Primary gastric chorioadenocarcinoma

Primary gastric chorioadenocarcinoma [PGC] is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO [etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine], with a complete response and good tolerability

External auditory canal as an unusual site for metastasis of breast cancer: a case report

Metastatic breast cancer is one of most common cause of death in women worldwide. The estimated incidence of breast cancer to be metastatic at diagnosis is 6%, with a five year survival rate of about 21%. There are three types of breast cancer recurrence: local, regional and distant metastasis mainly to the lung, liver, bone or brain. Review of literature indicate a relatively few reported cases about metastatic breast cancer to soft tissue. We present a case of metastatic breast cancer to left external auditory canal

Toll-like receptors 4 and 9 expression in systemic lupus erythematosus and dermatomyositis: relation to clinical status and disease activity

Systemic Lupus Erythematosus [SLE] is an autoimmune disorder affecting almost all organs and tissues. Dermatomyositis [DM] is a chronic muscle disorder that leads to muscle destruction. Although DM mechanisms remain unclear, there is an evidence of autoimmune origin. Toll-like receptors [TLRs] are the key initiators of innate and adaptive immune response due to high production of proinflammatory mediators and activation of antigen presentation. We used qPCR to investigate the expression of TLR4 and TLR9 in peripheral blood mononuclear cells [PBMCs] from SLE and DM patients, as well as muscle tissue biopsies from the DM patients, to explore their role and study their correlations with clinical manifestations and disease activity. Our findings showed a significant increase in TLR4 and TLR9 expression levels in PBMCs from SLE patients and muscle biopsies from DM patients. Such results emphasize the role of TLR signaling and innate immune system in the pathogenesis of both diseases

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature

The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma. [c] 2005 Elsevier Ltd. All rights reserved

possible renoprotective effect of some drugs inducing heat shock proteins in renal ischemic reperfusion injury in rats

Renal ischemia reperfusion [RIRI] injury is a clinically important problem. The aim of this study was to assess the possible renoprotective effect of inducing heat shock proteins by hydrocortisone and acetylsalicylic acid [ASA] in RIRI in rats. The present study was conducted on 56 male albino rats that were divided into four groups. Group I included normal Sham-operated rats that served as control for group II, Group II was subdivided into Group IIa in which renal ischemia reperfusion injury [RIRI] was induced and group IIb [in which RIRI was induced and received quercetin [HSP70 inhibitor] 24 hours and again 1 hour prior to the induction of RIRI. Groups III and IV consisted of rats with RIRI that received hydrocortisone without [Group IIIa] or with [Group IIIb] quercetin, and that received ASA without [Group IVa] or with [Group IVb] quercetin, respectively, intramuscularly 24 and 12 hours before and after the induction of RIRI. Thirty hours after induction of RIRI, serum urea concentration and creatinine clearance were assessed. Moreover; renal heat shock protein-70 [HSP70] level and renal caspase-3 activity [as an index of apoptosis] were assessed. A significant increase in serum urea concentration and in renal HSP70 level, and caspase-3 activity together with a significant decrease in creatinine clearance, has been observed in non-treated rats [group II] killed 30 hrs after RIRI compared to Sham-operated rats. Administration of hydrocortisone or ASA resulted in a significant decrease in serum urea concentration and in renal caspase-3 activity as well as a significant increase in creatinine clearance and a significant increase in renal HSP70 in rats killed 30 hrs following RIRI [group III and IV] compared to non-treated rats with RIRI. Induction of HSP70 mediated the renoprotective role of both drugs evidenced by a significant decrease in renoprotective effect of either drug in the groups that received quercetin [IIIb and IVb] compared to those that didn't receive quercetin [IIIa and IVa]. This study demonstrates a role for HSP70 in protection against RIRI. Pharmacological strategies to increase stress protein expression have potential merit to prevent ischemic injury to the kidney and other organs. The ability of hydrocortisone and ASA to induce ischemic tolerance suggests that there are advantages in their application in RIRI. First, either is a safe drug in clinical practice. Second, the induction time of ischemic tolerance is relatively rapid after administration of either. Third, there is no additional or special equipment required for the induction of tolerance. Clinical studies will be necessary to evaluate the therapeutic properties of either drug in preventing I/R injury not only in kidneys but also in other solid organs

