Role of diffusion weighted and perfusion weighted imaging in characterization of ovarian tumours

Background: ovarian cancer is the second most common gynecological cancer and the fifth most common cancer in women. Proper management depends on proper preoperative assessment with the help of clinical examination, laboratory tests and different imaging modalities. Radiological evaluation includes ultrasonography [US], computed tomography [CT] and recently magnetic resonance imaging [MRI]. Diffusion weighted imaging [DWI] has been established as a useful functional imaging tool in neurologic applications for a number of years, but recent technical advances now allow its use in abdominal and pelvic applications

Purpose: it was to evaluate the role of diffusion weighted and perfusion weighted MRI imaging in the characterization of ovarian tumours and differentiation between benign and malignant tumours

Patients and Methods: this study was performed on 24 patients. All patients had US finding of solid or complex adnexal lesions

Results: DWI and dynamic MRI are significant promising tool factors for characterization of ovarian tumours and differentiation between benign and malignant lesions with high sensitivity, specificity. The sensitivity, specificity and accuracy of detection of the nature of the lesions. Have been increases after adding of DWI and DCE-MRI to the conventional imaging

Conclusion: Adding of DWI and DCE-MRI to the conventional MRI improves the sensitivity and specificity of diagnosis and allows confident diagnosis and differentiation between benign and malignant lesions

Effect of flaxseed on reduction of diabetic complications in experimental rats

This work is aimed to study the effect of feeding flaxseed in management of Diabetes mellitus in experimental rat. About Thirty five male albino rats were used, experimental diabetes was induced. Rats were classified in groups as control, diabetic, diabetic received 5, 10 or 20% of flaxseed in the diet. After 6 weeks blood samples were collected also, the right femur was removed. Glucose concentration of diabetic rats treated with 5%, 10% or 20% flaxseed was significantly decreased. Upon adding flaxseed at 5, 10 or 20% ratios treatment in diabetic rats, kidney function mean values were normalized. ALT, AST, TC, TG, LDL-c and VLDL-c were increased in diabetic group; the level was decreased as rats received flaxseed. Bone mineral density and content in diabetic group were reduced and normalized after receiving flaxseed. So, diabetes has more pronounced effect on serum glucose, liver, and kidney functions lipids profile, and bone health and flaxseed has beneficial effect on the prevention of osteoporosis

relation between the duration of inhalation abuse of a volatile substance and its effect on the testis. a histological and biochemical study in adult male albino rats

Volatile substance abuse in general, and toluene inhalation in particular, for their neuropsychological effects, represents a significant problem in many developed and developing countries. The present work was designed to investigate the histopathological changes in the testis of adult male albino rats, induced by toluene vapour inhalation over different periods. The present study was carried out on forty adult male albino rats with body weights ranging from 60-100g. The animals were categorized into two groups: Group I: [Control Group] included ten rats received no treatment, Group II: [Toluene inhalants] included thirty adult rats exposed to toluene vapour inhalation. A clean dry piece of cotton was soaked with toluene liquid and placed in the covered cages three times daily, each for about thirty minutes for six days per week. These animals were subdivided into three equal subgroups according to the exposure period; Subgroup [A]: ten rats exposed to toluene vapour for two weeks, Subgroup [B]: ten rats exposed to toluene vapour for eight weeks, Subgroup [C]: ten rats exposed to toluene vapour for twelve weeks. At the end of each duration of the experiment, animals were scarificed by decapitation using light ether anesthesia after taking blood samples. I- Histological examination: Specimens were taken from the testis of all rats and processed for examination by light microscope using haematoxylin and eosin stain and ultrastructural study using the transmission electron microscope. II. Hormonal assay: The concentration of testosterone level, luteinizing hormone [LH] and follicle - stimulating hormone [FSH] were estimated by radio immunoassay. III. GAS chromatography: Concentration of toluene vapour in the blood was measured by High performance liquid chromatography. IV. Statistical analysis: The one way ANOVA test was applied to estimate the significant values of the hormonal assay for serum testosterone, LH and FSH and the 5% level of significance was chosen. The histopathological changes observed in the testis of rats exposed to toluene inhalation demonstrated its potentials to induce cytotoxic effects on the spermatogenic cells, Sertoli cells and the interstitial cells of Leydig. The severity of the toluene damaging potentials appeared to be dependent on and directly proportionate to the duration of toluene inhalation. So, the histological changes were mild and scattered in the testis specimens of group A [2 weeks inhalation] and was more severe in both eight and twelve weeks groups. The correlation between high performance liquid chromatography for toluene gas in blood, the biochemical gonadal and gonadotrophin hormonal assay and the histological assessment, explored the various mechanisms that were incorporated in the establishment of the toluene induced testicular injury. The present study proved the undoubting evidences for the damage potentials of toluene on the testis as the major reproductive organ in the male. Furthermore, the study showed the direct proportionality between the toxic effects of toluene vapor and the length of the exposure duration. Yet, the observed histological alterations were highly suggestive for a probable impaired reproduction in experimental animals which needs further study

