New biochemical marker in acute coronary syndromes: diagnostic and prognostic implications of plasma angiogenin

Acute coronary syndrome [ACS] represents a life threatening manifestation of atherosclerosis usually precipitated by acute thrombosis, induced by a ruptured or eroded atherosclerotic plaque, with or without concomitant vasoconstriction. Angiogenesis is a complex biological process that has precise coordination of multiple steps. Angiogenin is a potent angiogenic growth factor related to endothelial cell proliferation. This work tried to asses angiogenin as biochemical marker contributing to the pathophysiology of ACS and its prognostic value in adverse events of ACS. This study included 23 patients of ACS. Ten patients were in disease controls group and another twelve as healthy controls. The results revealed markedly elevated angiogenin levels in acute coronary syndrome compared to the controls [Disease group and healthy control group] p<0.0001. No significant difference in angiogenin levels between the disease control and the healthy controls. Angiogenin was high in those patients with adverse outcomes. Plasma angiogenin levels were significantly increased in ACS. Angiogenin may be involved in the pathogenesis of ACS and may have prognostic value to predict adverse events

Clinical under-staging of laryngeal carcinoma, pathological study and clinical application

There is clinical evidence of the safety and efficacy of conservation techniques for laryngeal carcinoma, but the supporting pathological data are incomplete. To formulate a surgical strategy, it is important to be able to predict, for tumors at any given mucosal site, the extent and the likelihood of invasion of the laryngeal spaces and the structures comprising the laryngeal framework. To demonstrate the potential for invasion of the laryngeal framework by laryngeal carcinoma at different sub-sites of the larynx and the effect of this invasion as regards clinically and surgically. This study was conducted upon forty-four patients suffering from laryngeal carcinoma, presenting to the ENT department in Cairo University Hospital from 2000 to 2004. All patients were treated surgically in the form either of total or partial laryngectomy. Every laryngectomy specimen was subjected to histopathological preparation and whole-organ section with special stress on cartilage invasion. Cartilage invasion of the laryngeal framework was proved histopathologically in 65.9% of patients. Cartilage invasion was detected in 81.9% of patients with anterior commissure carcinoma included in this study. There is increased incidence of laryngeal framework invasion with increased tumor size and more commonly in ossified or partially ossified cartilage. All Patients subjected to deep X-ray therapy or laser management as the sole treatment of their anterior commissure carcinoma presented with tumor recurrence and were subjected to more radical surgery. These findings reflect the aggressiveness of laryngeal carcinoma and may alter the planning of treatment, however, larger number of patients in further studies is required to detect the long term effects of these findings

Post-operative pain in relation to different tonsillectomy techniques

Tonsillectomy, with or without adenoidectomy, is a commonly performed operation. The surgical procedure is recommended for recurrent infected tonsils as well as enlarged tonsils, which can lead to pediatric sleep apnea and other breathing disorders. The pain can be severe, and patients are often unable to perform in work or school or eat regular food for a number of days after surgery. Our study investigated four different tonsillectomy techniques in order to show the effect of different techniques on post-operative pain and these techniques were performed on 60 patients indicated for tonsillectomy. All patients were above the age of 12 years. The choice of the age above 12 years is due to the fact that pain is experienced more after tonsillectomy in adults and also to ensure better cooperation in post-operative questionnaire. In our study we divided the 60 patients into 3 equal groups; we removed the right tonsil by conventional dissection technique in all cases and used as a control side while the left tonsil was removed by different technique in each group; laser in group A, bipolar diathermy in group B and dissection with obliteration of the bed in group C. All patients received similar post operative treatment regimen and followed up for 15 days. We found that each technique has some advantages and also disadvantages as regards post-operative pain and healing and so the conventional technique is the safest for our patients and easy technique and has less complications as it decreases the morbidity after tonsillectomy

TRUS-aided seminal vesiculography

Male infertility represents a percentage of the many other causes of infertility among couples. Obstructed male reproductive pathway till the prostatic urethra, represents one of the male causes which can be treated in confidence. Introduction of Trans-Rectal Ultrasonography [TRUS] with localization and cannulation of the seminal vesicles added much to the diagnosis of that problem, especially in obstructed cases. Fourteen patients were the material of our study. TRUS with needle insertion followed by fluoroscopic injection of the contrast to the seminal vesicles was performed. The patients attended with a mean age of 30 years, having different complains from painful ejaculation [8], perineal pain [8], infertility [7], and heamospermia [6]. After vesiculography, there were 12 patients having complete opacification of the distal ejaculatory ducts and partial opacification in 2 patients. Delayed complications in the form of epididymitis were seen in one patient

