Clinical and laboratory significance of endocervical Cysts

Aim of the work: To provide full assessment of cervical cysts clinically, and bacteriologically. To correlate the level of inflammatory cytokines [IL-8, IL-10 and MMP-9] with the nature of cervical cyst. To find out the impact of cervical cysts occurrence, type, site and number on the common female genital complaints such as vaginal discharge, deep pelvic pain and unexplained infertility

Study design: Prospective Cohort study

Setting: Women's Health Center of Assiut University Hospitals, tertiary care referral facility

Intervention: 75 cases were examined clinically, by transvaginal ultrasonography and diagnostic office hysteroscopy for the diagnosis of cervical cysts. Cyst aspiration was performed using interventional 2D ultrasonography and diagnostic office hysteroscopy. Cysts' aspirates were examined bacteriologically and cytologically. Sera of these patients were evaluated for IL8, IL10 and MMP-9

Main outcome measures: To estimate the relief of genital complaints as a result of cyst aspiration either as a single maneuvers or completed by administration of antibiotics guided by culture and sensitivity test of cyst aspirates, and pregnancy rate after one year in infertile women

Results: Cervical cysts were diagnosed in 75 patients. The mean size of the cervical cyst was 2.18 +/- 0.609 cm. It was found that 61.4% of cysts were infected, Chlamydia Trachomatis was detected in 13.33% of infected cysts, while Gardenella Vaginalis was detected in 24 %, GBS in 14.67% and Mycoplasma hominis in 14.67%. Patients with infected cysts had elevated IL-8 [P= 0.000], and had increased IL-10 [P= 0.000] in all groups in comparison with non infected cysts, but increased MMP-9 was detected in group III only [P=0.000], with significant correlation between size of the cysts and level of cytokines. Improved health related quality of life in the form of relief of deep dyspareunia and excessive vaginal discharge were reported in 42.8% and 59.3% of cases respectively. Pregnancy was achieved in 26.6% in the infertile females after 1 year of follow-up spontaneously or with the aid of controlled ovarian stimulation

Conclusion: Cervical cysts should not be ignored as a potential cause of common gynecological symptoms especially when it's large in size. Infected cysts account for reasonable ratio which may necessitate aspiration followed by culture and sensitivity test to the aspirate. Unexplained infertility shows some improvement after cyst aspiration and proper antibiotic administration

Relation between thrombin activatable fibrinolysis inhibitor and haemostatic alterations in patients with chronic liver disease and portal vein thrombosis

Recently, a new inhibitor of fibrinolysis was discovered which down regulates fibrinolysis after its activation by thrombin and was therefore named thrombin activatable fibrinolysis inhibitor [TAFI]. We aimed at evaluating TAFI level in chronic liver disease [CLD] and its relationship to important haemostatic parameters namely: tissue factor [TF], prothrombin fragment 1+2 [Fl+2], thrombomodulin [TM], protein C [PC], protein S [PS], thrombus precursor protein [TpP] and D-dimer [D-di] in a trial to clarify the role of TAFI in haemostatic alterations frequently encountered in CLD. The study included 35 CLD patients [Chid B or C], 15 [out of them] were complicated by portal vein thrombosis [PVT], in addition to 15 healthy controls. Significant reduction in TAFI level was detected in CLD patient with and without PVT in comparison to controls, however a significantly higher values were noticed in patients complicated by PVT when compared to those without thrombosis. Correlation analysis demonstrated a strong correlation between TAFI level and other measured parameters namely PT, PTT, PC, PS and D-dimer in PVT group. It could be concluded that TAFI plays a crucial role in regulation of coagulation and fibrinolysis. Reduced TAFI level in patients with CLD could result in up regulation of fibrinolysis. High TF level, associated with decreased natural anticoagulants namely PC and PS accompanied by a higher TAFI level and its increased activation could play a role in the development of PVT as a complication of CLD

Mitochondrial cytochrome C and ultrastructural changes in hepatic steatosis induced by hepatitis C virus

