Anaplastic thyroid cancer: a retrospective analysis of 120 cases

Anaplastic Thyroid Cancer [ATC] is one of the most lethal malignancies with very short survival and extremely poor treatment outcome. ATC accounts for 2-5% of all thyroid cancers worldwide with an annual incidence of about 2/million. To review the natural history and treatment outcome of ATC patients treated at King Faisal Specialist Hospital and Research Centre [KFSH and RC] located at Riyadh, Saudi Arabia. Retrospective review of 120 Saudi cancer patients collected from registry data at KFSH and RC from 1976-2008. Search key words included: thyroid cancer, anaplastic, undifferentiated and not otherwise specified. Search was not restricted to particular age, gender, treatment or tumor size. Demographic information, baseline patient characteristics including date of diagnosis, type of treatment and date of death were obtained from KFSH and RC registry data and Saudi death registry. A total of 120 cases were identified at our cancer centre from 1976 to 2008. Of these total, 73 were females [60.8%] and 47 were males [39.2%]. The average age at diagnosis was 63.34 +/- 12.8 years. Thirty-four patients underwent surgery [28.3%], 52 had a palliative radiation treatment [43.3%] and only 5 had chemotherapy [4.2%]. The median survival was 53 days [0-457]. Our review proves that ATC is rapidly fatal cancer and is unresponsive to currently available therapeutic options. More research is needed to understand the tumor biology and novel treatment options

New metal complexes of semicarbazones derived from para phenylene diamine of NOO/or NO donor sites and their antimicrobial screening

The synthesis and characterization of new Mn[II]. Co[II] Ni[II] and Cu[II] complexes with semicarbazone ligands derived from para phenylene diamine [where L[1] = Semicarbazide-4-yl-benzene-4 [2-hydroxybenzalde-hyde semicarbazone] [SBFIBS], L[2] = Betizene-1, 4-bis-[2-hydroxybenz-aldehyde semicarbazone-4yl] [BBHBS], L[3] = Semicarbazide-4yl-benzene-4 [2-hydroxyacetophen-one-semicarbazone] SBHAS and L[4] = Semicarbazide-4yl-benzene-4 [2-nitrobenzaldehyde semicarbazone] [SBNBS]] are reported. The ligands contain NOO/or NO donor sites. The elemental analysis suggests different stoichiometries 1: 2: 1 and 1: 2 [M: L]. IR spectra data indicate covalent bond through the oxygen atom of the hydroxyl group, coordination of the carbonyl oxygen and the azomethine nitrogen / or nitrogen of the amine group to the metal ion. TGA determined whether the water or solvent molecules are inside or outside the coordination sphere. Magnetic susceptibility and electronic data are in favour of octahedral structures except in the case of Co [II] complexes of ligand BBHBS and SBHAS as they favour the tetrahedral structure. The biological activity of the complexes has been tested. These complexes showed promising antifungal activities

plasma level of selenium and tumor necrosis factor-alpha and the activities of glutathione peroxidase lsoenzymes in colorectal cancer patients

Colorectal cancer represents a significant cause of morbidity and mortality worldwide. It is known that reactive oxygen species [ROS] are formed in excess in chronic diseases of the colon but the precise mechanisms of oxidative stress being induced in cancer cell and the role of ROS in colorectal cancer progression are still not exactly understood. The present study aimed to investigate the oxidative status of plasma as lipid peroxidation end products and the level of glutathione [GSH] in colorectal patients. The level of Selenium was also assessed by atomic absorption in association with the activities of GSH peroxidase isoenzymes [total, Se-dependent and non-Se-dependent]. Also the level of tumor necrosis factor-alpha [TNF-alpha] in plasma was assessed. The study was carried out on 30 colorectal cancer patients at different stages and grades and 10 healthy control subjects of matched age and sex. The results demonstrate that, colorectal cancer patients suffer from oxidative stress which is dependent on the grade and stage of the disease as indicated by elevated levels of lipid peroxidation end products, TNF-alpha and oxidized glutathione and by decreased levels of total and reduced GSH. Also, Se was significantly decreased in patients compared to control with the lowest level observed in grade III patients. This decrease in Se was associated with inhibited activities of total and Se-dependent GSH peroxidase while no change was observed in the activity of non-Se-dependent isoenzyme. Colorectal carcinogenesis is associated with serious oxidative stress and depletion of Selenium

new method to decrease the occurrence of embolic events during total hip replacement

