Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre

Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. This was a retrospective analysis of sixty-one [61] cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no case died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA [i.e. no lymph node affection]. There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative

Prevalence and coorelates of hypertensive complications in Egyptians

The Egyptian National Hypertension Project is a nation-wide survey conducted in the period 1991-1994. All hypertensive individuals as well as a sex and residence matched group of normotensive individuals were included in the study. The 2313 individuals included were subjected to clinical evaluation, laboratory testing, ECG recording and echocardiographic study. Left ventricular mass index estimated by echo was used to diagnose left ventricular hypertrophy [LVH]. The diagnosis of heart failure was based upon the clinical findings plus left ventricular systolic and/or diastolic dysfunction. Plasma creatinine more than 1.6 mg/dl was used to diagnose renal failure. LVH was present in 5% and 20% of the normotensive and hypertensive individuals. Age and systolic blood pressure had an important effect on the prevalence of LVH. The prevalence of coronary heart disease was 11.6% in normotensives and 19.5% in hypertensives. Heart failure was present in 5.8% of the normotensives and 13.3% of the hypertensives. Renal failure was present in 5.3% and 1.9% of the hypertensives and normotensives

Neuroradiological correlative study of pateints with transient ischemic attacks [TIAs] with special emphasis on the role of MRA

Accurate evaluation of the intracerebral vasculature is essential for proper diagnosis and treatment of many neurological disorders including TIAs. Vascular anatomy of brain can be assessed by many modalities including: Direct angiography, MRA, CT angiography and transcranial sonography. This study aimed to compare the validity and clinical matching of the different radiological and para-radiological modalities of examination in the evaluation of the cause of TlAs, with special interest to evaluate MRA and relation of TIAs to congenital vascular anomalies. 28 patients presented recently with TIAs were the subject of this study. Conventional CT of the brain, MRI brain, MRA brain and neck were performed to all patients while Duplex Doppler study of neck vessels was performed in 20/28 patients. MRA Brain showed positive findings in 20/28 patients while MRA neck showed positive results in 8 patients and both were negative in 2 patients [either one or both were positive in 26 patients] and they match clinical presentation in 20/28 of the patients and mismatch the clinical diagnosis in 8/28 of patients. combined MRA and MRI studies for the patients increase the diagnostic accuracy to 79% . .MRA neck showed 100% matching with D. Doppler examination of the neck vessels. MRI diagnosed 12/28 patients while CT diagnosed only 6/28 patients. Congenital anomalies of brain vessels occurred in 13/28 patients. The most common anomaly was absent Al segment in 28% of patients followed by absent P1 segment in 11% of patients. MRA missed the diagnosis in 2/28 patients while MRI proved it. Vertigo was a deceiving symptom, with the least accuracy and matching with all modalities of examination. MRA is the technique of choice to evaluate brain vascularity [accurate, safe, no contrast medium and no Ionizing radiation] with high accuracy and matching with clinical presentation. There is direct relation between the incidence of TIAs and congenital anomalies of the brain. MRI examination is very helpful in few patients while conventional CT can be replaced by MRI as it adds nothing and miss the diagnosis in many patients. Duplex Doppler study of neck vessels can replace MRA neck. We recommend the following scheme for evaluation of patients with TIAs :1. MRI brain, 2. MRA brain, 3. D.Doppler neck vessels

Surgical treatment of congenital deficiency of the tibia

Twenty cases [32 limbs] of congenital deficient tibia were surgically treated. The youngest patient was one-year old and the oldest was 5-year old. The follow up of these patients ranged from 2 years to 5 years with an average of 2.5 years. Patients were classified into 3 types: Type 1 [total absent tibia], type 2 [distal tibial deficiency], and type 3 [dysplasia of the distal tibia with diastasis of tibio-fibular syndesmosis]. The operative procedures were centralization of the fibula beneath the femoral condyles with or without fusion for type 1, tibiofibular synostosis for type 2 and calcaneo-fibular fusion for type 3. Types 2 and 3 patients showed satisfactory results, whereas the results in type 1 were not satisfactory, especially in type 1 patients who had centralization without fusion. The early appearance, the functional status of the quadriceps and the severity of flexion contractures of the knee were important factors in the selection of the operations likely to give the best function

Motor nerve conduction velocity and biphenyl hydantoin serum level-a study in epileptic patients

Motor nerve Conduction velocity was determined in the ulnar nerve and lateral popliteal nerve for epileptic patients receiving DPH. The results were correlated with the serum DPH levels as determined spectrophotometrically. No positive correlation was demonstrated statistically between both parameters. It is suggested that the lowering of conduction, velocity that might take place in some patients receiving DPH is most probably an idiosyncrasic effect of the drug