Hepatic steatosis is an important hallmark of hepatitis C virus [HCV] infection. There is substantial body of evidence to implicate steatosis in the development of hepatic fibrosis. The underlying mechanisms of HCV-related steatosis however are not yet clarified. This study was performed to evaluate ultrastructural mitochondrial changes in patients with HCV-induced hepatic steatosis and correlate these findings with serum cytochrome c and apolipoproteins. Thirty-seven HCV-positive patients admitted to Theodore-Bilharz Research Institute were selected. They did not have other confounding prosteatogenic variables: diabetes, overweight, alcohol consumption and prosteatogenic drugs as amiodarone; corticosteroids. In addition, 10 apparently age- matched subjects were selected as a reference group. All subjects were initially subjected to full history, thorough clinical examination, liver function tests; lipid profile, HCV-IgG antibody and hepatitis-B surface antigen. All patients were subjected to ultrasound-guided liver biopsy. Biopsy specimen was processed for light and electron microscopic histopathological examination. According to histopathological findings, patients were divided into 4 groups according to the stage of fibrosis[I, II, III and IV]into :-Group 1 [n=7]; Group 2 [n=9]; Group:3 [n=9] and Group 4 [n=12]or cirrhotic group respectively. Measurement of apolipoproteins A, B and II and specific estimation of serum cytochrome-C was performed. Interpretation of the results revealed accumulated fat droplets by ultrastructure identification in the hepatocytes together with hypobetalipoproteinemia and hypotriglyceridemia. This was accompanied with mitochondrial ultrastructural alterations in all the studied groups ranging from complete dissolution to loss of outer mitochondria] membrane. In addition, it is noteworthy that ultrastructural changes of the rough endoplasmic reticulum [RER] detected in this study may be a contributing factor to abnormal fat metabolism in HCV. Concomittantly, serum cytochrome c was significantly lowered in all the studied groups as compared to the reference mean value. Depletion of mitochondria] cytochrme c might result in accumulation of reactive oxygen species and further accentuation of steatosis. There was significant correlation between serum cytochrome c, apolipoprotein B and serum triglycerides in the patients' group, ushering that it might have its role in HCV-induced lipid changes. In the cirrhotic group, ultrastructural elucidation of homogenous unlocalized intracytoplasmic fat and evident intracytoplasmic collagen fibrils was reported in this study. This was associated with significantly lowered serum ApoAl, ApoB and triglycerides as compared to all other groups. The afore-mentioned data solidifies the evidence that hepatic steatosis and fibrosis are important sequence of HCV infection and confirm the ability of hepatocyte to synthesize collagen. Moreover, the discerned intracytoplasmic unsaturated fat droplets might mirror the inability of the HCV-dysfunctioning hepatocyte to cope with the excessive dietary intake of fat and hence accentuation of steatosis results. In conclusion, ultrastructural. mitochondrial and RER changes seems to confirm their relation- to the associated intracytoplasmic fatty acids accumulation, the decreased serum cytochrome c and apolipoproteins Al and B Moreover it confirms the cytopathic effect of HCV

Assessment of the clinical significance of serum vascular endothelial growth factor and matrix metalloproteinase-9in patients with hepatrcellular carcinoma

The pre-therapeutic serum levels of VEGF and MMP-9 were studied in patients with HCC, cirrhotic patients and in healthy subjects by an ELISA assay to elucidate the relationship between serum VEGF, MMP-9 levels and clinicopathological characteristics of HCC. The serum VEGF and MMP-9 were significantly elevated in HCC patients with macroscopic portal vein invasion and with metastasis as compared to HCC patients with neither invasion nor metastasis. Serum VEGF showed a significant difference between HCC patients with tumor size > 5 cm and < 5 cm, however serum MMP-9 did not vary with tumor size. It was concluded that the portal vein invasion and metastasis in HCC is a complex process involving multiple factors including VEGF-mediated angiogenesis and MMP-9 induced degradation of extracellular matrix. The pre-therapeutic serum VEGF and MMP-9 in HCC might be candidate biomarkers reflecting the disease potential for vascular invasion and metastasis, serum VEGF being a superior biomarker as it correlated also with tumor size

Immunomodulatory therapy for hepatocellular carcinoma

Hepatocellular carcinoma is probably the most common solid human malignancy in the world and its incidence in Egypt has dramatically increased during the last decade. In spite of the availability of different strategies for treating hepatocellular carcinoma in the form of surgical resection, transarterial embolization, percutaneous ethanol injection therapy, radiofrequency wave ablation and chemotherapy, a considerable percentage of cases were found not fit to go into one of all these modalities. On the other hand, the aqueous extracts of the European mistletoe plant [Viscum album] have been used for years for systemic nonspecific stimulation of the immune system in cancer therapy. This study tried to assess the effect of mistletoe [Viscum album] on the natural history of unresected HCC, on one side, and its role in preventing postoperative recurrence after surgically resected cases, on the other side. Thirty-three patients with advanced unresectable HCC represented the first group in this study and 10 cases of post surgical resection were included in the second group. Mistletoe proved itself as a save medication easily tolerable with minimal side effects, it improves the quality of life through immunological pathway, but in this study it failed to demonstrate any significant effect in the progression or limitation of the size of the tumor nor on prevention of recurrence after postoperative resection

Role of diagnostic laparoscopy in management of hepatobiliary malignancy: Prospective analysis

