Background and Objective: Upper tract urothelial carcinoma (UTUC) is uncommon; however, at the time of diagnosis, they are usually more invasive than bladder urothelial carcinomas. Although nephroureterectomy (NU) has been the gold-standard treatment, guidelines have been set for kidney-sparing treatment in selected groups of patients. While these guidelines are aimed towards patients fit for salvage radical treatment, little has been published on managing the symptomatic patient not fit for NU. Various modalities of endoscopic ablation in managing UTUC have been described in the literature, but there is currently no reported use of the diode laser. Therefore, we aim to assess its efficacy and safety profile in the ablation of UTUC in patients unfit for major abdominal surgery in radical nephroureterectomy regardless of the tumour grade and size.
Patients and method: A single centre retrospective review of patients who underwent Diode Laser treatment for UTUC over 4 years was done. Follow up through 6 monthly ureteroscopy alternating with computed tomography (CT) urogram was done to assess the need for further treatment.
Results: 30 patients were identified, with mean age 76 years (64-88) and variable tumour locations, including lower and mid ureter and renal pelvis, upper and lower calyces. 76.7% were ASA 3 and 20% ASA 4. The mean tumour size was 3.8 cm (2-7 cm). The mean number of sessions was 2.1 (1-6). 63.3% of the tumours were grade 2, while 30% were grade 3. A case of metastatic renal-cell carcinoma was diagnosed as a 4 cm filling defect in the kidney where the diode laser was used for resection biopsy and ablation. 16.7% experienced Clavien-Dindo grades 1-2 complications. A total of 6.7% of patients were converted to an inpatient stay. None of the patients needed blood transfusion nor did any develop a ureteric stricture on subsequent ureteroscopies. 48.3% of patients experienced clinical recurrences of which 57.1% were at a different site. Two of the patients developed metastatic disease. One patient died 3 years after initial treatment with disease progression.
Conclusion: The management of UTUC with diode laser is a safe and efficacious conservative treatment for disease and symptom control in patients unfit for radical treatment.
AIM: This randomised clinical study aimed to detect whether CMLOC attachment could improve Oral Health-Related Quality of Life (OHRQOL) when compared to ball attachment.
METHODS: Eighty edentulous patients were recruited to receive a single symphyseal implant for mandibular overdenture, after three months, randomisation was done to divide them into two groups; Dalbo ball (control group) and Cendres and Metaux locator (CM-LOC) (intervention) attachments respectively, oral health impact profile for edentulous patients (OHIP-EDENT)questionnaire was recorded before implant placement, two weeks after pick up, at 3, 6, 9, and 12 months.
RESULTS: Results revealed a lack of statistical significance between the two groups except for psychological discomfort at 2 weeks after pick-up (p-value = 0.029)
CONCLUSION: Single implant overdenture is a simple, reliable treatment modality for treating edentulous mandible and both CM LOC and Ball attachments are good alternatives for such treatment modality.
Background
Acute Subdural hematoma is a very crucial entity in traumatic brain injury, presented with disabling morbid complications and a high mortality rate; therefore, it is a massive socio-economic burden, leading to either direct or secondary brain injury, as hypoxia.
Aim and objectives
Comparative study between decompressive craniotomy (DC) and craniectomy in the management of acute subdural and their consequences. Assessing the most effective management protocol for ASDH with the least morbidity, short hospital’ stay and avoidance of re-operation.
Method
The study design is a prospective comparative randomized study, conducted on 30 patients with ASDH operated and managed starting December 2019 inclusive April 2021 at the Neurosurgery Department Cairo University Hospitals. They were divided equally into two groups: 15 had decompressive craniectomy and another 15 cases were operated upon with craniotomy. All patients were diagnosed with traumatic ASDH.
Results
The mean GCS pre-operative in DC was (9.4) mean with a range from (6 to 13) and the post-operative mean was (11.13) with a range from (4 to 15) compared to the results in the craniotomy group; the pre-operative mean was (9.6) with a range from (6 to 10) and the post-operative GCS mean (11.53) ranging from (6 to 14) that had a P value of 0.69.
Conclusion
There is no statistical significance in comparing decompressive craniectomy and craniotomy in dealing with ASDH, yet early time of surgical evacuation and duroplasty have shown to have good prognostic factors.
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