الأبحاث والمنشورات

Nodular fasciitis is a benign, rapidly growing inflammatory soft-tissue lesion, most often found in the head and neck. In the trachea it is very rare — and dangerous, because a fast-growing mass in the airway can obstruct it before anyone suspects a tumour.

We report a 5-year-old child with nodular fasciitis of the trachea causing near-complete obstruction. Bronchoscopy with biopsy established the diagnosis, and the lesion was excised bronchoscopically.

The case matters because the presentation imitates pneumonia. A child with persistent respiratory symptoms that do not behave as infection should is worth imaging and, where doubt remains, examining bronchoscopically. Early detection is what prevents a benign lesion from becoming a fatal airway obstruction.

This randomised study asked a narrower question than operative safety: what does a minimally invasive approach do to pain, recovery and — importantly — lung function after mitral valve repair?

Fifty patients with non-ischaemic mitral valve disease undergoing repair between 2017 and 2019 were randomly allocated to video-assisted anterolateral mini-thoracotomy or median sternotomy.

Operative time was longer in the minimally invasive group (207 versus 174 minutes), while cross-clamp and bypass times were only nonsignificantly longer. Intensive care stay was shorter (2.6 versus 3.8 days) and hospital stay much shorter (7.9 versus 14.5 days). The clearest difference was respiratory: postoperative FEV1 was 2.06 L after mini-thoracotomy against 1.39 L after sternotomy. Ejection fraction was unchanged between groups.

That respiratory difference is the mechanism behind the shorter stay. Leaving the sternum intact preserves the mechanics of breathing, which is what allows earlier mobilisation and fewer chest complications.

New cardiac surgery units need to know whether their results match international benchmarks. This study audited the first 100 coronary artery bypass operations performed in the cardiothoracic surgery department at Qena University Hospital.

The cohort reflected a high-risk population: 95 of 100 patients had multi-vessel disease, with diabetes in 55%, hypertension in 69%, dyslipidaemia in 55% and smoking in 58%. The left internal mammary artery was grafted to the left anterior descending artery in the majority of cases, with saphenous vein to the remaining targets. An intra-aortic balloon pump was needed in only 2%. Septicaemia was the significant complication encountered. At six months, 97% of patients were alive.

Publishing institutional results rather than relying on international figures is the point of the paper. It establishes a local baseline against which the unit can be measured, and lets surgeons and interventional cardiologists judge whether published international data actually applies to their own patients.

Traumatic diaphragmatic hernia is easy to miss. The injury is usually part of major trauma, and the noisier injuries alongside it draw attention away — yet a missed diaphragmatic tear can later strangulate stomach or bowel in the chest.

We retrospectively reviewed 50 patients diagnosed with acute traumatic diaphragmatic hernia between September 2014 and September 2017.

Blunt trauma accounted for 80% of cases and the left side was involved in 72%. Critically, the diagnosis was made before surgery in only 40% of patients — the majority were found at operation. Repair was abdominal in 74% and thoracic in 26%. Complications occurred in 60%, most often pneumonia (32%), and 16% died, with delayed referral or severe head injury accounting for most deaths.

The conclusion is about index of suspicion rather than technique: in any patient assessed for abdominal or respiratory symptoms after trauma — recent or long past — the diaphragm should be actively considered rather than assumed intact.