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Objective: To investigate whether rhinoplasty with osteotomies for the treatment of deformed nose induces changes in intraocular pressure (IOP). Design: Prospective, nonrandomized study. Setting: University-affiliated medical center. Patients: Thirty patients who underwent rhinoplasty with osteotomies for the nose were prospectively enrolled in this study. Fifteen patients had lateral osteotomies with the external perforating technique, and fifteen with an internal continuous technique with periosteal elevation. We excluded patients with diabetes mellitus, hypertension, glaucoma, previous ocular trauma, history of ocular surgery, and previous use of topical corticosteroid eye drops. Main outcome measures: The intraocular pressure (IOP) in each patient was measured by Goldmann tonometry preoperatively and postoperatively on days 1, 2, and 7. Results: 23 women and 7 men with a mean age of 27 years were enrolled in the study. The mean ± SD IOP of the eye was 15.69 ± 2.37 mmHg preoperatively. Postoperatively, the mean ± SD IOPs were 15.96 ± 1.92 mmHg on day 1, 15.45 ± 2.55 mmHg on day 2, and 15.72 ± 2.86 mmHg on day 7 ( P = .863). Conclusions: Although osteotomes during rhinoplasty caused variations in the IOP compartment, the changes in IOP were not statistically significant. Therefore, rhinoplasty should be a safe surgical procedure with respect to ocular physiological function, however monitoring IOP peri-operatively is advised. To our best knowledge, this is the first clinical trial to determine the effect of rhinoplasty with osteotomy on intraocular pressure.

Background: Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors. They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods: A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years. Used variables were: age, sex, forced expiratory volume in the 1 st second (FEV1), site, size, multiplicity, pathologic subtype, tumor grade, safety margin (SM), excised ribs, complications, estimated blood loss (EBL), neo-adjuvant and adjuvant treatments, Overall and disease free survival (DFS) were obtained using Kaplan-Meier method and compared using Log rank test. Cox regression was used to identify DFS predictors. Results: PMCWTs represented 10.5% of all thoracic malignancies in our institution. There were 51 females (52%). The median age was 39 years [interquartile range (IQR) =25–52.3)] years. Chondrosarcoma was the commonest tumor histology (20.4%). The median tumor size was 8 cm (IQR =5–14). Tumor multiplicity was found in 18.4% of patients. Bone resection was performed in 76 patients (78.3%), ribs resection was performed in 59 patients and the median number of resected ribs per patient was 3 (IQR =1–3) ribs. Sternal resection was done in 7 (7.1%) cases. R0 resection was achieved in 62.2% of patients. There was one operative related mortality (1.02%) and 17.3% patients suffered procedure related complications. Local recurrence developed in 35 (35.7%) patients. The overall survival (OS) at 1, 3 and 5 years was 73.9%, 45.6% and 34.6% respectively and the median OS was 33 months (95% CI, 21.8–44.2), while median DFS was 24 months (95% CI, 19.6–28.4). Predictors of better DFS were –ve SM (P Conclusions: In primary malignant CWTs (PMCWTs) achievement of wide resection margins is of great importance to minimize the local tumor recurrence that will have an adverse impact on long-term survival.

Background: Malignant pleural mesothelioma is a lethal disease and hence the strong need for identifying new prognostic factors. Methods: This is a retrospective study including all eligible patients with advanced malignant pleural mesothelioma (MPM) presenting to National Cancer Institute, Cairo University. Neutrophil lymphocyte (N/L) ratio was assessed before second line chemotherapy. 2.5 was used as the cutoff point. Endpoints were the assessment of correlation between N/L ratio and clinical response (CR), progression free survival (PFS) and overall survival (OS). Results: 52 patients (19 stage III and 33 stage IV) MPM were included and followed up during the period from July 2009 till November 2012 with a median follow-up period of 2.6 months. 87.5% of patients with N/L ratio > 2.5 showed progressive disease versus 91.7% in patients with N/L ratio 2.5 versus 14% for patients with N/L ratio 2.5 versus 66% for patients with N/L ratio

The penis is an important genitourinary organ and its reconstruction needs certain requirements in order to obtain a satisfactory outcome. This paper presents modifications in the technique of total penile reconstruction utilizing the free radial forearm flap (RFF) including the use of the remnant phallic skin and corpora, the use of the deep inferior epigastric artery as a donor artery to supply the flap after transfer and the use of the saphenous vein to augment flap venous drainage. These modifications shared in improving the outcome as regards a better operative time, avoiding exposure of large vessels, namely the femoral vessels, and providing sensory and erotic sensation to the flap

