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Background Arterial stiffness is strongly linked to the pathogenesis of heart failure (HF), and development of acute decompensation of patients with stable chronic HF. Purpose To compare the arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during hospitalization with acute decompensated state, and then three months later after discharge during the compensated state. Methods One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction (LVEF) ≤35% were included in the study. Fifty-six patients (56%) had ischemic cardiomyopathy (ICM) and the rest had dilated cardiomyopathy (DCM). During the initial and follow up visits, all patients were subjected to full medical history taking, clinical examination, electrocardiography (ECG), transthoracic echocardiography (TTE), routine labs and non-invasive pulse wave analysis (PWA) by the Mobil-O-Graph 24h PWA device for measurement of arterial stiffness parameters. Results The mean age was 51.6±6.1 years and 80% were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state as compared to their decompensated state values, table (1). During the decompensated state, patients with ICM showed a significantly higher PWV as compared to patients with DCM (9.2±1.1 vs 8.6±1.4 m/sec, P=0.042), patients presented with NYHA FC IV (n=64) showed higher AI (24.5±10.0 vs 16.8±8.6, p Conclusion Central arterial stiffness indices derived from the non-invasive Mobil-O-Graph 24h PWA device in patients with HFrEF were significantly lower in the compensated state as compared to the decompensated state. Patients with ICM, NYHA FC IV and females showed higher stiffness indices in their decompensated state of heart failure. Funding Acknowledgement Type of funding sources: None.

Background Arterial stiffness is strongly linked to the pathogenesis of heart failure and the development of acute decompensation in patients with stable chronic heart failure. This study aimed to compare arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during the acute decompensated state, and three months later after hospital discharge during the compensated state. Results One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction ≤ 35% were included in the study. During the initial and follow-up visits, all patients underwent full medical history taking, clinical examination, transthoracic echocardiography, and non-invasive pulse wave analysis by the Mobil-O-Graph 24-h device for measurement of arterial stiffness. The mean age was 51.6 ± 6.1 years and 80% of the participants were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state compared to the decompensated state. During the decompensated state, patients presented with NYHA FC IV (n = 64) showed higher AI (24.5 ± 10.0 vs. 16.8 ± 8.6, p p = 0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males. Conclusions Central arterial stiffness indices in patients with HFrEF were significantly lower in the compensated state than in the decompensated state. Patients with NYHA FC IV and female patients showed higher stiffness indices in their decompensated state of heart failure.

Background: The aim of this study was to compare local control and maximum mouth opening in excisionthe buccinator muscle with the skin versus excision the buccinator muscle without the skin.Methodology: This study was conducted on 40 patients with buccal squamous cell carcinoma (BSCC)without previous treatment, also T1 to T3 and N0 to N2 squamous cell carcinoma was involved in this study.The patients were divided randomly in 2 groups, 20 patients for each group. All patients were assessedfor local recurrence for 1 year. Maximum mouth opening was measured preoperative and compared bypostoperative measuring.Results: The local control was (100%) in the study group and (95%) in the control group, but There were nostatistically significant differences between the two interventions (P value 1). The maximum mouth openingwas decreased postoperatively than preoperatively and in study group than the control one,but there was nostatistically significance difference (P- value 0.22).Conclusions: Excision the buccinator muscle with its associated skin seems to decrease the local recurrenceand seems to decrease the maximum mouth opening, but with no statistically significant differences betweenthe two interventions. Indicating the needs for further studies.

Background: The conventional technique of thyroidectomy requires long skin incision, not satisfying patient and surgeon in terms of cosmesis and endoscopic thyroid surgery requires expertise. The aim of this study was to compare the clinical outcomes of patients undergoing minimal-incision thyroidectomy with those undergoing conventional thyroidectomy for benign thyroid diseases.Methods: Prospective randomized study that was carried on 50 patients who were undergone thyroidectomy at the department of surgery-Menoufia University from June 2018 to June 2019. The patients were divided into two groups. Group A included 25 patients who were operated upon using minimal incision thyroidectomy technique and group B included 25 patients who were undergone traditional thyroidectomy incision.Results: The length of skin incision was significantly shorter in the minimal-incision thyroidectomy than that in the conventional thyroidectomy group. Operative time was shorter in minimal incision technique. The incidence of postoperative complications was higher in conventional thyroidectomy group but didn’t reach to significant level. Patients undergone minimal-incision thyroidectomy experienced significantly less postoperative pain and were more satisfied with the cosmetic result than patients who underwent conventional thyroidectomy.Conclusions: Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible and safe option for selected patients with excellent cosmetic outcome, with minimal learning curve.