Clinical profile of giardiasis in under fives

Two groups of children with diarrhea [180], and without diarrhoea [120], were included in the study in order to compare prevalence and age frequency distributions of Giardia between the two group, as well as to find out if there are specific clinical criteria associated with Giardia Lamblia infection. Vegetative form of Giardia was found in 21.7% of diarrhoea cases whereas cyst form was found in 24.2% of diarrhoea cases. Giardiasis was most frequent in the age group corresponding to 19-24 months old. Children at the first 6 months of life did not present positive faecal samples. Statistical analysis indicated no association between sex and prevalence of Giardiasis. It was found that abdominal distension, abdominal cramps, anorexia, offensive stools with more than five motions of watery pale stools are the commonest manifestations in Giardia-associated diarrhea. It is recommended to study the age-specific sero prevalence of Giardias is to better understand the link between Giardia infection and age

Recurrent otitis media in children: relation to serum immunoglobulin G level

Sixty children having recurrent otitis media [four or more attacks over year or less] were enrolled in this study. All cases were subjected to thorough ENT examination, tympanogram and X-ray for nasopharynx. Serum immunoglobulin was measured for patients during the acute episode. Cases are subdivided [according to IgG level] into two groups: Group A [IgG 50% or more of control] and group B [IgG 25% or less of control]. Statistical analysis was done using SPSS PC +/- for windows version 10.0. Serum IgG of patients was lower than in normal control [yet not statistically significant]. Analysis of demographic data of patient subgroups revealed that group B with lower IgG is usually young males with a higher frequency of recurrence

Correlation between cord blood endothelin-1 and traditional indicators of perinatal asphyxia

To measure cord blood endothelin-1 concentrations in infants with perinatal asphyxia and to correlate it with two "classical" markers of hypoxia: the 5-mm Apgar score and cord arterial blood pH. A prospective, case control study was conducted on 24 full-term infants with a history of perinatal events suggestive of asphyxia. 5-mm Apgar score and cord arterial blood was collected immediately after delivery and was used to measure endothelin-l concentrations and cord arterial blood gases in all studied infants. Fourteen healthy full-term newborns with no evidence of perinatal asphyxia were used as controls. The perinatal asphyxia group comprised 24 full-term newborns with a mean [ +/- SD] gestational age of 38.4 +/- 1.3 weeks and a mean [ +/- SD] birth weight of 2833 +/- 508g. There was no significant differences between the perinatal asphyxia group and controls regarding the gestational age, delivery route, or gender. The Apgar score at 5 minutes in peninatal asphyxia group was markedly reduced with a mean [ +/- SD] of 4.7 +/- 1.3. Cord blood pH was significantly lower with a mean [ +/- SD] of 7.2 + 0.08 and base excess was significantly higher with a mean [ +/- SD] of 7.6 +/- 4.5 mEq/1 in perinatal asphyxia group compared to controls. Cord blood endothelin-l concentration was significantly higher in peninatal asphyxia patients compared to controls [p <0.001]. A significant negative correlation was found between cord blood endothelin-1 concentration and pH, base excess, and 5-mm Apgar score in the peninatal asphyxia group. The cord blood endothelin-1 is markedly increased in newborns with perinatal asphyxia and shows a significant negative correlation with 5-min Apgar score, cord arterial blood pH and base excess. Thus, it can be taken as a marker for perinatal asphyxia and that it would be very interesting to evaluate its usefulness as a prognostic index

Endoscopic Management of symptomatic maxillary retention cysts

The objective of this study was to present an experience in endoscopic management of symptomatic mucus retention cyst of the maxillary sinus during the period of March 2000 to November 2002. Seventy-four patients with symptomatic large cysts that filled at least 50% of the maxillary sinus space were included in the study. Most of the cysts were removed through the natural sinus ostium by a rigid nasal endoscope [59 patients]. The inferior meatal approach was used in 11 patients; in 4 patients, the sinus was entered through the canine fossa. The results showed that cysts recurred in only 4 patients during the first postoperative year. There were no complications from the procedure

