Correlation between Neutrophil Gelatinase-Associated Lipocalin and Endoscopic, Histopathologic and Clinical Activities of Ulcerative Colitis

Introduction:Detection of activity of ulcerative colitis (UC) is vital for predicting treatment outcome. The assessment depends on clinical, serologic, and endoscopic findings. One of the noninvasive biomarkers for disease activity detection is serum Neutrophil Gelatinase-Associated Lipocalin (NGAL). Aim:To assess the relationship between NGAL and endoscopic, histopathologic and clinical activity of UC.Methods:This study wasconducted on 50 cases with definitive diagnosis of UC and 15 cases with normal colonoscopyexamination as controls.UC cases were considered active if Geobes score was ≥3.1.Complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver and kidney function tests were done.Serum NGAL was estimated using ELISA technique. Results:UC caseswere classified into active group (n = 36) and inactive group (n = 14). In active UC cases, median value (IQR) of serum NGAL was significantly increased(101.15 (67.53 –156.40) ng/mL) compared to inactive cases (63.35 (60.98–65.20)ng/mL) and control group (24.80 (15.50 –31.50)ng/mL).Serum NGAL was well correlated with Geobes score, Mayo score, CRP and ESR.Serum NGAL at cut-off ≥ 63 can predict activity with sensitivity88.89%, specificity 85.71%, PPV 94.12% and NPV 75%.Conclusion:Serum NGAL is valuable noninvasive marker for assessment of UC disease activity

Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Factors affecting hearing aids efficiency in children with hearing loss at South Sinai

Hearing loss can cause significant educational and social problems. The prevalence of hearing loss in Egypt equals 16.02%. The present study was done to evaluate the role of factors affecting rehabilitative interventions in children using hearing aids. Data including type of hearing aid, mode of use [binaurally/ monaurally] and time of fitting were studied. The impact of social variables as the educational level of parents, family size and availability of water supply, electricity and sewage were also studied. Twenty nine children and adolescents, aged 3.5-18 years were studied. They were complaining of hearing loss and already fitted with hearing aid[s]. All children were subjected to otoscopy, tympanometry and pure tone audiometry. Children were living at different cities in South Sinai [Ras Sidre, Abu Redeis, El-Tur and Nuwaibaa]. These children were recruited from two special schools for deaf and hard of hearing through an expanded health program at South Sinai. The results reflected the demographic nature of these areas of consanguineous marriage and herido-familial type of hearing loss. The study showed that there was no significant relationship between consistency of hearing aid use and the mode of its use whether monaural or binaural on language acquisition and scholastic achievement. Among all the social factors that were studied only the parental education had a significant relationship with level of scholastic achievement [p= 0.007]. The study referred to the importance of early detection of hearing loss in children and the importance of proper fitting of hearing aid. It emphasized the importance of mainstreaming with the availability of qualified professionals and improved service provision. Also it high lightened the importance of parental education with hope of upgrading the social, educational and cultural level of population

Inguinal hernioplasty by laparoscopic total extraperitoneal versus open lichtenstein techniques: a randomized prospective study

Different techniques of laparoscopic inguinal hernioplasty are performed. The total extraperitoneal approach [TEP] represents an important such techniquc. In a randomized prospective study, we compared the TEP with the standard open repair. namely Lichtenstein hernioplasty. Thirty two adult males with inguinal hernia were included in the study. They were randomly and equally divided into two groups: open Lichtenstein [OL] group and laparoscopic [TEP] group. Data were collected regarding operative time, complications. positoperative pain, hospital stay, and resumption of normal activities. The mean follow up period was 15 months ranging from 10 to 23 months. The OL group included two direct hernias, while the TEP group included three direct hernias while the rest were indirect. The operative time for the OL group was significantly shorter the TEP group with a mean and range of 44 [30-80] versus 95 [60-160] respectively. TEP group had significantly less postoperative pain and analgesic needs compared to OL group. TEP patients resumed their normal activities significantly sooner than OL patients. Hospital stay did not differ between the two groups. Intraoperative bleeding from the inferior epigastric artery occurred once in the TEP group and was well controlled. Minor postoperative complications in the form or seroma, wound infection, and urinary retention were reported in both groups with no statistically significant differences and resolved spontaneously. Although requires longer operative time than open Lichtenstein inguinal hernioplasty, laparoscopic TEP hernioplasty results in less postoperative pain. analgestic, requirements. and earlier return to normal activities with comparable hospital stay and postoperative complications. Consequently, laparoscopic TEP inguinal hernioplasty could be considered as a strong competitor to the standard Lichtenstein technique. Still larger comparative studies with longer follow up are needed to objectively prefer one technique over the other

