Background: Reassurance is important because it influences lifestyle choices or fears of breast cancer in 70% of women of reproductive age who have breast discomfort and seek medical attention. Either cyclic or noncyclic mastalgia exists. Breast discomfort needs to be carefully evaluated and should be looked into the same way as any other breast symptom. Natural remedies like evening primrose oil and vitamin E are now being used as therapeutic options because of the undesirable side effects of other treatment approaches. Objective: In order to treat cyclic mastalgia, we compared the efficacy and adverse effects of vitamin E and evening primrose oil. Patients and Methods: We conducted a double-blind randomized controlled trial between February 2018 and February 2019 at Al-Jedaani Hospitals, KSA. A total of 160 women of reproductive age with a chief complaint of cyclic mastalgia were enrolled into this study. They were randomly assigned into 3 groups: group A of 55 patients (34.4%) received vitamin E, group B of 45 patients (28.1%) received evening primrose oil and group C of 60 patients (37.5%) received placebo. Overall pain severity and the effect of pain on patients' lifestyle were assessed at 1-month and 3-month follow-up visits. ResultsThe mean age of the patients was 31.23 ± 6.82 years. Highest respondents were aged between 30 and 38 years (34.5%). The median pain score and the effect of pain on patients' lifestyle were significantly decreased on successive follow-up visits. Although this decrease was significant in each individual group, it was not statistically significant compared to one another (P value = 0.619 and 0.621 respectively). Conclusion Vitamin E and evening primrose oil have a good impact on cyclic breast pain but their effect is not much different than placebo effect
Background About one third of gastro-oesophageal reflux disease (GORD) patients were found to have atypical or extra-oesophageal symptoms (EOS), which represent a diagnostic and therapeutic challenge. The efficacy of the current treatment strategy used to control these symptoms is still controversial. Anti-reflux surgery has been shown to significantly improve respiratory symptoms associated with GORD. Objective: The aim of the current study was to evaluate the outcomes of laparoscopic fundoplication to control GORDrelated EOS. Patient and methods: A prospective cohort study was conducted and included patients diagnosed with GORD with or without EOS or predominant EOS who were referred from Respiratory or ENT Departments. All participants underwent laparoscopic fundoplication surgery. Data about patients' demographics, body mass index (BMI), GORD/EOS presenting symptoms, 24 pH/manometry results, oesphagogastroduodenscopy findings, perioperative outcomes, quality of life using gastrointestinal quality of life Index (GIQOLI) questionnaire, patient's satisfaction using modified Visick score, and EOS severity using reflux symptom index (RSI) preoperatively, and 6 months postoperatively were collected and statistically analyzed. Results: A total number of 103 were included with mean age of 45.6 (SD 8.7) years, and 60% of the study's population was female. Mean BMI was 27.25 (SD 3.6). Heart burn was the main symptoms in all patients (71.9%), while chronic cough was the main EOS (27%). The mean operative time was 96 (SD 19.21) minutes, and mean hospital stay was 1.21 (SD 0.42) day. There was significant improvement in quality of life [65.7 (SD 11.6) and 118 (SD 12.8)] and reflux score [93.76 (SD 0.8) and 1.7 (SD 0.6)], RSI score for EOS [19.89 (SD 14.7) and 4.3 (SD5.3)] preoperatively and 6 month postoperatively respectively. Conclusion Laparoscopic fundoplication is a feasible option to control EOS associated with GORD with significant improvement of quality of life and reflux symptom index. Further larger studies are still warranted to evaluate the benefits on the long term.