Prevalence, risk factors and impacts of schistosomal and intestinal parasitic infections among rural school children in Sohag governorate

Parasitic diseases represent a major cause of morbidity and mortality in childhood in most parts of the world. Hygiene and play habits make children especially vulnerable to schistosomal and parasitic infections. The aim of this study is to define the prevalence of different types of parasitic infections, to define their risk factors and to determine their impacts on health and scholastic absenteeism and achievement of rural school students in Sohag Governorate, Egypt. A cross-section, analytical study design was chosen to perform this research on 960 rural school students. All the students were interviewed and examined clinically and laboratory. The study showed that 38.5% of the students were infected by parasites. Entaemoeba histolytica, Enterobius vermicularis and Giardia lamblia had the highest percentages, 20.4%, 16.6% and 15.2%, respectively. Male sex, last birth order, poor personal hygiene, low socioeconomic level, >/=3 infected siblings, previous parasitic infections and no early consultation for therapy were important risk factors [ORs=1.41, 2.32, 2.63, 2.86, 4.17, 9.80 and 10.83, respectively]. Also, 29.2% and 31.6% of infected students were below the 5th percentiles as regard weight-for-age and height-for-age, respectively. Anemia was present among 52.4% of infected students. Further, 3.2% of them had hepatomegaly. Also, 37.8% and 41.1% of infected students had 0-3 and 4-6 days/month absent, respectively, while, 34.3% of infected students had a scholastic achievement <50.0%. Improving personal and environmental hygiene and regular screening, treatment and health education for students as regard parasitic infections in Egypt is recommended

Progressive hypoxemia, hypercarbia and hyperthermia associated with prolonged anesthesia- a case report

The authors report a case of 66-year-old female patient, 55 kg, ASA I who, under general anesthesia in supine position, developed gradual hypoxemia [from a baseline PaO[2] of 250 to 91 mmHg], carbon dioxide build up [from a baseline PaCO[2] 31 to 41 mmHg] associated with gradual hyperthermia up to 38.3°C over seven hours, intra-operatively. These observations were noted while using a semiclosed carbon dioxide absorption circuit in conjunction with the Hygroster filter at a fresh gas flow of 4 1/min of 50% nitrous oxide in oxygen. While the ventilation pattern was unchanged throughout the procedure, there was a change in exhaled tidal and minute ventilation volume with a net decrease of 28 ml and 0.4 l/min respectively. Findings are probably the result of pulmonary atelecatasis under general anesthesia due to the use of a relatively high-inspired oxygen concentration [50%]. In addition, the use of a high humidity and temperature heat moisture exchanger [HME] filter [Hygroster] in conjunction with the circle absorber system may have resulted in over humidification and aggravated the pulmonary atelecatasis over the long operative time

Psychosocial impacts and quality of life of children with atopic dermatitis

This study was conducted on 100 children with atopic dermatitis [AD] attending Dermatology Clinic, Al-Hussein University Hospital and an equal number of children as controls. The aim of the study was to determine the psychosocial impacts of AD on children and their families, to define quality of life [QOL] of children and their families and to determine the relationship between these items and AD severity. A cross-section, analytical, clinic based study design was chosen to perform this research. Criteria for diagnosis of depression and anxiety were according to DSM IV. Also, we used The Children's Dermatology Life Quality Index and The Dermatitis Family Impact questionnaire to assess the impact of AD on the children's quality of life and to assess the impact of AD on the quality of family life, respectively. The most common behavioural and psychiatric impacts in children were dependence [33.0%] and anger [26.0%]. Also, AD interfered with children's' social life and recreation in 73.0% and 29.0% of them, respectively. While, mothers' psychiatric impacts and family disturbances were more in AD families; 43.0% and 70.0%, respectively. The impacts of AD were more in children and families with severe AD with statistically significant differences. Also, 86.0% of children with AD and 62.0% of their mothers had poor QOL

study on heart rate variability signals in healthy children and in patients with congenital heart disease