Left lateral imaging position in routine myocardial perfusion practice

Left lateral position in myocardial perfusion imaging has been described in the literature to reduce the incidence of diaphragmatic attenuation artifact, therefore improving the specificity of the test

Morphologic, immunphenotypic and clinical discriminators between T-cell / histiocyte-rich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma

Features of T-cell/histiocyte rich large B-cell lymphoma [THRLBCL] overlap with those of lymphocyte predominant Hodgkin lymphoma [LPHL]. The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities. Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern [nodular vs. diffuse], nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen [EMA] and Epstein-Barr virus [EBV]. A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+ was estimated for the diagnosis of TCHRLBCL. There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL [P=0.0001]. Three types of nuclei were identified [lymphocytic/histocytic, Reed-Sternberg and centroblast-like]. The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% [P=0.001], single CD20+ cells, 93% vs. 3.5% [P=0.00004], CD30+ cells, 30% vs. 0% [P=0.01], CD57+ cells, 41% vs. 93% [P=0.008], EMA+ cells, 27% vs. 60% [P=0.113], EBV+ cells, 24% vs. 0% [P=0.117], high nuclear grade, 70% vs. 0% [P=0.001], total score 2-7 [mean 4.68] vs. 0-2 [mean 0.72] [P=0.001], high stage, 86% vs. 7% [P=0.0001]. Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL

Grading of follicular lymphoma using flow cytometry

The treatment and prognosis of follicular lymphoma [FL] is dependant on the grade of the disease. In the World Health Organization classification of lymphoma, grading of FL into low grade [1 and 2] and high grade [3] is recommended. Grading of FL is possible in excision biopsy; histological grading is subjective and inconsistent Grading is extremely difficult in needle core biopsies and fine needle aspirates. We attempted to grade FL using flow cytometry [FCM] and CD 19/forward scatter. Cases of FL seen in our institution and submitted for FCM were evaluated for the percentage of cells detected beyond the 500-channel mark [on a 1024 scale] on a CD19/forward scatter dot plot. We hypothesized that these cells most likely represent centroblasts and their percentage would reflect the grade of the disease. Histological grading of the lymphoma on the open biopsies constituted the reference for FL grade. Thirty-six cases of FL, including 22 males and 14 females, ranging in age from 19 to 92 years [median, 42 years], were studied. There were 17 cases of low grade [grade 1; n=10 and grade 2; n=7] and 19 cases of high grade [grade 3] FL The percentage of cells identified beyond the 500-channel mark on CD19/forward scatter dot plot ranged from 0.12% to 12.55% [median, 4.9%] in low grade [grade 1 and 2] whereas the percentage of those cells in high grade FL ranged from 6.22% to 51.95% [median, 21%; p=0.00001]. Our findings suggest that using a CD19/forward scatter dot plot can help identify centroblasts in FL making grading possible on FCM, especially in small biopsies and fine needle aspirates

Occult hepatitis B virus infection in Egyptian patients with hepatitis C virus related chronic liver disease

