Vascular endothelial growth factor and insulin-like growth factor 1 in malignant and non malignant thyroid

Angiogenesis has been postulated to play an important role in the development of malignant tumors. One of the important proangiogenic factors involved in the growth of normal and neoplastic tissues is vascular endothelial growth factor [VEGF]. VEGF is expressed in normal thyroid as well as in thyroid pathologies such as Graves' disease, thyroiditis, and thyroid cancer. IGF-I is one of the most important growth factors and is needed for the proliferation and development of thyroid cells. To investigate the role of IGF-1 and VEGF in malignant and non malignant Thyroid. Serum and tissue levels of IGF-1 and VEGF were determined by ELISA in 10 Patients with toxic goiter, 10 patients with benign thyroid tumors, 10 patients with thyroid carcinoma and 10 healthy control individuals. There was no significant difference in mean serum levels of VEGF in healthy controls when compared to other groups of the study. However, there was a significant difference in the mean tissue levels of VEGF in patients with thyroid carcinoma, patients with benign thyroid tumors or toxic goiter when compared to those of healthy controls. Moreover, the mean tissue levels of VEGF was significantly higher in patients with toxic goiter compared to those of controls [P<0.05].Using a cutoff value of 3941.10 pg/g for tissue VEGF resulted in sensitivity and specificity of 90%, 100%, respectively for benign thyroid tumors and thyroid carcinoma. Mean serum levels of IGF-1 was significantly higher in patients with thyroid carcinoma when compared to either those of healthy controls or those of patients with toxic goiter. In addition, the mean serum levels IGF-1 was significantly higher in patients with benign thyroid when compared to either those of healthy controls or patients with toxic goiter. While, there was no significant difference in mean serum levels IGF-1 in patients with thyroid carcinoma versus those of patients with benign thyroid. There was no significant difference in mean serum levels IGF-1 in patients with toxic goiter versus those of healthy controls. By using a cutoff value of 360.4 ng /g, the sensitivity, specificity of tissue IGF-1 for toxic goiter were 90%, 100% respectively. Using the same cutoff value the sensitivity and specificity were 100% for both benign thyroid tumors and thyroid carcinoma. Tissue levels of VEGF increased in patients with thyroid carcinoma, patients with benign thyroid tumors and in patients with toxic goiter than in healthy controls. Tissue and serum levels of IGF-1 were increased in patients with thyroid carcinoma, patients with benign thyroid tumors. The risk of cancer is higher among people with raised concentrations of insulin-like growth factor. Ongoing clinical trials will answer if therapy directed towards angiogenesis may be an alternative way to improve outcome in those patients

randomized comparative study between needle aspirations versus surgical drainage in liver abscess

To compare the therapeutic effectiveness of ultrasound guided needle aspiration versus open surgical drainage in treatment of liver abscess. Between March 2003 and May 2006, 60 consecutive patients with liver abscesses were treated with intravenous antibiotics and randomized in two groups: ultrasound guided intermittent needle aspiration [18G disposable trocar needle]; and open surgical drainage. There was no statistically significant difference between the two groups regarding patient demographics, abscess size and number, the presenting clinical symptoms and laboratory findings. The success rate was 80% in needle aspiration group versus 100% of open surgical group, the number of aspirations required varied from one aspiration [10 patients] up to 3 aspirations in 8 patients. The average time needed for clinical relief and the mean hospital stay for the successful treated patients were similar in both groups. Although both needle aspiration and open surgical drainage are safe methods for treatment of liver abscesses, open surgical drainage is more effective

Wound complications and pro-inflammatory cytokine levels in wound fluid as a result of scalpel versus diathermy dissection

