added value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma

Primary CNS lymphoma is difficult to diagnose with conventional imaging modalities. Magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images have been recently investigated as a problem-solving tool for evaluation of primary CNS lymphoma with favorable results. To assess the value of advanced neuro-imaging [MR diffusion, perfusion and proton spectroscopy] in diagnosis of primary CNS lymphoma. Five adult patients with suspected primary CNS lymphoma [as suggested by clinical or conventional imaging techniques] were prospectively studied by magnetic resonance proton spectroscopy, dynamic susceptibility contrast DSC perfusion and diffusion weighted images aiming to confirm the suspected diagnosis. The examinations were done on 1.5T machines using diffusion weighted, dynamic susceptibility contrast perfusion and chemical shift CSI imaging sequences. Regarding DWI, all patients show low ADC value of 0.63 +/- 0.025[SD] x 10[-3] mm[2]/s, regarding the DSC perfusion. The max rCBV ratios are ranging from 0.23 to 1.52 with a mean ratio of 1.14 +/- 0.54[SD]. Regarding

Evaluation of notch and hypoxia signaling pathways in chemically induced hepatocelluar carcinoma in rats

Hepatocellular carcinoma [HCC] is a common worldwide malignancy. Notch signaling pathway contributes to the genesis of diverse cancers, however, its role in HCC is unclear. Hypoxia is a common feature of HCC. Signal integration between Nothc and hypoxia may be involved in HCC. The aim of this study was to evaluate the expression of some Notch pathway genes, in addition to hypoxia inducible factor-1 alpha [HIF-l alpha] during rat hepatocellular carcinogenesis. The study aimed also, to identify any crosstalk between Notch signaling and hypoxia throughout hepatocellular oncogenesis in rats. Hepatocellular carcinogenesis was chemically induced in rats. Tissue specimens were examined histopathologically and classified into early preneoplastic group, advanced preneoplastic group, and control group. The expression of Notch-l, Dll-4, and HIF-l alpha was evaluated in tissue samples by total RNA extraction and RT-PCR. The expression of target genes were significantly increased in the diseased group. There was a significant correlation between the expression of Notch-l, Dll4, and HIF-l alpha. These results indicate that overexpression of Notch-l, Dll-4, and HIF-l alpha may be associated with the malignant transformation of hepatocytes with a possible Notch-hypoxia cross talk during hepatocellular oncogenecity

Role of proton magnetic resonance spectroscopy in diagnosis of pilocytic astrocytoma in children

Pilocytic astrocytomas are the second overall most common pediatric brain tumor. Magnetic resonance [MR] imaging is widely used in the diagnosis and follow up of pediatric patients with pilocytic astrocytomas because of its ability to provide anatomical detail. However conventional MR imaging does not provide information about tissue biochemistry. To study the role of proton magnetic resonance spectroscopy in diagnosis of pilocytic astrocytoma in children. This study included seven pediatric patients with histopathologically proven pilocytic astrocytoma. All patients were subjected to full history taking and thorough clinical examination. Magnetic resonance [MR] imaging was performed at 1.5 Tesla MR system using a standard head coil. Imaging included conventional MRI and proton magnetic resonance spectroscopy. Proton magnetic resonance spectroscopy was done using either single or multi-voxel technique. Surgical biopsy was then performed to all patients and correlation with histopathological data was done. Out of the seven patients included in this study, six were females and one was male with mean age of 9.5 years, the tumor was located in five of them in the posterior fossa, located in right thalamo-peduncular region in one patient and located in the hypothalamic-chiasmatic region in one patient. MR spectroscopic study showed the same findings in all the lesions including high Cho/NAA and Cho/Cr ratios [3.53 +/- 1.5] and [7.21 +/- 4.2], respectively, relative low concentration of creatine with increased NAA/Cr ratio [2.32 +/- 1.1]. Lactate doublet was detected in all cases while no lipid peaks were detected. Based on the findings in this study we suggest that pilocytic astrocytoma has a specific spectroscopic metabolic profile which could be diagnostic for this type of tumor