Concurrent infections with hepatitis B virus [HBV] and hepatitis C virus [HCV] are increasingly recognized in patients with both acute and chronic hepatitis and the reciprocal influence of dual infection remains controversial. In Egypt, the last decade showed a remarkable decline in HBV infection associated with remarkable rise in HCV infection. This study investigates the prevalence of occult HBV in adults with HCV related chronic liver disease [CLD] to spot lights on its importance on the clinical outcomes. Ninety five patients with HCV related chronic liver disease [median age 50 yrs] were enrolled in this study. Thirty of them were suffering from hepatocellular carcinoma [HCC]. Sera were tested for HCV antibodies, HCV-RNA [nested RT-PCR], HBV markers [HBsAg, Anti-HBcAb IgM and total, HBeAg] and HBV-DNA [nested PCR for s, c and x regions]. All the studied patients were anti-HCV positive, where 47/95 [49.5%] of them were HCV RNA positive. HBsAg was detected in 25/95 [26.3%] [Overt HBV infection], Total anti-HBc was detected in 52/83 [62.65%], HBV-DNA was positive among 41/95[43.1%] with greatest prevalence for "c" region 39/95 [41%]. HBV DNA positive / HBsAg negative [occult HBV infection] was significantly prevalent in HCV-CLD vs HCC patients[p<0.001], and was found to be significantly increased in those who were HCV RNA positive rather than in HCV RNA negative patients [P< 0.05]. No significant difference was detected between patients with occult or over HBV infection as regard to liver enzymes or Child classification [P>0.05]. Occult HBV infection was found to be significantly increased in HCV related chronic liver disease with [p<0.05]. The high prevalence occult HBV-infection [particularly core DNA] may have clinical implications in the pathogenesis and therapy of HCV induced chronic liver disease. Standardized definition and diagnostic criterion of occult HBV infection are needed for future research to determine its prevalence and clinical significance

Pro-inflammatory effect of C-reactive protein and interleukin-6 in pre dialysis patients and its relation to atherothrombotic profile

The present study was undertaken to determine the level of circulating C-reactive protein and interleukin-6 in the sera of predialysis chronic renal failure patients and to correlate the levels of CRP and IL-6 with renal function. This study was carried out in Internal Medicine Departments and Tanta university hospitals during the period from September 2003 to April 2005. fifty five subjects were included in this study. They were divided into two main groups. Group I [n = 15] healthy individuals [9 males and 6 females] with mean age 51.1 +/- 9.8 years as a control group ,Group II [n - 40] predialysis chronic renal failure patients [24 males and 16females] with mean age 52.3 +/- 77.5 years. 16patients [40%] were chronic glomerulonephritis, 4 patients [10%] were chronic interstitial nephritis, 3 patients [7.5%] were poly cystic kidney disease, 1 patient [2.5%] was hydronephrosis and 16 patient] 40%] were of unknown causes. They had no other predisposing factors that may elevate the serum levels C-reactive protein or Interleukin-6 e.g infection, diabetes mellitus, other systemic inflammatory diseases or auto immune diseases. This group was subdivided into two subgroups: subgroup [a]: included patients with creatinine clearance 25 ml/min or more [n = 18], and subgroup [b]: included patients with creatinine clearance less than 25 ml/min [n = 22]. All subjects were subjected to full history taking, complete physical examination, abdominal ultrasound and the following investigations : serum creatinine, creatinine clearance, urea, albumin, total serum cholesterol, triglycerides, HDL, LDL, C-reactive protein and interleukin-6. Mean CRP in control group was 2.87 +/- 1.13 mg/L, while in patients group was 10.44 +/- 7.64 mg/L with a highly significant increase in patients group than control group [P < 0.000 1]. Mean CRP in subgroup [a] was 5.08 +/- 2.25 mg/l, while in subgroup [b] was 14.83 +/- 7. 71mg/l with a highly significant increase in subgroup [b] than subgroup [a] [P < 0.0001] Mean IL-6 in control group was 2.37 +/- 1.02 pg/ml, while in patients group was7.39 +/- 4.47 pg/ml ,with a highly significant increase in the group II than the control group [P < 0.0001] Mean IL-6 in subgroup [a] was 4.60 +/- 1.92 pg/ml, while in subgroup [b] was 9.67 +/- 4.70 pg/ml with a highly significant increase in subgroup [b] than subgroup [a] [p < 0.0001]. Significant inverse correlation between creatinine clearance and CRP was found [CRP versus Cr.clr = 0.704, P < 0.0001]. Also, a negative correlation was found between Cr.clr and IL-6 [IL-6 versus Cr.clr = -0.593, P < 0.0001]. There was mild significant correlation between creatinine clearance and HDL [P = 0.001]. A significant correlation between CRP and IL-6 [r = 0.637, P < 0.0001]. Negative significant correlation was found between CRP and albumin [CRP versus albumin r = -0.57, P < 0.0001]. There was increase in CRP and IL-6 and so inflammation and tissue damage, atherosclerosis, coronary and vascular disease with slight hyperlipidemia, which confirm that inflammation have a cardinal role in vascular disease, atherosclerosis and tissue damage in predialysis chronic renal failure patients

