A Very Low-Positioned Aortic Bifurcation

Anomalies of the aortoiliac arteries are rarely reported and are generally discovered incidentally on imaging performed mostly for investigation of other medical concerns. While aortic bifurcation is typically reported at the fourth lumbar vertebra, variations are possible. We present a case with very low aortic bifurcation, almost at the level of S2, with various other anomalies including a corkscrew left common iliac artery passing just anterior to the bladder dome with pulsation noted during cystoscopy. An ectopic right kidney was also noted. To our knowledge, these vascular anomalies have not been reported previously.

Retinal histopathological changes following intravitreal injection of different doses of bevacizumab: an electron microscopic study

To determine the retinal toxicity of intravitreal bevacizumab in rabbits by electron microscopy. Six albino rabbits received one injection of intravitreal bevacizumab in one eye, and no injection [control] in the fellow eye. Two rabbits received 1.25 mg in 0.05 ml, two received 2.5 mg in 0.1 ml, and two received 5mg in 0.2 ml. for each dose of bevacizumab, one rabbit was sacrificed one day after injection, and the other one week later. The retina was then examined by transmission electron microscopy. The control eyes showed no abnormality. At 1.25 mg there was no change compared with controls. At 2.5 mg, there was mild transient cytoplasmic degeneration in the inner segments of the photoreceptors and the horizontal cells of the outer nuclear layer. At 5mg, there was, in addition to the changes above, marked cytoplasmic degeneration of the retinal pigment epithelial [RPE] cells with shrinkage of the nucleus, and numerous vacuoles in the nerve fiber layer. At one week, there was significant resolution of these changes. There was no evidence of bevacizumab toxicity to the rabbit retina after a single intravitreal injection of 1.25 mg. At 2.5mg, there were mild transient changes, whereas definite toxicity to the RPE cells and nerve fiber layer were seen at 5mg. The maximum recommended dose of intravitreal bevacizumab is therefore 2.5 mg

comparative study between colonic J-pouch and coloplasty anastomosis after ultra-low anterior resection for middle and low rectal cancer

Rectal cancer is the second common gastrointestinal tumour and its surgical treatment varies according to its distance from anal verge. After low anterior resection and colorectal anastmosis, for upper 1/3 rectal tumour, patients usually have normal habits with minimal affection. However, for middle and lower rectal cancer, they require a pouch to minimize the functional disorders resulting from the rectal pouch and may be also related to the loss of normal anorectal sensation. To compare the functional results of coloplasty pouch [CP] versus the colonic J- pouch [JP], after low anterior resection. Thirty patients diagnosed to have an operable middle and low rectal carcinoma, were randomized into two equal groups, the J-pouch and the coloplasty group. All the patients underwent low anterior resection with temporary ileostomy diversion, after colo-anal asnastmosis with CP or JP formation. The patients had a preoperative and postoperative anal manometric study, at 6 months and 12 months interval after closure of ileostomy. This includes resting anal pressure, maximum squeeze pressure, and maximum tolerable volume, as well as the recto-anal inhibitory reflex. Patients had a questionnaire based on Hida et al. scoring system where different variables [evacuation, continence, urgency, perineal soiling and others] were graded from zero to two to quantify the overall functional results. There was no significant difference between both groups regarding intra-operative or postoperative complications, or hospital stay. Bowel evacuation was better for CP patients, at 6 months, however, it equalized in both groups with no significant difference at 1-year interval. Although, the resting anal pressure and the maximum squeeze pressure were lower than the preoperative values, but there was no significant difference between both groups after six months or one year duration. Finally there was a significant inverse correlation between the total functional score and the anasto-motic distance from the anal verge for both groups, the smaller the distance from the anal verge, the higher was the functional score [poorer function]. Patients with colo-plasty pouches were able to defer their bowel movement better, and had less nocturnal leak, at 6 months, however, bowel function equalized in both groups at 1 year, with no significant difference between both groups

association between helicobacter pylori cytotoxin associated gene A, vacuolating cytotoxin antigen, matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in cancer patients

This work aimed at studying the frequency of H. pylori in various solid tumors and hematological malignancies. Also, the association between H. pylori virulence markers [cytotoxin associated gene A, cagA and vacuolating cytotoxin antigen, vacA gene] expression and the plasma level of MMP-9 and its inhibitor, tissue inhibitor of metalloproteinase-1 [TIMP-1] in advanced cancer patients was investigated. This study included 17 patients with solid tumors including 8 patients with gastric patients having H. pylori -ve gastric ulcer [served as controls]. All patients and controls complained of dyspepsia. Multiple gastric biopsy specimens from antral and body regions were taken from all cases and controls and tested by polymerase chain reaction [PCR] for the expression of cagA and vacA genes. Plasma MMP-9 and TIMP-1 were measured using ELISA technique. The frequency of H. pylori in this study was 50%, 44.44% and 6 1.54% in gastric cancer, solid tumors and hematological malignancies, respectively. Significant increase in plasma MMP-9 level was detected in solid tumors and hematological malignancies compared to controls. Plasma MMP-9 level was also significantly higher in H. pylori +ve than H. pylori -ve cases with significantly higher values in those expressing cagA than those expressing vacA gene. The highest MMP-9 was present among H. pylori +ve patients with gastroduodenitis. It was concluded that the presence of H. pylori virulence markers especially cagA gene may play a role in cancer progression in cancer patients. So, its early detection and eradication may be beneficial in these patients