Reporting of the circumferential tumour margin involvement and preoperative levels of carcinoembryonic antigen as prognostic risk factors in colorectal cancer patients

Background and study aims: The two very important prognostic risk factors of colorectal cancer are circumferential tumour margin [CTM] involvement and preoperative levels of carcinoembryonic antigen [CEA]. The aim of this study is to monitor the frequency of reporting of the CTM in the postoperative pathology reports after colorectal cancer resection in addition to monitoring the frequency of reporting of preoperative levels of CEA and exploring the possibility of improving the frequency of reporting of both

Patients and methods: Reports of the CTM and preoperative level of CEA were found in 730 [664 retrospective and 66 prospective] patients with colorectal cancer. The possibility of improving the incidence of reporting was estimated by comparing the reporting frequency of both [retrospective and prospective] groups

Results: The percentage of reporting the involvement of the CTM was 46.08% and 81.81% for the retrospective group and the prospective group, respectively. The percentage of reporting the preoperative CEA levels was 40.9% and 68.7% for the retrospective and the prospective groups, respectively. There was a statistically significant difference in reporting both CTMs and the preoperative level of CEA between retrospective and prospective groups to the side of prospective group in which the p-value was <0.0001 for both groups

Conclusion: There was inadequate reporting of both the CTM involvement and preoperative levels of CEA in the retrospective patients with statistically significant improvement of this reporting in patients in the prospective group. This may point to the unawareness of the importance of both in the prognosis of colorectal cancer, which may be because both are not involved in the widely used tumour, node, metastasis [TNM] staging system

Synthesis and antitumor activity of some 5H-pyrrolizine, pyrimido [5, 4-a] pyrrolizine pyrimido [4, 5-b] pyrrolizine derivatives

Seven new series of condensed pyrrolizine derivatives of anticipated antitumor activity have been synthesized. Comprises ethyl-1-cyano-3-phenylcarbamoyl-6, 7-dihydro-5H- pyrrolizin-2-yl-carbamate, 2, 4-dioxo-1H-pyrimido [4, 5-b] pyrrolizine-9carbonitrile, 1-cyano-2 [3-substituted ureido]-3N-phenyl-6, 7-dihydro-pyrrolizine-3-carboxamide, 3- [alkyl / phenyl]-4-imino-2-oxo-9N-phenyl-2, 3, 4, 5, 6, 7-hexahydro-1H-pyrimido [5, 4-a] pyrrolizine-9-carboxamide, 4-arnino-3-[alkyl / phenyl]-2-oxo-2, 3, 4, 5, 6, 7-hexahydro-1H-pyrimido [5, 4-a] pyrrolizine-9-carboxamide, of 2-amino-3N-phenyl-6, 7-dihydro-5H-pyrrolizine-1, 3-dicarboxamide and 4-oxo-9N-phenyl-4. 5, 6, 7-tetrahydro-3H-pyrimido [5, 4-a] pyrrolizin-9-carboxamide derivatives. Eleven were screened for their in vitro antitumor activity and ten compounds proved to possess moderate to weak activities

Necrotizing sialometaplasia of parotid gland

A case of Necrotizing Sialometaplasia of parotid gland is reported. Clinical picture: This patient was initially diagnosed as a case of parotitis and treated by intravenous antibiotic for three days without improvement. Ultrasonography revealed fluid collection in the substance of the gland and needle aspiration revealed only blood. Fine needle aspiration was done and cytological examination revealed only blood cells without any glandular tissue. Incision and drainage of haematoma with incisional biopsy was done and histopathological examination confirmed the diagnosis of necrotizing sialometaplasia. After three weeks of conservative therapy without improvement superficial parotidectomy was done without any significant morbidity. Severe form of necrotizing sialoametaplasia affecting major salivary gland can be treated safely and effectively by sialoadenectomy

Kikuchi-Fujimoto disease: two case reports and review of the literature first pediatrics cases reported in kuwait

We reviewed 2 patients who had kikuchi-Fujimoto [KFD] and presented with prolonged fever and lymphadenopathy. The clinical and laboratory aspects of the patients confirmed by excisional lymph node biopsy. The histologic findings of the lymph biopsies showed the characteristic findings consistent with KFD, such as paracortical necrosis with karryorrhexis and an increase in the number of phagocytic histiocytes and atypical lymphoctes. KFD is a rare disease yet should be considered in the differential diagnosis for older children with prolonged fever and lymphadenpathy