The present work was carried out through winter seasons 2005-2006 to investigate the effect of root zone heating of plants behavior and yield under greenhouse conditions. This work aimed to explain the increases in plant fresh mass due to root zone heating. The two cultivars of snap beans were used. Seeds were sown directly on 15th of October 2005 to May 2006, respectively. Four treatments were used, hot water tube, plastic mulch, straw mulch and control (without any especial preparation). The average soil temperature recorded for each previously mentioned treatment were 26, 20.8, 19.9and 18.9 oC respectively. Plant growth, yield and quality of pods in addition to carbohydrates and fiber content of pods were determined in response to soil heating treatments compared to the control. Results indicated that using hot water treatment gave the highest mean fresh mass (47 gm/pod), the average leaves numbers (24.17 leaf/ plant), the maximum mean plant height was153 cm and plant dry mass (14.3 gm). The tallest plant height was obtained using plastic mulch treatment. There were no significant differences found in the number of shoots per plant and stem diameter in all treatments. No significant differences were found in pod fresh mass, pod diameter and pod length among treatments. The lowest value of total fiber content of pods was found in straw mulch treatment. The highest value of carbohydrates content of pods (15.6 gm) was observed in hot water tube treatment.

A chordoma is a slow-growing tumor representing about 5% of all malignant bone tumors. Mediastinal chordoma is very rare. We report a giant thoracic chordoma in a 32-year-old woman who presented with chest pain, progressive dyspnea, and cough. Open biopsy confirmed a definitive preoperative diagnosis, and complete surgical excision of the tumor was accomplished.

Parenchyma-sparing procedures are widely used in patients with low-grade malignancies of the airway when anatomically suited lesions exist. This study was conducted to evaluate the short-term and the long-term results of bronchoplastic procedures for patients with centrally located primary bronchopulmonary tumors.Between 2000 and 2009, 36 patients with primary lung tumors required bronchoplasty were retrospectively analyzed. Preoperative assessment included computed tomography (CT) of the chest, bronchoscopy, and spirometry. Pre operative diagnosis was acheived by bronchoscopy for all patients, mediastinoscopy was done for patients with primary lung cancer. Neo adjuvant chemotherapy was given for 6 patients with non small cell lung cancer (NSCLC).We had 15 males and 21 female, the mean age was 37 years and the mean hospital stay was 7.2 days. Operative procedures performed were:Sleeve lobectomy in 30 patients (13 right, 17 left), partial sleeve right pneumonectomy in 3 and bronchial resection with reanastomosis in 3 (2 left, 1 right). Twelve patients (33.3%) suffered post-operative problems. There was one operative related mortality. Post operative pathology revealed: 27 patients with typical carcinoid, 2 with atypical carcinoid, 4 with squamous cell carcinoma, 2 with adenocarcinoma and one with hamartoma. Pathological TNM staging revealed: 17 patients with stage IA, 11 with IB, 5 with IIA and 2 with stage IIIA. Follow-up data were available for all patients except two. Two patients died with disseminated disease 1.5 year and 2 years after surgery. The patient with hamartoma developed local recurrence 5 years later and re-excision was done. One patient with lung cancer developed bone metastases and was alive with disease, while the remaining 30 patients were alive and disease free. The overall 5 years survival was 83.3%.Bronchoplastic resections achieve local control and long-term survival comparable to the standard resections in patients with carcinoid tumor and NSCLC in anatomically suited lesions.Bronchoplasty - Primary - Lung - Tumors.

Post pneumonectomy bronchopleural fistula represents the most serious complication in thoracic surgery. Delayed fistula following tri modality treatment for mesothelioma is a serious problem regarding diagnosis and treatment. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage.Between 2002 and 2007, 85 extra pleural pneumonectomies for mesothelioma were performed. Only 58 patients completed the assigned tri modality treatment, five of them developed delayed bronchial stump dehiscence. The interval between primary surgery and stump dehiscence ranged from 6 months to 2 years.There were 4 right and one left sided fistulae. We had 4 males and one female, the mean age was 41 years. Bronchial stump was stapled in 3 patients and hand sewn closure was used in the remaining 2. By bronchoscopy, no stump recurrence was observed, but all patients with stapled bronchus had longer remaining stump. Empyema was present in all patients. All complicated patients received 2 field post operative radiotherapy with mediastinal dose of 40-45 Grays. The initial treatment consisted of tube thoracostomy followed by exploration through the previous thoracotomy incision with thorough curettage and wash of the infected space and removal of any exposed infected mesh. Bronchial stump was identified and re sutured. Re enforcement of the bronchial stump was done. Three patients required mechanical ventilation and 2 of them died. Surgery was successful in the remaining 3 patients.Delayed bronchial stump dehiscence is liable to develop especially for right sided lesions. Prophylactic augmentation of right sided stumps with vascularised muscle flap, shielding of pathology proven negative stumps during radiotherapy and improvement of radiation techniques may improve the dose distribution.Delayed - Bronchial - Stump - Fistula - Tri modality - Mesothelioma.

