THE PSYCHOLOGICAL IMPACT OF BREAST-CONSERVING SURGERY VERSUS MASTECTOMY IN EGYPTIAN FEMALE PATIENTS

The previous research on breast cancer's psychological impact was based on its effects on shape, with breast removal, and the subsequent effect on sexual attractiveness. Several changes that affect life behavior after breast cancer surgery including insomnia, difficulty returning to usual activities and work, nightmares and loss of appetite. These manifestations may be due to depression but they are only considered abnormal if they persist after the period of physical recovery from surgery. We conducted a study to assess the effects of the surgical decision and psychological impact of this decision on Egyptian females with breast cancer. Most patients were subjected to a questionnaire including all environmental and clinical factors affecting the surgical decision either mastectomy or breast-conserving surgery. As a conclusion we can say that breast conservative surgery is better accepted psychologically by patients than modified radical mastectomy as it did not affect sexual life, cosmetic appearance, mood, self-satisfaction, and quality of life.

RIGHT HEPATIC DUCT STENOSIS DUE TO MULTIPLE METALLIC CLIPS AFTER CHOLECYSTECTOMY. IS THERE A WAY OUT? RE-LAPAROSCOPY AND ERCP STENTING

Bile duct lesions with leakage and stenosis can occur after open or laparoscopic cholecystectomy. Multiple factors are involved either related to the patient or external due to technical equipment or surgeon. Bismuth classification is generally accepted. The aim is to restore the bile duct and to prevent short-term and long-term complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis, and secondary biliary cirrhosis. Endoscopic therapy with biliary sphincterotomy alone or with the additional placement of a biliary/nasobiliary stent drainage is recommended. Stenting should be avoided if complete strictures exist or a circumferential resection of the duct. Endotherapy can be considered a sensible option and should be the main-stay treatment in these patients but one must keep in mind it is costly and is usually practiced by experienced teams in tertiary centers. The purpose of our paper is to exemplify this complication which is inherently rare, to highlight the diagnostic and treatment tools with minimal long-term sequelae.

RECURRENCE OF MALIGNANT PERIPHERAL NERVE SHEATH TUMOR

Peripheral nerve sheath tumor (PNST) is known as a benign tumor called Schwannomas, developed from the Schwann cells that produce myelin and collagen, and can occur in a wide variety of locations. In some cases, it can take a malignant turn and grow as a pelvic mass known as malignant peripheral nerve sheath tumor (MPNST), malignant schwannoma, malignant neurofibroma, malignant mesenchynoma and neurogenic sarcoma. Our case report presents a female patient presenting dysuria and pelvic pain. The clinical examination revealed a palpable mass in the lower abdomen. The computer tomography (CT) scan of the abdomen and pelvic region showed a tumor mass that was in contact with the nearby organs, but not infiltrating them. After the surgery, histopathology confirmed the MPNST proliferation. A month after, the patient returned for a follow-up and presenting pelvic pain. The CT scan of the abdomen and pelvic region showed a tumoral mass compressing the nearby organs, but not infiltrating them. The patient was referred to oncology board for palliative treatment. The particularity of this case report is the short period of time recurrence of the MPNST, rather than metastases. The most important treatment for MPNSTs remains surgery, trying to achieve negative margins. However, there have been reported two cases of unresectable MPSNT with partial remission to chemo- and radiotherapy.

LATERAL HUMERAL CONDYLAR FRACTURE IN A PAEDIATRIC MONTEGGIA TYPE III EQUIVALENT

Monteggia fracture dislocations can be classic or equivalents. Equivalents, also known as Monteggia like lesions, are very rare especially type III and IV, which have been added to the literature after Luis Bado presented the original classification system of Monteggia fracture dislocations. Type III equivalent is classically defined as a proximal ulna fracture associated with a fracture of the lateral condyle of the humerus. In the literature only seven such cases have been reported so far. Here we present two such cases where one eight-year-old boy had a complex type of injury with a shear type fracture of the lateral humeral condyle and other a seven-year-old boy who had a plastic deformity of the ulna with an avulsion type fracture of the lateral humeral condyle. We also try to describe a novel mechanism of injury, known as, “Barzulla circle”, for the classical as well as equivalent type III Monteggia fracture dislocations.

A CORRELATIONAL STUDY BETWEEN FINE NEEDLE ASPIRATION CYTOLOGY AND HISTOPATHOLOGY OF PALPABLE BREAST LUMPS

Incidence of breast malignancies has been rising. Any breast lump needs to differentiated as surgery may not be required in all cases. The National Health Services Breast Screening Program recommends Fine Needle aspiration cytology (FNAC) as a non-operative diagnostic tool. FNAC is a cheap, readily available, relatively painless, repeatable and patient-friendly investigation with good sensitivity and specificity. FNAC does not yield a tissue diagnosis as opposed to core biopsy, however, a well-performed FNAC and reporting by an expert pathologist help to avoid unnecessary surgeries in benign lesions where only conservative management or elective surgery is needed. Aims: To study the correlation between FNAC and histopathological reports of palpable breast lumps. Materials and method: We conducted an observational study at a tertiary care hospital. The study included 237 patients of palpable breast lumps who had undergone FNAC, excisional biopsy and histopathology in the same institution. The results of FNAC and histopathology reports were correlated into benign and malignant categories. Results: There were 225 women and 12 men in this study. FNAC had reported 20 malignant (C4+C5) cases and 217 benign cases. Histopathology revealed 21 malignant cases and 216 benign cases. We observed a sensitivity of 90.48%, specificity of 99.54%, a positive predictive value of 95%, a negative predictive value of 99.08%, a concordance of 92.41%, a diagnostic accuracy of 98.73% and a negative likelihood ratio of 0.1 for FNAC. Conclusions: Besides other advantages, FNAC of a breast lesion is reliable enough to rule out malignancy.

