Evaluation of serum cartilage oligomeric matrix protein [Comp], soluble tumour necrosis factor receptor-II[sTNF-RII] and interleukin-6 [IL-6] levels in relation to serum estradiol, functional and radiologic findings in postmenopausal females with knee joint osteoarthritis

To evaluate the possible relation between serum levels of cartilage oligomeric matrix protein COMP, sTNF-RII, IL-6 and estradiol in post-menopausal females with clinically and radiologically documented osteoarthritic changes in the knee joint. Twenty post-menopausal females [PMOA] -with clinically and radiologically documented knee joint osteoarthritis were compared to a control group of ten post-menopausal females [control group [I]] and ten pre-menopausal females [control group [2]] "who were clinically and radiologically free of knee joint osteoarthritis. To all the studied subjects, a complete clinical examination was performed, including body mass index calculation, as well as scoring .systems for functional assessment of joint. Plain X-ray of both knee joints was performed. Serum samples were obtained for analysis of urea, creatinine, uric acid, total calcium, inorganic phosphates, C-reactive protein, rheumatoid factor COMP, sTNF-fUI, IL-6, and estradiol levels. The mean serum estradiol values in the PMOA, and control group [I] were significantly lower than their corresponding value in control group [2], and slightly lower in the PMOA than control group [1]. The mean serum COMP value was slightly higher in the PMOA group than its corresponding value in control group [1], and both mean sera values were significantly higher than their corresponding mean value in control group [2]. The mean serum sTNF-RII value was significantly higher in the PMOA group than its corresponding values in control group [1] and control group [2]. As regards mean serum IL-6 value, it was significantly higher in control group [1] than its corresponding values in the both PMOA and control group [2]. Based on ROC curve analysis in PMOA and control group [1], both serum COMP and sTNF-RII yitld a diagnostic specificity of 90% each, while the diagnostic sensitivity was 45% and 50% respectively. By using the combined approach, we were able to increase the diagnostic sensitivity of serum COMP and sTNF-RII to 90% and 83% respectively. On the other hand, the receiver operating characteristics [ROC] curve analysis of the same parameters in PMOA and control group [2], revealed a diagnostic sensitivity of 100% for each of serum COMP and s TNF-PJI as well as a diagnostic specificity of 90% for serum COMP and 70% for sTNF-RII. The fact that radiographic evidence of OA usually appears in advanced stages of the disease led to the need of identifying possible serum biochemical markers that could reflect the joint tissue status. From the above mentioned results, it could be concluded that the combined measurement of serum levels of the biochemical markers COMP and sTNF-RII may be used in identifying osteoarthritis in post-menopausal females. Furthermore, menopausal state per-se could play a role in the limitation of the diagnostic sensitivity of either of the two parameters if one of both analytes was chosen alone for measurement

Intercostobrachial nerve preservation during axillary clearance for cancer breast is: it a must?

Axillary clearance has been an integral part of breast cancer surgery. However, it can present sequela and complications including: limitation of shoulder movement, paresthesia and chronic pain in the arm and axilla, which are related to the nerve injuries. This study aimed at evaluating the feasibility of preservation of Intercostobrachial nerve [ICBN] during complete axillary dissection and to compare the impact of preservation or sacrifiction on postoperative axillary and inner aspect of the arm symptoms and sensation. The study was carried out on 58 consecutive patients with operable carcinoma of the breast, admitted to Alexandria Surgical Oncology Unit during 2003. Preservation of ICBN during complete axillary dissection was attempted in all patients. Accordingly they are divided into: thirty patients in whome the ICBN was preserved [Group A] and 28 patients, in whome the ICBN was sacrificed [Group B]. Clinical examination of the patients revealed that 34 cases were N[0] [58.6%]: 18 in group A and 16 cases in group B. During surgery, the nerve was found to be easily preserved in slim patients and when the axillary lymph nodes were not heavily involved. After 3 and 6 months; improvement of sensory symptoms was found both subjectively and objectively in group A. This was significantly noticed after 3 months postoperative. On the other hand persistence of anesthesia and hyposthesia was manifested in group B patients. Although patients who had preservation of ICBN were symptomatic in the immediate postoperative period, yet resumption of normal axillary and inner arm sensation was attained with longer follow up. It is recommended to preserve the ICBN wherever feasible as it has a positive impact on maintaining the axillary and inner arm sensation with a subsequent improvement in the quality of life in these patients