Bronchial carcinoid, nine years experience

Bronchopulmonary carcinoid tumors are low grade malignant tumors, of neuroendocrine origin. They are not associated with smoking. This work was conducted between 1995- 2003 to study bronchial carcinoid tumor regarding age and sex distribution, incidence rate, surgical techniques and patients survival. Eleven patients were included in this study. Bronchoscopic biopsy was obtained in 5 patients, transthoracic needle biopsy in 4 and the diagnosis was reached postoperatively in the remaining 2 patients. No carcinoid syndrome was found in any of our studied patients. There were 6 males and 5 females the mean tumor size was 2 X3.5 cm and the mean age was 32 years. Nine patients were symptomatic, and the tumor was discovered accidentally in the remaining 2. Bronchial carcinoid represented 22.4% of all carcinoid tumors and 8.2% of lung cancer patients referred to our institution during this period. Operative procedures performed were; lobectomy in 5, bilobectomy in 1, pneumonectomy in 3 and sleeve resection in 2 patients. Postoperative pathology revealed 10 patients with typical and I with atypical carcinoid. Morbidity was encountered in 3 patients, in the form of arrhythmia in 2 and air leak in 1 patient with no operative related mortality. Follow up data was available for 9 patients as 2 patients were lost to follow up. One patient with a typical carcinoid died 8 months postoperative from disseminated disease, the remaining 8 patients are alive disease free. Bronchial carcinoid is of low malignant potential with excellent survival following complete resection. Bronchoplastic procedures should be encouraged whenever indicated

Study of some risk factors of premature atherosclerosis and coronary heart disease in some Egyptian children

