Intra-arterial drug injection: an effective treatment protocol

Intra-arterial drugs injection [IADI] either iatrogenic or self administered in drug abusers is a source of considerable morbidity. Most interventions are largely empirical. No prospective human studies have shown that any specific treatment is superior to another. The aim of this study was to evaluate the outcome of different modalities of treatments in patients with IADI. This study included 36 patients divided into 2 groups: Retrospective group [A] [from November 2002 to July 2004] enrolled 13 patients [10 males and 3 females] and prospective group [B] [from August 2004 to June 2008] enrolled 23 patients [19 males and 4 females]. Group A received systemic treatment only [heparin, dexamethazone, antiplatelet and prostaglandins] and group B received intra-arterial treatment [heparin and streptokinase] in addition to the systemic treatment Normal outcome [normal extremities] improved greatly in group B [52%] than in group A [23%] although, this failed to reach statistical significance. Intra-arterial cannulation and administration of heparin and streptokinase is a good option in treating accidental IADI resulting in better final outcome than systemic heparinization and early treatment is mandatory for a good outcome

Serum ghrelin level in epileptic children

The relation between epilepsy and endocrine system is very important as neuroendocrinological studies on epileptic seizures elucidate part of the mechanisms of the brain function underlying epilepsy. Ghrelin is a growth hormone secretagogue secreted primarily by stomach cells with lesser amounts secreted by other cells. The aim of this study is to compare serum ghrelin level in epileptic children with control group. The study included 40 children with epilepsy and 12 healthy children as controls. They were selected from Neurologic Clinic and inpatient ward of Pediatric Department, Suzan Moubarak Hospital for Pediatrics, Faculty of Medicine, El-Rflinia University. Epileptic children were divided into partial or generalized epilepsy and both of them divided according receiving valproate therapy or not started antiepileptic drugs [AED] therapy. Serum level of ghrelin was estimated by ELIZA technique. The study showed that all epileptic children had significantly higher serum ghrelin level than that of the control group [p < 0.001]. All children with partial epilepsy had significantly higher level of ghrelin than those with generalized epilepsy [p < 0.01]. There were insignificant difference between the level of serum ghrelin in all epileptic children under valproate therapy and those don't started any AED therapy. Also no significant differences among both generalized and partial epilepsy under valproate therapy than the levels in epileptic children of both groups not under AED therapy [p > 0.05]. We conclude that ghrelin level increase in all epileptic children and in both generalized and partial epileptic groups when compared with control. Also there was significant higher level in partial epileptic children than the level in generalized epileptic children. There was no effect of valproate therapy on the levels of serum ghrelin in both partial and generalized epileptic children

Prognostic value of HER-2/NEU expression in breast carcinoma

Although axillary lymph node status is still the most powerful prognostic indicator, 15 to 45% of patients whose lymph nodes do not contain metastases still experience a recurrence and die. Conversely, up to 15% of patients with >10 positive lymph nodes treated only with surgery and radiotherapy survive without recurrence or metastases. Because of this, other prognostic markers have been developed to improve prognostic accuracy, particularly in the group of patients with node-negative tumors. To study the expression and prognostic value of HER-2/neu in breast cancer patients, to determine its role in defining high risk patients in cases with a relatively good prognosis [e.g. node negative cases and progesterone receptor [PR] positive cases]. This study included 90 patients with invasive breast cancer [44 patients node positive and 46 patients node negative]. Study for histopathologic prognostic factors was done and immunohistochemical study for HER-2/neu, oestrogen receptors [ER] and pogestrone receptors. HER-2/neu was positive in 26.1% of lymph node negative cases, positive in 31.8% of lymph node positive cases and positive in 28.9% of all patients.HER-2/neu overexpression, by itself, possessed a highly significant prognostic value for shorter overall survival [O.S] and disease free survival [D.F.S] for the whole patients group and for progesterone receptor positive cases. However, in the lymph node negative group it has significant prognostic value for shorter overall survival, by itself, but it lost its effect on steroid receptors. HER-2/neu overexpression seemed to identify patients with poor outcome from those subgroups known to have good prognosis e.g. progesterone receptor positive cases [regarding both disease free survival and overall survival] and node-negative patients [regarding overall survival]

