Total thyroidectomy is considered the best choice for thyroids carcinoma. However, it is still controversial for benign thyroid diseases because of higher complication rates. But meticulous surgical techniques by expert surgeons can avoid most of the complications and thereby avoid the risk of reoperation for any recurrences. The objective of the study was to evaluate and justify the use of total thyroidectomy in benign thyroid diseases especially in multinodular goiter and Grave’s disease. We have carried out an ongoing prospective study of thyroidectomy cases for different indications over a span of 5 years, from 2012 to 2016; in the Surgery department, Al-Thowra teaching hospital, Al-Beida. The total number of operated cases was 353. Cases were distributed according to age, sex, diagnosis and operative procedures. Various complications encountered were enlisted. Total thyroidectomy was performed in 247 cases for MNG and Thyroid malignancy. Hemi-thyroidectomy or lobectomy was done in 82 cases for solitary nodules. Enucleation of cysts was done in 6 cases. Operations were done for recurrent nodules in 18 cases. Overall complications were few and only minor. We recommend total thyroidectomy for all cases of MNG; which will reduce the risk of recurrence and development of malignancy in residual thyroid tissue. It also can prevent secondary thyrotoxicosis.
Necrotizing soft tissue infection (NSTI) of the lower limb in diabetic patients (pts) is a common serious problem and is often associated with serious complications such as increased morbidity and mortality. The study aimed to assess 3 years (yrs) experience of NSTI and to review treatment and outcome in diabetic pts at Al Thoura Teaching Hospital between May 1ST 2014 –30th April 2017, over a period of 3 yrs.24 cases of NSTI of lower limbs in diabetic pts were admittedin the period of MAY 1ST 2014 –30th April 2017. Assessment and analyzing details about their presentation, clinical features, predisposing factors, treatment offered, and outcomes were performed .16 male and 8 female pts with a mean age of 56.4 yrs (range of 39- 78 yrs) were included . Majority of patients were in the age group of 50 to 70 yrs. The most important risk factors were (glycosylated HbA1c > 9.5% in 91.66%), smoking (58.33%), hypertension and hyperlipidemia (66.66% & 83.33% respectively). Neuropathy was found in 62.5% and PVD in 50%. The total involved feet are 27. The port of infection was mostly by previous unhealed feet ulcer 48.1%. The most operated surgical procedure is aggressive frequent necrectomy (51%). Multiple toes amputations and extended tarsal amputation were needed in 29.6% and 20.8% respectively. The need for grafting, flap advancement after surgical control of infection was needed in 6 cases. The failure rate of conservative surgery was 11.11%. Complete healing was in 70.37% of cases. The morbidity rate was high in all patients in this study 92.59%. The mortality rate was 3.7%. We conclude that NSTI of lower limbs is a life-threatening infective condition, common among diabetic patients, and early diagnosis with immediate and frequent surgical debridement could reduce systemic complications, morbidity, and mortality considerably.
Dermatoses of the nipple and areola are rare. The Paget's disease is a common dermatosis, which is presented in the form of a well-demarcated erythematous area, sometimes erosive, oozing or hyperkeratotic. Because the condition may be confused with benign diseases of the nipple, treatment is frequently delayed. The study aimed to highlight the incidence and make a clinical assessment of patients with Paget’s disease of the breast in the eastern part of Libya. The Medical records and histopathological reports of all patients attended the breast clinic in 7th October Hospital in the period from June 1990 till December 2008 were collected and reviewed retrospectively. Demography, clinical features, and biopsy results were noted. The results: The total number of patients who had breast cancer was 897, from which Paget’s disease was diagnosed in 19 patients (2.1%). Mean age at presentation was 57.3 years, and all of them were Women. Eczema of the nipple-areola complex and palpable mass occurred in (63.1% and 42.1%) respectively. The metastatic axillary lymphadenopathy at time of presentation were found in 36.8%. We conclude that Paget’s disease is serious but commonly misdiagnosed. A thorough history and physical examination are important for every patient who is presented with skin and/or nipple changes of the breast, and physicians should maintain a high index of suspicion for Paget’s disease of the breast.
Carotid Stenosis is an important cause of stroke (20%) which is associated with high morbidity and mortality rates. The management is mainly by surgery or carotid stenting. This study reviews 3 years of experience and the outcomes in the treatment of carotid stenosis by the two methods. The study aimed to evaluate and compare the outcomes of both procedures during a 3yr period at a vascular Surgery department of the Cisanello Hospital. 302 pts were retrospectively analyzed; 151 pts assigned for each procedure. The average intervention time was significantly higher for the CEA group O.R: 0.556; 95% C.I; 0.349- 0.886, P: 0.014 but technical successes were achieved in 100% of CEA pts, whereas were achieved in 91.39% of the CAS group. The periprocedural stroke was nonsignificant between the two procedures. The Periprocedural TIA were show significant difference with more incidences in CAS pts [O.R: 7.292, 95% C.I; 1.150- 45.856, P: 0.032] but almost all pts improved. The cranial nerve injuries were a specific complication of CEA [11.9%]. The recurrent stenosis was seen only in CAS pts [2.9%] with O.R: 0.493, 95% C.I; 0.104- 2.345, P: 0.410. Both procedures are effective and comparable in outcomes in the management of carotid Stenosis.
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