Green tea induced cellular proliferation and the expression of transforming growth factor-pi in the jejunai mucosa of fasting rats

Objective: The aim of this study was to understand whether or not the protective effect of green tea after fasting-induced damage in the Jejunal mucosa of rat is dependent on cell proliferation and the stimulation of specific growth factors

Materials and Methods: Sixty adult male Wistar rats were used in this study. The animals were divided randomly into 5 groups, with 12 in each group [G1-5]. The animals in G1 [control group] were fed a rat chow diet and water ad libitum. The animals in G2 [fasting group] were fasted for 3 days. The animals in the G3, G4, and G5 groups were fasted for 3 days as G2, but were given water [G3] green tea [G4], or a vitamin E [G5] solution, respectively, for another 7 days. The animals were euthanized, and the jejunum was removed and processed for histological and immunohistochemical analysis

Results: Compared to the G3 group, the Jejunal mucosa of G4 rats showed a 70.6% higher level [p < 0.001] of expression of proliferating cell nuclear antigen and 98% higher level [p - 0.0001] of the expression of transforming growth factor-[Jl [TGF-[31], whereas the level of fibroblast growth factor-1 [FGF-1] and insulin-like growth factor-1 [IGF-1 ] expression was 22 and 1 1 % lower, respectively, in G4 animals as compared to G3 rats. These differences in the expression of FGF-1 and IGF-1 in G4 animals were not statistically significant

Conclusion: In this study, green tea repaired the fasting-induced damage in the Jejunal mucosa of rats, mainly by inducing a significant expression of TGF-|31 in the mUCOSa

Squamous cell carcinoma of the Gall Bladder masquerading as a liver abscess

The most common gall bladder malignancy is an adenocarcinoma. Other types of malignancies are rarely reported in the gall bladder [GB]. We report a rare case of squamous cell carcinoma of the GB in a 35-year-old. Bangladeshi lady who presented with signs and symptoms of a big liver abscess and normal tumor marker [CA- 19.9] levels

Management of liver trauma in Kuwait

The aim of this study was to introduce the concept of non-operative management [NOM] for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait. A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma [94 men and 23 women]. Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade [III-VI] liver injuries were managed in collaboration with the liver surgery specialist. The mean age of the 117 patients was 29.02 +/- 11.18 years [range 7-63]. NOM was successful in 94 [96%] patients and failed in 4 [4%] [these 4 then underwent successful surgery]. Nineteen [16.2%] were unstable and underwent surgery immediately; 15 [79%] of them survived [they had had grade III-V injuries] and 4 died [2 with grade V injuries and 2 with grade VI injuries]. Perihepatic packing was necessary in 8/19 [42%] patients. The overall mortality was 3.4% [4/117]. This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable

Vaccine immunotherapy for a deadly disease like malignant melanoma: where do we stand?

The incidence of cancer and its related morbidity and mortality remain on the increase in both developing and developed countries. Cancer remains a huge burden on the health and social welfare sectors worldwide and its prevention and cure remain two golden goals that science strives to achieve. Among the treatment options for cancer that have emerged in the past one hundred years, cancer vaccine immunotherapy seems to present a promising and relatively safer approach as compared to chemotherapy and radiotherapy. The identification of different tumor antigens in the last fifteen years using a variety of techniques, together with the molecular cloning of cytotoxic T lymphocytes [CTLs]-and tumor infiltrating lymphocytes [TILs]-defined tumor antigens allowed more refining of the cancer vaccines that are currently used in different clinical trials. In a proportion of treated patients, some of these vaccines have resulted in partial or complete tumor regression, while they have increased the disease-free survival rate in others. These outcomes a re more evident now in patients suffering fro m melanoma. This review provides an update on melanoma vaccine immunotherapy. Different cancer antigens are reviewed with a detailed description of the melanoma antigens discovered so far. The review also summarizes clinical trials and individual clinical cases in which some of the old and current methods to vaccinate against or treat melanoma were used. These include vaccines made of autologous or allogenic melanoma tumor cells, melanoma peptides, recombinant bacterial or viral vectors, or dendritic cells

Vibrio cholerae necrotizing fasciitis

We report a rare cause of necrotizing fasciitis in our geographical area. The patient was already compromised with chronic liver disease and diabetes mellitus