In this study, 100 patients were subjected to diagnostic laparoscopy [DL] to assess the respectability of their hepatocellular carcinoma. All patients were considered to be candidates for resection on the basis of preoperative imaging studies. Seven laparoscopic cases were incomplete due to adhesions. Eighteen patients were found to be unresectable at laparoscopy. Of the remaining 75 patients, 11 turned to be unresectable at open exploration yielding 14.7% false-negative rate. Laparoscopy identified 18 of 29 patients with unresectable disease. Laparoscopy was most accurate for identifying liver cirrhosis, peritoneal disease, additional hepatic disease and verifying the actual size of the tumor which is not accurately determined by the imaging techniques. On the other hand, laparoscopy was the least accurate method for vascular invasion and lymph node metastases. Adding laparoscopic ultrasound [LUS] to the DL technique can be valuable in tracing vascular invasion or finding additional hepatic tumors

Effect of anti - cox -z on tumor proliferation, angiogenesis and metastatic potential in induced colon cancer in adult albino rats: an immunohistopathological study

In this study, 60 male albino rats [average weight 100-150 g] were used. They were randomly divided into four groups, each comprised 15 rats: The first group served as a control; rats in the second and third groups were subcutaneously injected with 1,2 dimethylhydrazine [DMH] 20 mg/kg b.w. once a week for 20 weeks as well as rats in the third and fourth groups were orally administered celecoxib 20 mg/kg b.w. daily for 20 weeks. At the end of the trial, all animals were sacrificed to study the possible effects of selective cox-2 inhibitor on induced colon cancer tumor cell proliferation, angiogenesis and migration in the experimental animals. Colons, livers and lungs were taken, put in 10% neutral formalin, processed and stained for histopathological and immunohistopathological study. The tumor incidence in DMH treated group [2nd group] was 100%. Celecoxib + DMH treated group had fewer tumors and less angiogenesis compared with DMH treated group and control group [4th and 1st group]. Also, liver and lung metastasis were less in celecoxib + DMH treated group than the DMH treated group

New concept in histopathological grading and staging of chronic hepatitis C infection at Sharkia Governorate, Egypt

In this study, the Knodell histology activity index and the semi- quantitative reproducible description of the various morphological lesions of chronic hepatitis were applied on 109 liver biopsies taken from Egyptian patients infected with hepatitis C virus [HCV]. It was found that the presented histopathological features may be unusual for any of the known scoring systems. Therefore, a new system was suggested for grading and staging of liver diseases in Egyptian patients infected with HCV. Accordingly, the degrees of necro- inflammations are classified into 3 grades [1-3] and the progression of fibrosis is classified into 3 stages [1-3]. The reduced numbers of grades and stages proposed in this study may be attributed to the rapid course among Egyptians who differ in the environmental circumstances

Molecular cytogntic profiles of hepatitis C infection in patients at Sharkia Governorate, Egypt

In this study, 40 paraffin blocks liver tissues from HCV-PCR positive patients [HBV seronegative] were examined using DNA image cytometry to evaluate its role in diagnosing hepatocellular carcinoma [HCC] associated with hepatitis C virus [HCV] infection. Fluorescent in situ hybridization [FISH] technique using LSIZNF 217 chromosome 20q 13.2 probe was applied. The results showed a high percentage of S- phase fraction in cases of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA aneuploidy with a severe amplification of chromosome 20q 13.2. Consequently, DNA imaging cytometry is considered a good approach in differentiating dysplasia from well- differentiated HCC on the top of HCV infection. In conclusion, HCV has an acquired role in the development of HCC through the amplification of the aggressive tumor behavior oncogene LSIZNF 217 at chromosome 20q 13.2

Haematologial manifestations in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate the hematological manifestations occurring in patients suffering from chronic hepatitis C virus [HCV] infection. Positive HCV-RNA cases [109] were subjected to complete blood count [CBC], prothrombin time [PT], partial thromboplastin time [PTT], bleeding time [BT], coagulation time [CT], detection of fibrinogen degradation products [FDPs], measurement of plasma alpha- antitrypsin [AAT], then bone marrow [BM] aspiration and examination for 20 cases. The patients were classified into three groups according to the histopathological staging and grading of liver biopsy. The comparison between groups according to histopathological grading and staging for hematological and chemical parameters revealed a significant statistical difference in platelets count, S albumin, ALT and AST levels. The comparison between groups according to histopathological grading and staging for coagulation profile, AAT level and FDPs revealed a significant statistical difference between all parameters. Bone marrow aspiration and examination revealed mild hypocellularity with an increased number of lymphocytes and a relevance of plasmacytoid-lymphocytes

