Effect of autologous fibrin glue on seroma reduction after modified radical mastectomy for breast cancer: A randomized controlled trial

Introduction

Breast cancer stands out as the second most common cancer in the world with incidence 35.1% of all malignancies among females in Egypt. Fluid build-up after breast surgery is still the most annoying complication which leads to worse outcome. We aimed to evaluate whether autologous fibrin glue might lessen the formation of seroma following modified radical mastectomy.

Methods

This was a randomized controlled trial designed to configure the effect of autologous fibrin glue given in the study group using the drain in comparison to a control group who received the drain only; seroma volume was calculated every 24 h. For all of the cases. The drains were removed when the daily drainage was less than 30 ml for 3 consecutive days.

Results

We recruited 30 patients to each of the two groups. Age, pathology, breast cancer stage, number of lymph nodes and tumour size did not differ significantly between groups. A comparison of the median days to drain removal showed 8 days reduction in median days to drain removal compared in the intervention group (7 days) than the control (15 days). The patients in the fibrin glue group had a significantly lower cumulative drain output volume (mean ± SD of 505,6 ± 209,3 ml) than those in the control group (1674.1 ± 1 373,8 ml).

Conclusions

Autologous fibrin glue significantly decrease seroma formation post-modified radical mastectomy.

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Seroma is the most annoying complication after breast cancer surgery.

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Fibrin glue is an adhesive agent has been associated with reduction in the fluid build-up post mastectomy.

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Autologous Fibrin Glue is easily prepared and safe agent.

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The usage of Autologous fibrin glue help in short hospital stay after mastectomy.

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This is the first randomized clinical intervention to use fibrin glue from autologous nature to reduce seroma formation after MRM.

Effect of Autologous Fibrin Glue on Seroma Reduction after Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial.. [DOI: 10.21203/rs.3.rs-84034/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Introduction Breast cancer stands out as the second most common cancer in the world with incidence 35.1% of all malignancies among females in Egypt. Fluid build-up after breast surgery is still the most annoying complication which leads to worse outcome. We aimed to evaluate whether autologous fibrin glue might lessen the formation of seroma following modified radical mastectomy. Methods This was a randomized controlled trial designed to configure the effect of autologous fibrin glue given in the study group using the drain in comparison to a control group who received the drain only; seroma volume was calculated every 24 hrs. For all of the cases. The drains were removed when the daily drainage was less than 30 ml for 3 consecutive days. Results We recruited 30 patients to each of the two groups. Age, pathology, breast cancer stage, number of lymph nodes and tumour size did not differ significantly between groups. A comparison of the median days to drain removal showed 8 days reduction in median days to drain removal compared in the intervention group (7 days) than the control (15 days). The patients in the fibrin glue group had a significantly lower cumulative drain output volume (mean ± SD of 505.6 ± 209.3 ml) than those in the control group (1674.1± 1373.8 ml). Additionally, the patients treated with fibrin glue had a significantly shorter postoperative length of stay (8.5 (7–10) days) than the controls (15 (10–23) days. Conclusions Autologous fibrin glue significantly decrease seroma formation post-modified radical mastectomy. Research Registry Unique Identifying Number: researchregistry5372.

Effect of Autologous Fibrin Glue on Seroma Reduction after Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial.. [DOI: 10.21203/rs.3.rs-46934/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Introduction: Breast cancer stands out as the second most common cancer in the world with incidence 35.1% of all malignancies among females in Egypt. Fluid build-up after breast surgery is still the most annoying complication which leads to worse outcome. We aimed to evaluate whether autologous fibrin glue might lessen the formation of seroma following modified radical mastectomy. Methods: This was a randomized controlled trial designed to configure the effect of autologous fibrin glue given in the study group using the drain in comparison to a control group who received the drain only; seroma volume was calculated every 24 hrs. For all of the cases. The drains were removed when the daily drainage was less than 30 ml for 3 consecutive days. Results: We recruited 30 patients to each of the two groups. Age, pathology, breast cancer stage, number of lymph nodes and tumour size did not differ significantly between groups. A comparison of the median days to drain removal showed 8 days reduction in median days to drain removal compared in the intervention group (7 days) than the control (15 days). The patients in the fibrin glue group had a significantly lower cumulative drain output volume (mean ± SD of 505.6 ± 209.3 ml) than those in the control group (1674.1 ± 1373.8 ml). Additionally, the patients treated with fibrin glue had a significantly shorter postoperative length of stay (8.5 (7–10) days) than the controls (15 (10–23) days. Conclusions: Autologous fibrin glue significantly decrease seroma formation post-modified radical mastectomy. Research Registry Unique Identifying Number: researchregistry5372.