Evaluation of different treatment modalities of neurovascular compression in thoracic outlet syndrome

Objective: The aim of this study is to evaluate the results of different modalities of treatment of neurovascular compression manifestations of thoracic outlet syndrome [TOS]

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy

Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]

Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations

Primary gastric lymphoma: a clinicopathologic study

Seventy-six cases of primary gastric lymphoma treated between January 1980 and December 2001 were reviewed. All tissue specimens [endoscopic or surgically resected] were reexamined. Tumors were staged according to Ann Arbor staging system and the Muss-Hoff modification [IE in 30.3%, IIE in 39.4% and IIIE in 30.3%]. Sixty patients underwent gastrectomy [partial or total] with postoperative chemotherapy for 32 patients. Sixteen patients were treated by chemotherapy only. The mean follow up period was 15 years [range 6 months to 21 years]. The study concluded that primary gastric lymphoma is not uncommon tumor. Gastritis-like lesions are rare. If the tumor is resectable, gastrectomy provides the most accurate means of diagnosis, staging and locoregional control of the disease

Early experience in stereotactic radiosurgery of metastatic brain tumours in Egypt

The results of two prospective randomized studies 1, 2 indicate survival advantages for patients with single brain metastases treated with surgery and radiotherapy compared with radiotherapy alone. Radiosurgery - a minimally invasive technique that uses multiple convergent beams to deliver a high dose of radiation to a small volume precisely localized stereotactically - can serve as a surgical alternative. The biological and physical characteristics of metastases [radiographically discrete, small, spherical, non- invasive] render them ideal targets for radiosurgery, with the potential advantages of reduced morbidity, short hospitalization and reduced health care costs. At Mansoura we treated [10] patients with brain metastases, [7] had single lesions and [3] had multiple lesions [up to 5]. The age ranged between 51 and 68ys. The primary lesion was known in [8] cases. Each received a dose of 20 Gy to the tumor edge and a supplementary whole brain dose of 2000 cGy divided over 10 fractions. All patients, except one, tolerated the treatment well and were discharged from hospital within 3 days on average. One case who had five lesions developed hydrocephalus that was shunted, he died a few days later. Nine Patients showed subsequent radiological evidence of tumor shrinkage and central tumor necrosis. The peritumoural edema subsequently subsided and most patients became steroid independent within 3 months of radiosurgery .We acknowledge the small number of cases and short period of follow up that negate any statistical significance. However our limited experience shows that stereotactic radiosurgery is a safe alternative to open surgery, particularly for lesions in deep location, near eloquent cortex and for multiple lesions. Surgical resection would be more advantageous for metastatic lesion of size greater than 35 mm in diameter with significant edema and mass effect, particularly if there is significant mass effect on fourth ventricle

Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery

Despite advances in operative and postoperative care, long term survival rates following radical oesophagectomy are poor. Surgery remains the mainstay of radical treatment despite various series reporting similar results for treatment with radiotherapy, in particalar in the upper third of the oesophagus. We have studied a cohort of patients treated with definitive radiotherapy to examine the influence on survival of changes in diagnostic scanning and radiotherapy computer planning as well as various patient and disease related prognostic factors. From 1990 to 1996, 85 patients with clinically localised carcinoma of the oesophagus were treated at the department of clinical oncology and Gastro-Enterology Center, Mansoura university with definitive radiotherapy. This included 9 patients with oesophageal adenocarcinoma Diagnosis using barium swallow and endoscopy and biopsy were done for all cases. Radiotherapy doses fixed for all the patient 6500 cGy in 6.5-7 weeks. The 3- and 5-year survival figures were 27% and 21%, respectively, corrected for intercurrent deaths. Survival was better for adenocarcinoma than squamous cell carcinoma, though not statistically significant The only significant prognostic factor [P=0.01] was the use of diagnostic CT scanning [42% versus 13% 5-year survival with or without diagnostic CT scanning, respectively] which was associated with an increase infield size. Radiotherapy was well tolerated with no acute mortality or significant morbidity. Late stenosis requiring oesophageal dilatation was seen in four of twenty patients surviving 3 years or more. Survival following well planned radiotherapy is an effective alternative to surgery for both squamous cell and adenocarcinoma. Advances in staging and computerized planning and the use of multimodality treatment may further improve survival