Introduction: Hundred years ago, mortality from lung abscess was about 75% of patients. Open drainage of lung abscess decreased mortality on 20-35% and with antibiotic therapy mortality drop on about 8.7 %. At the same time, progress in oral and dental hygiene declined the incidence of lung abscesses. Today, aspiration from oral cavity is considered the major cause of lung abscesses as well as poor oral and dental hygiene. Aim: We aimed at defining an algorithm for surgical management of lung abscess through different options. Patients and methods: This was a comparative study performed on all patients who were admitted to Assiut University Hospital-Cardiothoracic Surgery department with lung abscess all over the duration from September 2016 to December 2017, who meet the listed inclusion and exclusion criteria. The patients were divided into 2 groups according to surgeon’s selection: Group (A): were managed with intercostal tube and further conservative management. Group (B): were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Results: The study was conducted on 42 patients, only 30 of which had reliable complete data. Group (A): consists of 20 patients (66.7%) were managed with tube thoracostomy and further conservative management. Group (B): consists of 10 patients (33.3%) were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Drug Addiction was a very important variable to add to our study as it is a frequent cause of aspiration and it's complications (10% of each group were drug addicts). There was a significant relation between complications and Charlson score of co-morbidity index (such as heart disease, AIDS, or cancer). The mortality in both groups was prominent mostly in patients who are older than 60 years and those who were presented and admitted for surgery with delayed referral or complicated by life threatening conditions such a pulmonary sepsis and acute renal failure. Conclusion: Tube thoracostomy in good way for primary management of lung abscess along with medical treatment in order to relieve toxemia and suppuration, limit fever and leukocytosis especially in large abscesses causing empyema or pyopneumothorax. Yet, patient age, delayed presentation and co-morbidities still contributed to mortality despite the surgical approach used.

Introduction: Hundred years ago, mortality from lung abscess was about 75% of patients. Open drainage of lung abscess decreased mortality on 20-35% and with antibiotic therapy mortality drop on about 8.7 %. At the same time, progress in oral and dental hygiene declined the incidence of lung abscesses. Today, aspiration from oral cavity is considered the major cause of lung abscesses as well as poor oral and dental hygiene. Aim: We aimed at defining an algorithm for surgical management of lung abscess through different options. Patients and methods: This was a comparative study performed on all patients who were admitted to Assiut University Hospital-Cardiothoracic Surgery department with lung abscess all over the duration from September 2016 to December 2017, who meet the listed inclusion and exclusion criteria. The patients were divided into 2 groups according to surgeon’s selection: Group (A): were managed with intercostal tube and further conservative management. Group (B): were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Results: The study was conducted on 42 patients, only 30 of which had reliable complete data. Group (A): consists of 20 patients (66.7%) were managed with tube thoracostomy and further conservative management. Group (B): consists of 10 patients (33.3%) were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Drug Addiction was a very important variable to add to our study as it is a frequent cause of aspiration and it's complications (10% of each group were drug addicts). There was a significant relation between complications and Charlson score of co-morbidity index (such as heart disease, AIDS, or cancer). The mortality in both groups was prominent mostly in patients who are older than 60 years and those who were presented and admitted for surgery with delayed referral or complicated by life threatening conditions such a pulmonary sepsis and acute renal failure. Conclusion: Tube thoracostomy in good way for primary management of lung abscess along with medical treatment in order to relieve toxemia and suppuration, limit fever and leukocytosis especially in large abscesses causing empyema or pyopneumothorax. Yet, patient age, delayed presentation and co-morbidities still contributed to mortality despite the surgical approach used.

Introduction: Hundred years ago, mortality from lung abscess was about 75% of patients. Open drainage of lung abscess decreased mortality on 20-35% and with antibiotic therapy mortality drop on about 8.7 %. At the same time, progress in oral and dental hygiene declined the incidence of lung abscesses. Today, aspiration from oral cavity is considered the major cause of lung abscesses as well as poor oral and dental hygiene. Aim: We aimed at defining an algorithm for surgical management of lung abscess through different options. Patients and methods: This was a comparative study performed on all patients who were admitted to Assiut University Hospital-Cardiothoracic Surgery department with lung abscess all over the duration from September 2016 to December 2017, who meet the listed inclusion and exclusion criteria. The patients were divided into 2 groups according to surgeon’s selection: Group (A): were managed with intercostal tube and further conservative management. Group (B): were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Results: The study was conducted on 42 patients, only 30 of which had reliable complete data. Group (A): consists of 20 patients (66.7%) were managed with tube thoracostomy and further conservative management. Group (B): consists of 10 patients (33.3%) were operated on via conventional Thoracotomy and underwent either segmentectomy, lobectomy or pneumonectomy. Drug Addiction was a very important variable to add to our study as it is a frequent cause of aspiration and it's complications (10% of each group were drug addicts). There was a significant relation between complications and Charlson score of co-morbidity index (such as heart disease, AIDS, or cancer). The mortality in both groups was prominent mostly in patients who are older than 60 years and those who were presented and admitted for surgery with delayed referral or complicated by life threatening conditions such a pulmonary sepsis and acute renal failure. Conclusion: Tube thoracostomy in good way for primary management of lung abscess along with medical treatment in order to relieve toxemia and suppuration, limit fever and leukocytosis especially in large abscesses causing empyema or pyopneumothorax. Yet, patient age, delayed presentation and co-morbidities still contributed to mortality despite the surgical approach used.