The goal of this study is to assess the efficacy of a modified surgical technique, designed to limit the increase in intramedullary pressure during insertion of the prosthesis and to reduce intra-operative embolic events. Forty patients treated with total hip replacement in Tanta university hospitals divided into 2 groups [group 1] treated with conventional cementing technique and [group 2] treated with a modified cementing technique with a cannula inserted into the intertrochanteric region of the femur to decrease the intramedullary pressure to avoid the increase of the intramedullary pressure after application of the cement and insertion of the stem. There was a significant difference between the incidence of embolism and increased pulmonary artery pressure [detected by trans-thoracic Echocardiography] between both groups of patients where the incidence of both were found to be much lower when the modified technique was used. Also the changes in the hemodynamic parameters [heart rate, blood pressure, and central venous pressure] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. The changes in the respiratory parameters [decreased oxygen saturation, decreased arterial oxygen tension, decreased end tidal CO2, and increased arterial CO2] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. Modified surgical technique [A vacuum drainage of the proximal femur along the linea aspera] was found to be effectively reducing the incidence of embolization during cemented hip arthroplasty

Trochanteric fractures, the best method of treatment

unstable trochanteric fracture is a problematic fracture especially in osteoporotic patients. No method of treatment can be considered to be a golden line of treatment for all types of fractures. The aim of this work is to compare the results of treatment of unstable trochanteric fracture by using dynamic hip screws, hooked plate and proximal femoral nail. This study was done in Tanta university hospitals during the period January 2000 till December 2006. Three hundred and thirteen patients were included in this study. However, 20 patients were excluded; 7 due to death and 13 were lost during the period of follow up. The patients were divided into 3 groups according to the method of treatment. Group A included 120 patients [68 males and 52 females] treated by DHS. Group B included 110 patients [46 males and 64 females] treated by hooked plate. Group C included 63 patients [30 males and 33 females] treated by PFN. According to Dubigne and Postel grading, in group A, 99 from 120[82.5%] were satisfied while 21 [17.5%] were unsatisfied. In group B, 61 patients from 110[55.5%] were satisfied and 49 patients [44.5%] were unsatisfied. However, in group C, 57 patients from 63 [90%] were satisfied while only 6 patients [10%] were unsatisfied. The average healing time was 14 weeks with using DHS, 19 weeks with using hooked plate and 12 weeks with using PFN. Post-operative X-ray showed a valgus position of the femoral neck in 18 [15%] out of 120 patients treated by DHS. Varus malposition had occurred in 30 patients [25%]. Valgus deformity occurred in 50% of patients with hooked plate while varus deformity occurred in 41.66% of the patients. On the other hand, only 4 patients [6%] in group C developed varus malposition. Lag screw cut out occurred in 13 patients [11%] in group A. Revision by arthroplasty was done in 7 cases and 6 treated conservatively due to the bad general condition of the patients. Implant removal was done after 2 years from complete union. In group C, only 3 patients [5%] had lag screw cut out; 2 treated conservatively and the lag had removed after union and only one required revision using arthroplasty. Implant failure had occurred in 11 patients [10%] in group B and revision was done in all of them. In treating unstable trochanteric fractures, PFN provides superior results on comparison with DHS or HP. DHS is another accepted alternative when the lag screw is inserted correctly and centrally. However, hooked plate is an inferior alternative when compared with PFN or DHS

[On the] geochemistry and mineral chemistry of the Gabbroic rocks at Wadi Um Khors area, central eastern desert, Egypt

The studied metagabbro-diorite complex comprises hornblende metagabbro, quartz-metagabbro, appinitic-metagabbro, and quartz diorite beside the fresh gabbro relics. They are calc-alkaline and were emplaced at subduction zones related to island arc magma. They were subjected to metamorphism but still carry minor relics of fresh gabbro. Mineralogically, the metagabbroic rocks are composed of plagioclase [An 30-45], Ca-rich clinopyroxenes [diopside and augite] and hornblende of green and olive brown colour]. The obtained crystallization temperature for the coexisting plagioclase- olive brown hornblende mineral pair was 600 - 700 °C and for the coexisting plagioclase- green hornblende mineral pair was 800 - 900 °C. The Ca-rich clinopyroxenes are low in alumina content suggesting crystallization between 500 and 1100 °C at shallow depth. Also, the analyzed clinopyroxenes pertain to those found in sub- alkaline rocks. The studied metagabbroic rocks show relative enrichments in LILE [Sr, Rb, Ba] over the HFSE [Nb, Zr, Y], a feature characteristic of subduction- related magmas

