Value of renal biopsy in the diagnosis of acute renal failure in children

This work aims to evaluate the role of renal biopsy in the diagnosis of patients presented with acute renal failure [ARE] with correlation between the clinical and pathological diagnosis and their impaction on the prognosis. The study was preformed on fifty patients presenting with the manifestation of ARE received in Pediatric Hospital Mansoura Eaculty of Medicine. Paraffin blocks were cut for hematoxyline and eosin and special stains as well. Analysis of pathological findings with clinical parameters related to outcome of patients. This study delineated that the childhood cause of ARF are acute glomerulonephritis [48%] followed by acute tubular necrosis [18%] then thrombotic microangiopathy [12%], then malignant lymphomatous infiltration [6%], then acute pyelonephritis [4%] lastly renal cortical necrosis [2%] and interstitial hemorrhage [2%]. The renal biopsy confirmed the clinical diagnosis in 58% of cases and altered .the clinical diagnosis in 12% of cases. Moreover in cases with uncertain clinical diagnosis the renal biopsy clarified the accurate diagnosis. More over the biopsy guided the treatment in some cases. The results of this study demonstrate that renal biopsy is essential in many cases of pediatric ARF not only to confirm the diagnosis but also to diagnose cases of unknown causes and changes the clinicat diagnosis in many cases as well

Value of screening colonoscopy in the diagnosis of Egyptian patients with lower gastrointestinal symptoms

Colorectal cancer is a major cause of mortality allover the world. Fecal occult blood testing, flexible sigmoidoscopy and total colonoscopy are the most commonly recommended screening tests for colorectal cancer, yet screening rates are still below target levels. To fully realize the benefits of early detection of colorectal cancer, screening rates must be improved. The current study has been conducted to study the current pattern of colorectal lesions from endoscopic and histopathologic perspectives in relation to clinical and laboratory aspects in Egyptian patients with different lower gastrointestinal symptoms. 165 cases with different lower gastrointestinal symptoms presented to Gastroenterology and Endoscopy Unit, Specialized Medical Hospital, Mansoura University. Clinical, laboratory, colonoscopic and histopathological examination of colonoscopic samples were done during the period from October 2005 to July 2006. The main lower gastrointestinal symptoms were abdominal pain, distension, altered bowel habits, dysentery and rectal bleeding. Ulcerative colitis represented 9.1% while colorectal carcinoma represented 4.1% of cases. The commonest symptoms and laboratory findings associated with colorectal carcinoma group were constitutional symptoms, constipation, rectal bleeding, fecal occult blood and iron-deficiency anemia. The colonoscopic examination is safe, accurate and cost-effective means of the screening for colorectal carcinoma

Detection of chlamydia pneumoniae in diseased aortic and mitral valves diagnostic dilemma

Chlamydia Pneumoniae [CP] is a common pathogen that has been linked to coronary artery disease. Also, CP antigen has been demonstrated in valve biopsy specimens from patients with acquired aortic valve stenosis and in patients with culture negative endocarditis. The aim of this paper is to study the presence of CP in both aortic and mitral valves by using polymerase chain reaction [PCR] and its relation to the pathology of the valve. 27 patients [16 males] who underwent aortic and mitral valve replacement were studied. Key demographic and clinical data were collected including age , gender , past history of rheumatic fever . NYHA class, preoperative 12 leads ECG. Chest X-ray and Echocardiography. One portion of the valve leaflet was sent for pathologic examination to detect the nature of valve disease e.g. rheumatic or non-rheumatic and the other portion was sent for PCR study. The age ranged from 19 to 55 years with mean valve 36.48 +/- 11.46. 5 patients had isolated aortic valve stenosis , 12 had mitral valve disease and 10 had double valve disease . Aschotf body and cells were seem in 11 patients and 5 patients had non-rheumatic degenerative aortic stenosis . 7 out of 27 cases [25.9%] were PCR positive. 5 of them were isolated non-rheumatic aortic stenosis and represent [33. %] of aortic cases. The remaining 2 PCR positive cases were rheumatic mitral valve disease one of them was severe isolated mitral regurgitation due to native valve endocardifis . CP infection was common with nonrheumatic aortic valves [P=0.045] and also with stenotic lesions than regurgitant ones [P=0.045]. Culture negative endocarditis maybe due to CP infection and also CP maybe present in rheumatic mitral valve most probably as passengers