Background: Intracardiac foreign bodies (FBs) are uncommon and have diverse presentations. The objectives of this study were to assess the types and presentation of intracardiac FBs and to evaluate the use of cardiopulmonary bypass (CPB) in their extraction. Methods: A retrospective descriptive study was carried out on 12 patients with a history or radiological evidence of a foreign body in the heart or the great vessels who were admitted between 2013 and 2018. Sternotomy was performed in 8 patients and left anterior thoracotomy in 4 patients. CPB was used in 4 patients with cardioplegic cardiac arrest. Aorto-bicaval cannulation was performed in 3 patients and femero-femoral bypass in 1 patient. Results: The mean age of our patients was 32.7 ±21.7 years (range 2-62 years), six were males. Six different intracardiac FBs were reported including retained bullets (n= 3), migrated catheter piece (n=3), sewing needles (n=3), displaced pacemaker lead (n= 1), circular saw (n=1) and missed pigtail catheter after pericardiocentesis (n=1). Recovery from cardiopulmonary bypass was smooth, and no hospital complications were reported. The mean duration of postoperative mechanical ventilation in all sternotomy patients was 7.8 ± 6.7 hours (5 ±2.1 in CPB patients and 10.7±8.9 in non- CPB). The duration of hospital stay in CPB cases vs. non-CPB was (5.5±1.3 vs. 5.7±0.9 days). No postoperative wound infection nor sternal dehiscence were reported. One baby who had lateral thoracotomy died on the fifth postoperative day because of severe gastroenteritis. No residual pericardial or pleural collection were reported in 6 months follow-up period. Conclusions: Retrieval of intracardiac FBs can be performed safely with low morbidity and mortality. The use of CPB did not increase morbidity or mortality. Removal of all types of intracardiac FBs is recommended to avoid complications.

Background: Lung cancer is one of the main human health threats. Survival of lung cancer patients depends on the timely detection and diagnosis. Among the genetic irregularities that control cancer development and progression, there are microRNAs (miRNAs). This study aimed to assess the plasma level of circulating miRNA-17 and miRNA-222 as non-invasive markers in non-small-cell lung cancer (NSCLC) patients. Patients and methods: A total of 40 patients with NSCLC and 20 healthy controls who were matched in terms of age and sex with the patient group were included in this case-control study. Estimation of miRNA-17 and miRNA-222 expression profiles in the plasma was done using quantitative real-time PCR (qRT-PCR). The relationship between both markers and their clinicopathological features were also determined. Receiver operating characteristic (ROC) curve analysis was done to evaluate the role of these microRNAs in NSCLC diagnosis and follow-up. Results: MiRNA-17 and miRNA-222 levels were significantly upregulated in NSCLC patients compared with controls (48.32±12.35 vs 1.16±0.19 and 34.53±3.1 vs 1.22±0.14) (P=0.000). Plasma miRNA-17 level was increased, and the miRNA-222 level was decreased across different stages of the disease; however, these differences were not statistically significant (P=0.4, P=0.5, respectively). The miRNA-17 levels were higher in the lung cancer patients with metastasis, but miRNA-222 levels were lower in patients without metastasis. We found no statistically significant difference in this regard (P=0.4 vs P=0.3, respectively). ROC curve analysis showed that the sensitivity and specificity of miRNA-17 were 77.78% and 87.50%, and of miRNA-222 were 50% and 88.89%. Conclusion: MiRNA-17 and miRNA-222 can be considered as non-invasive biomarkers for detection of early lung carcinogenesis and metastasis in patients with NSCLC, hence providing a basis for the development of novel therapeutic approaches.