Petrology, geochemistry and tectonic setting of Dyke swarms of Abu Dob area, central eastern desert, Egypt

Abu Dob granitic pluton is traversed by a large number of dyke swarms. The examined dykes are classified into acidic, intermediate, basic and alkaline. Most dyke swarms trend N-s to NNE-SW; some dykes trend NW-SE. The dykes are very steeply inclined at 75-85°. They generally possess a uniform thickness usually ranging from 0.5 to 40 m. The dykes sequence in Abu Dob area starts with the acidic, followed by the intermediate and then the Tertiary basalts and ends by the alkaline dykes. The intermediate and basic dykes are enriched in normative nepheline indicating their alkaline affinity, normative hypersthene is also present in trachydacite, trachyte, trachyandesite and in the alkaline basalt, Normative acmite appears in considerable amounts in the trachyte, phonolite and phonotephrite dykes pointing to a possible alumina deficiency. The mafic and intermediate dykes were possibly derived from alkaline magmas in a within plate environment, while the acidic dykes were derived from the late or orogenic calc-alkaline granitic magma and basalt sample has a tholeiitic nature. The dykes are enriched in HFS elements and depleted in LIL elements

Treatment of mild to moderate unilateral congenital ptosis using single suture levator resection

To assess the effectiveness single large suture levator resection in the repair of mild to moderate unilateral congenital ptosis. All patients included in the study were younger than 7 years. They all had unilateral congenital ptosis with fair to good levator function. They all underwent levator resection by a single large suture in the ptotic eyelid. At the end of our study, 80% of patients showed sufficient elevation of the ptotic eyelid with a MRD of >/=4mm. 75% of the patients showed symmetry between the two eyelids with eyelid margins within 1mm of each other. The results of our study suggest that the single large suture levator resection procedure is effective in the treatment of mild to moderate unilateral congenital ptosis

Evaluation of triple screening test in prenatal diagnosis of Down syndrome

To evaluate the triple screening test [using AFP, beta-HCG and uE3] in prenatal diagnosis of Down syndrome through comparing the results of the test with the outcome of pregnancy. We will also compare these results with the results of the double test [using AFP and beta-HCG] or MSAFP test to evaluate the value of combining beta-HCG, alpha-fetoprotein [AFP] and unconjugated estriol with maternal age in this three-analyte maternal serum screening program for Down syndrome. This study was conducted on 50 pregnant women, 35 years or older. Their gestational age ranged from 14th to 19th week of pregnancy detected through 1st day of last menstrual period. Blood samples were taken from them for measurement of alpha-fetoprotein, HCG and unconjugated estriol. Risk ratio was calculated for Down syndrome detection using three protocols: MSAFP alone, MSAFP and HCG, MSAFP, HCG, and unconjugated estriol [triple test] using Prisca software [DPC, France]. The [cut-off] median MoM values in pregnancies with Down syndrome were 0.73 [AFP], 2.02 [beta-HCG] and 0.74 [uE3]. After labour, the newborns of selected women for the study were evaluated clinically for diagnosis of Down syndrome. The results of all tests done before labour are compared with the clinical evidence of cases to evaluate them. The detection rate of triple test, double test, MSAFP test was 75%, 50%, 25% respectively. The false positive rate was 40%, 75% and 94% respectively. The correlation coefficient between each test and actual outcome of pregnancy was 0.626 for triple, 0.267 for double and 0.146 for MSAFP test. Using cut-off value 1:190 kept the same detection rate for triple test and lowered the false positive rate to 25%. Triple screening test using AFP, HCG and uE3 has the upper hand over MSAFP and double test in detection of Down syndrome as it has the highest detection rate and lowest false positive rate. The value of correlation coefficient means that other factors or analytes need to be added to improve the detective power of the tests. It is strongly recommended to lower the cut-off value to be 1:190 instead of 1:270. These results need to be evaluated on a more large scale

Petrology, geochemistry and tectonic setting of some younger alkaline volcanic rocks, central eastern desert, Egypt