HEPATIC HYDATID CYST RUPTURED INTRABILIARY IN A 28-YEAR-OLD HIV POSITIVE PATIENT

Echinococcosis is an endemic disease in countries from the Mediterranean area, Eastern Europe, the Middle and the Far East, Australia, South America and Eastern Africa. However, it has a worldwide distribution because the dog, a definitive host, is a ubiquitous animal. Another important factor that led to a worldwide spread of the disease is population migration, as the number of cases in non-endemic regions has been increasing. We present the case of a 28-year-old HIV positive patient suffering from a liver hydatid cyst that had ruptured inside the biliary pathways. US and CT were the imaging tools used to establish a preoperatory diagnosis and the main therapeutic approach was neutralizing the parasite using 90 degrees alcohol, Lagot deroofing, contents’ evacuation through open surgery and appropriate drainage afterward. ERCP was very useful in unblocking the main biliary pathways after the surgery as well as installing a stent to ensure its further permeability.

SPONTANEOUS RUPTURE OF DOUBLE J URETERAL STENT

The double J stent is widely used in urological endoscopic surgery with different indications (ureteral stenosis, ureteropelvic junction obstruction, retroperitoneal tumor or fibrosis) and can be a subject to multiple complications including migration, encrustation, stone formation and fragmentation which is a rare complication. We are reporting a rare case of a 42-years-old, followed for cervical cancer since 2018 revealed by an acute obstructive renal failure drained by a left double J ureteral stent (of long duration) and right percutaneous nephrostomy. The patient maintained the double J stent for 2 years. On clinical examination there was a lumbar tenderness on the left side and a hardened vaginal cervix on bimanual vaginal examination. The patient underwent a renovesical ultrasound showing a minimal left ureterohydronephrosis. The uroscanner with reconstruction revealed a fragmented double J stent on the left side.

3D PRINTING IN PEDIATRIC ORTHOPEDICS – THE NEW GENERATION OF PREOPERATIVE PLANNING IN THE FIELD OF PEDIATRIC ORTHOPEDICS

The evolution of modern medicine, in its continuous developing process, is highly connected with the progress achieved in the medical branch of technology. Regarding the surgical specialties, the technological progress breakthroughs may determine the appearance of new diagnosis techniques, but also shape innovative treatments, leading to superior therapeutic results. In the surgical treatment as a whole, an essential role is played by the Medical Imagistics. They either offer the much-needed visual support in order to reach an accurate diagnosis, or guide the surgeon in choosing a certain type of intervention. The importance of Imagistics is indisputable. It has also been proven so in intraoperatory guidance and monitoring the patient in post-surgery. In the evolution of medical Imagistics, after the transition to digital imaging, followed by graphic 3D reconstructions based on CT and MRI data, we find ourselves contemporary with a new turning point announcing a technological revolution: the transition from virtual 3D models to tangible 3D replica. Since the beginning, the 3D printing technology has been of great importance to the field of medical research and, once the technique gained popularity, it became a modern tool for many medical specialties, in particular for cranio-maxillofacial surgery, orthopedics, oncology, neurosurgery. The 3D printing technology managed to transgress dated barriers by facilitating the manufacturing of implants or implement new treatments in regenerative medicine. The purpose of this original paper is to present our 3D printing work protocol and general conclusions after 5 years of implementing 3D printing in pediatric orthopedics.

EARLY OUTCOME OF PANCREATICODUODENECTOMY IN SEPTUAGENARIANS AND OCTOGENARIANS IN NEPAL

Elderly population is growing because of increasing life expectancy. Decision-making for major surgery like pancreaticoduodenectomy in this group is challenging. Therefore, we evaluated the feasibility of this procedure by comparing perioperative outcomes in Septuagenarians and Octogenarians patients. From August 2017 to December 2019, 18 consecutive patients who underwent pancreaticoduodenectomy were enrolled. These patients were divided into two groups (group1 – septuagenarians and group 2 – octogenarians). A comparative study between two groups was done regarding perioperative outcome and early complications. 18 patients were enrolled, 10 patients (55.6%) were septuagenarians (70-80 years) and 8 (44.4%) patients were Octogenarians (>80 years). There was no significant difference in the rate of surgical and medical complications between the two groups. Furthermore, there were no significant differences in risk factors, blood loss and operating time between the groups. Overall mortality in the study is 5.5%. Pancreaticoduodenectomy is feasible treatment option in septuagenarians and octogenarians with the help of multidisciplinary approach. Age alone should not be considered as decision maker for pancreaticoduodenectomy.

LARYNGEAL SYNOVIAL SARCOMA – A CASE REPORT

Laryngeal synovial sarcoma is an extremely rare mesenchymal tumor. During the past four decades, literature findings revealed under 40 cases with this localization. We are bringing forward the case of a 70-year-old male patient who was referred to the ENT Clinic as a respiratory emergency – a tumor obstructing the laryngeal glottis, for which an emergency tracheotomy was initially performed, followed by a CT scan and a biopsy under general anesthesia through suspension videolaringoscopy. The histopathological report was suggestive of a biphasic synovial sarcoma. A multidisciplinary team set the surgical indication for total laryngectomy followed by chemo-radiotherapy. Long-term follow-up is mandatory for recurrence prevention. Patient has checked in for follow-up every 3 months over the past 2 years, with no macroscopic signs of tumoral relapse.