During the last decade the interest in the field of pediatric electrophysiology was progressing and attention towards pediatric arrhythmic mortality became of extreme concern. Analyses of heart rate variability [HRV] signals are one of the sensitive tools to study the autonomic control of the heart uming to solve the arrhythmic morbidity and mortality in the pediatric age group. Few studies had reported the normal values of HRV parameters in infants and children. As autonomic disturbances and arrhythmia are common features in patients with congenital heart disease, we tried to establish ranges for HRV parameters in normal individuals and in patients with congenital cardiac defects. One hundred and fifty infants and children were the study population. 50 patients had a cyanotic congenital heart diseases; 29 males and 21 females, with a mean age + SD of 88.75 +/- 139.8 months and 50 patients had cyanotic congenital, heart disease; 18 males and 32 females, with a mean age of 5.62 +/- 3.05 months. 50 subjects with no evidence of structural heart disease were included as controls; 24 males and 26 females, with a mean age of 6.33 +/- 3.65 months. For age matching between the study groups and controls, 50 normal subjects were compared with a cyanotics while only 36 of them were compared with cyanotics patients, The normal limits [mean +/- SD] of frequency domain HRV parameters for all the 50 controls were: LF ms[2] [388.7-509.5], LF-n.u [36.8-62.08], HF ms[2] [489.1-709.6] HF-n.u. [44.3-74.3] and LF/HF ratio [0.5-0.9]. The normal limits of HRV parameters for the 36 controls age-matched to the cyanotic group were LF ms[2] [386.5-514.1], LF-n.-u [39.5-61.9], HF ms[2] [515.0-693.4], HF-n.u [50.1-70.9], and LF/HF ratio [0.54-0.86]. There was a significant negative correlation between age and both LF n.u and HF n.u. with insignificant effect on LF/HF ratio. However, there were no gender variations in the studied HRV parameters of the control groups. We observed a significantly lower HF-n.u and higher LF ms[2], LF-n.u, HF ms[2] and LF/HF ratio in both acyanotics and cyanotics when compared to controls. We also noticed that high frequency bands HF m[2] and HF-n.u. were abnormally high in a large number of acyanotics and the LF/HF ratio was relatively higher in cyanotics, although the differences were statistically insignificant. The final results provided a basis for heart rate variability signals in children. Normal ranges for the various parameters were determined. Cyanotics express more sympathetic predominance than a cyanotics which might render them more susceptible to arrhythmias

Health profile of school children in an Egyptian village

This study was carried out in Senhera village, Kaluobia Governorate. The total population sample was 105 pupils from primary and preparatory schools. The pupils were chosen by systematic random sample. Aim of this work is to give some informations about health profile of school children in this rural area. The results of the study revealed that most of studied sample were from moderate socioeconomic standard [65.71%], general condition were good [35.24%] and poor [17.14%] among studied sample. Mean height of studied sample in cm. was 137 +/- 10.5 and mean weight in kg was 40.2 +/- 17. The good educational ability was 19.05% among studied sample. The percentage of Schistosoma haematobium, Schistosoma mansoni, pinworm infection and Giardia lamblia among studied sample were 4.76%, 6.67%, 11.43% and 12.38% respectively. The researchers recommended that upgrade the quality of health of school children and rising the level of their health education

Community perception twoards traditional medicine in Nasr - City [Cairo]

