Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer; during the period from January 2008 to December 2015; were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy; those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients; Group B is from 3 - 6 months and include 30 patients; Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups; however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Objectives: Aim of our work is to study the effect of early enteral feeding through either nasoentral or feeding jejunostomy tube post esophagectomy on patients recovery and hospital stay. Background: Postoperative nutrition is a well known aspect of care in recent years and has been shown to decrease the incidence of complications and hospital stay. Enteral nutrition has been shown to be superior to parenteral nutrition as it is more physiological, safer, cheaper and early enteral nutrition has been clearly confirmed to reduce postoperative morbidity. Methods: This is randomized combined retrospective and prospective study that is conducted in surgical oncology department, South Egypt cancer institute, Assiut University; from October 2012 to October 2016. Patients in this study were divided into two groups: group 1 includes patients with feeding jejunostomy and group 2 is patients with nasoenteral tube. Results: 25 Patients included in this study (19 males & 6 females). All cases were primarily diagnosed as esophageal cancer, middle and lower 1/3 esophagus or proximal gastric carcinoma infiltrating cardia by clinical data associated with abdominal sonar and/or C.T scan and upper endoscopy with biopsy. There was no significant difference in catheter related complications (P value 0.238). There was no operative mortality. Conclusion: Early postoperative enteral nutrition was feasible and safe for patients undergoing esophagectomy. There is no significant difference between NE and FJ. Enteral nutrition either through nasoenteral or feeding jejunostomy is an effective method for postoperative nutritional support in this type of major surgery.

Objectives: Aim of our work is to study the effect of early enteral feeding through either nasoentral or feeding jejunostomy tube post esophagectomy on patients recovery and hospital stay. Background: Postoperative nutrition is a well known aspect of care in recent years and has been shown to decrease the incidence of complications and hospital stay. Enteral nutrition has been shown to be superior to parenteral nutrition as it is more physiological, safer, cheaper and early enteral nutrition has been clearly confirmed to reduce postoperative morbidity. Methods: This is randomized combined retrospective and prospective study that is conducted in surgical oncology department, South Egypt cancer institute, Assiut University; from October 2012 to October 2016. Patients in this study were divided into two groups: group 1 includes patients with feeding jejunostomy and group 2 is patients with nasoenteral tube. Results: 25 Patients included in this study (19 males & 6 females). All cases were primarily diagnosed as esophageal cancer, middle and lower 1/3 esophagus or proximal gastric carcinoma infiltrating cardia by clinical data associated with abdominal sonar and/or C.T scan and upper endoscopy with biopsy. There was no significant difference in catheter related complications (P value 0.238). There was no operative mortality. Conclusion: Early postoperative enteral nutrition was feasible and safe for patients undergoing esophagectomy. There is no significant difference between NE and FJ. Enteral nutrition either through nasoenteral or feeding jejunostomy is an effective method for postoperative nutritional support in this type of major surgery.

Objectives: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. Study design: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. Setting: Academic medical center. Patients: Sixty patients were enrolled in this study after ethical committee approval. Interventions: Patients divided into 2 groups (30 each): Bupivacaine group (GB): given ultrasound guided TAPblock 20 ml 0.5% bupivacaine diluted in 20 ml saline; Morphine group (GM): given ultrasound guided TAPblock with 20 ml 0.5% bupivacaine + 10 mg morphine sulphate diluted in 20 ml saline. Measurements: Patientswere observed for total morphine consumption, time for first request of rescue analgesia, sedation scores, hemodynamics and side effects for 24 h postoperatively. Results: Morphine added to bupivacaine in TAP block compared to bupivacaine alone reduced total morphine consumption (5.33 ± 1.28 mg) (10.70 ± 3.09 mg) respectively (p b 0.001), prolonged the time to first request of analgesia (10.40 ± 4.96 h) (6.97 ± 3.26 h) respectively (p b 0.008), with a statistically significant decrease in (VAS-M) in GM compared with GB at 12 h postoperatively (p b 0.002). No significant differences in hemodynamics, respiratory rate, oxygen saturation, sedation score, and side effects except for nausea were observed (p N 0.05). Conclusion: Addition of morphine to bupivacaine in TAP block is effective method for pain management in patients undergoing major abdominal cancer surgery without serious side effects

Objectives: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. Study design: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. Setting: Academic medical center. Patients: Sixty patients were enrolled in this study after ethical committee approval. Interventions: Patients divided into 2 groups (30 each): Bupivacaine group (GB): given ultrasound guided TAPblock 20 ml 0.5% bupivacaine diluted in 20 ml saline; Morphine group (GM): given ultrasound guided TAPblock with 20 ml 0.5% bupivacaine + 10 mg morphine sulphate diluted in 20 ml saline. Measurements: Patientswere observed for total morphine consumption, time for first request of rescue analgesia, sedation scores, hemodynamics and side effects for 24 h postoperatively. Results: Morphine added to bupivacaine in TAP block compared to bupivacaine alone reduced total morphine consumption (5.33 ± 1.28 mg) (10.70 ± 3.09 mg) respectively (p b 0.001), prolonged the time to first request of analgesia (10.40 ± 4.96 h) (6.97 ± 3.26 h) respectively (p b 0.008), with a statistically significant decrease in (VAS-M) in GM compared with GB at 12 h postoperatively (p b 0.002). No significant differences in hemodynamics, respiratory rate, oxygen saturation, sedation score, and side effects except for nausea were observed (p N 0.05). Conclusion: Addition of morphine to bupivacaine in TAP block is effective method for pain management in patients undergoing major abdominal cancer surgery without serious side effects

T-cell immunoglobulin mucin 3 (TIM-3) is a transmembrane protein that plays an important role in several autoimmune diseases. The relationship between TIM-3 and excessive immune responses in immune thrombocytopenia (ITP) is still unknown. In this study, we evaluated the relationship between the expression of TIM-3 on peripheral blood mononuclear cells in patients with ITP and the disease severity. The frequency of lymphocyte and monocyte subsets and their TIM-3 expression were evaluated in patients with acute ITP (n ¼ 45) and in healthy control (n ¼ 20) using flow cytometry. Based on bleeding severity, patients were classified into 3 subgroups as mild (n ¼ 12), moderate (n ¼ 25), and severe (n ¼ 8) bleeding. T-helper lymphocytes was found to be significantly decreased in the severe bleeding group compared to the mild and moderate bleeding groups, while CD56high natural killer (NK) cells were significantly expanded in severe bleeding group. In contrast, classical, intermediate, and nonclassical monocytes, natural killer T lymphocyte (NKT), and CD56dim NK cells showed no significant changes among different patient groups. This alteration of lymphocyte and monocyte subsets was associated with significant decrease in TIM-3 expression on CD56high NK cells, T-helper lymphocytes, NKT cells, and nonclassical monocytes in patients with ITP compared to the controls. Lower level of TIM-3 was found in severe bleeding group compared to mild and moderate bleeding groups. These results indicate that TIM-3 may be involved in the pathogenesis of ITP which subsequently can represent an opportunity for new therapeutic plan, moreover. This may have a prognostic value for disease severity.

T-cell immunoglobulin mucin 3 (TIM-3) is a transmembrane protein that plays an important role in several autoimmune diseases. The relationship between TIM-3 and excessive immune responses in immune thrombocytopenia (ITP) is still unknown. In this study, we evaluated the relationship between the expression of TIM-3 on peripheral blood mononuclear cells in patients with ITP and the disease severity. The frequency of lymphocyte and monocyte subsets and their TIM-3 expression were evaluated in patients with acute ITP (n ¼ 45) and in healthy control (n ¼ 20) using flow cytometry. Based on bleeding severity, patients were classified into 3 subgroups as mild (n ¼ 12), moderate (n ¼ 25), and severe (n ¼ 8) bleeding. T-helper lymphocytes was found to be significantly decreased in the severe bleeding group compared to the mild and moderate bleeding groups, while CD56high natural killer (NK) cells were significantly expanded in severe bleeding group. In contrast, classical, intermediate, and nonclassical monocytes, natural killer T lymphocyte (NKT), and CD56dim NK cells showed no significant changes among different patient groups. This alteration of lymphocyte and monocyte subsets was associated with significant decrease in TIM-3 expression on CD56high NK cells, T-helper lymphocytes, NKT cells, and nonclassical monocytes in patients with ITP compared to the controls. Lower level of TIM-3 was found in severe bleeding group compared to mild and moderate bleeding groups. These results indicate that TIM-3 may be involved in the pathogenesis of ITP which subsequently can represent an opportunity for new therapeutic plan, moreover. This may have a prognostic value for disease severity.

T-cell immunoglobulin mucin 3 (TIM-3) is a transmembrane protein that plays an important role in several autoimmune diseases. The relationship between TIM-3 and excessive immune responses in immune thrombocytopenia (ITP) is still unknown. In this study, we evaluated the relationship between the expression of TIM-3 on peripheral blood mononuclear cells in patients with ITP and the disease severity. The frequency of lymphocyte and monocyte subsets and their TIM-3 expression were evaluated in patients with acute ITP (n ¼ 45) and in healthy control (n ¼ 20) using flow cytometry. Based on bleeding severity, patients were classified into 3 subgroups as mild (n ¼ 12), moderate (n ¼ 25), and severe (n ¼ 8) bleeding. T-helper lymphocytes was found to be significantly decreased in the severe bleeding group compared to the mild and moderate bleeding groups, while CD56high natural killer (NK) cells were significantly expanded in severe bleeding group. In contrast, classical, intermediate, and nonclassical monocytes, natural killer T lymphocyte (NKT), and CD56dim NK cells showed no significant changes among different patient groups. This alteration of lymphocyte and monocyte subsets was associated with significant decrease in TIM-3 expression on CD56high NK cells, T-helper lymphocytes, NKT cells, and nonclassical monocytes in patients with ITP compared to the controls. Lower level of TIM-3 was found in severe bleeding group compared to mild and moderate bleeding groups. These results indicate that TIM-3 may be involved in the pathogenesis of ITP which subsequently can represent an opportunity for new therapeutic plan, moreover. This may have a prognostic value for disease severity.