Laparoscopic adhesiolysis in acute small bowel obstruction: a preliminary experience

OBJECTIVE

The aim of this study is to evaluate laparoscopy as another tool for management of cases of adhesive acute small bowel obstruction.

METHODS

Fourteen patients suffering from suspected adhesive small bowel obstruction were explored laparoscopically over a period of 24 months. The Veress needle was inserted either in a virgin part of the abdomen away from previous scars or under direct vision using an open technique. Careful inspection of the entire abdomen was done, and the small bowel was "run" in a retrograde fashion starting at the cecum. The point of obstruction was localized and adhesiolysis was performed, thus resolving the problem.

RESULTS

Laparoscopic exploration was able to determine the site and cause of obstruction precisely in all 14 cases, with resolution of the problem laparoscopically in 12 patients (85.7%). Two cases were converted to open surgery (14.3%). There were no mortalities and low morbidity (7.1%). The mean hospital stay was 3.7 days.

CONCLUSION

Laparoscopic surgery can be an advantageous alternative to open surgery in acute small bowel obstruction, thus providing a new technique for its diagnosis and treatment with all the advantages of minimally invasive surgery.

Laparoscopic orchidopexy: the treatment of choice for the impalpable undescended testis

OBJECTIVE

Management of the impalpable testis often represents a significant diagnostic and therapeutic challenge for the radiologist and surgeon. The aim of this work is to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of the impalpable testis.

METHODS AND PROCEDURES

Thirty-three patients with 43 impalpable testes are included in this study. For each patient, magnetic resonance imaging (MRI) then laparoscopy were performed. Either the testis or blind-ending cord structures are searched for. The testis was either brought down to the scrotum or removed depending on the condition of each patient.

RESULTS

MRI detected 16 out of 43 impalpable testes (37.2%). Laparoscopy, on the other hand, detected 18 intra-abdominal testes, 7 inguinal and 16 blind-ending cord structures either above or below the internal inguinal ring. Blind-ending cord structures suggested a vanished testis. Orchidopexy was done for 23 cases, orchidectomy in 18 cases and laparoscopy only in 2 cases.

CONCLUSION

Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. Intra-abdominal dissection allows more testes to be brought down to the scrotum. The procedure is best viewed as laparoscopy-assisted, as orchidopexy has to be done in a conventional manner.

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity

OBJECTIVE

Surgery has been recognized as an effective long-term treatment for morbid obesity. The purpose of this study is to present our experience of laparoscopic adjustable gastric banding (LAGB) as a safe and effective treatment for morbid obesity.

METHODS AND PROCEDURES

Over eight months, 39 morbidly obese patients, having a Body Mass Index (BMI) > 40 kg/m2, were included in this study. Conservative measures failed to maintain weight loss in all patients. The procedure is performed through a 5-trocar technique. The procedure involves gastric partitioning and stoma formation by an inflatable band. The stoma can be adjusted by injection of saline in the band reservoir.

RESULTS

The mean age of the patients was 31.3 years. The mean BMI was 44.2 Kg/m2. All procedures were completed laparoscopically. The mean hospital stay was 2.7 days. The morbidity rate was 15.32%. Patients were followed up for a mean period of 6.7 months. The mean BMI after six months (in 28 patients) was 36.6 Kg/m2.

CONCLUSION

Laparoscopic insertion of the adjustable gastric banding is a safe and effective method for the treatment of morbid obesity and should be the standard way of band insertion.