Avoiding mastoid cavity problems: mastoid obliteration using bioactive glass

The aim of this study was to evaluate bioactive glass as an ideal material for the purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems. In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical techniques according to pathology and situation during surgical exploration, basically adhering to standard principles of eradicating disease in chronic unsafe ear. After performing the canal wall down [CWD] or the canal wall up [CWU] technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form Bioglass. Cases were divided according to operative procedures, type of reconstruction and material used into 3 groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass. B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid cavity by particulate form Bioglass. C- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass. Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction on the dura even with contact to Bioglass. Infection was seen in 2 cases [10%], however was readily controlled by topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred. The successful formation of bone with elimination of mastoid cavity problems proved that using Bioglass is appropriate for performing clinical mastoid obliteration

Correlation between clinical, radiological and operative findings in management of tuberculous and pyogenic spondylitis

Spinal infection is a major category of spinal diseases that is difficult to differentiate clinically from degenerative diseases or spinal neoplasm. Evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide the invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities as aggressive neoplastic lesions of the spine. The aim of this study was to determine the accuracy of MRI for discrimination between different types of spinal infections mainly between tuberculous spondylitis and pyogenic spondylitis. We did a retrospective study of MRI images of 30 patients who had confirmed spondylitis either tuberculous or pyogenic in their MRI of the spine. Then we correlate the clinical and operative findings with the preoperative radiology of the patients. Statistical analysis was performed with the Fisher exact test and Monte Carlo test. The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis a well-defined paraspinal abnormal signal was present in 14 patients 88% in tuberculous spondylitis vs 4 patients 28% in pyogenic spondylitis, a thin and smooth abscess wall was present in 14 patients 88% in TB vs 2 patients 14% in pyogenic spondylitis, presence of paraspinal or intraosseous abscess [15 patients 93% in TB vs 6 patients 42% in pyogenic infection, subligamentous spread or more than two vertebral levels was detected in 12 patients 75% in TB vs 5 patients 35% in pyogenic spondylitis. thick and irregular abscess wall was present in 5 patients 35% in pyogenic spondylitis vs 0% in TB, a horizontal bandlike sparing of the body was present in 4 patients 28% in pyogenic spondylitis vs 0% in TB. Hyperintense signal on T2-weighted images was more commonly observed in tuberculous spondylitis 15 patients 93% in tuberculous vs 8 patients 57% in pyogenic. The accuracy and specificity of preoperative MRI diagnosis correlated to the postoperative pathological findings was 100% of both types of spondylitisMRI is an accurate and sensitive modality in diagnosis of spinal infection. It also has a high specificity in differentiation of tuberculous spondylitis and pyogenic spondylitis

Gamma knife surgery for idiopathic trigeminal neuralgia targeting the neurovascular contact zone: the Cairo International medical centre initial experience

Gamma knife radiosurgery is being increasingly performed in the management of patients with medically unresponsive idiopathic trigeminal neuralgia [ITN]. The purpose of this study is to assess initial outcomes in patients treated with gamma knife surgery [GKS] for ITN unresponsive to pharmacologic treatment or previous invasive procedures. Eighteen patients with ITN unresponsive to pharmacologic treatment and/or previous invasive procedures underwent stereotactic GKS targeting the neurovascular contact [NVC] zone in Gamma Knife Centre, International Medical Centre in Cairo, Egypt. Follow-up period ranged between 6 - 28 months. Six patients categorized their pain as group I: excellent response, 6 patients as group II: good response, 3 patients as group Ill: fair response and 4 patients as group IV: poor response. The treatment was successful in 15 patients [groups I and II had complete relief and group Ill had partial relief], 83% of the studied cases. The time of pain relief ranged between 1 -3 months. All the 18 patients in our study had NVC that was proven and detected in the 3D-T2-MRI sequence and was the gamma knife target point for treatment. Side effects seem to be limited to sensory impairment that is usually mild in intensity and occurred in only 3 patients in our study. Gamma knife surgery is a safe and effective treatment for ITN unresponsive to pharmacologic treatment and/or previous invasive procedures

Comparison of effects of cholecystokinin and erythromycin on bile chemistry and gallstone formation in aged guinea pigs.

