postoperative follow-up showed that the most frequent complication was postoperative ascites, which was seen in 12 (80%) cases in the open group and in six (40%) cases in laparoscopic group, with highly significant difference between both groups. Recurrence occurred in one patient in the LLR group and no cases in the other group. Conclusion LLR is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic liver segments II, III, IVa, V, and VI. LLR for HCC has superior short-term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team. [ABSTRACT FROM AUTHOR]

Background Trauma is considered to be a leading cause of death in young adults. Blunt mechanisms account for ∼95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. Objective In our study, we assessed the efficacy of laparoscopy in managing patients with blunt abdominal trauma to avoid unnecessary laparotomies. Patients and methods An observational prospective cohort study was conducted on all isolated blunt abdominal trauma cases at Ain Shams University Surgery Hospital from 1/3/2019 to 1/9/2019. The total sample size was 50 patients, comprising 25 patients who underwent laparoscopy and another 25 who underwent laparotomy. Results Laparoscopy decreased the operative time in comparison with laparotomy. The mean operative time for patients who underwent laparoscopy was 123.28 min, whereas in patients who underwent laparotomy was 150.48 min. Laparoscopy is associated with decreased postoperative ICU stay (1–3 days) in comparison with laparotomy (2–5 days) and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, where two patients had respiratory tract infections and no mortality after laparoscopy, whereas six patients had respiratory tract infections, six patients had wound infection, one patient had deep venous thrombosis, and two patients died after laparotomy. Conclusion Laparoscopy is found to be a good alternative to laparotomy, as it is considered to be a reliable and safe method in hemodynamically stable patients with blunt abdominal trauma. It can be used to reduce the rate of laparotomy with lower morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Background Thyroid disease has a common occurrence, especially in iodine-deficient areas. Thyroid nodules have been reported in as many as 50% of the population, on autopsy. They may be discovered in up to 41% of the patients on ultrasonography (US). Aim The aim of this study is to introduce the value of US-elastography in the diagnosis of thyroid nodules for reducing the number of unnecessary thyroidectomies, which add burden to the patient and community, and consequently, the complications of this surgery will be reduced. Patients and methods This prospective cohort study was conducted at El Demerdash, Ain Shams University Hospital, on 50 patients with the diagnosis of multinodular goiter, who were treated by total thyroidectomy between November 2016 and November 2018, with minimum follow-up of 1 month postoperatively. All patients who accepted to participate in our study were consented for participation after ethical committee approval. Results Using the US-elastography, we noted that the scores 3–4 were seen in eight (16%) of 50 patients, where six (12%) of them were malignant and two (4%) were benign. However, the scores 1 and 2 were detected in 42 (100%) patients, and all were benign. The two false-positive patients with scores 3–4 diagnosed with the elastography scoring system could be owing to calcifications and fibrotic changes, rendering the nodules harder. On the contrary, no false-negative results were found as score 1 and 2 by the elastography scoring system. Conclusion Conclusively, in the future, fine-needle aspiration cytology may not be used for the diagnosis of malignancy in patients presented with multinodular goiters who were diagnosed as being suspicious of malignancy by sono-elastography. [ABSTRACT FROM AUTHOR]

Background Breast-conserving treatment has become the standard treatment in early breast cancer; its goal is to provide a treatment as effective as mastectomy with the added benefit of a preserved breast. However, it is sometimes difficult to achieve good cosmetic results, particularly in patients with breast cancer located in the upper inner quadrant, for which the traditional conservative surgery results in a deformed breast. Aim The aim was to compare prospectively the oncoplastic outcome of lower pedicle mammoplasty and round block techniques for early-stage breast cancers in the upper inner quadrant. Patients and methods This is a prospective, randomized study on 20 female patients who were diagnosed in the upper inner quadrant to have early breast cancer and are candidates for oncoplastic breast surgery. The study was conducted at Ain Shams University Hospitals. Approval of the Ethics Committee and written informed consent from all participants were obtained. Patient selection was achieved through a number of inclusion and exclusion criteria. Results There is a significant difference between the two groups. Inferior pedicle mammoplasty needs longer operative time and postoperative hospital stay and drainage days with more intraoperative blood loss in comparison to the round block technique. As regards postoperative complications, inferior pedicle mammoplasty has more wound complications such as wound infection and dehiscence than the round block technique. Conclusion Early breast cancer patients with lesions in the upper inner quadrant are candidate for either inferior pedicle mammoplasty or round-block technique. Round-block technique is safer for them, as morbidity is lower, better cosmoses, no need for contralateral summarization, and fewer complications, so no delay in radiotherapy and inferior pedicle mammoplasty needs more surgeon experience. [ABSTRACT FROM AUTHOR]