Production of iron-fortified bread employing some selected natural iron sources

Iron fortification of wheat breads is the optimal approach for reducing the high prevalence of iron deficiency in wheat-eating developing countries as in Egypt. The effectiveness of some natural iron-fortificants for potential use in Egyptian bread was tested. Defatted soybean flour, soybean flour, soybean hull flour, molasses and fenugreek flour at different levels besides FeSO4.7H2O as standard were separately incorporated in the wheat flour dough. Dough characteristics were studied using a Brabender Farinograph, where addition of such fortificants improves significantly (p < 0.05) the water absorption, development time, dough stability and dough weakening. Good breads with high nutritive value, excellent crust color, crumb grain and high overall acceptability were produced by adding either 10% defatted soybean flour, 5% soybean hull flour, 2% molasses or 4% fenugreek flour. Rat feeding trials have shown a good haematological response, i.e. higher haemoglobin (Hb) and haematocrit (Hct) values gained. Additional work is needed to identify other fortification options and to develop targeted fortification programes that will supply iron to all segments of a population in greatest need.

A new modified layout for laparoscopic cholecystectomy

OBJECTIVE

The aim of this study is to present an economic and convenient modification of the layout for laparoscopic cholecystectomy, utilizing a three-port technique.

METHODS

The surgeon stands on the left side of the patient, while the assistant stands between the patient's legs. The scrub nurse stands on the right side of the patient facing the surgeon. The assistant also operates the camera. Only three ports are used. This technique was used in 119 consecutive patients over a 24-month period. Endoscopic retrograde chlolangiopancreotography (ERCP) was done preoperatively in patients suspected to have choledocholithiasis.

RESULTS

Sixteen patients had ERCP done preoperatively and in 12 of them sphincterotomy and stone removal was carried out. Laparoscopic cholecystectomy was successfully completed in 115 patients. The mean operative time was 35 minutes. Four cases were converted (3.6%), one due to bile duct injury, two others due to extensive adhesions, and a fourth due to cholecystoduodenal fistula. The total morbidity rate was 4.2%. The mean hospital stay was 1.8 days.

CONCLUSIONS

Laparoscopic cholecystectomy can be safely and conveniently done using only three ports in the modified position described. You need only one assistant, only one monitor and one less trocar. There is no prolongation of the operative time and the results are comparable to the classic four-trocar technique.

Application potential for some sugar substitutes in some low energy and diabetic foods

Preparation of acceptable low energy fiber enriched and diabetic jams, cakes and biscuits using different formulas of sucrose substitutes with the partial replacement of wheat flour with bran as a source of dietary fibre, was studied. Special care was paid to evaluate the nutritional plus keeping qualities and the potential effect of the most acceptable formulae from each food stuffs group on the blood glucose level in lean and obese diabetes mellitus patients. It was technologically possible to prepare acceptable, high nutritional diabetic and low energy apricot, guava and strawberry jams and jellies by combinations of sweeteners using xylitol (i.e. xylitol-sorbitol-aspartame and xylitol-fructose). The attainment of a suitable texture may be more difficult in xylitol and sorbitol jams, therefore 0.2 g CaCl2. 2H2O was added. Storage of these jams at 4 degrees C improved their keeping quality significantly (p < 0.05), where the microbial load was less than 20 cells per gram and the products were free from molds and yeasts. Also, high nutritional and acceptable cakes and biscuits for low energy supply and for diabetic subjects can be sweetened with low level of aspartame in combination with fructose, sorbitol and xylitol. Consumption of such low energic and diabetic food items reduces significantly (p < 0.05) the plasma glucose level in lean and obese diabetics. Addition of wheat bran in bakery products not only reduced both energy value of these foods and blood glucose, but it also improved peripheral insulin activity by its system modification.

Acute cholecystitis is an indication for laparoscopic cholecystectomy: a prospective study

OBJECTIVE

Acute cholecystitis has been considered as a relative or absolute contraindication to laparoscopic cholecystectomy. The purpose of this study is to present our experience of laparoscopic cholecystectomy as a safe and effective treatment of acute cholecystitis.

METHODS

Laparoscopic cholecystectomy was offered to 34 consecutive patients with acute calculous cholecystitis, diagnosed according to strict clinical and ultrasonographic criteria. We used only three trocars. The gallbladder was routinely aspirated and sharp graspers were used. We adopted the fundus-first method of dissection when safe identification of the Calot's triangle was difficult. The cystic duct was ligated whenever necessary.

RESULTS

The procedure was completed in 31 patients. The mean length of the laparoscopic procedure was 43 minutes, their mean hospital stay was 2.8 days. For the open group the mean length of the operative procedure was 66 minutes, while the mean hospital stay was 5.3 days. The overall morbidity rate was low.