Histological study of the protective effect of N-acetylcysteine on pancreatic acinar cells in experimentally induced acute pancreatitis in male albino rats

Despite extensive research efforts, there is a lack of specific medical/ pharmacological interventions of excellent clinical value in acute pancreatitis. The exact mechanisms by which diverse etiological factors induce an attack are unclear. Since reactive oxygen species [OR] are involved in acute pancreatitis, the present study was designed to assess the protective role of N-acetylcysteine in preventing the histological changes in pancreatic acinar cells, induced by L-arginine in albino rats. Twenty five male albino rats weighing 250-300g were included in this study. They were divided into four groups. Group I [10 rats]: the control group was further divided into: Group Ia: 5 animals received physiological saline injections i.p. Group Ib: 5 animals received N-acetylcysteine in a single dose of 50 mg/kg orally. Group II [5 rats]: in the treated group, acute pancreatitis was induced by two injections of 250 mg/100 g body weight of L-Arginine intraperitoneally in an 1-h interval. Group III [5 rats]: the animals were administered N-acetylcysteine in the same dose as that given to group Ib 1 hour prior to L-Arg administration. Group IV [5 rats]: the rats received the same dose of N-acetylcysteine 1h after L-Arg was given. All rats were sacrificed 24 h after the second L-Arg injection. Specimens from the pancreas of each animal were subjected to light microscopic examination using Haematoxylin and Eosin stain and ultrastructural examination. Histological results of group II [rats received L-Arginine] showed variable histological changes with different severity. Interlobular and interstitial tissue oedema, cellular infiltration and extravasation of blood appered in some sections. The peripheral fat cells were necrotic. Most lobules revealed loss of normal architecture with focal peripheral areas of acinar cell lysis. Some acinar cells showed cytoplasmic vacuolations and nuclear changes. Marked dilatation of rER, focal areas of rarefaction and depletion of zymogen granules were also noticed in ultrastructural examination. Pretreatment with N-acetylcysteine revealed marked protective effect on the histological changes of pancreatitis induced by L-arginine. This protection was less evident in group IV receiving N-acetylcysteine after administration of L-arginine and induction of pancreatitis. N-acetylcysteine proved to be of benefit in protection of the pancreas from the experimentally induced pancreatitis by L-arginine especially if administered before induction. Supplemental antioxidant therapy seems promising in the regulation of the progress of acute pancreatitis and it is recommended to be given to patients at an earlier stage or those at risk for the development of acute pancreatitis

Concurrent weekly paclitaxel/carboplatin and split course thoracic radiation therapy in unresectable stage III A/B non-small cell lung cancer

This phase II study was conducted to assess tolerance and efficacy of concurrent weekly paclitaxel and carboplatin with split course thoracic irradiation in patients with locally advanced unresectable non-small cell lung cancer [NSCLC]. Patients with histologically confirmed unresectable stage IIIA/IIIB NSCLC with Karnofsky performance status of >/ 70 and weight loss /<5% with no palpable supraclavicular lymph nodes were treated with thoracic irradiation, 2 Gy daily, 5 days/week for three weeks [total dose of 30 Gy], followed by 10 days rest and the dose was repeated for a total dose of 60 Gy. Concurrently with radiation, patients received weekly paclitaxel 45 mg/m2 and carboplatin 100 mg/m2 given on days 1, 8, 15, 30, 37 and 44. Response was assessed by chest CT scan 2 months after treatment was completed and survival was calculated from the time of start of treatment. Between October 1999 and August 2000, 29 patients were treated. The median age was 56 years, there were 22 males [75.9%] and 7 females [24.1%]. Ten patients [34.5%] had stage IIIA disease and 19 patients [65.5%] with stage IIIB. Regarding acute toxicity, only 1 patient [3.4%] suffered from grade 4 toxicity [neutropenia]. Grade 3 esophagitis, pneumonitis and neutropenia were reported in 17.2%, 20.7% and 17.2%, respectively. The overall response rate was 69% with 6.9% complete response and 62.1% partial response. The median overall survival was 16.8 mon., with 1 and 2 year survival rates of 58.6% and 31%, respectively. The recorded 1 year and 2 year progression free survival rates were 48.3% and 27.6%, respectively, with a median time of progression of 11 months. The study concluded that this treatment regimen produces high response and survival rates with modest toxicity in patients with locally advanced unresectable NSCLC and it must be compared either alone or preceded by induction chemotherapy with the standard cisplatin based chemoradiation treatment

