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: 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.

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To evaluate multimodality treatment therapy in patients with locally advanced low rectal adenocarcinoma as a trial for sphincter-saving radical resection with good local control. Twenty two patients underwent preoperative concurrent chemoradiotherapy, (CCRT) and radical resection for locally advanced low rectal adenocarcinoma. Patients received preoperative bolus 5-fluorouracil (5-FU) and leucovorin concurrent with radiotherapy to a total dose of 50.4 Gy, followed by radical resection surgery 6 weeks after CCRT. Fifty-five percent of patients achieved tumor downstaging, 14% of patients showed pathological complete remission, sphincter-saving rate was 82%, and there were no deaths related to preoperative CCRT or surgery. Mild hematological and gastrointestinal toxicity was noted during the course of preoperative CCRT. Overall, 3-year survival rate was 78% and the rate of locoregional recurrence was 13.6%. This study showed that many patients with locally advanced rectal cancer can be operated on with sphincter-saving radical resection surgery under good local control after preoperative CCRT which induces tumor downstaging.

Background: There are currently two different treatment modalities available for treatment of achalsia; pneumatic dilation (PD) and Heller myotomy (HM). Both of them are focused on decreasing the LES resting pressure thereby allowing the distal esophagus to empty with the aid of gravity. Ideally, the choice between the 2 treatment options should be based upon prospective, randomized and comparative studies. Studies comparing pneumatic dilatation with rigiflex balloon and laparoscopic Heller myotomy have recently been reported. This study aims to compare the results of pneumatic dilatation versus laparoscopic Heller's myotomy combined with Dor fundoplication in cases of achalasia of the cardia to consider which group of patients should be subjected to either methods for better management.Methods: This study is a prospective randomized clinical trial conducted in Ain Shams University Hospitals during the period from June 2012 till October 2014. Thirty patients who were diagnosed as having achalsia were randomized into 2 groups: group A included 15 patients who underwent pneumatic dilatation and group B included 15 patients who underwent laparoscopic Heller's myotomy.Results: The mean operative time was significantly longer in Heller's myotomy group [99 (80-120min)] than pneumatic dilatation group [46.6(40-60min)] (P < 0.001). The mean hospital stay was significantly longer in the HM group 2.1 days than the PD group 1.1 day (P< 0.001). There was no need for conversion to open Heller's in the HM. There was no significant difference in the incidence of intraoperative complications between both groups. There was a statistically significant lower symptom scoring in the HM group than PD group (P<0.001). Postoperative complications in the form of reflux symptoms and recurrence of achalasia symptoms were significantly lower in the HM group than the PD group (P<0.001).Conclusion: Laparoscopic cardiomyotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 month after treatment with special care must be taken in the future studies to laparoscopic myotomy alone as it is thought to be the best way for the management of achalasia in the future.