CONCLUSIONS

The benefits of laparoscopic cholecystectomy can be safely extended to patients with acute cholecystitis. The operation must be done early in the course of the disease. The surgeon should have adequate laparoscopic experience and maintain a low threshold for conversion to open exploration. Modifications in technique should be adopted to achieve a successful outcome.

Effect of selected Egyptian cooking methods on faba bean nutritive value and dietary protein utilization 2: ability of faba bean products to support hemoglobin response in rats

To evaluate the dietary protein utilization and iron deficiency anemia as affected by the faba bean nutrient intake, a bioassay with rats was carried out with different experimental diets containing four faba bean products (stewed beans 'Medammis', deep fried dough 'Falafel', boiled germinated beans 'Nabet Soup' and poured paste 'Bissara') widely consumed in the Middle East. Amino acid composition of all faba bean products was determined and compared to raw beans. Severe heat-processing markedly decreased some essential amino acids, especially phenylalanine, cystine, methionine and tryptophan. Protein scores were 24.6, 19.5, 29.2, 28.2 and 35.6 for raw faba beans, 'Medammis', 'Falafel', 'Nabet Soup' and 'Bissara', respectively. 'Bissara' possessed the highest nutritional value, since it had the lowest GDR value [Grams consumed of product to cover the daily requirements for adult man in protein (63 g) and in energy (2900 kcal)] for the limiting amino acids (L A A). As indicated by P S/150 values [Satisfaction of the daily requirements of the adult man when 150 g (one can content) are consumed of product] for L A A, i.e. methionine+cystine (lowest P S/150 value), the above-mentioned faba bean products cover about 53, 77, 77 and 97% of the daily requirements of adult man in L A A, respectively. Fecal nitrogen excretion increased and true nitrogen digestibility decreased significantly (p < 0.01) with the inclusion of 'Medammis' in the diet. 'Nabet Soup' exhibited the highest true nitrogen digestibility. In contrast, the biological value of nitrogen was apparently unaffected. Highest blood hemoglobin level was found in rats fed diets containing 'Bissara', 'Falafel' and 'Nabet Soup', whereas the addition of 'Medammis' in the diet induced a significant (p < 0.05) reduction in blood hemoglobin level of fed rats.

Effect of Egyptian cooking methods of faba beans on its nutritive value, dietary protein utilization and iron deficiency anemia. 1. The role of main technological pretreatments

In order to study the effects of main technological pretreatments practised for preparing Egyptian faba bean products, i.e. decortication as well as soaking and germination followed by dehulling on the nutritional value, series of experiments were carried out. Such pretreatments had a significant effect on the changes in the chemical composition of faba beans. The proportion of the removed hulls reached generally about 14%. Data revealed also pronounced improvements on the nutritive value as a result of all studied pretreatments, especially germination being the most effective. Chemical scoring of all determined essential amino acids was > 60, except methionine and cystine showed the lowest score (< 20). Germinated seeds had the highest chemical score for the restricting amino acids beside the lowest GDR value [Grams consumed of product to cover the daily requirements for adult man in protein (63 g) and in energy (2900 kcal)]. All pretreatments caused a significant decrease in the antinutritional factors, especially soaking followed by dehulling, whereas decortication led to a significant increase in phytic acid content.

Technological aspects of keeping and pickling qualities of cucumbers as influenced by fertilizers

The effect of the interactions between K (potassium) and Ca (calcium) applications (preharvest treatment), packaging method and storage conditions on the keeping and pickling qualities of cucumber were investigated. Spraying with 100 ppm K and 5000 ppm Ca prolonged the shelf-life of cucumber, especially when packaged in perforated polyethylene and stored at refrigeration conditions. Packaging and refrigeration both reduced weight loss and decay percentages. Decay was greater in packaged fruits stored at high temperature. Packaging had only a slight effect on chemical composition. Packaged fruits from plants sprayed with 100 ppm K maintained their fresh appearance and firmness > or = 3 times longer than a control sample at ambient conditions and over 20 days under refrigeration. Sensory evaluation of pickled cucumbers revealed that both K and Ca applications on plants during growth improved substantially the pickling quality of cucumber.