Background:The inguinal hernia can be repaired using a variety of laparoscopic methods. The most popular procedures are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). TEP technique is regarded closet to ideal. However, it has limitations that inspired the evolution of e-TEP. This small e stands for enhanced or extended view. Although the division of Douglas' line is not inherent to e-TEP technique, it offers a wider working place for secondary ports. Objective: To compare extended view totally extraperitoneal repair with inherently divided Douglas' line to totally extraperitoneal repair of inguinal hernia concerning operative time, ease of the procedure and postoperative complications. Patients and Methods: This prospective cohort study enrolled 55 patients diagnosed with inguinal hernia underwent laparoscopic repair between January 2019 and November 2021. Thirty-one patients (56.4%) underwent e-TEP technique with inherently divided Douglas' line (group I) and twenty-four patients (43.6%) underwent TEP technique (group II). Results: No significant difference was found between the two groups regarding age, sex and body mass index. Overall complication rate was higher in TEP group than in e-TEP group. Mean operative time, hospital stay, and pain score were less in e-TEP technique with inherently divided Douglas' line. The number of used tacks, and early return to work were significantly different for favor of e-TEP group. Conclusion:Enhanced view TEP technique with inherently divided Douglas' line is superior to TEP technique for repairing inguinal hernia in providing a better visual angle and ergonomics with lower complication rates and shorter operative time
Background: Management of acute sigmoid volvulus was documented using a variety of surgical techniques. It has been established that mechanical bowel preparation is not required for elective colorectal surgery. To lower the risk of post-operative infectious complications and anastomotic dehiscence, one-stage primary resection and anastomosis of left sided colon blockage with on-table antegrade colonic lavage are becoming more and more popular. Objective: The aim of the current study was to assess the safety of single stage resection and anastomosis in the treatment of acute left sided colonic blockage brought on by acute sigmoid volvulus without intraoperative colonic lavage. Patients and methods: This study was conducted in the Department of Surgery, Ain shams University Hospitals (Cairo, Egypt) between June 2018 till June 2021. It included 37 patients who presented with acute sigmoid volvulus and managed by colonic resection and primary anastomosis then furtherly classified into two groups based on the usage of antegrade colonic lavage to evaluate their outcome. Results: Preoperative characteristics of the 2 studied groups were comparable. In terms of mortality, general morbidity, or significant morbidity, there was no difference between the 2 studied groups. Operative time was significantly higher in Group I where Intra-operative Antegrade Colonic lavage (IOACL) took place, which could be attributed to the extra step of setting the lavage system and colonic irrigation time. Of the studied 37 patients, superficial wound infection occurred in 12 patients and 3 of them progressed to develop complete wound dehiscence, however; neither required further surgery as no disruption and managed conservatively with antibiotics and wound dressing. Conclusion: Colonic resection and primary anastomosis can be used to safely treat left-sided colonic blockage brought on by acute sigmoid volvulus without the need for mechanical bowel preparation.
Background:The key to effective therapeutic endoscopic therapy is early dysplastic Barrett's oesophagus (BO) alteration detection. Oesophago-gastro-duodenoscopy (OGD) technical proficiency is quickly attained, but the diagnosis accuracy is still quite variable, especially in non-specialized endoscopic facilities. Objective: We aimed to evaluate the quality of endoscopic diagnosis and the adherence to guidelines of BO in our unit. Patients and Methods: A retrospective cohort analysis was done for 436 eligible endoscopic reports after independent review for confirmation of BO. Cohorts represent the complete audit cycle during the period from 01/01/2018 till 01/07/2022. Group A represented first audit data, and group B represented re-audit data. Results: A total eligible reports of 256 of BO in group A, and 180 reports in group B were reviewed. There was no significant difference between the groups regarding the age (62.7 ± 13.5 and 60.1 ± 15.1 years), male sex (68% and 70 %), and endoscopist specialty respectively. Surveillance was the most common indication (32.4% vs 35.5%), followed by Reflux (16.7% and 15%) in both groups respectively. Compliance with Prague, Paris, and Seattle protocol was significantly higher in group B (P value ≤0.05). Lack of awareness of the new guidelines, surgeon specialty, older age of the endoscopist, long segment of BO were the main factors of poor results in group A. Conclusions: In the absence of local standard protocol for endoscopic diagnosis of BO, the adherence to the guidelines was poor. Compliance with the guidelines after implementing new recommendations results in better outcomes. It is important to complete the audit cycle to ensure that the quality improvement was achieved.
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