The present paper deals with some alkaline volcanic rocks occurring as small masses and plugs widespread in the Central Eastern Desert of Egypt. They occur in the form of plugs, sheet and dykes at Gebel El-Degheimi, Um Hombos, Um Khors plugs and Wadi El Miyah. The alkaline volcanic rocks are composed essentially of trachyte grading into trachyte, Qz-trachyte or phonolite. The studied volcanics contain acmite, aegirine and aegirine-augite. The alkaline volcanic rocks are enriched in alkalies and characterized by high contents in Nb, Y, Zr, Rb and Zn. Furthermore, the tectonic setting of these late volcanic alkaline rocks suggest that the trachyte masses erupted in a within plate tectonic environment. They were possibly derived from magmatic differentiation of an alkaline basaltic magma that suffered contamination with crustal material

On chromite mineralization and hosting serpentinites at Gebel Um Khasila area, eastern desert, Egypt

The present work deals with serpentinites and the associated chromite mineralization at Gebel Um Khasila area in the Central Eastern Desert, Egypt. Chromite occurs as lenses localized along thrust faults in serpentinites. The serpentinites were formed principally after peridotite to dunite constituting the base of ultramafic rocks of a dismembered ophiolite sequence. The serpentinites are similar to Alpine - type ultramafic rocks. The predominant occurrence of antigorite is almost identical to the regionally metamorphosed antigorite serpentinites.The chromite mineralization occurs as massive, nodular and disseminated crystals and may exhibit a pull-part texture. Alteration of chromite was initiated simulteaneously with the serpentinization and probably accelerated with the intrusion of the metagabbro-diorite, masses. Reaction rims of chromite with host rock was possibly initiated by ascending Fe-rich solution and altering the chromite composition

Utility of doppler study of the arterial system of the upper limb prior to radial artery harvesting in coronary bypass candidates

Preoperative evaluation of the arterial system of the non-dominant upper limb in RA harvesting candidates to estimate the compliance of the ulnar artery to receive the entire flow from the brachial artery for better case selection to avoid post-operative ischaemic complications in the used upper limb. Doppler and/or Power Doppler examination were performed prior to surgery to evaluate the arterial system of the non-dominant upper limbs of 32 patients admitted as candidates for radial artery harvesting for coronary bypass surgery. The state of radial artery removal was imitated by RAC at the wrist. The PSV, EDV and RI were estimated under basal conditions and during RAC. The readings were collected, tabulated and compared to previous reports and accordingly some of the candidates were excluded from RA harvesting owing to significant expectations of upper limb ischaemic manifestations following RA removal. Doppler and/or power Doppler is a very useful preoperative screening test for better selection of candidates for RA harvesting for coronary bypass surgery to avoid post-operative upper limb ischaemic manifestations following RA removal

Effects of chronic nicotine administration on male fertility in albino rats [an experimental study]

This work was designed to investigate the effects of intraperitoneal administration of nicotine in different doses over a period of 60 days on the fertility of adult male albino rats. Ninety-four adult male albino rats were used in this study and divided into four groups: A control group of ten rats received saline only and three test groups each containing 28 rats. Each of the test groups received a different dose of nicotine [0.5, 0.75 and 1.0 mg/kg b. w., respectively, every other day for 60 days]. Each group was further subdivided into three subgroups; the first [14 rats] was sacrificed immediately after 60 days, while the second and third subgroups [seven rats each] were sacrificed one and two weeks after stopping nicotine therapy. By the end of the experiment, blood samples were obtained from sacrificed rats and used for hormonal assay [testosterone and leutinizing hormone levels]. Then, the rats were subjected to epididymal spermatozoal examination and histopathological study of their testes. The results were presented and discussed

Thallium-201 scintigraphy in evaluation of breast masses

The purpose of the present study was to evaluate thallium-201 as a tumor seeking agent in patients with breast cancer. Forty-five female patients [20-67 years of age] with breast complaints were included in this study. After clinical examination, mammography and thallium-201 scintigraphy were performed and all cases were inspected pathologically to confirm the findings of both techniques. The results revealed that thallium-201 scintigraphy can reliably detect primary tumors of the breast with a high degree of sensitivity in group A which included 35 patients with no prior history of breast cancer. As 21 patients were found to have malignant breast lesions pathologically, the scintigraphic technique revealed only two false-negative cases out of them [sensitivity 90.4%, specificity 85.7% and accuracy 94.3%]

Intrapulmonary route for drug administration: effects on plasma concentrations and blood gases