The incidence of posterior mediastinal tumors relative to all tumors of the mediastinum is 23% to 30%. The posterior mediastinum is a potential space along each side of the vertebral column and adjacent proximal portion of the ribs. Primary tumors of posterior mediastinum are usually neurogenic. The aim of this study was to evaluate different surgical approaches used for the resection of posterior mediastinal tumors, and to assess morbidity, mortality and patients' survival.Between January 2001 and January 2004, 30 patients with posterior mediastinal tumors were included. CT scan of the chest and CT guided biopsy were done for all patients; whereas MRI was done for suspected intraspinal extension. Posterolateral thoracotomy was the approach used in most of the patients. The Akwari approach was used in most of the patients with Dumbbell tumors.Neurogenic tumors constituted 67% of cases, being neuroblastoma in 60%. The non neurogenic tumors included a heterogenous group of rare tumors (n=10). Dumbbell tumors were found in 10 patients. Neuroblastoma was the commonest tumor to cause intraspinal extension (40%). Wide local excision was done in 13 patients; whereas extended resection was done in the remaining 17 patients. The mean intra-operative blood loss was 800cc and the mean hospital stay was 12 days. The size of the resected tumor ranged from 3 X 4 cm to 30 X 22 cm, 80% of tumors were malignant. Morbidity in relation to the procedures developed in 8 patients (atelectasis, meningitis, paraplegia, Horner syndrome and mild wound sepsis in 4, 1, 1, 1 and 1 of the patients; respectively). One postoperative mortality, due to meningitis was recorded. The overall survival by the end of three years was 87.7% with a mean survival of 30.4 months. The overall disease free survival was 55.9% with a mean disease free survival of 26.2 months.Posterior mediastinal tumors may reach large size before becoming symptomatic. Complete surgical excision (including adjacent invaded organs) mainly by open technique should be the rule for these patients as there is survival benefit. Great care should be taken when dealing with Dumbbell tumors.

This study was conducted to evaluate the success rate of management of advanced. Lung cancer patients with malignant pleural effusion comparing talc powder with tetracycline for pleurodesis.We report 60 patients with lung cancer associated with malignant pleural effusion treated in the department of surgery NCI, Cairo University, between January. 1998 and February, 2003. Patients were Divided Into Three Groups: Group I: Pleurodesis using tetracycline (20 patients). Group II: Pleurodesis using talc slurry (20 patients). Group III: Pleurodesis using talc insufflation (20 patients). Good response to pleurodesis is defined as no pleural fluid re-accumulation or minimal pleural fluid re-accumulation not causing symptoms or requiring further aspiration for one month.There were 34 males and 26 females, mean age was 54 years with range of 42-66 years, right sided effusion was present in 32 patients (53%) and left sided in 28 patients (47%). Pathological subtypes were adenocarcinoma in 32 patients, squamous cell carcinoma in 18 and undifferentiated carcinoma in 10 patients. In group I, 12 patients (60%) showed good response to intrapleural tetracycline, 15 patients (75%) responded in group II, while 17 patients (85%) showed good response in group III. Post pleurodesis complications included, fever, chest pain and empyema.It is concluded from this study that thoracoscopic talc insufflation was an effective, easy and low cost method for producing pleurodesis in patients with recurrent malignant pleural effusion and proved to be better than talc slurry and tetracycline.

Yolk-sac tumor mimics the yolk sac of the embryo, and the presence of alpha fetoprotein in the tumor cells is highly characteristic. We present an 18-year-old boy with primary pulmonary yolk-sac tumor diagnosed postoperatively. A computed tomographic scan revealed a huge intrathoracic soft tissue mass 20 x 25 cm occupying most of the left hemithorax. Two trials of computed tomographic-guided needle biopsy were nonconclusive. A left upper lobectomy was performed with a complete tumor resection. Postoperatively, the patient's alpha fetoprotein (AFP) was 10,512 IU/mL with gradual decline under chemotherapy. The patient is alive 10 months after surgery and is disease free.