Background: Complete mesocolic excision (CME) as a standard surgery for left sided colon cancer is proven however there is a great debate and deal of discussion if the extra effort needed for it in right sided colon cancer worth the gain that is achieved. We aimed in our study to assess the outcome of CME with central vascular ligation for treatment of right sided colon cancer performed either laparoscopic (lap.) assisted or by open technique.Methods: This was a prospective randomized study on sixty patients who were presented with right sided colonic cancer. Patients were divided into two groups. Group (A) open one and group (B) lap. assisted group.Results: Both groups were comparable regarding demographic data, although operative time was significantly shorter in open group (p>0.001). Lap. assisted group achieved a significant difference as regards to blood loss, incision length, duration of hospital stay, resume of oral feeding, tumor to high vascular tie as well as higher number of harvested lymph nodes with no difference in recurrence rate and overall survival rate over a period of 3 years follow up.Conclusions: The principles underlying CME are anatomical and logical as it entails return back to embryology, and the results published points to the improved survival and decreased local recurrence particularly when it is performed in the proper mesocolic plane, using of laparoscopy may help in that due to better visualization of planes thus the gain of CME even in right sided colon cancer may exceed the pain in hand skilled colorectal lap. surgeons.

Background: The purpose of this study was to compare between laparoscopic and open complete mesocolic excision (CME) with central vascular ligation (CVL) in right colon cancer.Methods: From January 2016 to December 2018, a prospective cohort study of 60 patients who diagnosed as operable right sided colon cancer was performed. The patients were classified into laparoscopic CME with CVL and open CME with CVL groups. Demographic variables, comorbidities, tumor location, intraoperative parameters, duration of hospital study, histopathological findings, postoperative complications and follow up data were compared between the two groups. Demographic variables included age and sex distribution. Intraoperative parameters included incision length, operative time and operative blood loss.Results: 60 patients were selected in this study. Both groups were the same in the age and sex distribution, potential comorbidities and tumor location. Patients in the Laparoscopic CME with CVL group had shorter incision lengths, longer operative times, less operative blood loss, shorter hospital stay, less number of retrieved lymph nodes , the same TNM (tumor nodes metastasis) classifications, similar histopathological findings and comparable incidence of postoperative complications.Conclusions: Laparoscopic CME with CVL procedure is a safe, valid and feasible surgical method for right colon cancers.

Background Data: Cervical spine nerve sheath tumors (SNTSs) represent a special location of interest and challenge for neurosurgeons because the lesion in this region tend more to have extradural and extraspinal component (dumb-bell tumors) than dorsal or lumbar region. These tumors extension is most likely because of short intraduradural root in the cervical region. Dumb-bell tumors require special surgical strategy and approaches to allow complete removal of these tumors from both intraspinal and extraspinal components without traction on the spinal cord. Purpose: to evaluate our experience in management of cervical spinal nerve sheath tumors with special consideration for dumb-bell tumors that operated by multidisciplinary team and discussing our result. Study Design: A prospective descriptive clinical case study. Patients and Methods: This was a prospective study including nine patients suffering from cervical spinal nerve sheath tumors who were treated from January 2006 to December 2012. Each case was analyzed according to sex, age, clinical presentation, magnetic resonance imaging (MRI) of the brain and whole spine, surgical intervention, pathology and outcomes. The patients were followed in our outpatient clinic, where they were assessed clinically and functionally by VAS score and JOA score as well as radiologically by MRI of the cervical spine. Results: There were nine cases in this study with cervical SNTSs with age ranged from 30 to 56 years in eight cases with one case reported at 6 years. There were 5 females and 4 males. Five cases in this study (56%) were dumb-bell tumors and four cases were only intraspinal. All dumb-bell tumors were operated by combined posterior and anterior approach at the same session. Six cases (67%) were schwannoma, two cases (22%) were neurofibromas and one case was malignant nerve sheath tumor. The results were generally good. 80% of patients with preoperative pain (78%) had moderate to complete pain relive. All cases with preoperative cord related motor deficit (56%) had improvement to satisfying degree. Conclusion: SNTSs are uncommon lesions and tend to have extradural component in the cervical region. Proper clinical and radiological evaluation should be performed to exclude Neurofibromatosis 1 or 2 with associated spinal and /or intracranial tumors. Multidisciplinary team management provides optimum result for removal of dumb-bell tumors but the posterior approach should be performed first to prevent neurological manipulation. The incidence for recurrence and reoperation of small residual tumor are generally low. (2013ESJ059)

