ABSTRACT
Background: Appendicitis is the most important acute surgical condition of the abdomen, and appendectomy constitutes one of the most common surgical operations worldwide. Many factors can cause appendicitis but the intestinal parasitic infections are one of the most important causes
Objective: The present study aimed to evaluate and detect the role and incidence of various parasitic infections in appendectomy specimens from Egyptian adult patients with acute appendicitis attending the General Surgery Emergency room at Al-Azhar University Hospitals, Cairo, Egypt [Al-Hussein and Sayed Galal Hospitals]
Patients and methods: The present study was carried out on 200 patients undergoing appendectomy with a provisional diagnosis of acute appendicitis during the period from December 2015 to November 2016. The removed appendices were fixed in 10% buffered formalin, sectioned, stained with HandE and examined for histopathological changes and presence of parasites. Stool examination was also done by direct smear, formol ether concentration techniques as well as CBC examination for all patients
Results: Stool examination revealed 120 [60%] out of the total 200 appendectomy patients were positive for parasitic infections, while CBC examination revealed leucocytosis among 167 [83.5%], and eosinophilia in 40 [20%] as well as anemia in 43 [21.5%] in all the studied patients. Histopathological examination revealed parasitic infections in 6 [3%] of appendectomy specimens. The presence of E. vermicularis worms and their eggs as well as Schistosoma ova were observed in 4 [2%] and 2 [1%] of cases respectively. Features of acute suppurative appendicitis were observed in 143 [71.5%] of cases, of which, 98 [49%] cases had luminal obstruction by fecalith and 45 [22.5%] showed patent lumen. Non suppurative appendicitis were presented in 57 cases [28.5%] which included lymphoid hyperplasia in 21 cases [10.5%] and neuronal hyperplasia in 6 cases [3%] as well as granulomatous appendicitis with features consistent with appendiceal Crohn's disease [CD] in 30 cases [15%]
Conclusion: The study concluded that parasitic infections constitute 3% of the surgically removed appendices where Schistosoma eggs and E. vermicularis [adults and eggs] were the parasites recorded. So differential diagnosis of parasitic infections in the etiology of acute appendicitis should be made properly which can save patients from a negative laparotomy, morbidity and even mortality
ABSTRACT
Background: Polycystic ovary syndrome [PCOS] is a common complex genetic condition of women in the reproductive age. PCOS is a heterogeneous syndrome characterized by clinical/biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin therapy has been proved to improve fertility in patients with PCOS, inducing not only high ovulation and pregnancy rates, but also reducing the incidence of miscarriages
Aim of the Work: This study was aimed to evaluate the effects of metformin therapy on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors [AR], in patients with PCOS
Patients and Methods: 100 patients with PCOS were included in this study. Each investigated case was submitted to detailed medical history, clinical examination that included body hair distribution, body weight, height and body mass index [BMI], transvaginal ultrasound, laboratory investigations [included fasting insulin, free testosterone, LH and FSH levels]. Endometrial pipelle samples were taken for histopathological evaluation and assessment of androgen receptor expression. These investigations were done before and after three months of metformin treatment
Results: A significant decrease of BMI of the investigated cases after metformin therapy was observed [P value <0.003]. There was a significant decrease of LH level after metformin therapy from 9.17 +/- 2.84 Miu/ml to 6.18 +/- 3.6 Miu/ml and of fasting insulin level from 14.3 +/- 4.3 to 8.2 +/- 5.9. Insignificant increase of FSH level from 3.87 +/- 1.8 to 4.85 +/- 2.6 and also insignificant decrease of free testosterone level from 1.58 +/- o.83 to 1.38 +/- 1.4 were also observed. Histopathological results of the endometrial specimens before metformin therapy revealed histologic features of early proliferative endometrium in 64 cases, 20 cases with a late proliferative endometrium and examination of the remaining 16 cases revealed features of simple endometrial hyperplasia. Among the 64 cases diagnosed as early proliferative endometrium before the therapy, 60 cases showed features of a late proliferative endometrium after treatment and the remaining 4 cases showed no histomorphologic changes. Among the 20 cases diagnosed as a late proliferative endometrium before therapy, 6 cases showed features of early secretory phase after therapy, 6 cases showed features of mid-secretory endometrium while the remaining 8 cases showed a late secretory endometrium that indicate successful ovulation after therapy. Regression of hyperplasia after therapy was noted in 6 of the 16 cases diagnosed as simple endometrial hyperplasia. Immunohistochemical [IHC] results revealed marked increase in endometrial AR expression in patients with PCOS compared to the normal fertile controls [p<0.004]. Also, a significant decrease of AR expression in endometrial epithelial and stromal cells after metformin administration in patients with PCOS was noted [p<0.003]
Conclusion: Metformin therapy restores normal menstrual cyclicity in patients with PCOS, induces ovulation and showing significant decrease in endometrial AR expression
ABSTRACT
Background: The classification of molar pregnancies into a complete and a partial hydatidiform mole and the differentiation from hydropic abortions are usually accomplished by histomorphologic features alone, but sometimes may be inaccurate or inconclusive. Immunohistochemical staining techniques have been reported as a good diagnostic method complementary to the histologic diagnosis. One of the advantages of this technique is the ability to apply it retrospectively to sections of formalin fixed/paraffin embedded tissue and therefore, there is no need for expensive or sophisticated techniques
Aim of the Work: This study aimed to determine if immunohistochemical expression of p53, p63, p57 and Ki67 could aid in differentiating molar from non molar pregnancies on one hand and complete mole from partial mole on the other hand
Materials and Methods: A total of 180 placental specimens were enrolled in this study including 60 non molar placental specimens with hydropic changes [HA] and 120 molar specimens [60 complete hydatidiform moles [CHMs] and 60 partial hydatidiform moles [PHMs]. The studied cases were examined histologically and immunohistochemically for expression of p53, p63, p57 and Ki67
Results: There was a significant difference in p57 expression between HA and PHM [P value < 0.05], HA and CHM [P value < 0.0001] and also between PHM and CHM [P value < 0.003]. There was a significant difference in Ki67 expression between HA and PHM [P value < 0.03], PHM and CHM [P value < 0.01] and between HA and CHM [P value < 0.009]. There was no significant difference in P63 expression between HA and PHM [P value .0.8], PHM and CHM [P value .0.5], and also between HA and CHM [P value .0.2]. A significant difference in p53 expression between HA and CHM [P value < 0.007] was noted, also between PHM and CHM [P value <0.005], while no significant difference between HA and PHM in expression of p53 [P value .0.8]