Comparison between fibreoptic and blind nasotracheal intubation criteria in awake surgical patients

This work was designed to compare the applicability of awake blind nasal and that of fibreopiic nasotacheal intubation in thirty adult sedated patients [ASA I and It] in whom the trachea planned to be intubated nasally. They were scheduled for elective oral or maxillofacial surgery under general anaethesia. They were randomly assigned into two equal groups according to the method used for intubation [n=15per group]. After complete airway block, group [I] patients were intubated using blind nasal technique, while group [II] patients were intubated using fibreoptic technique. Twelve patients were intubated at first attempt, two at second and one patient at third attempt in blind nasal group, while eleven intubated at first, three at second and one at third attempt in the fibreoptic group. These differences were insignificant. The mean time required for successful intubation was significantly less in blind nasal group [83.1 +/- 12.5] seconds than in fibreoptic group [97.5 +/- 17.1] seconds. Also, success rate, heamodynamic changes and adverse events were comparable in both groups. in conclusion: this study showed that blind nasal and fibreoptic nasotracheal intubation are valuable techniques in awake sedated patients. There was no significant difference between the success rate of both techniques. Blind nasal intubation under topical anesthesia may provide an alternative safe method in cases of anticipated difficult intubation, particulariy if fibreoptic bronchoscope is not available or failed to pass through the glottis as the view is obscured by blood and/or secretions

Phospholipid binding proteins antibodies: diagnostic importance and clinical associations in the antiphospholipid syndrome

Venous or arterial the thrombosis, abortion, and the presence of antiphospholipid antibodies [aPL] define the criteria for the antiphospholipid syndrome [APS]. The heterogeneous group of antibodies against phospholipids and plasma proteins may influence several coagulation pathways and lead to thrombophilia. Deep vein thrombosis and pulmonary embolism are the most common venous events. To establish whether antibodies directed against phospholipid-binding plasma proteins such as beta2-glycoprotein [beta2GPI], prothrombin [PT], and annexin V [Anx V] and antithrombin [anti-Thr] antibodies constitute a risk factor for thromboembolism in patients with primary antiphospholipid syndrome [pAPS] and systemic lupus erythematosus [SLE] and for miscarriage-in women with recurrent pregnancy loss [RPL], and whether their determination together with that aCL would help to increase the diagnostic sensitivity of aPL tests. The prevalence of various antibodies directed toward phospholipids [CL] and phospholipid-binding proteins [beta2GPI, PT, Anx V, and anti-Thr] was determined by immunoenzymatic method in 95 patients samples. Twelve patients with aCL-positive primary anti-phospholipid syndrome [pAPS]; 45 patients with SLE, 12 of whom had thrombotic complications [SLE/APS] and 33 of whom has no thrombosis; and 38 women with unexplained recurrent pregnancy loss comprised our study group. Fifty healthy subjects matched for age and sex were studied as the control group. Anti- beta2GPI, anti-PT, and IgG anti-Anx V anti-Thr antibodies were detected in 9[75%], 6 [50%],3[25%] and 3[25%], respectively, of the 12 aCL-positive pAPS patients; IgG and/or IgM aCL, anti- beta2GPI, anti-PT, IgG anti-Anx V and anti-Thr antibodies were detected in 17 [37%], 15 [33%], 20[44%], 6[13%] and 11[24%], of the 45 SLE patients respectively. The highest risk for thrombosis in SLE patients was associated with the presence of IgG anti-PT antibody [odds ratio [OR] 13.4, P<.001, vs. 7.7 aCL, 2.8 anti- beta2GPI, 0.6 anti-Anx V, and 8.7 anti-Thr]. Anti-Pt has slightly lower specificity than aCL however the occurrence of both antibodies brought the specificity 94%. In patients with recurrent pregnancy loss [RPL] the prevalence of IgG and/or IgM aCL, anti- beta2GPI, anti-PT, IgG anti-Anx V and anti -Thr antibodies was 6% [2], 12% [9], 6% [5], 16% [6], 18% [7], and 5% [2] respectively. Anti Anx V was the antibody significantly associated with miscarriage. The result of this study indicates that: It is useful to measure anti-PT antibodies in addition to the more widely used aCL and anti- beta2GPI antibodies in the prognostic evaluation of SLE patients for the risk of thrombosis. The results also confirm that anti-Anx V antibodies may play an important role in recurrent pregnancy loss. The determination of anti-thrombin antibodies may contribute to better diagnosis of APS