Background and objective Supramandibular facial lymph nodes (SFLNs) are one of the unusual sites of lymph nodes metastases. This prospective study investigated the possible involvement of SFLNs in cases of head and neck carcinoma. Patients and methods SFLNS were identified and dissected from 30 neck dissections obtained from 30 patients (22 male individuals and eight female individuals) with squamous cell carcinoma (SCC) of the oral cavity without locoregional recurrence or distant metastases. Result Histopathological examination of the removed SFLN nodes proved positive for metastases in nine neck dissections, five cases of buccal mucosa SCC (41.7% of the cases) and four cases of alveolar margin SCC (44.4% of the cases). Conclusion SFLNs are a probable site of lymph node metastases in SCC of the alveolar margin and buccal mucosa. Careful dissection above the lower margin of the mandible can safely remove these nodes without significant injury to the marginal mandibular branch of the facial nerve.

Objective: The study introduces a simple vascular control procedure to minimize intraoperative blood loss during resection of advanced head and neck malignancies through clamping to the external carotid artery (ECA). Patients and methods: This prospective study included 20 patients with different operable head and neck cancer randomized to perform vascular clamping of ECA during neck dissection before tumor resection (group A, n = 11) or classical neck dissection and resection of the tumors without vascular control (group B, n = 9). Results: There was no significant difference between the 2 groups regarding demographic and disease characteristics. Statistically significant decrease of blood loss was observed in the vascular control group. Blood loss in group A was nearly a quarter of that in group B. Conclusion: Temporary intraoperative clamping of the ECA minimizes blood loss, and consequently, the need for blood transfusion with all its complications. In addition, it ensures more optimum survival of the full-thickness graft used for coverage of the head neck defect left after surgery.

Background: Assessment of predictors and prognostic factors of locoregional recurrent breast cancer will help in management of those patients. The aim of this study was to assess and identify the predictors and prognostic factors for locoregional current breast cancer.Methods: This prospective study will be carried out on 50 female patients with history of breast cancer underwent surgical procedures either modified radical mastectomy (MRM) or conservative breast surgery (CBS) and adjuvant therapy (chemotherapy, radiotherapy, hormonal therapy).Results: Significant relationship between recurrence of breast cancer and Oral contraceptive pills of the studied female patients with history of breast cancer underwent surgery.Conclusions: Number of positive lymph nodes, lympho-vascular invasion, positive safety margin and presence of extensive intra-ductal component all these factors increase risk of recurrent breast cancer.

Human bocavirus (HBoV) is a prevalent virus worldwide and is mainly associated with respiratory disorders. Recently, it was detected in several disease conditions, including cancers. Colorectal cancer (CRC) is the third main cause of cancers worldwide. Risk factors that initiate cell transformation include nutritional, hereditary and infectious causes. The aim of the current study was to screen for the presence of HBoV in solid tumors of colorectal cancer and to determine the genotypes of the detected strains. Surgically excised and paraffin-embedded colorectal cancer tissue specimens from 101 male and female patients with and without metastasis were collected over the last four years. Pathological analysis and tumor stages were determined. The presence of HBoV was screened by polymerase chain reaction, and the genotype of the detected HBoV was determined by direct gene sequencing. Most of the examined specimens were adenocarcinoma with mucinous activity in many of them. Twenty-four out of 101 (23.8 %) CRC tissue specimens were found to contain HBoV-1. Low sequence diversity was recorded in the detected strains. The virus was detected in both male and female patients with an age range of 30-75 years. It is proposed that HBoV-1 could play a potential role in the induction of CRC.

Objective The aim of the study was to assess the hormonal profile level in females with pelvic tumors after surgical transposition of the ovaries during surgery followed by postoperative radiotherapy to the pelvis.

