Background: Breast cancer is the most common cancer among women worldwide. The presence of axillary lymph node metastases in breast cancer is an important factor in assessing prognosis and determines management after surgery. The study aimed at identification of the factors that predict axillary lymph node involvement in CA breast. Addressing the prognostic effect of axillary lymph node involvement in turn of predicting the recurrence of CA breast.Methods: This is a prospective review of one hundred cases of Ca breast who have underwent modified radical mastectomy and axillary clearance at Al-Karama Teaching Hospital during the period from January 2014 to December 2018.Results: Positive axillary involvement was found in (74/100, 74%). The highest occurrence of positive axilla was found in (less than 30 and 30-39 years) age groups (27/74, 36%) with the outer quadrants (upper and lower) constituting the majority (50/74, 68%). Positive axillary involvement was mostly notified in tumor grade T4 (39/74, 53%) and in poorly differentiated lesions (47/74, 64%). The highest recurrence rate was found in patients with positive axillary metastases (12/74, 16%), nodal involvement of ten or more nodes (9/41, 22%), nodes with extracapsular extension (10/51, 20%) and in patients who have not taken and/or completed their chemo-radiation sessions (9/11, 82%).Conclusions: Positive axillary lymph node involvement was seen mostly in: young age patients, outer quadrant lesions, tumors with skin involvement, and poorly differentiated lesions.

Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations among diabetics.Methods: this clinical prospective study includes 120 diabetic foot patients admitted to AL- Karama teaching hospital from 1st January 2015 to 1st January 2019. All patients assessed for age, gender, duration of diabetes, hyperglycemia at admission and control of diabetes, history of smoking, hypertension, assess dominant foot and examination of diabetic foot lesion and classify it according to Meggit-Wagner grading status, indications for amputation and outcome.Results: The male to female ratio was 2:1. Most frequent age group of patients treated by amputation was between 50-80 years. Among patients treated with amputation (68.33%) of patients had diabetes mellitus for 11-20 years. From patients admitted with diabetic foot (53.33%) were smokers. Regarding hypertension (93.33%) of all patients were hypertensive. It was noted that (65%) of patients lesion occur in dominant foot Regarding Wagner's grading system (36.66%) of patients were grade 4 followed by grade 1 (21.66%). regarding mode of treatment (53.33%) of patients treated by amputation and other treated conservatively. Only 3 patients from 60 died while other discharged well after complete treatment.Conclusions: Increasing in age, long duration of diabetes mellitus, poor control of diabetes, smoking and occurrence of lesion in dominant foot all considered as a significant risk factors for increase liability amputation.

Background: The solitary thyroid nodule, defined as a palpable discrete swelling within an otherwise apparently normal gland, is usually a benign lesion. However, patients and physicians alike are typically concerned about the possibility of thyroid cancer. This study describes a strategy for the treatment of clinically euthyroid patients who have a solitary thyroid nodule that prevents unnecessary testing while identifying the few patients who require therapy.Methods: This is a prospective study of randomly selected patients with clinically palpable, solitary thyroid nodule diagnosed and treated at Al-Karama Teaching Hospital from September 2015 till December 2018. Initially 176 patients were diagnosed by clinical examination to have solitary thyroid nodule but after investigation and operative finding, 42 patients were found to have multinodular goiter and all excluded from the study.Results: All the 134 patients included in the study (21 males and 113 females) have been evaluated by clinical examination; thyroid scan and fine needle aspiration, ultrasound and the results of the evaluation have been correlated with operative histologic diagnosis. The study was undertaken to obtain information on the usefulness of the above measures for predicting or ruling out malignancy in solitary thyroid nodule.Conclusions: The incidence of malignancy seems to be higher among male, presented with hard nodule at palpation, those associated with hoarseness or palpable cervical lymph nodes. A cytological diagnosis of malignant tumor is reliable and provides sufficient basis of definitive surgery for thyroid cancer.

Background: An abdominal wall hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the wall of the abdominal cavity. Different approaches have been described in regards to management and repair of hernia. The present study aims at showing the rate of frequency to use the prosthetic mesh versus classical repair in adult inguinal hernia.Methods: A retrospective study lasted from October 2014 to July 2018 in Al-Karama Teaching Hospital. The study Samples consist of 315 patients with inguinal hernia, the age group (20-70) years old they were diagnosed according to clinical examination. There are 76 patients operated on using mesh technique (tension free).Results: All patients in our series were male, with age group (20-70) years. However, the inguinal hernia more frequent with increase age. In age groups; (40-49) was 25 patients (32.89%). The indirect inguinal hernias are most common in the young 65% whereas direct hernias are most common in the old. In our series sixty-one (80.26%) patients with indirect inguinal hernias, eleven (11.82%) patients with direct hernias and six (5.263%) patients with pantaloon type.Conclusions: The frequent uses of mesh in inguinal hernioplasty increasing with age. Tension –free hernioplasty is technically simple surgical operation, which can be used to repair any groin hernia. The use of mesh patch with or without plug is technically easier to work than the classical methods and far simple to secure to surrounding tissues.

Background: Hypocalcemia is a well-recognized complication of thyroid surgery. The aim of this study was to determine the incidence of hypocalcemia after thyroid surgery and find out the risk factors involved regarding the patient age, gender, muscular build, clinical diagnosis, extent of surgery, ligation of the inferior thyroid artery, and pathology report. Methods: This prospective study was carried out on 50 patients who underwent thyroid surgery for various thyroid diseases at the surgical department of Karama teaching hospital for the period between January 2016 to July 2016. Serial serum calcium measurements were recorded as well as details of the operation, patient age and gender, ligation of the inferior thyroid artery or not, pathological report. Hypocalcemia was considered transient if it was resolved within 6months and permanent if it persist after 6months and the patient was maintained on supplementation therapy of calcium and vitamin D. Results: Author found that the incidence of post-thyroidectomy hypocalcemia was 30% and in the majority of the cases (24%) was transient, while it was permanent in only (6%) of cases and had occurred mainly after total thyroidectomy and in cases with ligation of the inferior thyroid artery. Conclusions: Author concluded that post thyroidectomy hypocalcemia is a relatively common complication but it is transient in the majority of the patients. Its incidence is related to the extent of the surgery and can be reduced by the good preparation of the patient preoperatively.