Role of MRI in assessment of hepatocellular carcinoma [HCC] after TACE [Trans-arterial Chemoembolization] with persistent high alfa fetoprotein [AFP]

Background: evaluation of treatment success after TACE is essential for making therapeutic decisions, e.g., to repeat, interrupt or completely terminate TACE. An understanding of the various therapeutic strategies and their post therapy imaging appearance is essential for accurately assessing treatment response. Evaluation of tumor response should include not only tumor markers, but also imaging modalities. Evaluation of the therapeutic effect of HCC after TACE is primarily based on the findings of imaging studies. CT is the standard imaging technique for monitoring the effectiveness of TACE. MRI is complementary to CT in the evaluation of the therapeutic response. To know the advantages and limitations of each imaging technique in the evaluation of the therapeutic effect of HCC is important in determining if the treated tumor is completely necrotic or requires additional treatment

Objective: the purpose of this work was to study the MRI appearance of the HCC lesion after TACE in patients with high persistent AFP in cases when hyper-attenuating iodized oil impairs the assessment of residual tumor enhancement on contrast enhanced CT

Patients and Methods: the age of patients ranged between 50 to 73 years with a mean age 58 years. All patients were diagnosed as HCC patients on a background of liver cirrhosis. Twelve patients were positive for HCV and three patients were positive for HBV infection

Results: our study included 15 patients, 12 males and 3 females with age 51 and 73 years with a mean age of 58years. All patients included were diagnosed with HCC by a previous triphasic CT and alfa feto protein. The patients underwent TACE and the patient's response to embolization was assessed by AFP and CT or MRI within 1-3 months post chemoembolization. All the selected candidates showed persistent elevation of alfa feto protein after the procedure and within the 1-3 months post TACE. MRI was performed to these patients and their MRI results were either negative or positive explaining the persistent rise of AFP where 13 patients showed positive results and 2 patients showed negative MRI findings. The positive patients were further categorized into groups according to their post tace MRI findings. 4 patients had de novo new lesions, 6 patients had recurrence and 3 residual tumor patients

Conclusion: diffusion-weighted MR imaging was found to be a reliable predictor along with contrast enhanced MR imaging when CT was not conclusive

History of cupping (Hijama): a narrative review of literature / 中西医结合学报

Cupping (Hijama in Arabic) is an ancient, holistic method for the treatment of a variety of diseases. Though the exact origin of cupping therapy is a matter of controversy, its use has been documented in early Egyptian and Chinese medical practices. Diverse human civilizations have contributed to the historical development and continuation of cupping therapy. This narrative review describes the history of cupping, historical definitions, cupping instruments and uses of cupping therapy. Electronic searches of relevant databases (PubMed, Google Scholar and OvidSP) were conducted using keywords and Boolean operators. Manual searches and references of published articles and books were also conducted. A number of articles (N = 625) were retained for extensive review, and finally 83 articles were included in this paper. The historical descriptions of cupping therapy were found in ancient human civilizations of the Eastern and Western world. There were inconsistent data concerning the origin of cupping, definitions, instruments, procedures, definite advancements and research in Hijama over centuries. Cupping therapy fell out of favor in 17th and mid-18th centuries but recovered popularity in modern medicine. Currently, cupping therapy is used for health promotion, prophylaxis and treatment of a variety of diseases around the world. Cupping therapy with a good safety profile has a checkered history and is a well-recognized traditional method for managing medical conditions. Currently, the scope of cupping therapy is expanding, and a growing body of research is providing additional evidence-based data for the further advancement of cupping therapy in the treatment of a variety of diseases.

Public knowledge, attitude and practice of complementary and alternative medicine in Riyadh region, Saudi Arabia

Complementary and alternative medicine [CAM] is well established worldwide. The present work is aimed at studying the knowledge, attitude and practice of CAM by the people of Riyadh region, Saudi Arabia. A cross-sectional descriptive household survey study of the people living in Riyadh city, as well as the surrounding governorates. A multistage random sample was taken from 1[st] January to the end of March 2010, with a total number of 518 participants. Data were collected using a pre-designed questionnaire through direct interview. The data was collected based on socio-demography, as well as knowledge, attitude and practice of CAM. Participants were nearly sex-matched, consisting of approximately 70% Saudi and 30% non-Saudis. About 89% of the participants had some knowledge of CAM. Mass media e.g. [T.V., newspapers and radio] and family, relatives and friends represented the main sources of CAM knowledge, [46.5% and 46.3% respectively]. Nearly 85% of participants or one of their family members has used some form of CAM before, and the most common users of CAM practices were females, housewives, and illiterate subjects [or those who could just read and write], as well as participants aged 60 years and above. Medical herbs [58.89%], prayer [54%], honey and bee products [54%], hijama [35.71%] and cauterization or medical massage therapy [22%] were the commonly used CAM practices. Most participants agreed that there are needs for; CAM practices [93.8%], regulations for CAM [94.9%], health education [96.6%], specialized centers [94.8%] and CAM clinics [92.7%]. While only 8.3% of participants usually discussed CAM with their physicians. There is a high prevalence and increased public interest in CAM use in the Riyadh region. There is a positive attitude towards CAM, yet most participants are reluctant to share and discuss CAM information with their physicians

