Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report

Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system. Case Report Amale adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, ametastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital. Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part inmaintaining the performance and the quality of life of the patient.

Role of MRI in assessment of hepatocellular carcinoma [HCC] after TACE [Trans-arterial Chemoembolization] with persistent high alfa fetoprotein [AFP]

Background: evaluation of treatment success after TACE is essential for making therapeutic decisions, e.g., to repeat, interrupt or completely terminate TACE. An understanding of the various therapeutic strategies and their post therapy imaging appearance is essential for accurately assessing treatment response. Evaluation of tumor response should include not only tumor markers, but also imaging modalities. Evaluation of the therapeutic effect of HCC after TACE is primarily based on the findings of imaging studies. CT is the standard imaging technique for monitoring the effectiveness of TACE. MRI is complementary to CT in the evaluation of the therapeutic response. To know the advantages and limitations of each imaging technique in the evaluation of the therapeutic effect of HCC is important in determining if the treated tumor is completely necrotic or requires additional treatment

Objective: the purpose of this work was to study the MRI appearance of the HCC lesion after TACE in patients with high persistent AFP in cases when hyper-attenuating iodized oil impairs the assessment of residual tumor enhancement on contrast enhanced CT

Patients and Methods: the age of patients ranged between 50 to 73 years with a mean age 58 years. All patients were diagnosed as HCC patients on a background of liver cirrhosis. Twelve patients were positive for HCV and three patients were positive for HBV infection

Results: our study included 15 patients, 12 males and 3 females with age 51 and 73 years with a mean age of 58years. All patients included were diagnosed with HCC by a previous triphasic CT and alfa feto protein. The patients underwent TACE and the patient's response to embolization was assessed by AFP and CT or MRI within 1-3 months post chemoembolization. All the selected candidates showed persistent elevation of alfa feto protein after the procedure and within the 1-3 months post TACE. MRI was performed to these patients and their MRI results were either negative or positive explaining the persistent rise of AFP where 13 patients showed positive results and 2 patients showed negative MRI findings. The positive patients were further categorized into groups according to their post tace MRI findings. 4 patients had de novo new lesions, 6 patients had recurrence and 3 residual tumor patients

Conclusion: diffusion-weighted MR imaging was found to be a reliable predictor along with contrast enhanced MR imaging when CT was not conclusive

Role of Pet/Ct in assessment of post therapeutic hepatocellular carcinoma

Aim of the work: this study aimed to highlight the role of PET/CT in evaluation of post-therapeutic hepatocellular carcinoma, hence guiding the clinician to proper management strategy

Patients and methods: 35 patients [32 male and 3 female] were included in this study. All patients had history of local treatment of HCC; most of the cases were treated with TACE or RFA. They had undergone 18F-FDG PET/CT for evaluation of the therapeutic effect after the end of the therapy

Results: our study demonstrated that 18F-FDG PET/CT is a significant prognostic factor for tumor recurrence in post-therapeutic HCC with a cutoff TSUVmax/LSUVmax value of 1.3

Conclusion: 18F-FDG PET/CT imaging have a prognostic significance in evaluation of patients with posttherapeutic HCC and provide valuable information that can be used in the treatment response evaluation and clinical decision making process

Role of magnetic resonance imaging and ultrasonography in diagnosis and follow up rheumatoid arthritis in hand and wrist joints

Aim of the work: to compare the role of ultrasonography and magnetic resonance imaging in the diagnosis of wrist joint affection in patients with rheumatoid arthritis

Patients and methods: this study included 50 patients diagnosed as rheumatoid arthritis [41 females and 9 males] with mean age 43 years; they were subjected to high resolution ultrasound and MRI of the wrist joint for the dominant affected wrist clinically. Comparison and correlation between both modalities was done

Results: our results showed agreement between ultrasound and MRI in the assessment of synovial inflammation, activity and bone erosions in wrist joint in rheumatoid arthrtis patients

Conclusion: we concluded that both modalities were comparable and close to each others as regards the bony erosions and synovial hypertrophy and inflammation in the wrist joints in patient with rheumatoid arthritis and the ultrasound was useful tools in detection of erosions and synovial inflammation so can be used in patients without erosions on conventional x ray and also can be used in follow up and monitoring the patients with established diagnosis of rheumatoid

Super-selective hepatic angioembolization for traumatic hepatic artery laceration in a child