Prevalence and clinical correlations of acquired activated protein C resistance and antiphospholipid antibodies in patients with systemic lupus erythematosus

Systemic Lupus Erythematosus [SLE] is an autoimmune disorder affecting multiple organ systems. Antiphospholipid [aPL] antibodies are frequently found in plasma of SLE patients and venous thromboembolism VTE is common manifestation. This work was designed to assess the level of antiphospholipid antibodies [B2 glycoprotein I antibodies, anti prothrombin antibodies and lupus anticoagulant], protein C resistance and factor V Leiden in SLE patients and evaluate the correlation to thrombotic tendency in those patients. 50 SLE patients and 30 normal controls were included and subjected to measurement of antibodies to B2 glycoprotein I and antiprothrombin antibodies using ELISA technique, Lupus anticoagulant was estimated using diluted Russell Viper Venom Test [dRVVT], activated protein C resistance APC-R was measured by modified coagulometric technique and Factor V Leiden by PCR technique. Acquired APC-R was present in 17 out of 50 patients [34%] and all of them are not found to have Factor V Leiden mutations. The presence of acquired APC-R was a strong risk Factor for venous thromboembolism VTE. [OR 5.63 CI 1.8 - 11.2 P < 0.001] Raised level of all aPL antibodies found in patient group Anti B2GPI in 30%, anti PT in 50% and LA activity in 46% of SLE patients. A significant association was observed between APC-R and co-existence of anti- B2GPIAb and LA activity or of antiprothombin antibodies and LA activity. There was no association between APC-R and presence of anti-B2GPIAb, antiprothrombin Abs or LA activity alone. However, multivariate logistical regression analysis was performed it was clear that only the coexistence of antiprothrombin antibodies and LA activity was a significant risk factor for APC-R. [OR 3 - 53 95% CI 1.45 - 8.58.] There was no significant differences between SLE patient and control group as regard Protein C, Protein S or AT III levels. Coexistence of only antiprothrombin Abs and LA activity was a significant risk factor for APC-R and it may be important for pathogenesis of VTE in patients with SLE

Association of inherited thrombophilia with pre-eclampsia

Preeclampsia and its association with thrombophilia remain controversial, due to inconsistent results in different studies, which include different ethnic groups, selection criteria, and patient numbers. The aim of this was to determine the relationship between thrombophilia and preeclamptic patients. In a prospective case-control study, we compared 50 consecutive women with preeclampsia [group 1] with 50 normal pregnant women [group 2]. All women were tested two months after delivery for mutations of factor V Leiden, methylenetetrahydrofolate reductase [MTHFR], and prothrombin gene mutation as well as for deficiencies of protein C, protein S, and antithrombin III. A throinbophilic mutation was found in 22 [44%] and 16 [32%] women in group 1 and group 2, respectively [P>0.05 OR 1.9, 95% CI 0.7-2.3]. The incidence of Factor V Leiden mutation [heterozygous], prothrombin mutation [homozygous] MTHFR mutation [homozygous] was not statistically significant in group 1 compared with group 2 [P>0.05]. Also, deficiencies of protein S, protein C, and antithrombin III were not statistically significant in group 1 compared with group 2 [P>0.05]. There was no difference in thrombophilic mutations between preeclamptic patients and normal pregnant women. Therefore, we suggest that preeclamptic patients should not be tested for thrombophilia

Efficacy of oral fluconazole in the treatment of cancer patients with oropharyngeal candidiasis

The present prospective non comparative study included 30 evaluable cancer patients with oropharyngeal candidiasis treated in NEMROCK. All patients received either systemic chemotherapy [81%] or oropharyngeal radiation therapy [19%]. The majority of cases [81%] were enrolled after [culture proven failure] other antifungal agents used to control oropharyngeal candidiasis. All patients were treated by oral fluconazole and an initial dose of 50-100 mg/day for a median period of 12 days [range 7-28 days]. Side effects were generally mild including nausea, abdominal pains and heart burn being observed in 5 patients with none of them needing dose reduction of fluconazole. Complete cure was achieved in 80% of the patients and mycologic eradication was documented in 60%, whereas reinfection was seen in 10%

Malignant mesothelioma: Epidemiology - diagnosis and treatment results of 46 cases

