Chemical pleurodesis for malignant pleural effusion

Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis, this study was designed to compare the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion. Seventy-five patients with malignant pleural effusion were assigned into five groups each of 15 patients, Talc slurry 5 gm, Tetracycline500 mg, Bleomycin1 IU/kg, Iodopovidone [2%] and patients underwent tube drainage only. Tube thoracotomy was performed in all patients and agents were administered through the chest tubes. Tetracycline, talc slurry, iodopovidone andbleomycin, resulted inan insignificantly different success rates of 80%, 80%, 66.6%.73.3%, at 30 days and, 66.6%, 73.3%, 60%, 66.6%, at 60 days respectively while tube alone was much lower, 40% and 26.7% respectively. Chest tubes were removed after an average of 7.2 +/- 1.4 days for tetracycline, 7 +/- 0.8 days for talc slurry, 7.6 +/- 0.9 days for iodopovidone and 6.4 +/- 1.5 days for bleomycin which did not differ significantly. Chest pain was more common in the tetracycline group, dyspnea was more common in the talc group, and fever was more common in the iodopovidone group. Since tetracycline, talc slurry, iodopovidone, andbleomycin achieved comparable success rates in this study, we suggest that the drug availability and cost are important factors in choosing a sclerosing agent in developing countries

Correlation between fluorescein angiography, optical coherence topography and visual acuity in diffuse diabetic macular edema pre and post intravitreal injection of triamcinolone acetonide

To study the correlation between macular thickness by OCT, macular edema by FA and visual acuity finding in eyes with diffuse diabetic macular edema pre and after intravitreal injection of triamcinolone acetonide. This study included 40 eyes of 28 diabetic patients diagnosed as they had diabetic macular edema. Group I: included 20 eyes with primary diabetic macular edema. Group II: included 20 eyes with refractory diabetic macular edema. All patients received 4mg of intravitreal triamcinolone acetonide [IV TA]. Full ophthalmological examination. Fluorescein angiography and measurement of macular thickness [MT] by OCT were done to all cases preoperatively and 1.3 and 6 months postoperatively. Pre IVTA in group I: there was strong negative correlation between FA and VA[r/=-0.519] and weak correlation MT and VA[r=-0.421] while the correlation was positive between MT and VA[r=0.924]. In group II; there was negative correlation between FA,MT and VA[r=-0.594 and r=-0.672] but the correlation between MT and VA was positive, after IVTA allover the follow up period there was positive correlation between FA and MT in both groups. While the Correlation between BCVA and FA in Group I was negative correlation at 3rd and 6th month, the correlation in Group II was statistically non significant The correlation between MT and VA in group I was statistically significant 3 months after injection in both groups, however its effect decreases and recurrence of macular edema occurred 6 months after injection. In group II the correlation between MT and VA was statistically non significant. There is strong correlation between VA, OCT and fluorescein leakage. Visual acuity depends mainly on the macular perfusion not the amount of edema. OCT can differentiate between diffuse macular edema and cystoid macular edema diagnosed by fluorescein angiography

Synthesis and reaction of pyrido[2,3-d] pyrimidine with related thiazolo and enaminonitrile derivatives

In a one-pot synthesis pyrido[2,3-d] pyrimidine-2-thione derivatives [3a-c] were prepared via the reaction of a mixture of 6-aminothiouracil [1], cyclooctanone and a proper aldehyde in dimethylformamide. Compound 3 reacted with a mixture of chloroacetic acid and aromatic aldehyde in acetic acid and acetic anhydride to give 6-aryl-thiazolo [4,5-a] cyclooctenopyrido [2,3-d] pyrimidine -3,5-diones [4a-c]. Compound 3b underwent cyclization on boiling with 3-chloro-2,4-pentandione in acetic anhydride/pyridine solution to give 5. On the other hand, compound 3b reacted with bromo-malononitrile to give enaminonitrile [6] Compound 6 reacted also with aliphatic acids to give 14-[chlorophenyl]-2-[unsub./methyl] pyrimido[4',5':4,5] thia-zolo[3,2-a] cyclooctenopyrido [23-d] pyrimidine- 4,15- dione [8a,b]

Revision endonasal endoscopic dacrocystorhinostomy [REEDCR] with adjunctive intraoperative Mitomycin-C application