This work aimed to compare four different methods of endotracheal and bronchial lidocaine administration with respect to the site of administration. Forty-eight patients undergoing elective operations with an anesthetic risk ASA I and II were included in this study. In this study, all other patients received lidocaine under bronchoscopic control through the side channel of bronchoscope either deep endotracheal, into the right main bronchus and into the right lower lobe bronchus. At 10 points of time after drug administration, blood samples were taken for measurements of lidocaine plasma concentration [using high pressure liquid chromatography] and blood gas analysis. Therapeutic blood concentrations [>/ 1.4 mug/ml] could be achieved and toxic blood concentrations [>/ 6 mug/ml] could be avoided with all methods of administration. No significant difference was found between the different methods with regard to peak concentration, time to peak, onset and duration of therapeutic levels or relative bioavailability. A significant decrease in PaO2 to 75% of the baseline was seen with all methods used

Intracranial Vascular abnormalities: value of conventional MR angiography

Forty-eight patients with a variety of intracranial vascular abnormalities were studied by conventional MR angiography. It proved to gave an important role in the diagnosis of 12 cases of vessel thrombosis, 15 aneurysms, 10 arteriovenous malformations, 3 cases of idiopathic sinus thrombosis, 7 cases of neoplasms adjacent to venous sinuses and a case of megadolichobasilar artery. The MR findings were correlated with clinical, CT and conventional angiography findings when available. This study highlights some of features of the intracranial circulation that make conventional MR angiography valuable in the demonstration of vascular disease

Value of MRI in assessment of suprarenal masses

Fifteen patients with variable adrenal pathology were studied by magnetic resonance imaging [MRI]. They included six adenomas [three non-functioning and three hyperfunctioning presented as Cushing and Conn syndromes], two pheochromocytomas, four metastases, a case of carcinoma, a case of hyperplasia and a case of histoplasmosis. SE, short TR sequences provided best anatomic images, especially for initial screening of the adrenal area preferably in combination with thin sections. SE, long TR long TE sequences were useful for tissue characterization of adrenal masses and for differentiation of non- hyperfunctioning adenomas from other adrenal masses, including high intensity metastases and pheochromocytomas. Enhancement with Gd- DTPa further increased the specificity of MRI. This study assessed the ability of MRI to demonstrate abnormal adrenal glands with determination of the MRI features of various adrenal mass lesions

diagnostic value of MR imaging in the evaluation of carpal tunnel syndrome

Magnetic resonance [MR] imaging of the wrists was performed in fourteen patients who were suspected to have carpal tunnel syndrome [CTS]. The most predominant MR abnormalities were that related to the median nerve [seven cases] and of such nerve abnormalities, the most frequent sign was the swelling being segmental at the proximal part of the carpal tunnel in two cases and diffuse in three cases. In three cases, altered signal intensity of the median nerve was noted. These findings seemed to represent edematous changes of the median nerve due to compression and/or neuritis. Bowing of the flexor retinaculum was seen in three cases. Swelling of the tendon sheath was demonstrated in five cases and hemangiomas in another two cases. Surgical correlation was obtained in four wrists. Based on this study, MR imaging proved to be capable of demonstrating characteristic pathological changes of the median nerve in CTS regardless of the cause and in some cases it could detect the underlying cause, thus helping in the treatment planning

Transvaginal sonographic evaluation of ectopic pregnancy

Effectiveness of transvaginal sonography for identification of ectopic pregnancy was studied in 43 pregnant women. Forty patients had tubal, two cornual and one ovarian ectopic pregnancies. The most common sonographic finding was a sac-like adnexal ring which was seen in 27 of the women. This finding was strongly associated with an intact Fallopian tube. In 16 of the women, an adnexal mass with a complex texture was found. Out of these 16 women, 13 had a tubal hematoma and 3 had a ruptured tube. Transvaginal sonography also enabled detection of hemoperitoneum in 38 patients. The results of transvaginal sonography were compared with pregnancy test and surgical findings. This study suggested that the status of an ectopic pregnancy could be predicted reliably on the basis of transvaginal sonographic findings

Laparoscopic cholecystectomy in acute cholecystitis

To study the role of laparoscopic surgery in treatment of acute cholecystitis in different aspects including peri and post operative outcomes. Forty cases with acute cholecystitis were included in this study, that underwent laparoscopic cholecystectomy within 48-72 hours of admission to the hospital. Operating time, estimated blood loss, febrile morbidity, length of hospital stay, recovery from pain, post-operative recovery and return to normal activities and work. Cost-effectiveness, and doctors training were also, evaluated. The procedure was successfully completed in 34 cases [85%], and no operative mortality was reported. These data, suggest that laparoscopic cholecystectomy is a good as well as can be safely attempted in cases presented with acute cholecystitis