Background Living donor liver transplantation (LDLT) has become an accepted treatment option for end-stage liver disease. Biliary complications still remain a major concern and are considered the Achilles' heel of LDLT, with a morbidity ranging between 20 and 42.1%. The high incidence of biliary complications can be attributed mainly to the affection of the blood supply of bile ducts. The high hilar dissection technique was described aiming at preservation of bile duct vascular supply. Patients and methods A total of 66 adult LDLT donors were operated in a single, liver transplant center (Ain Shams University Specialized Hospital) between January 2017 and August 2018. The study cases were divided into two groups: group A with conventional hilar dissection and group B with en bloc high hilar dissection. A comparative study was conducted between the two groups as regards early and late biliary complications. Results The 66 LDLT donors were divided into two groups: group A included 33 donors with conventional hilar dissection and group B included 33 donors with en bloc high hilar dissection. The occurrence of postoperative biliary leak was significantly more in the conventional hilar dissection group (18.2%) compared with the en bloc high hilar dissection group (3.0%) (P=0.046). Conclusion The en bloc high hilar dissection technique may decrease the incidence of biliary complications in LDLT donors as it protects the biliary vascular supply and facilitates the closure of the donor stump. [ABSTRACT FROM AUTHOR]

Background/objective: The purpose of this study is to evaluate the cases of lower urinary tract injuries during cesarean section with or without hysterectomy in cases with morbid placental adherence.Methods: This record based retrospective study was conducted at Ain Shams University Maternity Hospital in Cairo, Egypt during the period between January 2014 and December 2016. It included all patients who had urinary tract injuries during cesarean section with or without hysterectomy in the cases with morbid placental adherence and they were collected from files of pregnant women who were admitted at hospital planned for termination of pregnancy. Patients were enrolled in four groups, Group 1: cases without urinary tract injuries. Group 2: cases with injuries to the bladder. Group 3: cases with injuries of the ureter. Group 4: cases with injuries to the bladder and ureter.Results: This study gave us new information about the incidence of urinary tract injuries during cesarean section with morbid adherence placenta was 21.7% (Bladder 11.7%, Ureter 4.7%, and bladder with ureter 5.3%). There were various types of repair of urinary tract injury, as the following, bladder repair 10.8%, ureteric catheterization 0.9%, ureterovesical repair or reimplantation 1.5%, bladder repair and ureterovesical 1.2%, bladder repair and ureteric catheterization 2.3%, ureteric catheterization and ureterovesical 1.5 and 6.4% of cases needed urologic consultations. There is a real relation between urinary tract injury and obesity (55.3%). Bladder invasion was found in only 26.9% of all cases according to sonography findings. Most of the cases were delivered by cesarean section in 67.5%, and the remainders were delivered by cesarean hysterectomy 32.5%. About 96.5% of cases needed a blood transfusion.Conclusions: The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to compare the efficacy and safety of sublingual and vaginal misoprostol for termination of pregnancy in women with first trimester missed abortion.Methods: A single-blind, parallel group, randomised clinical trial (ClinicalTrials.gov NCT02686840) was conducted in a university hospital between 1 February 2016 and 31 January 2017. All women who presented with first trimester missed abortion were invited to participate in the study and were randomised to one of two groups: one group received sublingual misoprostol in three doses of 800 μg every 4 h, while a second group received vaginal misoprostol in the same dosage regimen. The primary outcome of the study was the rate of complete abortion within 7 days after initiation of treatment.Results: The study included 200 women (100 in each arm). By day 7, successful complete abortion was significantly more frequent in the sublingual misoprostol group (71.4%) than in the vaginal misoprostol group (51.5%) (p = .006). By day 30, the rate of complete abortion was higher in the sublingual misoprostol group (90.6%) than in the vaginal misoprostol group (83.9%), but with no statistically significant difference (p = .164). The mean length of the induction-expulsion interval in the sublingual misoprostol group was significantly shorter compared with the vaginal misoprostol group (12.3 ± 3.1 h vs 16.4 ± 4.2 h, respectively; p = .001) and the sublingual misoprostol group had a smaller drop in haemoglobin level (p = .001). The side effects of misoprostol were significantly more frequent in the sublingual group compared with the vaginal group.Conclusion: Sublingual misoprostol is more effective than vaginal misoprostol in completing first trimester missed abortion, with a shorter induction-expulsion time. Sublingual misoprostol is, however, associated with more side effects, such as unpleasant taste, gastrointestinal symptoms and fever, compared with vaginal misoprostol. [ABSTRACT FROM AUTHOR]