Symptomatic tendon subluxation after surgical release for deQuervain's disease treated by Brachioradialis tendon flap

Symptomatic palmar subluxation of the abductor pollicis longus and the extensor pollicis brevis tendons developed in a 23 years old man after surgical release for deQuervain's disease. The sub- luxation occurred with the wrist in flexion and the thumb in pal- mar abduction. Nonoperative treatment was ineffective. Surgery was performed to reconstruct a new tendon restraint using a distally based flap from the brachioradialis tendon. Twenty months postoperatively the patient was free of tendon subluxation or pain and had full motion and power of his wrist

Prevalence of HCV infection in immunocompromised children and adults: evaluation of a novel screening test

It has been recently hypothesized that the hepatitis C virus [HCV] might be involved in the pathogenesis of lymphoproliferative disorders [LPD], systemic lupus erythomatosus [SLE], nephrotic syndrome and renal failure [RF]. The aim of this study is to determine the prevalence of HCV infection among immunocompromised patients and a trial to assess the sensitivity of HCV core antigen [HCVcAg] testing as a screening method compared to PCR-RNA in these patients. The study included 75 patients with malignant lymphoproliferative disease [LPD] under long term chemotherapy including immunosuppressive therapy [30 children and 45 adults] [group II], 46 chronic renal failure patients under hemodialysis [10 children and 36 adults] [group III], 20 systemic lupus erythematosus patients [SLE] under long term immunosuppressive therapy [10 children and 10 adults], group IV and 30 nephrotic syndrome patients under long term immunosuppressive therapy [20 children and 10 adults] [group V]. Thirty healthy subjects were included as controls [group I]. HCV detection by HCV-antibodies, HCVcAg and HCV PCR were done for all patients and controls. The results showed that there was significantly increased prevalence rates of HCV infection among immunocompromised patients. Positivity was 53.33% in LPD group, 47.83% in chronic renal failure group, 45% in SLE group and 33.33% in nephrotic syndrome group. Also our results revealed that, in studied patients [children and adults], HCVcAg in comparison to PCR had diagnostic sensitivity of 100%, specificity of 98.38%, accuracy of 99%, positive predictive value of 97.53% and negative predictive value of 100%. [1] immunocompromised patients have a higher prevalence rate of HCV infection. [2] increased prevalence were significantly higher in patients with non-Hodgkin's lymphoma [NHL], membranoproliferative glomerulonephritis [MPGN] and with the increased duration of hemodialysis in patients with chronic renal failure. [3] HCV infection may play an important role as a risk factor in both lymphoproliferative disorders, and clinical pattern of SLE. [4] HCVcAg maybe considered as an alternative to HCV-RNA assay in screening of HCV infection

study of the association between gastric apoptosis and helicobacter pylori [H. pylori] in hepatitis C cirrhotic patients

Recent studies have suggested that bacterial coinfection with Helicobacter species in patients with hepatitis C virus [HCV] may increase the burden of both infections on the hepatobiliary and gastrointestinal tracts. The aim of this study was to evaluate the association between H. pylori infection and gastric apoptosis in patients with hepatitis C cirrhosis. One hundred consecutive patients with dyspepsia; 50 with posthepatitis C cirrhosis and 50 without hepatitis C or cirrhosis, were studied. The presence of H. pylori was tested by urease test and Gram staining of gastric biopsies. The apoptotic index was calculated in gastric biopsies stained with hematoxylin and eosin. A statistical analysis was done to correlate H. pylori infection with gastric apoptosis in both groups. A verbal consent was taken from all patients after explaining the need for endoscopy and H. pylori testing to diagnose their illness. The accuracy of rapid urease test and Gram staining was almost similar in detection of H. pylori. The results of this study have shown that gastric apoptosis increased significantly in cirrhotic patients with H. pylori infection than non-cirrhotic patients with H. pylori infection. This increase was highly significant in comparison with cirrhotic and non- cirrhotic patients without H. pylori infection. Also, non-cirrhotic patients with H. pylori injection had significantly more gastric apoptosis than cirrhotic and non-cirrhotic patients without H. pylori infection. On the other hand, no significant difference was found in gastric apoptosis between cirrhotic and non-cirrhotic patients without H. pylori infection. In conclusion, H. pylori was associated with more gastric apoptosis. Hepatitis C cirrhosis increases gastric apoptosis in patients with H. pylori infection independent of the degree of cirrhosis and concomitant endoscopic findings including portal hypertensive gastropathy [PHG]. There was an association between H. pylori infection and gastric apoptosis specially in hepatitis C cirrhotic patients. This result warrants prospective studies to determine the possible interaction between H. pylori and HCV in increasing gastric lesions in patients with cirrhosis