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate some immunological manifestations in chronic hepatitis C patients and to find out its relationship with liver pathology. The study included 109 positive HCV-RNA patients classified according to liver histopathology into three groups: Group I included 22 patients [G1S1], group II included 67 patients [G2S2] and group III included 20 patients [G3S3], where G = the degree of necro-inflammatory process and S = the stage of liver fibrosis. All patients were investigated for the presence of cryoglobulin, antineutrophil cytoplasmic [ANCA], anti-liver kidney microsomes [LKM], anti-double stranded DNA, [ds-DNA], anti-nuclear [ANA], anti-mitochondrial [AMA] and anti-smooth muscle [ASMA] autoantibodies. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be considered as useful prognostic indicator for the increased risk of cirrhosis in chronic HCV patients. Follow up studies were recommended

HCV and associated concomitant infections at Sharkia Governorate Egypt

This study was performed on 109 cases divided into 6 groups according to the concomitant infection with hepatitis C virus [HCV]. The results proved that groups 1, 3 and 5 had a higher level of viremia than the other groups and a higher risk was found in these groups, as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The study concluded that these factors play an important role in the progression of HCV infection. The death of the patients of this progressive condition occurs in younger age and due to liver failure more than to HCC

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt

This study included 109 patients with detectable hepatitis C virus [HCV] by real time PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathological staging and grading. The different clinical, biochemical, virological and ultrasonographic parameters were assessed and analyzed and the variables that showed a significant association with the histopathological staging and grading were included in the multivariate logistic regression analysis. The regression model revealed that platelet count, matrix metalloproteinase-9 [MMP-9], portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load added a significance to the model in a decreasing order of significance. From these findings, a new score ranged from 0-9 was generated. The score model was applied to the patients to assess its validity, where it proved to be accurate in discriminating patients with mild inflammation and fibrosis [sensitivity 81.8%, specificity 80.5% and accuracy 80.7%] and more accurate in detecting patients with cirrhosis [specificity 96.6%, sensitivity 80% and accuracy 93.6%], but less accurate in detecting patients with moderate to severe fibrosis [specificity 66.7%, sensitivity 68.7% and accuracy 67.9%]. Also, the results revealed that co-infection with schistosomiasis, old age >/45 years and positive history of blood transfusion as a source of infection were significantly associated with severe hepatic pathology

role of aflatoxin-contaminated food materials and HCV in developing hepatocellular carcinoma in Al-Sharkia Governorate, Egypt

In this study, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique revealed that corn, wheat, peanut, lupine "tennis", white rice, cowpea "lobiya", fava bean and brown rice showed a prevalence of AFB1 [64.7%, 53%, 53%, 47%, 47%, 41%, 29.4% and 29.4%, respectively]. A positive correlation was found between aflatoxin and positive HCV- PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV- infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products

Promising early results for keloid treatment with intralesional colchiciae a clinical and histopathological study

In a clinical trial, 14 cases with keloids were treated by local infiltration of colchicines. The results were evaluated objectively and subjectively. Lesional biopsy was obtained before and after treatment and examined by light microscopy. Marked reduction of the size of the lesions and decrease of such complaints as itching and erythema were noted. Favorable results were obtained according to the patients in 83.4% and according to the opinion of the medical examiner in 91.7% of cases. Systemic complications of colchicines absorption, i.e. nausea, did not occur in any patient. Histopathologic examination of the lesions after colchicines infiltration reveled marked reduction in the density of collagen bundles which are widely dispersed throughout the dermis. Intralesional infiltration of colchicines is safe and effective treatment of keloids

Medulloblastoma results of treatment of 45 patients

This study dealt with characteristics and treatment outcome of 51 patients with medulloblastoma [27 females and 24 males]. According to the Chang staging system, four patients had T1, 15 had T2, 13 had T3 and 16 had T4 tumors and the stage was unknown in three patients. Eight patients had leptomeningeal dissemination [M3]. Complete tumor resection was performed in 12, near total resection in nine, partial resection in 19 and biopsy only in 11 patients. Forty-five patients completed postoperative irradiation using a telecobalt machine with an 80 cm SSD. The total dose to the whole brain ranged from 30-40 Gy over 4-5 weeks and an additional boost of 15-20 Gy over 2-3 weeks was given to the posterior fossa. The total dose to the spinal cord ranged from 30-35 Gy over 4-5 weeks

Gall stones and the risk of gallbladder cancer

Gallstones have long been recognized as important risk factor for development of gallbladder cancer. Now many have advocated cholecystectomy in all persons found to have cholelithiasis. It is found that 10-20% of gallbladder cancer are discovered in the course of cholecystectomy for gall stones [1]. The rest probably occur in gallbladder containing silent gallstones. In this sense, all silent gallstones are not silent

Transplantation of living liver graft in different possible sites

Orthotopic liver transplantation becomes a standard operation. The number of recipients are increasing because of the wide indications. In many centers, many of the waiting patients may die due to shortage of liver grafts. In this work, we used living liver graft, implanted in three different sites. The donor operation is not dangerous. Results proved that implantation as orthotopic non-auxiliary is better than the other sites