Repair of common carotid artery injury with an external carotid artery flap

Objectives: To describe a new technique to repair injuries of the common carotid artery

Clinical Presentation and Intervention: A 30-year-old man sustained an iatrogenic injury to the left common carotid artery during surgical dissection of a left branchial cyst. The artery was repaired as follows: the left external carotid artery was ligated distally, its stump was longitudinally opened to create an arterial flap, which was then used to repair the defect in the common carotid artery. The patient remained free of any symptoms throughout 1 year of follow-up

Conclusion: Use of an external carotid flap provides an alternative method of repairing an injured carotid artery

Is there a need for doppler vascular examination for the diagnosis of varicose vein? A prospective study

To compare the validity of a careful clinical examination with venous Doppler studies in the management of patients presenting with varicose veins. Subjects and Ninety-five consecutive patients presenting with varicose veins from September 1998 to August 1999 were included in this study. Of the 95 patients, 52 were males and 43 females. Eighty-four were expatriate laborers and 11 Kuwaiti nationals. Seventy-one were active workers under the age of 30. All of the patients underwent a full clinical examination for varicose veins, and a management plan was developed for each patient prior to Doppler venous study. The results of the Doppler studies were then compared with the clinical examination results, and the management plan was changed, if necessary, based on the Doppler results. Both clinical and Doppler examinations were equally effective in diagnosing primary varicose vein and identifying sites of venous incompetence. A family history for varicose veins was found in 21% and standing for a long period of time was a risk factor in 51% patients. The most common symptoms were pain and heaviness. Doppler study findings were useful in changing the management plan of 14 [15%] patients, 6 with recurrent varicose vein and 8 obese patients with chronic venous insufficiency. The majority of the patients [n = 82] benefited from surgery and were free of symptoms. This prospective study demonstrated that detailed clinical examination was sufficient to diagnose most patients suffering from primary varicose veins. Doppler vascular studies were useful in changing the treatment modality for those presenting with recurrent varicose vein or obese patients with signs and symptoms of chronic venous insufficiency with no clinically clear varicosity

Vascular injuries caused by orthopaedic screws

To describe 3 cases of vascular injuries due to orthopaedic procedures. Clinical Presentation and Intervention: Of 242 vascular injuries, 3 were due to orthopaedic screws. The 1st patient presented with a late complication [after 3 years] of an orthopaedic screw placed in close proximity to the axillary artery that with time got eroded and leaked to form a false aneurysm which later caused embolisation to the arm and limb ischaemia. The 2nd and 3rd cases were due acute ischaemia following the orthopaedic procedures. Both were injuries to the popliteal artery, one after a long screw and the other after drilling the tibia. The aneurysm of the 1st case was resected, the screw was removed and a reversed segment of the right long saphenous vein was used to repair the axillary artery. In the 2nd patient, a bypass of the left popliteal artery to the tibio-peroneal trunk was performed using a reversed 12-cm-long saphenous vein graft retrieved from the right thigh. In the 3rd patient, the right popliteal vein was ligated, and a reversed 25-cm-long saphenous vein graft retrieved from the left thigh was used for a femoro-popliteal bypass. For the 3 patients, postoperative recovery was unremarkable. Pulses were present within 6-10 months of follow-up. Conclusions: Whenever limb vascularity is compromised after an orthopaedic procedure, a high index of suspicion for an arterial injury should be exercised and prompt referral to the vascular service is mandatory. Repair of injured vessels with a saphenous vein graft provides excellent long-term results

Acute suppurative necrotizing pancholangitis. A case report

To present a case of ascending cholangitis with resulting necrosis of the biliary system with perforation. Clinical Presentation and Intervention: A 40-year-old male patient presented with upper abdominal pain, fever and jaundice assessed clinically and investigated by laboratory and radiological tests. Endoscopic retrograde cholangiogram and surgery were performed. However, because of extensive suppurative pancholangitis involving most of the intrahepatic radicles, sound surgical drainage could not be accomplished. Unfortunately, the patient died 2 days after surgery. In this case of severe cholangitis, endoscopic and surgical interventions were not successful and might have contributed to the worsening of the condition