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Total thyroidectomy is recommended as a line of management of thyroid cancer in many cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to that of intramuscular (IM) ketamine and placebo after total thyroidectomy. Methods: A total of 90 patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I to II, with a body weight of 50 to 90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into 3 groups to receive treatment after hemostasis. Group (I) received 1 mg/kg ketamine in a total volume of 10mL normal saline instilled in the wound. Group (II) received 1 mg/kg of IM ketamine. Group (III) received 10mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analog scale at rest and movement and hemodynamics were assessed immediately, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared with that in groups II and III, and in group II compared with that in group III (P=0.000). Visual analog scale at rest and movement were decreased immediately postoperatively in groups I and II in comparison with their values in group III; group II had higher sedation scores. Conclusions: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.

Total thyroidectomy is recommended as a line of management of thyroid cancer in many cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to that of intramuscular (IM) ketamine and placebo after total thyroidectomy. Methods: A total of 90 patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I to II, with a body weight of 50 to 90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into 3 groups to receive treatment after hemostasis. Group (I) received 1 mg/kg ketamine in a total volume of 10mL normal saline instilled in the wound. Group (II) received 1 mg/kg of IM ketamine. Group (III) received 10mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analog scale at rest and movement and hemodynamics were assessed immediately, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared with that in groups II and III, and in group II compared with that in group III (P=0.000). Visual analog scale at rest and movement were decreased immediately postoperatively in groups I and II in comparison with their values in group III; group II had higher sedation scores. Conclusions: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.

Total thyroidectomy is recommended as a line of management of thyroid cancer in many cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to that of intramuscular (IM) ketamine and placebo after total thyroidectomy. Methods: A total of 90 patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I to II, with a body weight of 50 to 90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into 3 groups to receive treatment after hemostasis. Group (I) received 1 mg/kg ketamine in a total volume of 10mL normal saline instilled in the wound. Group (II) received 1 mg/kg of IM ketamine. Group (III) received 10mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analog scale at rest and movement and hemodynamics were assessed immediately, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared with that in groups II and III, and in group II compared with that in group III (P=0.000). Visual analog scale at rest and movement were decreased immediately postoperatively in groups I and II in comparison with their values in group III; group II had higher sedation scores. Conclusions: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.

Total thyroidectomy is recommended as a line of management of thyroid cancer in many cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to that of intramuscular (IM) ketamine and placebo after total thyroidectomy. Methods: A total of 90 patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I to II, with a body weight of 50 to 90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into 3 groups to receive treatment after hemostasis. Group (I) received 1 mg/kg ketamine in a total volume of 10mL normal saline instilled in the wound. Group (II) received 1 mg/kg of IM ketamine. Group (III) received 10mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analog scale at rest and movement and hemodynamics were assessed immediately, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared with that in groups II and III, and in group II compared with that in group III (P=0.000). Visual analog scale at rest and movement were decreased immediately postoperatively in groups I and II in comparison with their values in group III; group II had higher sedation scores. Conclusions: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.

Total thyroidectomy is recommended as a line of management of thyroid cancer in many cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to that of intramuscular (IM) ketamine and placebo after total thyroidectomy. Methods: A total of 90 patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I to II, with a body weight of 50 to 90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into 3 groups to receive treatment after hemostasis. Group (I) received 1 mg/kg ketamine in a total volume of 10mL normal saline instilled in the wound. Group (II) received 1 mg/kg of IM ketamine. Group (III) received 10mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analog scale at rest and movement and hemodynamics were assessed immediately, 1, 2, 4, 6, 12, and 24 hours postoperatively. Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared with that in groups II and III, and in group II compared with that in group III (P=0.000). Visual analog scale at rest and movement were decreased immediately postoperatively in groups I and II in comparison with their values in group III; group II had higher sedation scores. Conclusions: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.

Background: Adjuvant postoperative breast radiotherapy improve local control and overall survival. Based on radiobiological and clinical data analysis, hypofractionated radiotherapy had comparable survival to conventional regimen radiotherapy. One of the major limitations of breast radiotherapy is cardiac toxicity that more significant in patients has left breast cancer. Methods: This retrospective study recruited 200 patients with left nonmetastatic breast cancer. All patients underwent surgery followed by adjuvant 3D hypofractionated radiotherapy with different hypofractionation schedules with no cardiac or other comorbidity, Patients ≥18 years, were eligible. Patients with tumor size more than 1 cm or with lymph node involvement received adjuvant chemotherapy and those with positive estrogen and/ or progesterone receptors received hormonal therapy with either estrogen receptor modulator like tamoxifen or aromatase enzyme inhibitors like letrozole according to patient menopausal state and those with Her2neu Over-expression received trastuzumab. The cardiac toxicity was evaluated by measuring the left ventricular ejection fraction (LVEF) prior to treatment and repeated 3 years after radiation therapy or when indicated. Results: Median age was 55 years, 25% less than 50 years, T2 detected in 47.5% of patients, N1 in 40%, while positive hormonal receptors reported in 75%. Her2neu Over-expression reported in 20% and these patients received trastuzumab. At 94 months median follows up period, ten-year LRR-FS was 93.9%, DM-FS was 80.8%, and OAS was 88.9%. Grade I cardiac toxicity reported in 12 patients (6%), the univariate analysis of factors associated with significantly increased cardiac toxicity is only concurrent trastuzumab and none other factors were significant. Conclusion: The results of our study suggest that hypofractionation radiotherapy not associated with increased risk of cardiac toxicity in left-sided breast cancer patients and there is no difference between different hypofractionation radiotherapy protocol as regard cardiac toxicity with the comparable result as regard LRR, DM and survival. Trastuzumab increased cardiac toxicities during hypofractionated radiotherapy and this should study in large randomized trials with long-term follow-up to confirm these findings. [Tamer M. Samy, Samia Abdelkareem, Marwa Abdelgawad, Shimaa Ahmed. Cardiac toxicity of hypofractionated radiotherapy in left breast cancer. Cancer Biology 2018;8(2):65-72]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 8. doi:10.7537/marscbj080218.08.