The liver is commonly injured through blunt abdominal trauma in children. Transaction of the hepatic artery and subsequent angioembolization is well reported in the adult population; however, the evidence of its effectiveness is lacking in pediatrics. We report a case of a child who sustained a grade 3/4 liver injury with contrast blush as evidenced on CT scan. The case was treated by super-selective angioembolization with no major or minor complications. To our knowledge, this is the first case report of pediatric hepatic angioembolization in the Middle East

Utilizers' satisfaction with health care services provided by new Damietta general health center

Utilizers' satisfaction is a multifaceted and a very challenging outcome to define. Patient expectations of care and attitudes greatly contribute to satisfaction. Other psychosocial factors, including pain and depression, are also known to contribute to utilizer's satisfaction scores. Were to assess the utilizers' satisfaction with health care services provided by New Damietta Health Center and to determine health care providers' opinions about the causes of the users satisfaction from their points of view and how to improve it. A cross sectional study was conducted on the attendants of New Damietta General Health Center. The study included 130 health care utilizers and 49 health care providers from first of April to end of June 2014. Data collection was performed by an interview questionnaire. The results showed that out of 130 health care utilizers, 96 [73.8%] were females, 91 [70.0%] were in the age group 19-45 years, and the overall rating of services as reported by the users was 62.46%. About half [46.2%] of the respondents reported that they had a good care at the center. While, a minority [3.8%] recorded that the center's services were poor. The users illustrated that the health care services and health care providers were the best items in the center, 53.9% and 46.0%, respectively. The cheap services were considered the commonest cause of satisfaction as reported by 47.9% of females and 53.0% of males. While, drug deficiency was the commonest cause of dissatisfaction as mentioned by 73.0% of females and 55.9% of males. The majority of our respondents were relatively satisfied regarding different aspects of care. However, still there are many efforts [e.g. drug adequacy] needed for improvement of patient satisfaction. Health authorities should paid attention to overcome causes related to utilizers' dissatisfaction as drug unavailability

Identification of virulence factors, accessory gene regulator [agr] locus and antibiotic resistance pattern of Staphylococcus aureus isolated from diabetic foot ulcers

Background: Staphylococcus aureus [S.aureus] is a common virulent pathogen in diabetic foot infections. Infection of diabetic foot ulcer [DFU] is a major cause for impaired healing and leads to osteomyelitis, bacteraemia and sepsis. Treatment failure of DFU may ultimately lead to limb amputation

Objectives: This work was carried out to clarify the role of S.aureus as a causative agent of diabetic foot infection, and characterize the antibiotic resistance pattern, virulence factors implicated in the pathogenicity of S. aureus and the accessory gene regulator as a global regulator of virulence determinant production

Methodology: This study was carried out on 111 patients admitted to diabetic foot clinic [MUH] having infected diabetic foot ulcer. Grading of infection was assessed. The collected specimens were cultivated on 5% sheep blood agar and mannitol salt agar. Isolates were identified as S. aureus by being catalase positive, mannitol fermenter, DNase positive and coagulase positive. Virulence was characterized by thermonuclease test, slime production, hemagglutination test, and biofilm formation. Multiplex PCR was used for detection of agr groups

Results: S.aureus represented 32% of total pathogens isolated. 58.3% of S.aureus strains were slime producers. 70.8% were biofilm producers. The most prevalent agr type was agr 1 and represented 54.2% followed by agr 2 [29.2%], agr 3 [8.3%], and agr 4 [4.2%]

Conclusion: S. aureus is the most common cause of diabetic foot infection at our locality. Slime and biofilm producing strains are more resistant to antibiotics than non producers. S. aureus infection is more common among grade 2 and 3 ulcers. This data is crucial for selection of appropriate antibiotic therapy. agr type 1 is the most prevalent type in DFU at our locality

Endovascular management of pulmonary arteriovenous malformation

Although many studies showed that pulmonary arteriovenous malformations [PAVM] are relatively rare disorders, they are still an important part of differential diagnosis of common pulmonary problems such as hypoxemia, dyspnea on exertion and pulmonary nodules. A thirty-five-year-old female patient presented with low oxygen saturation six hours post simple vaginal delivery. The patient was investigated by echocardiography, chest x-ray and CT pulmonary angiography, which confirmed the diagnosis of pulmonary arteriovenous malformations [PAVM]. Pulmonary conventional angiogram with transcatheter coil embolization was performed to treat the condition. The patient had uneventful recovery following coil embolization of pulmonary arteriovenous malformations