Effect of tramadol on the cerebral cortex of adult male albino rats and the possible protective role of naloxen hydrochloride

Tramadol is a centrally acting analgesic agent used in the treatment of mild to moderate pain. It has a low affinity to opioid receptors and inhibits the reuptake of nor epinerphrine and serotonin producing an analgestic action by blocking nociceptive impulses in the spine. This work aimed to clarify toxic effects of tramadol hydrochloride on the brain and the possible protective role of naloxone hydrochloride. The study was carried out on 40 adult male albine rats that divided randomly into four equal groups: control; tramadol treated; naloxone treated and protective [tramadol and naloxone treated]. The regime of treatment was given daily for one month. Cerebral cortex of each animal was processed for histological, histochemical and immunohistochemical studies. The obtained results were analyzed morphometrically and statistically. Histologically and histochemically, cerebral cortex of tramadol treated rats showed many foci of degenerated cortical neurons with areas of vacuolations denoting cell loss. The degenerated neurons exhibited shrunken appearance with pyknotic nuclei. There were areas of haemorrhage in the superficial layers of cerebral cortex surrounded by glial cells and congestion of capillaries. Degenerated cortical neurons showed weak PAS reaction and pale staining with tuluodine blue. Immunohistochemically, glial cells showed positive immunoreactivity for GFAP in the form of intense react ion. On the other hand, histological, histochemical and immunohistochemical examination of the prophylactic group displayed normal appearance of most nerve cells and few cells appeared distorted. Area persent of GFAP immunoreactions in astrocytes in all groups showed significant increase in the treated group when compared with the control or prophylactic group. Toxic effects of tramadol should be kept in mind during chronic usage and general supportive treatment is recommended in over dosage beside naloxone as it could ameliorate some [not all] tramadol induced toxic effects

Long term results of conservative management in T1 and T2 breast cancer among 170 cases

This retrospective study included 170 patients with histologically proven early breast carcinoma [T1 and T2 /<4 cm]. All patients underwent a conservative surgical resection of the primary tumor and axillary dissection. Postoperative radiation therapy was given as whole breast irradiation to a total dose of 50 Gy over 5 weeks in 25 fractions, followed by a boost 16 Gy over 1 and 1/2 weeks in 8 fractions to the tumor bed. Among the whole group, only 122 patients received adjuvant chemotherapy. At the end of the study with a median follow up period of 60 months, treatment failure was documented in 70 patients. Isolated local recurrence was detected in 26 patients and regional recurrence was reported in only 4 patients. Distant dissemination was recorded in 40 patients. Univariate analysis revealed that age group, menopausal status and adjuvant chemotherapy were significant factors influencing the relapse rate [0.006, 0.006 and 0.032, respectively]. The overall actuarial 5- and 10-year survival rates for the whole group were 80% and 60%, respectively. The overall actuarial 5 and 10-year survivals for patients developing local recurrence were significantly higher than the survival of patients who developed regional or distant relapse denoting a successful salvage treatment. While, the 5- and 10-year distant metastasis free survival rates of the whole group were 64.5% and 49.2%, respectively. Cox regression multivariate analysis showed that the relapse site, adjuvant chemotherapy, age group and number of involved axillary lymph nodes were independent prognostic factors that significantly influenced the over survival. On the other hand, the relapse site and age group were the significant factors that affected the distant metastasis free survival