Background: Juvenile idiopathic arthritis (JIA) is prevalent among children below the age of 16 years and is characterized by persistent stiffness, swelling, and joint pain. Certain types of JIA can lead to severe complications such as growth retardation, ocular inflammation, and joint impairment. Eye problems can be observed in children with JIA, either as an outcome of the ailment or infrequently, as an adverse impact of certain medications. The capacity of the eye to differentiate shapes and the particulars of objects at a specific distance is denoted by visual acuity (VA). Objective: The aim of the current work was to find out visual acuity abnormalities in Juvenile Idiopathic Arthritis. Patients and Methods: This study included a total of 30 JIA patients and 20 age and gender matched controls, attending at Department of Rheumatology, Rehabilitation and Physical Medicine and Ophthalmology, Faculty of medicine, Benha University Hospitals, Egypt. CBC, ANA, ESR, CRP, KFTs, and LFTs were done. Ophthalmological examination of best corrected visual acuity (BCVA) by A logMAR chart and refractive errors assessment were done. Results: JIA group was classified according to diagnosis to 25 oligo-articular JIA (83%), 3 poly-articular JIA (10%) and 2 systemic onset JIA (6.7%). Visual acuity was affected in 7 patients of Oligo articular JIA (28.0%) and none of Poly articular and systemic onset subtypes were affected. Myopia was detected in 5 of oligo-articular JIA (20%). Conclusion: It could be concluded that visual acuity abnormalities and refractive errors in JIA represent an important issue which requires frequent ophthalmological examination of JIA patients. [ABSTRACT FROM AUTHOR]

The diagnosis of Sweet's syndrome (SS) is based on a set of criteria that requires the presence of two major and at least two minor criteria. In some cases, however, the diagnosis is not as straightforward due to the absence of certain criteria. The objective of the present study was to review the clinical, histopathological, and laboratory features of the current diagnostic criteria for SS, and to evaluate their validity in the cases reported in the literature as well as in 40 patients treated at our institution. Our comprehensive review of the current criteria for SS reveals that the two major criteria have been consistently present in all cases - including ours - since the first description of SS in 1964. With regard to the minor criteria, on the other hand, there has been marked variability between different studies, and many cases failed to fulfill the requirement of showing two minor criteria. In order to simplify the diagnosis, avoid misdiagnosis, and allow for prompt treatment, we propose two sets of revised diagnostic criteria for SS. The first set comprises constant clinical and histopathological features that must be present and are by themselves sufficient for the diagnosis of SS to be established. The second set includes variable features whose absence does not warrant ruling out SS., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)