Abstract Background: The use of a hypofractionated 15–16 fraction radiotherapy course replaced the standard fractionated whole breast irradiation (SF–WBI) more than 10 years ago, resulting in shorter waiting lists, lighter machine loads, and more patient compliance. Objectives: Assessment of Arm Lymphedema in breast cancer patients postmastectomy treated with adjuvant single-weekly hypofractionated radiotherapy to the whole breast. Aiming to improve the lifestyle and reduce the suffering of cancer patients. Patients and ethods: Adjuvant RTH to the chest wall was given to 30 postmastectomy women who had infiltrating duct carcinoma of the breast that was histologically confirmed. The dose was 30 or 28.5 Gy in 5 fractions given once a week at a dose of 6.0 or 5.7 Gy. All patients were assessed for ipsilateral arm lymphedema by monitoring the arm circumference on both sides before radiation treatment and at 3, 12, and 24 months after radiation treatment. Results: The incidence of lymphedema grade 0 was (93.3%) in the study group before radiotherapy; at 12 and 24 months after the end of radiotherapy, it was (83.3%) and (80%), respectively (P = 0.044). Grade I was noted in 2 patients (6.66%) before RTH and in 4 patients (13.3%) at 24 months of follow-up (P = 0.682). One case (3.33%) showed grade 2 lymphedema at 3 months after radiation treatment, and 2 cases (6.66%) after 24 months of the end of RTH (P = 0.194). Conclusion: Breast cancer patients can achieve satisfactory results in terms of dosimetric parameters and lymphedema grades by receiving once-weekly whole breast irradiation

Abstract

Background: Post-burn cubital contracture is a common, debilitating complication, especially because the elbow has thin, mobile tissue and nearby neurovascular structures. Surgical reconstruction requires balancing coverage durability, recurrence risk, and early movement. Perforator flaps maintain axial blood supply while providing flexible, pliable tissue.

Objective: To evaluate functional and aesthetic outcomes of the lateral arm perforator flap (LAPF) for reconstruction of post-burn cubital contractures in children.

Patients and Methods: A prospective, single-centre case series was conducted at Assiut University Hospital from June 2023 to May 2025, involving children with mature postburn cubital contracture. They underwent scar excision, stepwise release, then reconstruction using Doppler-mapped perforator-based propeller LAPF. Follow-up occurred at 3, 6, and 12 months, assessing elbow motion and function with the Arabic version of QuickDASH (reported by parents in younger children and self-reported by older children, where feasible), scars with POSAS, and occurrence of complications.

Results: Fifteen children (4–18 years; mean 11 ± 7; 60% male) underwent surgery. The mean post-release defect was 7 ± 2 × 9 ± 3 cm; flap size was 8 ± 2 × 11 ± 3 cm with 120°–180° rotation. Donor sites were closed primarily in 10 patients (66.7%) and grafted in 5 (33.3%). Extension deficit improved from 73.1 ± 26.4° to 9.6 ± 7.4°; flexion–extension arc increased from 78.5 ± 21.9° to 126.8 ± 10.7°; Arabic QuickDASH improved from 51.2 ± 12.6 to 4.5 ± 2.8 at 12 months (all p < 0.001). All flaps survived; venous congestion in 3 patients (20%), with 2 (13.3%) having partial necrosis. No elbow instability or permanent ulnar nerve deficit occurred. POSAS improved to ~3 at 12 months.

Conclusions: LAPF is a reliable regional option for pediatric post-burn cubital contracture reconstruction, providing sustained improvements in elbow motion and patient-reported function with overall acceptable morbidity. A longer follow-up is required to confirm durability through growth.

Abstract

Background: Macroglossia is a term used to describe a large tongue which protrudes outside of the mouth while in a resting position. It is relatively an uncommon condition in children. True macroglossia; congenital or acquired; includes both muscular hypertrophy and tissue infiltration. Congenital macroglossia commonly presents as part of a syndrome, or idiopathic muscular hypertrophy which is a rare entity of true tongue enlargement without any underlying etiology. It is responsible for many functional and psychological disorders. The current surgical approaches emphasise protecting the neurovascular bundles, retaining sufficient length, and preserving lingual movement. The keyhole technique combines both an anterior wedge resection and a central tongue reduction. This debulks the tongue significantly while protecting the lateral neurovascular bundles.