Diathermy [electrocautery] has been postulated as a risk factor for wound complications. This study was conducted to evaluate the effects of diathermy and scalpel dissections on wound complications and local cytokine levels. From Jan. 2007 to Dec. 2007, we recruited 36 patients with operable breast cancer for this study. Those patients undergoing modified radical mastectomy were assigned to flap dissection with either diathermy [n = 18] or scalpel [n = 18]. Blood loss, drain volume and duration, seroma formation and wound complications were recorded. Tumor necrosis factor-alpha [TNF-alpha] and interleukin [IL]- 6 levels were measured in drain fluids at postoperative 24 hours. The diathermy group had significantly reduced blood loss and total drain volume, but increased seroma formation rate. Significantly elevated levels of TNF-alpha were measured in drain fluids of patients with diathermy dissection. The use of diathermy causes less bleeding and total drain output with an increased rate of seroma formation. Diathermy dissection increases pro-inflammatory cytokine response in wound fluid, which may reflect an aggravated inflammation and increased potential for tissue damage

Different surgical options in treatment of cancer cardia and lower third esophageal cancer

To study different techniques in resection of carcinoma of lower esophagus and cardia with regards to techniques, complications, morbidity, mortality, and survival. from Feb. 2005 to Aug. 2006, this study included 33 patients with operable carcinoma of the lower esophagus or cardia as evident by clinical and investigatory tools including endoscopy and biopsy, patients were classified into: Type I [cancer of distal esophagus,] included 10 cases, were treated by total esophagectomy in 5 cases, or distal subtotal esophagectomy in 5 cases. Type III [cancer of the subcardial area infitrating the esophagus gastric junction] included 8 cases, were treated by total gastrectomy in 4 cases, and proximal gastrectomy in 4 cases. Type 11 [cancer of the gastric cardia] included 15 cases, were treated by the 5 types of operation as guided by the extent of the tumor and the proximity to either stomach or esophagus. The extent of lymphadenectomy was dependent on tumor type, node size, and gross involvement, approach, and general condition of the patient. Curative resection [RU] was performed in 25 patients [75.8%], 7 cases of type I, 11 cases of type II, and 7 cases with type III tumors, while incomplete resection [RI+R2,] was done in 8 cases [24.2%,], 5 cases of transhiatal esophagectomy in type land II tumors, and 3 cases of proximal gastrectomy with less than D2 resection. Tumor free resection margins were achieved in 29 patients [88%,], node metastasis were found in 24 cases [72.2,], 6 cases of type I, 12 cases of type II, and 6 cases of type Ill tumors. Two cases with type I tumor had >50% positive mediastinal nodes, and 2 cases with type III tumor had >50% positive abdominal nodes. Significant complications occurred in 9 cases [27.3%], as anastamotic leak in 3 cases were managed conservatively, respirator]' complications in 2 cases [6.1%], and wound infection in 4 cases [12.1%]. Mean hospital stay was comparable with no statistically sigi4ficant difference [15.8, 15.2, and 14.8 days for type I, II, and III respectively,]. There was no significant difference in morbidity, mortality, and disease free survival [DFS,] between cases of subtotal or total esophagectomy [transhiatal or 3 field approach] with P values 0.1, 0.95, 0.91 respectively. Similarly there was no significant dfference between patients with type I and II who underwent proximal or total gastrectomy [P=0. 6]. There was a better survival for patients with stage I and II compared to stage III and IV [P=0. 00]], for well and moderately differentiated grade I and II tumors than poorly and undifferentiated tumors grade III and IV [P =0. 008], for negative nodes compared to those with positive nodes [P=0. 03], while involvement of more than 50% of abdominal lymph nodes had a reverse action on the survival [P =0. 001]. Type of the tumor had no influence on the survival [P=0.5], while the stage, node involvement, and operation were statistically significant. So efforts should be directed towards earlier diagnosis, better selection, and minimizing post operative complications, and R0 resection should be attempted