Coronary heart disease is a major health problem and one of the most important leading causes of adult deaths although it starts since childhood. Genetic predisposition of coronary heart diseases have been well established, so children of parents or grandparents with premature coronary heart diseases are more susceptible to develop the disease than others. Those with positive family history of premature coronary heart disease are more susceptible to lipid and lipoprotein abnormalities. Lipoprotein [a] is a strong predictor for premature coronary heart disease, together with total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol. Lipoprotein [a] is genetically determined and if it is elevated in a child, it predicts premature coronary heart disease. The effect of a high lipoprotein [a] increases if associated with high serum low density lipoprotein cholesterol or low serum high density lipoprotein cholesterol. This study was done on two groups of children: The First Group: Included 50 children [age ranging from 5-15 years] of parents with a history of premature coronary heart disease or cerberovascular disease diagnosed clinically and through investigations. The Second Group: Included 25 children [age ranging from 5-15 years] of parents without coronary heart disease or cerberovascular disease. All these children were examined clinically and the following parameters were done and recorded: Anthropometric measurements [Height [Ht], Weight [Wt], Skin fold]. Body mass index [BMI]. Blood pressure [SBP, DBP]. Fasting blood glucose [FBG]. Uric acid level [UA]. C-reactive protein [CRP]. Lipid profile: Cholesterol [TC], Triglyerides [TG], High density lipoprotein [HDL], Low density lipoprotein [LDL], Lipoprotein [a] [LP[a]]. Anti hepatitis A virus [HAV] and anti Helicobacter pylori [H.P] antibodies. The Study Showed that: There was no significant difference between cases and controls in age, HT, WT, BMI, skin fold, SBP and DBP. There was no significant difference between cases and controls in TG. FBG and UA. There was a significant increase in cases than controls in TC and LDL. Also there was a high significant increases in cases than controls in LP[a], while there was a high significant increase in controls than cases in HDL. There was no significant difference between cases and controls in sex, HAV, HP or CRP. There was insignificant correlation between LP[a] and age, BMI, skin fold, SBP, BDP, LDL, FBG and UA. There was a significant correlation between LP[a] and TC. Also there was a high significant correlation between LP[a] and TG, HDL. We concluded that high serum TC is not enough for determination of the risk of atherosclerosis and CHD and that high TG alone is not a risk factor except if associated with low serum HDL and high serum LDL. We recommend screening of all children with a positive family history of premature CHD and/or hypercholesterolemia for lipids and lipoprotein abnormalities especially LP[a] which is a strong predictor for premature CHD and this enables early diagnosis and early successful management by following special dietetic measures with avoidance of excess saturated fatty acids, avoidance of obesity and smoking and practicing physical activities. Prevention and treatment of infections especially HAV and HP is encouraged. Genetic counseling and discouraging against marriage for heterozygotes for CHD and/or hypercholestrolemia as their children may be homozygotes for the disease

Magnetic resonance imaging in Crohn's Disease : evaluation of activity - correlation with Crohn's activity lndex

Background: The frequent and periodic evaluation of crohn's disease [CD] activity is vital in planning the proper therapy, surgical or pharmacological, monitoring drug effects and detecting post-operative recurrence. The evaluation of inflammation is currently based on a combination of clinical symptoms, physical findings, laboratory parameters, endoscopy and various radiology studies. So far, an absolute reference method to assess disease activity doesn't exist, and many parameters are used by the physicians

Objective: We investigated magnetic resonance imaging [MRI] as a tool to evaluate CD activity in newly diagnosed and follow up patients in correlation with clinical and laboratory markers represented by crohn's Disease Activity lndex [CDAI]

Patients and Methods: This study included 27 patients with proven CD. Twelve patients were included in their 1st month from initial diagnosis. Fifteen patients were regular follow up. Patient evaluation included: careful clinical evaluation, laboratory tests, colon ileoscopy, and if needed barium studies. MRI evaluation was performed at the level of the pathological bowel-loops for the following parameters: bowel-wall thickness [WT]; wall enhancement [WE]; and wall signal on T2- W [SPIR] images

Results: Clinically active disease with CDAI score above 150 was noted in fifteen patients. All 27 patients had ileal CD. Ten patients had ileocolonic CD. One patient had gastric in addition to her ileocolonic disease. Magnetic resonance imaging [MRI] findings were: WT was normal in all patients with inactive disease, while in patients with active disease WT was mild in 2 patients, moderate in 4 patients, and severe in 9 patients. WE was normal in 10 patients, and mild in 2 patients of the inactive disease patients, while mild in 8 patients, and severe in 7 patients of the active disease patients. In inactive disease patients T2Wsignal was mild in 1 patient, and absent in 11 patients, while it was high in 7 patients, and mild in 8 patients of the active disease patients. Statistically significant correlation was noted between WT and CDAI, WE and CDAI, and T2W and CDAI. Also, significant correlation was noted between WT and WE, and T2W and WE