Background: Adjuvant postoperative breast radiotherapy improve local control and overall survival. Based on radiobiological and clinical data analysis, hypofractionated radiotherapy had comparable survival to conventional regimen radiotherapy. One of the major limitations of breast radiotherapy is cardiac toxicity that more significant in patients has left breast cancer. Methods: This retrospective study recruited 200 patients with left nonmetastatic breast cancer. All patients underwent surgery followed by adjuvant 3D hypofractionated radiotherapy with different hypofractionation schedules with no cardiac or other comorbidity, Patients ≥18 years, were eligible. Patients with tumor size more than 1 cm or with lymph node involvement received adjuvant chemotherapy and those with positive estrogen and/ or progesterone receptors received hormonal therapy with either estrogen receptor modulator like tamoxifen or aromatase enzyme inhibitors like letrozole according to patient menopausal state and those with Her2neu Over-expression received trastuzumab. The cardiac toxicity was evaluated by measuring the left ventricular ejection fraction (LVEF) prior to treatment and repeated 3 years after radiation therapy or when indicated. Results: Median age was 55 years, 25% less than 50 years, T2 detected in 47.5% of patients, N1 in 40%, while positive hormonal receptors reported in 75%. Her2neu Over-expression reported in 20% and these patients received trastuzumab. At 94 months median follows up period, ten-year LRR-FS was 93.9%, DM-FS was 80.8%, and OAS was 88.9%. Grade I cardiac toxicity reported in 12 patients (6%), the univariate analysis of factors associated with significantly increased cardiac toxicity is only concurrent trastuzumab and none other factors were significant. Conclusion: The results of our study suggest that hypofractionation radiotherapy not associated with increased risk of cardiac toxicity in left-sided breast cancer patients and there is no difference between different hypofractionation radiotherapy protocol as regard cardiac toxicity with the comparable result as regard LRR, DM and survival. Trastuzumab increased cardiac toxicities during hypofractionated radiotherapy and this should study in large randomized trials with long-term follow-up to confirm these findings. [Tamer M. Samy, Samia Abdelkareem, Marwa Abdelgawad, Shimaa Ahmed. Cardiac toxicity of hypofractionated radiotherapy in left breast cancer. Cancer Biology 2018;8(2):65-72]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 8. doi:10.7537/marscbj080218.08.

Background: Adjuvant postoperative breast radiotherapy improve local control and overall survival. Based on radiobiological and clinical data analysis, hypofractionated radiotherapy had comparable survival to conventional regimen radiotherapy. One of the major limitations of breast radiotherapy is cardiac toxicity that more significant in patients has left breast cancer. Methods: This retrospective study recruited 200 patients with left nonmetastatic breast cancer. All patients underwent surgery followed by adjuvant 3D hypofractionated radiotherapy with different hypofractionation schedules with no cardiac or other comorbidity, Patients ≥18 years, were eligible. Patients with tumor size more than 1 cm or with lymph node involvement received adjuvant chemotherapy and those with positive estrogen and/ or progesterone receptors received hormonal therapy with either estrogen receptor modulator like tamoxifen or aromatase enzyme inhibitors like letrozole according to patient menopausal state and those with Her2neu Over-expression received trastuzumab. The cardiac toxicity was evaluated by measuring the left ventricular ejection fraction (LVEF) prior to treatment and repeated 3 years after radiation therapy or when indicated. Results: Median age was 55 years, 25% less than 50 years, T2 detected in 47.5% of patients, N1 in 40%, while positive hormonal receptors reported in 75%. Her2neu Over-expression reported in 20% and these patients received trastuzumab. At 94 months median follows up period, ten-year LRR-FS was 93.9%, DM-FS was 80.8%, and OAS was 88.9%. Grade I cardiac toxicity reported in 12 patients (6%), the univariate analysis of factors associated with significantly increased cardiac toxicity is only concurrent trastuzumab and none other factors were significant. Conclusion: The results of our study suggest that hypofractionation radiotherapy not associated with increased risk of cardiac toxicity in left-sided breast cancer patients and there is no difference between different hypofractionation radiotherapy protocol as regard cardiac toxicity with the comparable result as regard LRR, DM and survival. Trastuzumab increased cardiac toxicities during hypofractionated radiotherapy and this should study in large randomized trials with long-term follow-up to confirm these findings. [Tamer M. Samy, Samia Abdelkareem, Marwa Abdelgawad, Shimaa Ahmed. Cardiac toxicity of hypofractionated radiotherapy in left breast cancer. Cancer Biology 2018;8(2):65-72]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 8. doi:10.7537/marscbj080218.08.