Acute limb ischemia: delayed presentation and outcome

Acute limb ischemia still represents an important dangerous situation in vascular surgery. Delayed presentation of acute ischemia usually leads to catastrophic outcome. Late ischemia represented 20.4% of all cases of acute limb ischemia admitted to our hospital during one year period. We were aiming to evaluate such cases with acute prolonged limb ischemia identifying causes of delayed presentation and its imprint on patients limb and life. Forty-five patients [45 limbs] were included in this study. There were 25 females and 20 males with ages ranged between 20 and 85 years [mean; 58 years]. The lower limbs were affected in 91.1% of cases while the upper limbs were involved in 8.9%. Sixty percent of cases had embolic ischemia while 40% suffered from thrombotic ischemia. The average ischemic interval was 6.8 days. Methods of treatment included medical and/or surgical intervention. Doctors of other specialties were responsible for delayed presentation in 62.2% of cases because of wrong diagnosis or treatment. Patients themselves were blamed in 31.1% of cases due to ignorance or low socioeconomic level. Long distance from the nearest specialty hospital was the cause of delay in 6.7% cases. Overall, a good outcome was recorded in 11.1% patients. Major amputation was ultimately required in 71.1% patients. Death occurred in 4.5% patients. Treatment of acute prolonged limb ischemia is difficult and results in high morbidity. Proper management of acute limb ischemia requires educational programs for genior doctors, patients and community to realize its causes, manifestations, methods of diagnosis, and importance of time factor and its imprint on patient's limb and life

Enoxaparin versus heparin for the prophylaxis of post-operative deep vein thrombosis in general surgery

Patients undergoing surgery with a prolonged general anesthesia or a period of a limited postoperative mobility, or both, face a high risk of thromboembolism. Surgical procedure is considered as the third most common risk factor for thromb oembolism after old age and obesity. To asses the value of enoxaparin in the prophylaxis of venous thromboembolism and the possible complications in comparison to heparin in high risk patients undergoing general surgery. In the period between March 2003 and May 2005, 200 patients admitted for different surgical procedures were randomized into 2 equal groups: [1] Group A where unfractionated heparin was used as a prophylactic anticoagulant drug, and [2] Group B where enoxaparin was utilized. Patients were obese with one or more risk factors for deep vein thrombosis. Clinical and laboratory assessment in addition to venous duplex scanning of the lower limbs were performed. The ages of the patients ranged from 40 to 82 years with a mean of 61 years. A mean preoperative hospitalization period of 6.1 days and a mean operative duration of 95 minutes was recorded. Postoperative deep venous thrombosis [DVT] occurred in 10 [5%] patients, 8 of them were asymptomatic [4 in each group] and diagnosed by duplex ultrasound. The 2 remaining patients had symptomatic DVT, both were in group A. Bleeding complications occurred in 30% and 16% patients of group A and group B, respectively. Low molecular weight heparin [enoxaparin] is more effective and safer than unfractionated heparin, but with higher costs in the prophylaxis of postoperative deep venous thrombosis

early experience with laser therapy of hemangiomas and vascular malformations

The purpose of this study is to examine the effects of Nd: YAC laser on treatment of hemangiomas [n=30] and vascular malformations [n = 4]. A series of 27 patients [6 males and 21 females] with an age ranged from 4 months to 22 years were included. Most of patients [70.3%] were in their first year of life. Of the 30 hemangiomas, 13 were classified as capillary, 12 as cavernous, and 5 as mixed hemangiomas. Of the 34 vascular anomalies, 27 [70.6%] were located in the head and neck region. The indications for laser therapy were cosmetic disfigurement in 26 [76.5%], functional problems such as visual field defects and feeding difficulties in 6 [17. 6%], and ulceration or bleeding in 2 [5.9%] lesions. Our patients were subjected to 132 laser treatments utilizing both non-contact and contact techniques of laser beam application. Results were as follows: 64.7% lesions showed good response while 26. 5% demonstrated fair response. Bad response had occurred in 8.8% of lesions. Complications of laser therapy included excessive scarring in 2 [5.9%], ulceration in 3 [8.8%] and bleeding in 1[2.9%] case. These findings demonstrated that Nd: YAC laser therapy is a safe and effective treatment of vascular skin lesions that give satisfactory cosmetic and functional results without major side effects