BACKGROUND: There has been considerable interest in gall bladder motility in recent years. We compared the effects of cholecystokinin (CCK) and erythromycin on bile chemistry and gallstone formation in aged guinea pigs. METHODS: Two groups of guinea pigs (1-mo and 3-y old; n=40 each) were studied. Each group was divided into four subgroups of 10 animals each; one subgroup received lithogenic diet, one each received CCK or erythromycin daily in addition to lithogenic diet for 4 weeks, and one received normal diet. After 4 weeks, the presence of gallstones or sludge was recorded and bile composition including concentrations of bile acid, cholesterol, lecithin and protein concentrations was studied. RESULTS: No gallstones were observed in the 1-mo-old animals. In the 3-year-old animals, 9 of 10 guinea pigs on lithogenic diet and 4 of 10 in each treatment subgroup and the normal diet subgroup developed gallstones. CCK and erythromycin had similar effects on bile chemistry and stone formation. CONCLUSIONS: Aging increases the formation of gallstones in guinea pigs. Erythromycin is as effective as CCK in reducing gallstone formation by improving gall bladder motility.

Comparison between percutaenous ethanol injection and radiofrequency ablation in treatment of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a common type of cancer with approximately 260000 new cases each year and liver cirrhosis could be a predisposing factor [Isselbacher and Dienstag 1998]. Management of HCC depend on the early detection of the tumor, the size and its site. Surgical management versus medical approaches were studied and gave different results in different situations. Radiofrequency ablation is a new minimally invasive technique, which must be evaluated properly. In the study comparison between results of percutaneous ethanol injection [PEI] and percutaneous rediofrequency ablation [PRFA] as a method of treatment of HCC of a diameter less than 3cm. 30 patients with HCC less than 3 cm in diameter either single or multiple lesion with a total number of 50 lesions were divided into 2 groups, group I: 15 patients having 22 lesions treated with PEI and group II 15 patients having 28 lesions treated with PRFA. Both groups were age, sex, histopathological type of tumor matched groups. The rate of complete success was detected as follows: in group I [PEI] 10 lesions [45.5%] of lesions showed complete success. In group II [PRFA] 21 lesions [75%] of lesions showed complete success, complications appeared more prominent in group I more than group II. We concluded that PRFA gave better results of treatment than PEI, less invasive less complications and less number of sessions

Evaluation of antibodies to 60s ribosomal phosphoproteins in systemic lupus erythematosus