Introduction Conservative surgery has become a well-established alternative to mastectomy in the treatment of breast cancer. However, in case of larger lesions or small-sized breasts, the removal of adequate volumes of breast tissue to achieve tumor-free margins and reducing the risk of local relapse may compromise the cosmetic outcome, causing unpleasant results. To address this issue, surgical techniques, the so-called oncoplastic techniques, have been introduced in recent years to optimize the efficacy of conservative surgery in terms of both local control and cosmetic results. Patients and methods A Clinical Interventional descriptive single arm randomized prospective study, conducted on twenty female patients presenting with operable breast cancer stages 1 and 2 located at the Upper or Central breast. Ages ranging 25 to 75 years to be treated using the “round block” technique. Results Cosmetic results were found to be excellent in three cases, good in eight cases, fair in five cases, and poor in two cases. In this study, the cosmetic results were unacceptable (fair and poor) in patients who underwent 25% resection or in whom the resected area was part of the lower portion of the breast. Conclusion These techniques are useful for performing breast-conserving surgery in the upper portion of the breast. However, if the excision volume is greater than 20% or excision of part of the lower portion of the breast is required, other procedures should be considered. This article discusses the indications, advantages, and limitations of the round block breast-conserving oncoplastic techniques and its results in terms of feasibility, maintaining breast esthetics, limitations, and early complications.

Background: Elective dissection of cervical lymph nodes in oral cavity cancers gives very precious data on its pathological state, judge for adjuvant therapy requirement plus its therapeutic effect but it has its morbidities that cannot be condoned. Tumor thickness (TT) in oral cavity cancers show an increasing value to be one of the most important and reliable factors that have a great relationship to regional node involvement.Methods: Forty-three patients with T1, T2 oral cavity squamous cell carcinoma with clinically and radiologically negative cervical L.Ns underwent elective neck dissection and the relation between the tumor thickness and the nodal metastasis was monitored. Tumor thickness was estimated preoperatively by using the intra-oral ultrasound and confirmed by histopathology postoperatively.Results: Only 12 out of 43 neck dissections (27.9%) showed positive L.Ns metastasis of primary tumor. The excised number of L.Ns ranged from 15 to 31 with mean±SD (21.58±3.59) L.Ns. The (TT) ranged from 1.4 mm to 7.8 mm. Our statistical results showed that there is a cutoff point which was 4 mm where (TT) > 4 mm showed significant results with histologically found positive cervical node metastasis compared to (TT) ≤4 mm specimens.Conclusions: Relationship of tumor thickness to lymph node metastasis was found to be significant as shown by this study. Our results clearly demonstrate that conservative elective neck dissection is indicated in patients with stage I/II oral cavity carcinoma whose tumors are > 4 mm in thickness as they mostly have latent metastasis.

Background: Resecting oral squamous cell carcinoma (SCC) with an appropriate margin of uninvolved tissue is critical in preventing local recurrence and in making decisions regarding postoperative radiation therapy. This task can be difficult due to the discrepancy between margins measured intraoperatively and those measured microscopically by the pathologist after specimen processing. Material and methods: A total of 61 patients underwent resective surgery with curative intent for primary oral SCC were included in this study. All patients underwent resection of the tumor with a measured 1-cm margin. Specimens were then submitted for processing and reviewing, and histopathologic margins were measured. The closest histopathologic margin was compared with the in situ margin (1 cm) to determine the percentage discrepancy. Results: The mean discrepancy between the in situ margins and the histopathological margins of all close and positive margins were 47.6% for the buccal mucosa (with a P value corresponding to 0.05 equaling 2.1), which is statistically significant, 4.8% for the floor of mouth, 9.5% for the mandibular alveolus, 4.8% for the retromolar trigon, and 33.3% for the tongue. Conclusion: There is a significant difference among resection margins based on tumor anatomical location. Margins shrinkage after resection and processing should be considered at the time of the initial resection. Tumors located in the buccal mucosa show significantly greater discrepancies than tumors at other sites. These findings suggest that it is critical to consider the oral site when outlining margins to ensure adequacy of resection. Buccal SCC is an aggressive disease, and should be considered as an aggressive subsite within the oral cavity, requiring a radical and aggressive resective approach. © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Purpose Since of the 1940s, there has been wide controversy about the most effective surgical treatment for the primary benign parotid tumor. This review investigates the effectiveness and associated complications of superficial parotidectomy versus total conservative parotidectomy in the management of primary benign parotid tumors. Material and methods An electronic search with restricted dates (1920–2014) and restricted language was performed in August 2014. Thirteen studies were included. In total, 2477 patients were enrolled in the 13 studies, with 1317 patients undergoing superficial parotidectomy and 391 patients undergoing total conservative parotidectomy; 769 patients treated with other surgical techniques were excluded. The maximum follow-up period varied between 2 and 24 years (mean 2.8 years). Results The incidence of recurrence in the superficial parotidectomy patients ranged from 0% to 15% (mean 5.7%), whereas, in the total conservative parotidectomy patients it ranged from 0% to 16% (mean 3.03%). The incidence of the facial nerve paresis according to collected data in the superficial parotidectomy group ranged from 0% to 23% (mean 6.75%), whereas in the total conservative parotidectomy group it was 0%–45% (mean 15%). The incidence of facial nerve paralysis in the superficial parotidectomy group ranged from 0% to 3% (mean 0.8%), whereas in the total conservative parotidectomy group it was 0%–17 % (mean 4.4%). Conclusion The results of this review suggest that superficial parotidectomy is superior to total conservative parotidectomy in the management of primary benign tumor in superficial lobes. In addition, superficial parotidectomy showed a minimal recurrence rate for benign tumor in superficial lobes.

