This study aimed to evaluate the therapeutic yield of levonorgestrel-releasing intrauterine device (LNG-IUD) for management of tamoxifen induced menorrhagia in women who had mastectomy for treatment of breast cancer. This study included 34 patients who had breast cancer, underwent mastectomy, were maintained on tamoxifen post-operatively for at least 6 months, and had also newly developed menorrhagia throughout their follow-up period. All the patients underwent clinical examination for determination of duration and heaviness of menstrual blood loss (MBL), transvaginal ultrasonography (TVU) and endometrial biopsy for exclusion of abnormal pathology, estimation of blood iron indices and quality of life (QoL) scoring. Baseline endometrial biopsy detected simple endometrial hyperplasia (EH) in 4 patients and 30 patients had proliferative endometrium. Three patients were excluded and 31 patients completed the follow-up period without the need for shift to hysterectomy. Both mean duration and heaviness of MBL showed significant progressive decrease throughout the observation period as compared to baseline data. At the end of follow-up period, 5 women became amenorrheic, 2 women had moderate MBL and 24 women had mild MBL. Iron indices studies showed significant improvement at the end of follow-up as compared to baseline indices and total QoL scoring recorded at 6 and 12 months after enrollment were significantly higher as compared to baseline scores with significantly higher scores at 12 months. LNG-IUD could be considered as an appropriate therapeutic modality for tamoxifen-induced menorrhagia in patients who had mastectomy for breast cancer with significant reduction of duration and severity of MBL and improved QoL and iron indices.

Introduction:Diverticulosis is considered to be mainly a problem of old age, with a prevalence of 35-50%. About 10-25% of patients with diverticulosis will develop diverticular disease compilation in their lifetime. The clinical presentation of diverticular disease depends on the severity of the inflammatory process and whether complications are present. Complicated diverticulitis refers to the presence of perforation, obstruction, bleeding and abscess or fistula formation. Between 25 and 55% of the patients with complicated diverticulitis will require surgery during their initial hospitalization. 1,2 The first attack of uncomplicated diverticulitis is treated conservatively. Sigmoid resection is indicated for

The upper and lower lips are prominent facial features of significant importance for esthetic and functional reasons. Defects of the lips are typically caused by either trauma or neoplasm; however, lip reconstruction poses a particular challenge to the surgeon in that the lips are the dynamic center of the lower third of the face. Their role in aesthetic balance, facial expression, speech, and deglutition is not replicated by any other tissue substitute.Therefore, proper restoration of lip form and function post-injury is of paramount importance. 1,2 Both lips, but especially the lower lip, are at risk for cutaneous malignancy because of their prominent location. Lip cancer is second only to skin cancer in terms of frequency in the head and neck region. Both sequamous cell carcinoma and basal cell carcinoma were commonly seen in the upper lip. Surgery is the treatment of choice for most of these cancers;

Introduction:The present study aimed to evaluate the applicability and value of great auricular nerve (GAN) preservation on sensory recovery of supplied dermatomes after superficial parotidectomy. Patients and Methods: The study included 35 patients; 23 males and 12 females with mean age of 5110.2±; range: 2962-years. All patients presented by unilateral swelling in the parotid region and underwent superficial parotidectomy. The GAN was identified at the point just beneath the lobule (for branches identification) and at the point on the sternoclienomastoid muscle beside the external jugular vein (for trunk identification). The anterior branch is usually sacrificed while the posterior superficial and deep branches were preserved. Touch sensation of ear lobule and the infraauricular area was evaluated using a cotton swab and represented on 100-point visual analogue scale (VAS) with 0=no sensation of the pinna and 100= no difference in sensation compared to that of the other side. The quality of life (QOL) after parotidectomy was evaluated using a similar VAS with 0=a feeling of severe discomfort; while 100=no discomfort or difficulties. VAS scores were evaluated 2-weeks, 1, 2, 3 and 6-months after surgery. Results: Posterior branches of GAN could be preserved in 23 cases (65.7%) while the nerve was thin and could not be preserved in 8 cases and was adherent and could not be dissected in the remaining 4 cases, thus GAN was excised in 12 cases (34.3%). Mean VAS scores showed a significant increase at each time of examination compared to the previous records up to 3-months after surgery; but VAS scores recorded at 6-months after surgery were non-significantly higher compared to that recorded at 3-months. Recorded VAS scores at 2, 3 and 6 months after surgery were significantly higher in patients with preserved GAN compared to those with excised GAN. At 6-months after surgery, only 6 patients (26.5%) with preserved GAN had sensation score of <50, while the other 17 patients (73.5%) had sensation score of >50, whereas all patients with excised GAN had sensation score of <50. Number of patients with preserved GAN who had high sensation scores was significantly higher compared to those with excised GAN. Conclusion: It could be concluded that preservation of posterior branches of GAN is feasible and improves the outcome of superficial parotidectomy with significant preservation of sensation of earlobe and the infraauricular area and improved quality of life.