This work aimed to assess the community perception as regards knowledge, attitude and use of traditional remedies in Nasr City, Cairo, where all person attending El-Hay El-Sades, PHC Center, were interviewed during one month [October 2003] with a pre-tested questionnaire. 35.6% of the total studied sample had used traditional remedies, mostly herbs [88.3%] with higher prevalence among females [56.1%], older people [56.9%], educated persons [53.5%] and higher socio-economic ones [80.0%]. A strong belief in herbs as an efficient therapy was reported by 54.3% of persons, especially among educated persons [81.7%] in contrast to cautery and bone setting, where the predominant attitude was that these are harmful as reported by 60% and 58% of the sample, respectively. It was also found that three- quarters of the responders did not consult any conventional health care before using these remedies, and 80% of the remaining quarter did not get good benefit from consultation

study of clasp designs for asymmetric distal extension partial dentures

The clasp design in distal extension removable partial dentures [RPD] plays an important role in the distribution of load between the abutment teeth and the edentulous ridge. This study was assigned to evaluate clinically and radiographically the effect of the Budtz-Jorgensen and Bochet, Equipoise and RPA clasp designs in mandibular distal extension RPD on the abutment teeth supporting structures. Fifteen partially edentulous patients [asymmetric Kennedy class I] were divided into three groups [five each]. Each group received RPD with one of the three clasps. The Plaque Index, Gingival Index, attachment loss, bone height and tooth mobility were recorded at denture insertion and after 3,6,9 and 12 months. The Budtz-Jorgensen and Bochet clasp showed no change in the supporting structures throughout the 12 months. The Equipoise clasp and the RPA clasp showed significant Plaque accumulation and gingival inflammation after 9 and 12 months. In addition, the RPA clasp showed a significant increase in attachment loss and alveolar bone loss after 12 months. However, there was no tooth mobility in the three groups throughout the follow-up period

epidemiological study of dermatosis among school children in Qualioubia Governorate

This study was done in Qalyoubia governoment on a total of 1500 pupils, half of them were affected by a kind of skin disease. Six schools [four primary, one preparatory and one secondary] were chosen for this study. Dermatosis affected 48.69% of the studied boys and 51.97% of the girls. About half of the cases were infective skin diseases, while non-infective skin diseases represented 38.97% and only 9.51% were of double nature. Pediculosis capitis was the most common infective skin disease affecting school pupils. Fungal infections were represented by 9.79%, then viral infections and lastly bacterial infections. On the other hand, pityriasis alba was the most common non-infective skin disease, followed by Acne vulgaris. The study revealed that skin diseases were more common among pupils whose parents were illiterate or educated

Ipsilateral bronchial intubation in a neonate for expansion of post-operative unilateral atelectasis

Ipsilateral bronchial intubation was used for reexpansion of unilateral pulmonary atelectasis in a newborn, who developed postoperative right atelectasis following extrapleural repair of tracheoesophageal fistula

Hazards of nitrous oxide administration in presence of venous air embolism

Nitrous oxide administration in presence of venous air embolism results in its volume augmentation. The present case report of a 50-year old patient undergoing posterior fossa tumor excision in the sitting position demonstrates the hazards of nitrous oxide in presence of venous air embolism. Administration of 66% nitrous oxide 140 minutes after the incidence of air embolism resulted in a significant decrease of end-tidal carbon dioxide tension, moderate hypotension, and tachycardia, suggesting volume augmentation of the air embolism. The results of our case report are in contrast to that by Shapiro et al who noted that nitrogen washout following administration of 100% oxygen was complete 65 minutes after the occcurrence of venous air embolism. Shapiro and colleagues suggest the use of nitrous oxide challenge as a diagnostic aid in deciding when lung excretion of intravascular air is complete. However, our case report implies that nitrogen washout was not complete 140 minutes after venous air embolism incidence. Accordingly, we recommend to stop nitrous oxide administration once air embolism is suspected and to refrain from its readministration throughout the rest of surgery