Inhalation injury greatly increases the incidence of respiratory failure and the acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of our research was to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relation between inhalation injury and death in burn patients.This study included 130 burn patients with inhalation injury admitted to Menoufiya University Hospital Burn Center, Egypt, from January 2004 to April 2008 (61 males and 69 females). We found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury in our study was 46.3% (130 patients were identified as having inhalation injury out of 281). The overall mortality for patients with inhalation injury was 41.5% (54 patients out of 130) compared with 7.2% (11 patients out of 151) for patients without inhalation injury. These statistical data make it clear that inhalation injury is an important factor for the prediction of mortality in burn patients. Approximately 80% of fire-related deaths are due not to the burn injury to the airway but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, mostly confined to the upper airways.Major airway, pulmonary, and systemic complications may occur in cases of inhalation injury and thus increase the incidence of burn patient mortality

Purpose The aim of the study was to determine the feasibility and accuracy of sentinel lymph node biopsy (SLNB) in patients with advanced breast cancer after preoperative chemotherapy. Patients and methods A prospective study was conducted on 73 patients with advanced operable breast carcinoma previously treated with preoperative chemotherapy. Sentinel lymph node (SLN) mapping was performed at the time of surgery. Following surgery all patients received comprehensive postoperative radiotherapy at 50 Gy/5 weeks. Results Seventy-three patients with a median age of 52 years who had been previously treated with preoperative chemotherapy at Menofia University Hospital and National Cancer Institute (NCI) between May 2006 and May 2013 were selected for this study. The SLN detection rate was 79.5%. Thirty-three of 58 patients (56.9%) had successfully mapped positive SLNs. The false-negative rate was 22.4%. Conclusion This study confirms the feasibility of SLNB after preoperative chemotherapy in the case of advanced operable breast cancer. According to the detection rate and false-negative rate SLNB may predict metastatic disease in the axilla of patients with tumor response following preoperative chemotherapy.

Objective The objective of this study was to compare the efficiency and safety between the use of shoelace darn repair and the use of mesh repair in the management of midline abdominal incisional hernia. Background Midline abdominal incisional hernia is a complication caused by surgical wounds after different surgical procedures. Management of midline abdominal incisional hernia is performed through different surgical approaches. Patients and methods This was a 1-year, prospective, randomized study including 40 patients with midline abdominal incisional hernia. The patients were divided into two equal groups - group I (20 patients) repaired by shoelace darn repair and group II (20 patients) repaired using a polypropylene mesh. Both groups were evaluated for incidence of infection, hematoma formation, seroma formation, and recurrence for 12 months. Results Wound hematoma was found in one patient (5%) from group I and in one patient from group II (5%); there were no statistically significant differences between the two groups with regard to hematoma (P = 0.987). Similarly, seroma was found in one patient (5%) from group I and in one patient from group II (5%); there were no statistically significant differences between the two groups with regard to seroma (P = 0.987). Three patients (15%) from group I had recurrence of hernia, whereas two from group II had recurrence of hernia (10%), and statistical analysis proved that there was no significant difference between the two groups with regard to hernial recurrence (P = 0.637). One patient (5%) from group I complained of postoperative chronic pain, whereas two from group II (10%) complained of postoperative pain, and statistical analysis proved that there was no significant difference between the two groups with regard to postoperative chronic pain (P = 0.553). Wound infection was found in one patient (5%) from group I and in three patients from group II (15%), and statistical analysis proved that there was no significant difference between the two groups with regard to wound infection (P = 0.602). Conclusion From the present study, we concluded that shoelace darn repair is a better option for managing midline abdominal incisional hernias.