Despite their recognition in systemic lupus erythematosus [SLE] patients more than 30 years ago, the prevalence and disease associations of anti-ribosomal P[anti-P] antibodies are controversial. We attempted in this study to evaluate the prevalence, the clinical significance and the pathogenesity of anti-ribosomal antibodies in SLE patients. Our study included 82 patients with SLE [71 females and 11 males] with age ranging from 17 to 50 years [27.6 +/- 9.2] in addition to twenty age and sex matched healthy individuals as a control group. Routine investigations, together with urine microscopy, 24-hour urinary protein quantitation, creatinine clearance, liver function tests and serum C3 level were performed. Renal biopsy was performed for most patients with lupus nephritis. Brain Computed tomography [C.T], Electroencephalogram [EEG] and Magnetic Resonance Immaging [MRI] were done for patients with neuropsychiatric lupus. The clinical activity of the disease was assessed by the SLE disease activity index [SLEDAI] after full clinical examination including rheumatological examination. Immunologic investigations included: 1] determination of anti-P antibodies by an enzyme linked immunosorbent assay [ELISA] method using a highly purified COOH terminal 22 amino acid peptide as an antigen. 2] indirect immunofluoresent technique for the detection of antideoxy ribonucleic acid [dsDNA], anti-smooth muscle antibodies [ASA] and anti-mitochondrial antibodies [AMA]. 3] ELISA methods for the detection of anticardiolipin antibodies [ACA] IgG and IgM, hepatitis C virus antibodies [HCV] IgG and hepatitis B surface antigen [HBsAg]. Anti-P antibodies were positive in 22/82 [26.8%] of patients with SLE and in none of the normal control subjects. Accordingly we classified our patients into two groups: Group I with positive anti-P antibodies [22 patients] and group II with negative anti-P antibodies [60 patients]. Hepatitis [which could be attributed to SLE and not to other causes since they were negative for ASA, AMA, HCV and HBV] was reported in 21/82 [25.6%] of our SLE patients. Fifteen of them were from the anti-P positive group [15/22, 68.1%] and 6 were from the anti-P negative group [6/60,10%]. This difference was statistically highly significant [p<0.001]. Regarding the incidence of lupus nephritis, it was [18/22, 81.8%] in the anti-P positive group, while in the anti-P negative group it was [24/60, 40%], the difference was statistically significant [p<0.001]. There was no statistically significant difference between anti-P positive and anti-P negative patients with regard to the presence of anti-ds DNA antibodies. Lupus psychosis was reported in 12/22 [54.5%] of anti-P positive patients [group I] and in 6/60 [10%] of anti-P negative patients [group 11], the difference was statistically highly significant [p<0.001]. The level of ACA in the sera of our patients was correlated significantly with the level of anti-P antibodies [r = 0.573 and p<0.001 for IgG ACA and r = 0.773 and p<0.001 for IgM ACA]. Clinical observations revealed that the presence of anti-P antibodies was significantly correlated with disease severity determined by systemic lupus erythematosus disease activity index [SLEDAI]. The SLEDAI score was significantly elevated with a mean of 26.9 +/- 2.6 in anti-P positive patients [group I] and a mean of 17.2 +/- 1.6 in the anti-P negative patients [group II] [p<0.001]. The level of C3 was significantly reduced in anti-P positive patients when compared with anti-P negative patients [p<0.001]. We concluded that, although anti-P antibodies were present in a small percentage of SLE patients, yet they were significantly associated with more aggressive disease, with increased incidence of hepatic, renal and central nervous system [CNS] involvements. Thus, the determination of anti-P antibodies may be one of the useful prognostic tools in identifying a subset of SLE patients with more severe disease associations and early major organe affections, that necessitate close clinical observations and frequent follow up visits. Large scale prospective study can better illuminate the relationship of anti-P antibodies to clinical disease expression, especially hepatitis and CNS involvement

Role of crystallin insolubilization in cataract formation

This work aimed to study the electrophoretic pattern of lens proteins and to study the pathological variation in lens protein in cataract to decide if cataract results from insolubilization of lens protein or due to appearance of a new type of protein. Also, decide if these changes in lens protein composition occur in equal proportion among various types of cataract. The results stated complete absence of crystallin in the water soluble moiety of both nuclear cataract and cortical cataract. There is an increase in proteins of high molecular weight and decrease in low molecular weight protein. Bs crystallin is incorporated into the high molecular weight aggregates of the water insoluble moiety of lens protein

Serum levels of some proteinase inhibitors in non-malignant and malignant liver diseases

The aim of this study was to investigate the levels of alpha-2-macroglobulin [alpha-2-M] and alpha-I-antitrypsin [alpha I AT] in non malignant and malignant liver diseases to be used as a biochemical marker of malignant transformation as well as to detect the degree of malignancy. Alpha-2-macroglobulin and alpha-I- antitrypsin levels were measured in serum by single radial immunodiffusion plates. The study showed a significant increase in alpha-I AT in non malignant liver diseases group, primary untreated liver cancer group and advanced liver cancer group when compared with that of the control group. Alpha-2 M showed a high significant increase only in advanced liver carcinoma with insignificant changes in other groups