Prevalence and predictors of renal artery stenosis detected by renal duplex sonography in type 2 diapetes mellitus

Diabetes mellitus [DM] is a risk factor for atherosclerosis that may lead to renal artery stenosis [RAS]. This study aimed to screen type 2 diabetic patients for presence of RAS and to identify the main predictors of its presence. The study included 473 patients [204 males and 269 females], aged 40 years or more with a well established DM of more than 5 years duration. Data about smoking, hypertension, diabetic retinopathy, ischemic heart, cercbrovascular and peripheral vascular diseases, macro and microalbuminuria, impaired kidney function and dyslipidemia were collected using history taking, physical examination and appropriate laboratory investigations. Renal ultrasonography and duplex renal scans were obtained for each patient under standardized conditions to determine the size and volume of the kidneys and to evaluate dynamics of the renal blood flow to diagnose RAS. The prevalence of RAS among all patients was 5.9%, and was 11.7% in those with hypertension. Logistic regression analysis was performed to examine and control for the joint effect of multiple factors potentially predicting presence of RAS. The odds ratio [OR] of RAS for the hypothesized predictors were determined to assess the significance of the association. There was a significant association between RAS and presence of abdominal bruit [OR=11.3], difference of length between the two kidneys [OR=3.4], age of patients [OR= 1.6] and duration of DM [OR= 1.1]. RAS is a common complication in type 2 DM. Type 2 DM patients should be scheduled for regular renal duplex check up and this may be done more frequently in patients with certain features that predict presence of RAS

Retinal hemorrhages in newborns

Of 150 live newborns examined within 3 hours of birth, 54 [36%] were found to have retinal hemorrhages. Head circumference was significantly correlated [P < 0.05] with retinal hemorrhage, while gestational age, sex, birth weight, fetal distress, and Apgar rating of the newborn showed no significant correlation. Birth injuries, especially ocular and periocular ones, were associated with a significantly higher incidence of retinal hemorrhages [83%]

Ocular biometry in fullterm newborns

This study was designed to evaluate parameters of eye size in fullterm newborns in our region of the world, and to compare these values for the two sexes. Two hundred fullterm infants [110 male, 90 female], born by uncomplicated vaginal delivery were subjected to an ophthalmological examination including ocular ultrasound biometry on both eyes within 24 hours after birth. The following data were elicited, expressed as mean +/- standard deviation: duration of gestation 40.1 +/- 1.3 weeks, birth weight 3.29 +/- 0.407 kg; body length 51.1 +/- 2.08 cm; and head circumference 34.59 +/- 1.56 cm. Regarding the eye: axial length 16.94 +/- 0.488 mm; depth of the anterior chamber 2.49 mm +/- 0.201 mm; and lens thickness 3.45 mm +/- 0.297 mm. There was a statistically significant difference in the measured parameters of eye size between male female innnfants in our sample. Our results did not significantly from those of surveys performed on other populations in the world

Ocular biometry in full term newborn

This study was designed to re-evaluate the eye size and its measurements in fullterm newborns and to estimate these values in both sexes. Two hundred fullterm newborns [110 males and 90 females] delivered normally after a duration of 40.1 +/- 1.331 weeks gestational age were selected for this study. They were of birth weight 3.29 +/- 0.407 kgm, body length 51.1 +/- 2.08 cm and head circumference 34.59 +/- 1.565 cm. They were subjected to ocular ultrasound biometry for both eyes within one day after delivery. We found that, the mean axial length was 16.94 +/- 0.48 mm, the anterior chamber depth was 2.49 +/- 0.201 mm and lens thickness was 3.45 +/- 0.297 mm. There was a significant difference in these measurements between males and females in this sample of newborns