Background: Lung cancer is one of the main human health threats. Survival of lung cancer patients depends on the timely detection and diagnosis. Among the genetic irregularities that control cancer development and progression, there are microRNAs (miRNAs). This study aimed to assess the plasma level of circulating miRNA-17 and miRNA-222 as non-invasive markers in non-small-cell lung cancer (NSCLC) patients. Patients and methods: A total of 40 patients with NSCLC and 20 healthy controls who were matched in terms of age and sex with the patient group were included in this case-control study. Estimation of miRNA-17 and miRNA-222 expression profiles in the plasma was done using quantitative real-time PCR (qRT-PCR). The relationship between both markers and their clinicopathological features were also determined. Receiver operating characteristic (ROC) curve analysis was done to evaluate the role of these microRNAs in NSCLC diagnosis and follow-up. Results: MiRNA-17 and miRNA-222 levels were significantly upregulated in NSCLC patients compared with controls (48.32±12.35 vs 1.16±0.19 and 34.53±3.1 vs 1.22±0.14) (P=0.000). Plasma miRNA-17 level was increased, and the miRNA-222 level was decreased across different stages of the disease; however, these differences were not statistically significant (P=0.4, P=0.5, respectively). The miRNA-17 levels were higher in the lung cancer patients with metastasis, but miRNA-222 levels were lower in patients without metastasis. We found no statistically significant difference in this regard (P=0.4 vs P=0.3, respectively). ROC curve analysis showed that the sensitivity and specificity of miRNA-17 were 77.78% and 87.50%, and of miRNA-222 were 50% and 88.89%. Conclusion: MiRNA-17 and miRNA-222 can be considered as non-invasive biomarkers for detection of early lung carcinogenesis and metastasis in patients with NSCLC, hence providing a basis for the development of novel therapeutic approaches.

Background: Lung cancer is one of the main human health threats. Survival of lung cancer patients depends on the timely detection and diagnosis. Among the genetic irregularities that control cancer development and progression, there are microRNAs (miRNAs). This study aimed to assess the plasma level of circulating miRNA-17 and miRNA-222 as non-invasive markers in non-small-cell lung cancer (NSCLC) patients. Patients and methods: A total of 40 patients with NSCLC and 20 healthy controls who were matched in terms of age and sex with the patient group were included in this case-control study. Estimation of miRNA-17 and miRNA-222 expression profiles in the plasma was done using quantitative real-time PCR (qRT-PCR). The relationship between both markers and their clinicopathological features were also determined. Receiver operating characteristic (ROC) curve analysis was done to evaluate the role of these microRNAs in NSCLC diagnosis and follow-up. Results: MiRNA-17 and miRNA-222 levels were significantly upregulated in NSCLC patients compared with controls (48.32±12.35 vs 1.16±0.19 and 34.53±3.1 vs 1.22±0.14) (P=0.000). Plasma miRNA-17 level was increased, and the miRNA-222 level was decreased across different stages of the disease; however, these differences were not statistically significant (P=0.4, P=0.5, respectively). The miRNA-17 levels were higher in the lung cancer patients with metastasis, but miRNA-222 levels were lower in patients without metastasis. We found no statistically significant difference in this regard (P=0.4 vs P=0.3, respectively). ROC curve analysis showed that the sensitivity and specificity of miRNA-17 were 77.78% and 87.50%, and of miRNA-222 were 50% and 88.89%. Conclusion: MiRNA-17 and miRNA-222 can be considered as non-invasive biomarkers for detection of early lung carcinogenesis and metastasis in patients with NSCLC, hence providing a basis for the development of novel therapeutic approaches.

Background: Lung cancer is one of the main human health threats. Survival of lung cancer patients depends on the timely detection and diagnosis. Among the genetic irregularities that control cancer development and progression, there are microRNAs (miRNAs). This study aimed to assess the plasma level of circulating miRNA-17 and miRNA-222 as non-invasive markers in non-small-cell lung cancer (NSCLC) patients. Patients and methods: A total of 40 patients with NSCLC and 20 healthy controls who were matched in terms of age and sex with the patient group were included in this case-control study. Estimation of miRNA-17 and miRNA-222 expression profiles in the plasma was done using quantitative real-time PCR (qRT-PCR). The relationship between both markers and their clinicopathological features were also determined. Receiver operating characteristic (ROC) curve analysis was done to evaluate the role of these microRNAs in NSCLC diagnosis and follow-up. Results: MiRNA-17 and miRNA-222 levels were significantly upregulated in NSCLC patients compared with controls (48.32±12.35 vs 1.16±0.19 and 34.53±3.1 vs 1.22±0.14) (P=0.000). Plasma miRNA-17 level was increased, and the miRNA-222 level was decreased across different stages of the disease; however, these differences were not statistically significant (P=0.4, P=0.5, respectively). The miRNA-17 levels were higher in the lung cancer patients with metastasis, but miRNA-222 levels were lower in patients without metastasis. We found no statistically significant difference in this regard (P=0.4 vs P=0.3, respectively). ROC curve analysis showed that the sensitivity and specificity of miRNA-17 were 77.78% and 87.50%, and of miRNA-222 were 50% and 88.89%. Conclusion: MiRNA-17 and miRNA-222 can be considered as non-invasive biomarkers for detection of early lung carcinogenesis and metastasis in patients with NSCLC, hence providing a basis for the development of novel therapeutic approaches.

Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes. Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study. Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group. Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement.

Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes. Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study. Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group. Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement.