Background: No drug, used as adjuvant to spinal bupiv-acaine has yet been identified that specifically inhibits noci-ception without its associated side effects. The goal of neuraxial drug combination is to provide better analgesia with reduction in the incidence and severity of side effects. Objective: This prospective randomized double-blind study was conducted to evaluate the analgesic and adverse effects of intrathecal dexmedetomidine when added to intrath-ecal magnesium sulphate in patients undergoing lower abdom-inal surgery under bupivacaine spinal anesthesia. Methods: Ninety adult patients classified as ASA I and II scheduled for lower abdominal surgery were randomized to one of three groups. Each patients was given 3.6ml spinal injectate that consisted of 3ml 0.5% hyperbaric bupivacaine and 0.6ml containing either, normal saline (group C), 50mg magnesium sulphate (group Mg), or 50mg magnesium sulphate and 5ug dexmedetomidine (group MgD). The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, pain score, time to rescue analgesic, level of sedation and adverse effects were recorded intraoperatively and up to 24 hours after spinal anesthesia. Results: The onset time to reach peak sensory and motor level was shorter in group MgD as compared with the control group C (p0.007), and it was significantly prolonged in group Mg (p0.001). In both Mg group and MgD group when compared with group C, there was a significant prolonged time to two segment regression, sensory regression to S1, regression to Bromage 0 and time to first rescue analgesic in addition to a significant decreased postoperative pain scores and lower postoperative analgesic requirements. The effects were greater in group MgD than in group Mg. Hemodynamic stability was maintained and other side effects were irrelevant in the three groups. Conclusion: It was found that adding intrathecal dexme-detomidine 5ug to intrathecal magnesium sulphate 50mg, improves the quality of bupivacaine spinal anesthesia and enhances postoperative analgesia in lower abdominal surgery and there were no significant adverse effects in either of the groups.

Background: No drug, used as adjuvant to spinal bupiv-acaine has yet been identified that specifically inhibits noci-ception without its associated side effects. The goal of neuraxial drug combination is to provide better analgesia with reduction in the incidence and severity of side effects. Objective: This prospective randomized double-blind study was conducted to evaluate the analgesic and adverse effects of intrathecal dexmedetomidine when added to intrath-ecal magnesium sulphate in patients undergoing lower abdom-inal surgery under bupivacaine spinal anesthesia. Methods: Ninety adult patients classified as ASA I and II scheduled for lower abdominal surgery were randomized to one of three groups. Each patients was given 3.6ml spinal injectate that consisted of 3ml 0.5% hyperbaric bupivacaine and 0.6ml containing either, normal saline (group C), 50mg magnesium sulphate (group Mg), or 50mg magnesium sulphate and 5ug dexmedetomidine (group MgD). The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, pain score, time to rescue analgesic, level of sedation and adverse effects were recorded intraoperatively and up to 24 hours after spinal anesthesia. Results: The onset time to reach peak sensory and motor level was shorter in group MgD as compared with the control group C (p0.007), and it was significantly prolonged in group Mg (p0.001). In both Mg group and MgD group when compared with group C, there was a significant prolonged time to two segment regression, sensory regression to S1, regression to Bromage 0 and time to first rescue analgesic in addition to a significant decreased postoperative pain scores and lower postoperative analgesic requirements. The effects were greater in group MgD than in group Mg. Hemodynamic stability was maintained and other side effects were irrelevant in the three groups. Conclusion: It was found that adding intrathecal dexme-detomidine 5ug to intrathecal magnesium sulphate 50mg, improves the quality of bupivacaine spinal anesthesia and enhances postoperative analgesia in lower abdominal surgery and there were no significant adverse effects in either of the groups.

Background: No drug, used as adjuvant to spinal bupiv-acaine has yet been identified that specifically inhibits noci-ception without its associated side effects. The goal of neuraxial drug combination is to provide better analgesia with reduction in the incidence and severity of side effects. Objective: This prospective randomized double-blind study was conducted to evaluate the analgesic and adverse effects of intrathecal dexmedetomidine when added to intrath-ecal magnesium sulphate in patients undergoing lower abdom-inal surgery under bupivacaine spinal anesthesia. Methods: Ninety adult patients classified as ASA I and II scheduled for lower abdominal surgery were randomized to one of three groups. Each patients was given 3.6ml spinal injectate that consisted of 3ml 0.5% hyperbaric bupivacaine and 0.6ml containing either, normal saline (group C), 50mg magnesium sulphate (group Mg), or 50mg magnesium sulphate and 5ug dexmedetomidine (group MgD). The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, pain score, time to rescue analgesic, level of sedation and adverse effects were recorded intraoperatively and up to 24 hours after spinal anesthesia. Results: The onset time to reach peak sensory and motor level was shorter in group MgD as compared with the control group C (p0.007), and it was significantly prolonged in group Mg (p0.001). In both Mg group and MgD group when compared with group C, there was a significant prolonged time to two segment regression, sensory regression to S1, regression to Bromage 0 and time to first rescue analgesic in addition to a significant decreased postoperative pain scores and lower postoperative analgesic requirements. The effects were greater in group MgD than in group Mg. Hemodynamic stability was maintained and other side effects were irrelevant in the three groups. Conclusion: It was found that adding intrathecal dexme-detomidine 5ug to intrathecal magnesium sulphate 50mg, improves the quality of bupivacaine spinal anesthesia and enhances postoperative analgesia in lower abdominal surgery and there were no significant adverse effects in either of the groups.

Background: No drug, used as adjuvant to spinal bupiv-acaine has yet been identified that specifically inhibits noci-ception without its associated side effects. The goal of neuraxial drug combination is to provide better analgesia with reduction in the incidence and severity of side effects. Objective: This prospective randomized double-blind study was conducted to evaluate the analgesic and adverse effects of intrathecal dexmedetomidine when added to intrath-ecal magnesium sulphate in patients undergoing lower abdom-inal surgery under bupivacaine spinal anesthesia. Methods: Ninety adult patients classified as ASA I and II scheduled for lower abdominal surgery were randomized to one of three groups. Each patients was given 3.6ml spinal injectate that consisted of 3ml 0.5% hyperbaric bupivacaine and 0.6ml containing either, normal saline (group C), 50mg magnesium sulphate (group Mg), or 50mg magnesium sulphate and 5ug dexmedetomidine (group MgD). The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, pain score, time to rescue analgesic, level of sedation and adverse effects were recorded intraoperatively and up to 24 hours after spinal anesthesia. Results: The onset time to reach peak sensory and motor level was shorter in group MgD as compared with the control group C (p0.007), and it was significantly prolonged in group Mg (p0.001). In both Mg group and MgD group when compared with group C, there was a significant prolonged time to two segment regression, sensory regression to S1, regression to Bromage 0 and time to first rescue analgesic in addition to a significant decreased postoperative pain scores and lower postoperative analgesic requirements. The effects were greater in group MgD than in group Mg. Hemodynamic stability was maintained and other side effects were irrelevant in the three groups. Conclusion: It was found that adding intrathecal dexme-detomidine 5ug to intrathecal magnesium sulphate 50mg, improves the quality of bupivacaine spinal anesthesia and enhances postoperative analgesia in lower abdominal surgery and there were no significant adverse effects in either of the groups.

Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background Malignant ovarian germ cell tumors (MOGCTs) are rare and represent 1–1.5% of all cancers in children and adolescents. The aim of this study is to analyze the clinicopathological pattern at presentation and management and outcome of MOGCTs in children and adolescents. Patients and methods Retrospective study included all girls diagnosed with MOGCTs between January 2005 and January 2015 in Pediatric and Surgical Oncology Departments at South Egypt Cancer Institute, Assiut University. Data were collected from patients' records including initial presentation, diagnosis (tumor markers and imaging), surgical staging and pathologic types. Management (surgical and chemotherapy details) and outcomes were also analyzed. Results Forty girls aged between 4 to 17 years (mean age of 9.5 years) with diagnosis of MOGCTs during study period were included. The most common presenting symptoms and signs were abdominal swelling, abdominal pain, and pelvic mass. Precocious puberty was noted in two patients. Surgical interventions in most patients were unilateral salpingo-oophorectomy (n = 20). Early stages I and II were reported in 15 and 12 patients respectively, while 10 patients had stage-III disease and 3 patients had stage IV. Yolk sac tumors were reported in 27.5% of patients. All patients were treated with platinum based chemotherapy. The 7-year overall survival was higher for patients with early stages (I and II) compared with advanced stages (III and IV) (100% versus 30.8% respectively. Conclusions Early presentation with appropriate management using fertility sparing surgery and platinum-based chemotherapy provides excellent survival with fertility preservation in children and adolescents. Based on the lower survival of patients with advanced disease, efforts should focus on increasing the awareness in the community of the importance of early diagnosis of ovarian tumors.

Background The feasibility of a laparoscopic approach in patients who have had a prior laparotomy (PL) remains controversial. We hypothesized that laparoscopic colorectal resection was safe and feasible in patients with previous open abdominal surgery. Methods A retrospective review (2007–2015) of all patients undergoing laparoscopic resection for sigmoid and rectal adenocarcinoma with or without prior midline laparotomy (NPL) was performed. Primary endpoints included conversion and perioperative morbidity. Secondary endpoints included length of stay and perioperative outcomes. Demographics, surgical history, oncologic staging, and short-term outcomes were reviewed. Results We identified 211 patients, ofwhom33 (15.6%) had a prior laparotomy. Significantly more patients in the PL group were female (76.2 vs. 52.8%, p = 0.004). Patients with PL were of similar age to NPL patients (69.3 vs. 62.5, p = 0.09), and comorbidities, tumor staging, and neoadjuvant therapy were comparable between groups (all p > 0.05). Additional trocar placement was significantly higher in PL group (33.3 vs. 17.4%, p = 0.03), while conversion rate did not reach statistical significance (24.2 vs. 12.9%, p = 0.08). The postoperative complication rate was comparable between PL and NPL patients (33.3 vs. 25.3%, respectively, p = 0.2). Conclusions Prior laparotomy should not be a contraindication to patients undergoing laparoscopic colorectal surgery, though surgeons should anticipate a higher likelihood of conversion to open.