The aim of this study was to determine the efficacy of the adjunctive use of Mitomycin C in revision endonasal endoscopic dacrocystorhinostomy. A prospective randomized controlled study included 36 patients who underwent 44 endoscopic dacrocystorhinostomy [DCR] procedures. A total of 44 surgeries were divided into 2 equal groups, a traditional group [group I] underwent revision endonasal endoscopic dacrocystorhinostomy [REEDCR] and a Mitomycin-C adjunct to REEDCR group [group II]. In group I, the male to female ratio was 7:11 with mean age 36 years [range 25-56], while in group II the male to female ratio was 4:5 with mean age 37 years [range 23-58].The surgical procedures in both groups were exactly the same. The submucosal fibrosis from prior surgery was sharply dissected with removal of any scar tissue to enter the sac's interior. The sac opening was enlarged to a diameter of at least 20 mm. U - shaped intubation of the superior and inferior canaliculi was performed with a thin silicone tube. A piece of neurosurgical cottonoid saturated with 0.5 mg/ml Mitomycin-C was placed over osteotomy site for 5 minutes in group II surgeries. The silicone tubes were removed at 6 months after surgeries in all patients. The REEDCR results were assessed subjectively and objectively at the end of 1[st] week after surgery and during the follow up period at 3[rd], 6[th] and 9[th] postoperative months. Subjective assessment was based on the patients symptom of epiphora. The objective assessment of anatomical and functional outcomes included irrigation test, functional endoscopic dye test [FEDT] as well as nasal endoscopic assessment of rhinostomy site [nasolacrimal ostium size and pathological conditions]. Surgery was considered successful when the patient had no or minimal conditional epiphora and the fluid passed freely without reflux on lacrimal irrigation. In group II [Mitomycin group], 86% [19/22] eyes got significant improvement of the epiphora symptom compared to 77% [17/22] in group I [conventional group]. The higher subjective improvement in group II was associated with a higher objective improvement based on positive irrigation test in 86% and positive FEDT in 82% of patients compared to group I [77% irrigation test positive and 73% FEDT test positive]. Endoscopic nasal examination of rhinostomy site in group I failed cases revealed scar tissue formation in 3 cases [14%] and granulation tissue formation in 2 cases [9%]. In group II, assessment of rhinostomy site revealed scar tissue formation in 9% of cases [2 out of 22] while no granulation tissue formation was detected in this group. In group II, the mean rhinostomy diameter decreased from 14 +/- 1.2 mm on the first postoperative week to 10.3 +/- 2.1mm at the 3rd. month, 8.2 +/- 2.3mm at the 6th.month and 5.7 +/- 1.8mm at the 9th.month. This diameter change was significantly less than that in group I. By the end of follow up period the mean rhinostomy diameter in group II [5.7 +/- 1.8mm] was significantly greater than that in group I [3.6 +/- 1.4mm]. The adjunctive intra-operative Mitomycin-C local application increases the success rate of revision endonasal endoscopic DCR with a high safety profile, we suggest that Mitomycin-C reduces the fibrous adhesion, scarring and granulation tissue formation at the ostium area preventing further shrinkage of the final ostium. Large scale-study with long follow up period and different Mitomycin-C concentrations and exposure time is needed

Further studies and synthesis of new pyrido[2,3-d]-pyrimidines, thiazolopyridopyrimidines: the reaction of 6-aminothiouracil with cyclic alpha, beta-unsaturated ketones

6-aminothiouracil [1] reacts in boiling dimethylformamide with cyclic alpha, beta -unsaturated ketones [2] yielding the 7-aryl-thioxo 5, 6, 7, 10, 11, 12-hexahydro, 7-aryl-10-thioxo-5, 6, 10, 11-tetrahydro -9H-benzo [h] pyrimido [4, 5-b]quinolin-8-one systems[4, 5] and 5-aryl-2-thioxo-1, 2, 3, 5, 6, 7, 8, 9, 10, 11-decahydro-, 5-aryl-2-thioxo-1, 2, 3, 6, 7-, 8, 9, 10-octahydrocyclohepta [5, 6] pyride [2, 3-d] pyrimidin-4-one[8, 9], respectively. The latter pyridopyrimidines reacted with chloroacetic acid in presence of an aidehyde to furnish a 10- arylidene -7- aryl- 5, 6- dihydro-11- thia-8a, 12, 13- triazabenzo- [a] cyclopenta [i] anthracene- 8, 9- dione or 2 -arylidene -5- aryl- 7, 8, 9, 10- tetrahydro -6H-1-thia-3a, 11, 12-triaza-cyclohepta [b] cyclopenta [g] naphthalene -3, 4-dione [10, 11]. The reaction with halo-derivatives such as methyliodide, 3-chloro-2.4 pentanedione furnished the alkylated pyrimidines 12, 14, 16, 17, 19, 20. The latter products reacted with hydrazine hydrate to give the hydrazine derivatives 21. The cyclization of 12, 14 to 13, 15 using acetic anhydride/pyridine have been reported

Reduction of chemically induced hepatitis in rats by adenosine

The protective effect of adenosine [1 mg/kg LP.] in hepatitis induced experimentally in rats with dgalactosamine [800 mg/kg LP.] was assessed. The degree of protection was determined biochemically by measuring AST, ALT and bilirubin in addition to hepatic nitric oxide, and by histo-pathological examination of liver. In d-galactosamine induced hepatitis in rats, there were significant elevation of ALT, AST, bilirubin and NO2 and NO3 in addition to foci of necrosis and infiltration of lymphocytes in hepatic lobules and portal tracts. In rats treated with adenosine [1 mg/kg LP.] there were significant reduction of ALT, AST, bilirubin and NO2 and NO3 in addition to more or less normal histological picture of liver. In conclusion, these findings revealed that adenosine had a protective anti-inflammatory effect on liver and this effect may be due to a reduction of hepatic nitric oxide