Though hydatid disease affects many organs in the human body, splenic hydatid accounts for approximately 0.8-4% of all human echinococcosis cases. Up to recently, splenectomy was the preferred surgery for hydatid spleen. Since 1980, conservative options to treat such a disease have become more and more prevalent. Our study aimed to assess our experience in open splenic preservative surgery for splenic hydatid in a single institutional center. Our retrospective research included ten patients with splenic hydatid operated between August 2013 and January 2018 at our medical center. The spleen was affected alone in seven cases, the liver and spleen were affected in three cases, and one of the patients had intra-peritoneal cyst disease. The diagnosis was confirmed primarily by ultrasonography. In some instances, computed tomography and magnetic resonance imaging were required. A chest x-ray was performed to rule out pulmonary hydatid in all patients. Open surgery procedure, field isolation, cystic fluid aspiration, and injection of 1% cetrimide solution, respiration, endocystectomy, suture of cystic edges to the intracystic tube drain were performed. All surgeries had albendazole before and after the operation 15 mg/kg/day. There were no significant intra or postoperative complications, and no further surgery was required. Patients remained hospitalized for 3-5 days. No recurrence after 1-3 follow-up years. However, three patients failed to follow up within two years. Our experience with splenic hydatids prompts us to use splenic conservation surgery whenever possible instead of splenectomy.
The effects of neoadjuvant chemotherapy in increasing the rate of conservative breast therapy and associated with reducing morbidity and better cosmetic has been fully acknowledged. Now, there are commonly used neoadjuvant chemotherapy for operable early breast carcinomas patients. Currently, neoadjuvant chemotherapy is used for locally advanced breast carcinoma, inflammatory breast cancer, and down staging of the large tumor to allow for breast conservative therapy. A prospective study performed in the department of surgery in Al-Sadder Medical City/Najaf city/Iraq, from the …….. of October 2015 to the 1st of October 2018, where 48 patients presented with a breast cancer diagnosis by clinical examination, Mammography, breast ultrasound, chest x-ray, bone scan, serum CEA, CA15_3 level, the initial diagnosis of breast cancer made by core needle biopsy. Breast saving surgery consisted of wide local excision with a safe margin with standard level I, II lymph node of axilla dissection. The resected specimen and lymph node was sent for histopathological examination; the size, width, length &height dimension were recorded and the resection margin was recorded positive if close to 2mm and negative if >2mm tumor-free margin. The 48 patients enrolled in this study with a mean age at diagnosis of 44.6 ± 8.4 years. 34 patients received neoadjuvant chemotherapy, Locoregional recurrence reported in 4 patients (28.6%) not received neoadjuvant chemotherapy (P. value < 0.001), the higher relapse rate was reported significantly in the cases aged more than 50 years compared to those aged 50 years or below (P. value = 0.05, significant). Neoadjuvant chemotherapy decreases the incidence of locoregional recurrence of early breast carcinoma after breast-conserving surgery.
BACKGROUND: Fistula in ano is a chronic problem for the patients. It causes distressing because of foul odor and soiling with recurrent infection and discharge. Recurrence and anal sphincter injury were the most critical complications following surgery. Loose, thick seton placement was the most promising surgical operation. AIM: To reduce the time of seton placement, therefore, decreasing the suffering of patients from soiling and multiple dressing. PATIENTS AND METHODS: A retrospective study, one hundred patients with high type fistula in ano treated surgically in Al-Sader Medical city and Al-Najaf daily private clinic, Najaf city, Iraq, from February 2018 to March 2019. Fistulography and magnetic resonance imaging have taken from all patients. After that, fistulectomy with loose, thick seton suture placed for 3 months. Patients with the persistence of high fistula tract underwent a second surgery and third operation until complete healing. RESULTS: One hundred patients with high type fistula in ano with male 96 (96%) and female patients were 4 (4%). The rate of complete healing among male patients after the first operation was 90 (93%), while female patients showed a 4 (100%) rate of complete healing after the first operation. Three of the remaining male patients with persistently high fistula tract showed complete healing after the second operation, whereas 3 (3%) the rate of complete healing was 100% after the third operation. CONCLUSION: A loose, thick seton placed in high type fistula tract for 3 months provides excellent protection to the external anal sphincter with less recurrence rate and rapid healing.
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