Conclusion: MRI can play a larger role in the clinical assessment of CD activity. MRI has shown good accuracy in detecting the inflammatory changes of CD and in differentiating non-active form active disease

Biological markers in Helicobacter pylori-associated gastritis and carcinoma : the value of a scoring system

Background: Helicobacter pylori-associated gastritis has been linked to the pathogenesis of gastric adenocarcinoma [GA], especially when associated with intestinal metaplasia [IM] and atypia/dysplasia [A/D]. We examined p53 expression, ploidy and proliferative activity and assessed H. pylori infection in relationship to IM and/or A/D in cases of gastritis not associated with GA and in cases of GA

Methods: We examined 53 gastric biopsies from patients with gastritis not associated with GA, including patients with gastritis not associated with IM and/or A/D [n=35] and with gastritis associated with IM and/or A/D [n=21]. Thirty-six distal gastrectomy specimens from patients with GA constituted a third group of patients. A scoring system that encompassed the presence or absence of H. pylori, degree of gastritis, IM and/or A/D, p53, MIB-1 proliferative index [MPI] and ploidy was estimated in the cases of gastritis and in cancer-associated mucosa [CAM] and the adenocarcinoma from patients with GA

Results: Patients with GA had a higher median age than those with gastritis without IM and more were males [ratio, 2.2:1]. H. pylori was detected in 75% [40/53] of gastritis specimens and in 55% [20/36] of GA cases. There was a statistically significant difference between the incidence of gastritis without IM and/or A/D and CAM [P=0.01]. p53 expression was seen in 67% of cases [14/21] of gastritis with IM and/or A/D and in only 5% [2 cases] of gastritis without IM [P=0.0005]. A statistically significant difference in MPI was seen between CAM and GA [P=0.01] and gastritis without IM and/or A/D and gastritis with IM [P=0.004]. Cases of gastritis without IM and/or A/D had a median score of 8 while cases of gastritis with IM and/or A/D had a median score of 12 [P=0.0003]. CAM had a median score of 13, which was significantly different than gastritis without IM and/or A/D [P=0.0003]

Conclusion: The presence of IM and/or A/D can be used in H. pylori-associated gastritis as a starting point to further investigate high-risk lesions. Those showing p53 expression, high proliferative activity and aneuploidy require closer follow up and perhaps additional biopsies. Although aneuploidy is commonly seen in GA, its presence in cases of gastritis as an isolated finding should not indicate a high-risk lesion

new technique for total thyroidectomy with preservation of parathyroid glands and function

Thyroid lobectomy is the basic thyroid operation. The most dangerous complications of this operation are permanent hypoparathyroidism and recurrent laryngeal nerve paralysis. Many attempts have been made to preserve parathyroid gland function including the use of complex microsurgical techniques, and reimplantation techniques that are not always successful. In this article we describe a new technique that preserves the parathyroid glands and their blood supply thereby avoiding permanent hypoparathyroidism. Forty seven patients were operated upon using this technique between January 1998 and March 2000. Twenty nine cases underwent total thyroidectomy [seven of them with unilateral or bilateral functional neck dissection] while eleven patients underwent lobectomy on one side and subtotal thyroidectomy on the other side. Lobectomy on one side only was performed in seven patients. Parathyroid integrity and function was demonstrated by serum calcium estimation and thalium technitium subtraction scans while recurrent laryngeal nerve integrity was demonstrated by indirect and direct laryngoscopy. There were no cases with either permanent hypoparathyroidism or recurrent laryngeal nerve injury as proved by thalium technitium scans, serum calcium and laryngoscopy. Operative time was within the normal range for comparable operations using the classic technique. No postoperative complications were noted. Total thyroid lobectomy using this technique was found to be safe, reproducible and avoids two potentially catastrophic complications. We advocate a minimum of unilateral thyroid lobectomy in all cases regardless the pathology to minimize the possibility and inherent risks involved in reexploration of both sides of the neck