This retrospective study included 46 cases of pathologically proven malignant mesothelioma referred to NEMROCK during the period 1978-1989 inclusive. There was a significant progressive increase in the relative frequency of the disease throughout the study. The median age of the patients [39 years] was strikingly younger than the westerns. Asbestosis was encountered in 50% of the cases. Chest pain and dyspnea were the most frequently encountered symptoms, while constitutional symptoms were seen in 41%. Epithelial subtype was the commonest histopathologic variant [43%]. Only 22% of the cases were diagnosed by one pathological sample while 24% needed more than 3 pathological samples to confirm the diagnosis. The diagnostic accuracy was modest for fluid cytology [21%] and blind needle biopsy while satisfactory results were obtained by C.T. guided biopsy [64%] and thoracotomy [86%]. Ipsilateral volume loss with nodular pleural thickening [predominently basal] were the most common radiological features. C.T. Scan was superior to plain chest films in detecting minimal effusion, pericardial involvement and mediastinal disease. None of the treated patients achieved complete remission by treatment. The response rate was 17% for radiotherapy [12 cases] and 25% for the combination of ifosfamide and adriamycin [20 cases], with a median survival of 14 months and 11 months respectively. By multivariate analysis old age, late stages and bad performance status were significantly associated with poor survival

Ifosfamide and adriamycin combination in the treatment of diffuse malignant mesothelioma

In a pilot study [Jan.-Dec. 1989], twenty cases of diffuse malignant mesothelioma were treated in NEMROCK by a combination of ifosfamide and adriamycin. All patients were evaluable for treatment response, toxicity and survival data. The chemotherapy program consisted of ifosfamide 1.25 gm/m-/d x 4 days [given with Mesna as 20% of ifosfamide dose on hours 0, 4, 8/d] and adriamycin 50 mg/m on day 5. Treatment was repeated on 4 weekly basis till progression or to a total of six cycles. None of the 20 patients achieved complete remission, while 5 cases [25%] had partial response [PR] for a median duration of 14 months. Four cases [20%] had minimal response, while 7 cases [35%] had stable disease [SD] and 4 cases [20%] had disease progression [DP]. The mean survival time was 20.7 months for PR+MR versus 6.6 months for SD+DP [P<0.00001]. Fifty percent of the cases experienced complete symptomatic relief with definite improvement of their pretreatment performance status [P.S.]. Toxicity was generally mild to moderate being nausea and vomiting [100%], alopecia [100%], haematologic [40%] and mild infection. No grade 4 toxicity was observed. Multivariate analysis showed that response to treatment, symptomatic relief, early stage, younger age and good P.S. were associated with improved survival

Treatment of metastatic colorectal carcinoma with 5-fluorouracil and folinic acid: a pilot study

Twenty four evaluable patients with metastatic colorectal carcinoma were entered into a pilot study that used 3 consecutive days of 5- fluorouracil [600 mg/m2 as 24 hours infusion] and folinic acid [120 mg/m2 as 4 hours infusion]. This regimen was repeated on 3 weekly basis. Eight patients [33%] were considered to be refractory to previous fluorouracil monotherapy. Objective response [including one complete remission] was seen in 33% of the patients. Two out of the 8 previously treated patients [25%] exhibited partial remission. The mean survival time was 13.5 months for responders 8.5 months for stable disease and 3.8 months for progressive disease [P less than 0.01]. Treatment related toxicity was generally mild with no single life threatening complication. Diarrhea and oral mucositis were the 2 most commonly encountered adverse effects

Locally advanced breast cancer: a problem for a combined approach

One hundred sixty seven evaluable cases with non-inflammatory locally advanced breast cancer [Stage III b] were retrospectively studied for the results of treatment, pattern of relapse and survival at a follow up period of 2 years. The patients were collected at Kasr Elaini centre of Radiation Oncology and Nuclear Medicine over a period of 9 years [1979-1987]. The patients were managed by different single and combined treatment modalities [Non protocol]. At 2 years, patients treated by locoregional treatment approaches [Surgery and/or radiotherapy] had a very poor relapse free survival [23%] which improved to 41% when 6-9 courses of chemotherapy were added after locorgional treatment [P<0.05]. best relapse free survival [59%] was obtained when intial [Neoadjuvant] chemotherapy [adriamycin based regimen] was used prior to surgery and radiotherapy. When radiotherapy was used to control the primary disease; doses above 65 Gy could achieve 78% local control at 2 years versus 30% in doses below 60 Gy [P< 0.05]. The role of surgery and its timing as well as extent were discussed concluding that prior chemotherapy was of great benefit