Adjuvant cisplatin with concurrent radiation therapy for resectable locally advanced carcinoma of head and neck

This randomized prospective study was performed to evaluate the efficacy and toxicity of postoperative concomitant chemoradiation for patients with locally advanced [stages III and IV] but operable squamous cell carcinoma of head and neck region. Eligible patients had completely resected tumor and histological evidence of extracapsular spread of metastatic lymph node or positive surgical margins. The patients were randomized to receive postoperatively either conventional radiotherapy alone [60 Gy] or concomitant cisplatin [100 mg/m2] on day 1, 22 and 43 and radiotherapy [60 Gy]. A total of 37 patients were entered into this study. At a median follow up of 23.7 months in both groups, the locoregional failure rates at 2 years were 50% and 36.8% in radiotherapy and chemoradiotherapy arms, respectively. The difference was not statistically significant. Although the incidence of distant metastasis was reduced by the addition of chemotherapy but it was not statistically significant. The 2-year disease free survival and overall survival were 38.9% and 50% in radiotherapy group compared with 52.6% and 57.9% in chemoradiotherapy group. The differences were not statistically significant. The chemotherapy was satisfactorily well tolerated and did not affect the ability to deliver the radiotherapy. The most common treatment related toxicity was mucositis, in the combined group, 5 patients [26%] developed severe mucositis that necessitated treatment interruption versus only 2 patients [11%] in the RT group. The study concluded that postoperative concomitant cisplatin and radiotherapy for patients with high risk resectable locally advanced head and neck carcinoma improves the locoregional control, together with improvement in both the 2-year disease free and overall survival. This seems to be true despite of not reaching the 5% level of significance, which may be due to the relatively small sample size

Cisplatin and paclitaxel concomitant with radiotherapy in locally recurrent cancer cervix

Twenty-three eligible patients with locally recurrent cervical carcinoma after radical hysterectomy were treated with concomitant cisplatin/paclitaxel and radiation. Thechemotherapy regimen consisted of cisplatin [20 mg/m2] and paclitaxel [45 mg/m2 therapy] that were given every other week concomitantly with 65-70 Gy local pelvic irradiation over 7 weeks. Eight patients [34.8%] experienced grade 3-4 acute toxicity during treatment. Late morbidity was reported in 4 patients [17.4%]. The chemotherapy related morbidity included mainly hematological toxicity, nausea and vomiting and neurotoxicity. The radiation related morbidity included mainly skin reaction, prostatitis and cystitis. Objective response was achieved in 69.7% ofpatients [34.8% complete response and 34.8% partial response]. The median duration of follow up for whole group was 17.1 months. Sex patients [26.9%] were alive with no evidence of disease with a median survival of 30.6 months. The 2 year overall survival was 26.9%. Five patients [21.7%] developed distant metastases. There was a tendency towards better results for earlier initial stage of the disease, patients older than 50 years old, squamous cell carcinoma tumors, tumors < 5 cm, central pelvis tumors and disease free interval from initial surgery more than 1 year. The study concluded that concomitant cisplatin/paclitaxel and radiation is a safe and tolerable treatment with reasonable response rate and satisfying survival for locally recurrent cancer cervix. However, this regimen must be run on a larger number of patients with a longer follow up period to get significant predictors of the response and survival and to guide in identifying the subset of patients that may benefit from more aggressive therapy

Concurrent temozolomide [TMZ] and irradiation for the management of high grade malignant glioma

This pilot study was conducted on 18 newly diagnosed patients with malignant glioma [11 patients with glioblastoma multiforme [GBM] and 7 patients with anaplastic astrocytoma [AA]] to assess the safety, tolerability and efficacy of concurrent administration of temozolomide [TMZ] and radiation. The eligible patients received 40 Gy [1.8 Gy/fraction, 1 fraction/day, 5 days/week] to the computed tomography [CT] or magnetic resonance imaging [MRI] enhancing lesion and surrounding edema with a 3 cm margin, then 20 Gy to a smaller volume including the contrast enhancing lesion plus 1-2 cm margin. Starting from the first day of radiation, the patients received oral TMZ [150 mg/m2] daily for 5 days and repeated every 28 days for two cycles. The study demonstrated the safety and efficacy of concurrent TMZ with radiation in newly diagnosed high grade gliomas and supported a further continued investigation of low daily dose TMZ with concurrent radiation, preferably with some cycles of TMZ as an adjuvant to radiation, in a multicenter phase III randomized trial containing a large number of patients and comparing this regimen with radiotherapy alone in newly diagnosed high-grade astrocytomas