Serum levels of soluble CD95 in patients with systemic lupus erythematosus

The present study was carried out on 30 patients with systemic lupus erythematosus [SLE] and ten apparently healthy individuals as a control group.Systemic lupus erythematosus activity index [SLEDAI] was applied to all patients. Anti-double stranded DNA antibodies [Anti-dsDNA Abs.], interleukin-18 [IL-18] and soluble CD95 [Apo-1/Fas] were determined in the sera of all studied subjects. The mean +/-SD SLEDAI in all patients was 15.25+/- 6.76 . The anti-dsDNA antibodies was positive in all studied patients [mean +/- SD 264.36 +/- 114.85 IU/ml]. Serum IL-18 showed significant elevation in SLE patients as compared to the control group [Mean +/-SD 246.13+/- 114.32I U/ml vs. 45.5 +/- 7.32 IU/ml; p < 0.001]. Serum Soluble CD95 [sCD95] showed significant increase in all SLE patients as compared to the control group [Mean+/-SD 648+/-116.96 pg/ml vs. 270+/-50.24 pg/ml; p < 0.001]. Serum sCD95 also showed significant rise in SLE patients with moderate activity as compared to those with mild activity [Mean +/- SD 629.16+/- 72.54 pg/ml vs. 535 +/-35.97 pg/ml; p<0.05]. The serum level of sCD95 in SLE cases with severe activity showed significant increase when compared to those with moderate activity [Mean+/-SD 797.5 +/- 41.66 pg/ml vs. 629.16 +/- 72.54 pg/ml; p <0.001]. Anti-dsDNA antibodies showed significant positive correlation with SLEDAI [r=0.772; p<0.01]. IL-18 also showed a significant positive correlation with the SLEDAI [r=0.670; p<0.01]. Soluble CD95 showed significant positive correlation with SLDAI [r=0.865; p<0.01], with anti-dsDNA antibodies [r=0.775; p<0.01] and with IL-18 [r =0.722; p<0.01]. From these results it was concluded that serum sCD95 is increased in patients with systemic lupus erythematosus and it is correlated with anti-dsDNA antibodies, with IL-18 and with the disease activity, so it can be useful marker of disease activity for proper management and follow up of SLE patients

Effects of different dose regimens of milrinone on hemodynamics and left ventricular systolic function after cardiopulmonary bypass

Milrinone can improve myocardial systolic function and hemodynamics by increasing contractility and decreasing afterload, although its appropriate dose regimen has not yet been established for cardiac surgical patients. Despite milrinone effectively increases cardiac function after cardiopulmonary bypass, few studies have specifically evaluated its efficacy during cardiac surgery. We investigated the effects of milrinone on hemodynamics and left systolic ventricular function in cardiac surgical patients immediately after emergence from cardiopulmonary bypass [CPB]. Forty five patients undergoing cardiac surgery were studied. They received milrinone [25, 50, or 75 ug/kg] bolus dose over ten minutes followed by 0.25, 0.5, 0.75 ug/kg/min in three patients groups. Heart rate, mean arterial blood pressure, pulmonary capillary wedge pressure, and cardiac index were determined before and after the administration of milrinone and transesophageal echocardiogram were recorded while constant filling pressures were maintained by volume reinfusion from the CPB reservoir. All three doses of milrinone significantly increased CI [2.5, 3.1,3.2 L/min/m2], HR [98, 96,100 bpm], SV [61,66,67 ml/beat] and EF [61, 66, 66%] after 5 min from the milrinone use [p<0.001] and significantly decreased the MAP [80, 81, 82 mmHg], SVR [1127, 965, 928 dyn.s.cm-5] and PVR [183, 165, 157 dyn.s.cm-5] at the same time interval [p<0.001] while the PCWP and CVP did not show valuable change. The 50- and 75-ug/kg doses produced significantly larger increases in cardiac index than the 25-ug/kg dose; however, the 75 ug/kg dose did not produce a significantly larger increase in cardiac index than did the 50-ug/kg dose. Two patients receiving milrinone 25 ug/kg developed premature ventricular contractions. The 75-ug/kg dose was associated with a case of ventricular tachycardia treated with xylocaine infusion and three cases of severe hypotension [BP <60 mmHg] requiring phenylephrine infusion and IV fluid replacement. Thus, milrinone improves hemodynamics and left ventricular systolic function when constant loading conditions are maintained

