Download 2006

receiving chemotherapy were investigated at National Cancer Institute, Egypt. These patients were
subjected to clinical evaluation, chest CT scan, conventional blood cultures for bacterial and fungal
pathogens, aspergillus GM antigen detection and PCR assay utilizing pan-fungal primers. Results: Of the
91 FN episodes, 15 were proven IFI; whereas 27 cases were either probable (n= 13) or possible IFI (n=
14), and 49 were unlikely to be IFI episodes. Based on positive results for proven/probable IFI and
compared to culture results, Pan-fungal PCR showed sensitivity, specificity, positive and negative
predictive values of 75%, 92%, 84% and 87%; respectively. Aspergillus antigen test showed a sensitivity
of 79%, specificity of 61%, positive and negative predictive values of 54% and 83%; respectively. A
negative PCR in the proven and probable cases was closely related to previous antifungal therapy for a
rior history of IFI.Conclusions: In patients at high risk for IFI, the results of PCR assay correlated well with
the diagnosis of IFI. The PCR test is more specific than the GM test for screening high risk group cancer
patients in a hospital laboratory. The specificity of GM test is not sufficient and can be improved by PCR.
The PCR assay seems more promising than the GM test for objectively defining IFI. The main value of the
simultaneous use of these tests is to confirm the diagnosis. Therefore, when positive, these tests could
provide an alternative to invasive investigations such as lung biopsy
Keywords
Invasive fungal infection IFI; Haemato-oncology patients; Polymerase ahain reaction PCR;
Galactomannan GM; Aspergillus antigen.
ISSN : 0743-684X Impact Factor : 0.55
Journal : Reconstructive Microsurgery 22 No 2 97-104 (2006) Free Anterolateral Thigh Flap for
Reconstruction of Major Craniofacial Defects Ayman Amin, M.D. , Mohammed Rifaat, M.D., FRCS ,
Francisco Civantos, M.D. , Donald Weed, M.D. , Mohammed Abu-Sedira, M.D. and
Mahmoud Bassiouny, M.D.
Abstract :
Free-tissue transfer has revolutionized skull-base surgery by expanding the ability to perform cranial
base resection and by improving the quality of reconstruction. The anterolateral thigh flap has come
recently into use in the field of head and neck reconstruction. Its role in craniofacial and midface
reconstruction has not been specifically defined. This study involved a total of 18 patients who were
treated over a 5-year period from 1998 to 2003. Seventeen patients had locally advanced head and neck
cancer, requiring craniofacial resection, and one patient had a complicated gun shot wound of the
forehead. Thirteen patients were treated at the National Cancer Institute, Cairo University, Egypt, and
five patients at the University of Miami,
Florida. The patients presented with defects of the anterior skull base (5), lateral skull base (3), scalp and
calvarium (3), and the midface (7). The anterolateral thigh flap was used as a myocutaneous flap in 11
cases and as a perforator fasciocutaneous flap in seven cases. Musculocutaneous perforators supplied
the majority of flaps (17/18). Total flap survival occurred in 17 cases; one patient developed complete
flap necrosis. The most commonly used reciepient vessels were the facial vessels and the external
jugular vein. Major complications included one case with meningitis; the patient died after failure of
treatment. Another patient died 6 weeks postoperatively from pulmonary embolism. One patient
developed CSF leak that stopped spontaneously. In addition, two patients developed minor wound
dehiscence that healed spontaneously. The donor-site wound healed without problems except in two