Case Presentation: A five-year-old boy presented with congenital macroglossia due to idiopathic muscular hypertrophy. Other aetiologies, especially syndromes like Beckwith-Widemann syndrome Trenaunay Klipper syndrome and Down syndrome or vascular anomalies, like venous malformations were excluded. Macroglossia was surgically corrected by the keyhole technique. Functional and aesthetic results were excellent at rest and during mobility of the tongue.

Conclusions: Congenital macroglossia requiring reduction glossoplasty is relatively rare and these procedures are, therefore, uncommonly performed. Regardless of its rarity, it can be life saving for some infants and children, and life altering for the others. Reduction glossectomy can greatly enhance the functional and aesthetic results of macroglossia.

Abstract

Background: Gynecomastia surgery generally yields reliable chest contouring results. Perioperative bleeding sequelae (blood-stained lipoaspirate, drain burden, ecchymosis, and hematoma) remain clinically relevant and may delay recovery. Antifibrinolytic tranexamic acid (TXA) is routinely used in major surgeries to decrease blood loss and transfusions. Its use in gynecomastia surgery is limited.

Objective: To evaluate the efficacy of different tranexamic acid (TXA) application methods in controlling perioperative bleeding in gynecomastia surgery.

Patients and Methods: In a prospective, randomized, controlled trial at Assiut University Hospital (Assiut, Egypt), 48 males with true gynecomastia (16-45 years; BMI <35 kg/m²) underwent suction-assisted liposuction with selective glandular excision were randomized (1:1:1; n=16/group) to: Group A (standard tumescence), Group B (local TXA: 500 mg added to tumescence), or Group C (IV TXA: 500 mg, maximum 15 mg/kg). The primary endpoint was estimated intraoperative blood content of the lipoaspirate; key secondary endpoints were postoperative drain output and duration, ecchymosis (incidence and maximal extent), operative time, length of stay, and early complications over 6 weeks. One-way ANOVA with appropriate post-hoc testing and chi-square/Fisher tests were used (two-tailed P<0.05).

Results: Intraoperative aspirate blood content differed significantly across groups (P<0.001) and was lowest with local TXA (control 375.00±40.82 mL; local TXA 190.63±20.16 mL; IV TXA 341.25±37.04 mL). Drain output favoured local TXA (65.63±15.04 mL vs 41.88±11.09 mL vs 55.00±5.16 mL; P<0.001) with shorter drain duration (4.19±0.91 vs 3.19±0.40 vs 3.38±0.50 days; P<0.001). Ecchymosis extent was smaller with local TXA (6.19±2.01 vs 1.10±1.10 vs 2.10±1.20 cm; P<0.001), while ecchymosis incidence was numerically lower with local TXA (37.5% vs 6.25% vs 12.5%; P=0.057). Operative time differed modestly (98.75±7.19 vs 104.38±9.64 vs 106.25±8.06 minutes; P=0.039). Early complications were infrequent and did not differ significantly between groups (P=0.210).

Conclusion: Adjunctive TXA improved bleeding-related recovery surrogates in adult gynecomastia surgery, with local TXA in the tumescent solution providing the most consistent reductions in intraoperative aspirate blood content and drain burden. TXA also reduced the extent, with a non-significant trend toward fewer ecchymoses. Larger trials are warranted to define clinical benefit and safety.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the
main reason of hospital admission. Early diagnosis and prognostication of patients
are important to guide clinicians in optimal decisions regarding the type and site of
care. Different scores used to assess the severity of exacerbation and predict the
outcome. This study aimed to assess the value of four scores (DECAF, BAP-65,
CURB-65 and qSOFA) in predicting intensive care unit admission and in-hospital
death in patients with AECOPD

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the
main reason of hospital admission. Early diagnosis and prognostication of patients
are important to guide clinicians in optimal decisions regarding the type and site of
care. Different scores used to assess the severity of exacerbation and predict the
outcome. This study aimed to assess the value of four scores (DECAF, BAP-65,
CURB-65 and qSOFA) in predicting intensive care unit admission and in-hospital
death in patients with AECOPD.