Accuracy of ultrasonography in assessing patients presenting with shoulder pain

Distingiushing between shoulder disorders can sometimes be difficult, where an imaging technique is needed for further evaluation of such cases. Ultrasound [US] is a fast, safe, inexpensive, widely available, totally non-invasive, radiation free and can provide a dynamic view of moving parts. This present study was performed to assess the usefulness of ultrasound examination in detecting the pathology of the painful shoulder. Forty painful shoulders were assessed clinically and diagnosed with US examination. The diagnosis was confirmed with magnetic resonance imaging [MRI]. US was found to be reliable and highly accurate for the detection of full-thickness tears, calcific tendinitis and acromioclavicular joint [ACJ] degeneration [accuracy = 100%]. In the assessment of partial thickness tear, rotator tendinitis with bursitis and ACJ impingement, US failed to diagnose some cases [accuracy = 92.5%, 92.5% and 95% respectively]. US is an accurate, highly specific tool in the diagnosis of soft tissue disorders, being a logical extension of the clinical examination of the musculoskeletal system. Also, it is an economic, fast technique rather than the expensive MRI

Longitudinal measurement of methotrexate liver concentrations do not correlate with liver damage, clinical efficacy or toxicity during a 3.5 years, double-blinded study in rheumatoid arthritis

In a 3 [1/2] year prospective, double-blind study of methotrexate used to treat RA, we examined whether methotrexate and methotrexate polyglutamates accumulation in the liver correlated with clinical efficacy or clinical/laboratory toxicity. We also validated a new histologic measure of liver histology [the Iowa Score] relative to the Roenigk grading system. Forty rheumatoid arthritis patients participated in a prospective, double-blind, 3 [1/2] year study of methotrexate treatment. Liver biopsies, liver methotrexate and methotrexate polyglutamate concentrations, laboratory tests, evaluation of disease activity and evaluation of adverse events were done prospectively at baseline, 1, 2 and 3 [1/2] years. Radiochemical ligand binding assays and HPLC methods were used to measure methotrexate and methotrexate polyglutamates. Statistical analysis included ANOVA, linear regression and logistic regression modeling. No significant changes in the mean values of AST, ALT, alkaline phosphatase, albumin or hemoglobin occurred. A surprisingly high percentage of patients had at least one abnormal alkaline phosphatase, AST or ALT [25 to 52%] although most abnormalities were small or transient. The last abnormal AST, the number of abnormal AST and ALT's plus female gender correlated with histological liver abnormalities [r[2] = 0.41] using a new histologic scoring system [the Iowa Score]. Histological abnormalities did not progress using either the Roenigk or Iowa Scores, although a slight numerical increase in fibrosis over time appeared possible. The amount of alcohol use correlated with fatty change and the methotrexate dose at biopsy was associated with liver histological abnormalities [p= 0.03 and 0.049, respectively]. Total liver methotrexate concentrations were stable from year 1 to year 3 [1/2] and the percentage of higher order polyglutamates were relatively high [38 to 56%] relative to monoglutamates. No correlation of these concentrations with clinical response or toxicity, histology or liver function tests could be documented. This analysis demonstrated the accumulation and stabilization of methotrexate concentrations in the liver and examined correlations between methotrexate liver concentrations, patient demographics, liver histology, concomitant medications and disease activity. No such correlations were found, decreasing the likelihood that methotrexate concentrations in serum would be useful measures to predict significant hepatotoxicity. This study longitudinally examines methotrexate concentrations and its polyglutamates in the liver and correlates them with histology, liver function tests, demographics and clinical efficacy and toxicity. While previously examined cross-sectional, such a study including methotrexate and metabolite concentrations has never been completed longitudinally. Correlations of histology with AST, ALT and alcohol were found, but no concentration to histology, clinical or toxicity relationships were seen. This implies a very low likelihood that serum methotrexate levels will be useful to measure or predict liver toxicity from methotrexate. In addition, this study validates a new, more sensitive [than the Roenigk score] histology liver scoring system [the Iowa Scale]