Assuring quality care through a managerial in-service training program for head nurses working at Assiut University Hospital

This study was carried out on 25 head nurses to assess baseline quality care and the head nurses' knowledge and practice related to their managerial role before and after conducting a management/in- service education program based on needs assessment. A questioner and a performance observation check-list were used for data collection. Similarly, both patients and nurses records were assessed. The tools were applied three times before implementation of the program, 15 days after implementation, then after one month from post-test. The results denoted that head nurses' knowledge for management items and responsibilities was rather low before the training program and improved significantly at the post-test and this continued in the follow up period. Similarly, both patients and nursing records were improved significantly following the training program

Familial interstitial lung disease in five family members with different pathological staging

Reports on familial interstitial lung disease [ILD] are rare and all are indicative of high mortality. We report familial ILD in four siblings and their father. Lung biopsy on each patient revealed different stages of ILD in the form of usual interstitial pneumonia [UIP] in one child, desquamative interstitial pneumonia in 2 children, and non-specific interstitial pneumonitis with a predominance of inflammatory cells in another child. All four siblings presented with repeated chest infection, cyanosis and became oxygen dependent. Chloroquine was used in treating all 4 siblings with variable response. The child with UIP died from progressive disease while on treatment. The father was diagnosed at 40 years of age with ILD and extensive fibrosis, but did not respond to cyclophosphamide treatment. In conclusion, familial interstitial lung disease can present with different pathological stages in the same family members and the response to treatment depends on the degree of inflammation or fibrosis. The condition should be diagnosed early before it reaches an irreversible stage

B-and T-Lymphocyte distribution in benign and malignant lymphoepithelial lesions of the parotid gland: correlation with epstein-Barr virus expression and a proposed mechanism of malignant transformation

Epstein-Barr virus expression in malignant lympoepithelial lesions [LEL] of the parotid gland has been well established. The virus is occasionally expressed in benign, IEL, especially in immunocomprmised hosts. The pathogenesis of the disease as it related to virus expression and lymphocyte subsets has not been clearly defined. In this study, we attempted to identify B- and T-lymphocyte distribution in the lesions as it related to EBV expression in LEL[s] of the parotid gland. Formalin-fixed paraffin-embedded sections of 18 cases of LEL of the period gland were immunohistochemically tested for the distribution of B- and T-lymphocytes in the lesions, using the antibodies L-26 [CD 20] for B-lymphocytes and UCHL-1 [CD-45RO] for T-lymphocytes. The sections were also tested by in situ hybridization for EBV mRNA expression, using the EBER-1 probe specific for EBV-1 gene. The 18 lesions included seven malignant LEL, seven benign LEL and four benign lymphoepithelial cysts. All malignant LEL[s] showed a high and diffuse level of epithelial expression of EBV Mran. Of the 11 benign lesions, only one cases showed focal epithelial expression of EBV mRNA. This was a case of benign LEL in an HIV-positive male. All the benign lesions, except that expressing EBV mRNA, showed a T-/B-lympocyte ratio averaging 2:1. All cases expressing EBV mRNA, including the case of benign LEL in the HIV-positive patient, showed a T-/B-lymphocyte ratio averaging 1:3. Our findings suggest that a T-lymphocyte-mediated immune response may play an essential role in suppressing proliferation of EBV in benign LEL of the parotid gland. This immune mechanism may be significantly disturbed in the malignant lesions, leading to uncontrolled viral replication and carcinogenesis