ABSTRACT
Recent epidemiological studies have implicated Cytomegalovirus [CMV] infection in the etiology of cancer bladder. The present study was designed to estimate the performance characteristics of different assays, used for identification of CMV infection in schistosomal patients. The study was conducted on sixty cancer bladder patients; thirty five with schistosomiasis [group I] and twenty five without [group II], and twenty control subjects were included [group III]. PCR technique for detection of CMV DNA was performed on bladder tissue, serum, buffy coat and urine. ELISA for detection of IgG and IgM in sera and Antigenemia test and electron miscroscopic studies [EMS] on buffy coat were performed. CMV DNA was significantly detected in group I versus group II by PCR on bladder tissue, buffy coat, and serum respectively. None of the urine samples were positive for CMV DNA. The results of different assays were evaluated in relation to PCR results on tissue biopsies. Antigenemia test showed significant difference between group I versus group II. The EMS was found to increase the sensitivity of PCR on bladder tissue. Both PCR on serum and antigenemia test showed similar sensitivity of 56%, but a specificity of 100% and 81% respectively. In conclusion, the significant association of CMV infection with cancer bladder in Egyptian patients, suggest that the virus may be implicated in the development of such malignant transformation especially in cases with schistosomal affection. Both pp65 antigenemia assay and PCR on serum are two major assays available for diagnosis and monitoring of CMV infections. The EMS could increase the sensitivity and accuracy of PCR on bladder tissue and on buffy coat. Further investigation on a larger number of patients are required in immunodeficient schistosomal cancer bladder patients in order to clarify the role played by CMV in bladder cancer
ABSTRACT
Several studies have demonstrated an association between human papilloma virus [HPV] infection and urological malignancies. Inactivation of p53 tumor suppressor gene is a common genetic change in human cancers. Since proper understanding of the natural history of bladder cancer and significant prognostic factors is critical for management of this disease, we aimed to study the role of HPV16, 18 types and p53 protein expression among 72 Egyptian patients with bladder cancer in relation to schistosomiasis and clinicopathological parameters. Polymerase Chain Reaction assay [PCR] was used for detection and typing of HPV-DNA in bladder tissue biopsies where as p53 protein over expression was detected by immunohistochemistry. Results revealed that 36.1% of bladder tumors were schistosomiasis-associated, while 69.4% and 78.6% were significantly related to transitional cell carcinoma [TCC] and low grade tumor respectively. HPV16, 18 DNA types were detected in 41.7%, the majority of which [66.6%] was of type-16. p53 protein expression and its coexistence with HPV DNA-types was detected in 66.7% and 38.9% of tumors respectively. Although p53 protein expression had no statistically significant relation to schistosomiasis, the presence of HPV DNA or its coexistence with p53 showed statistically significant relation. In pre-malignant lesions, positive HPV DNA incorporation and p53 expression were detected in 20% and 12.5% respectively. Fair correlation was recorded between the presence of HPV DNA-types and p53 expression [kappa coefficient = 0.421]. Significant marked expression of p53 was detected in 92.9% of HPV DNA positive cases. There was no significant association between tumor recurrence and HPV DNA positivity. It is worth mentioning that marked expression of p53 was significantly associated with recurrent tumors [85.7%]. In conclusion, both HPV infection and p53 protein expression could contribute to schistosomal bladder carcinogenesis in an independent way. Over expression of p53 could play a role as an indication for high risk HPV infection or for tumor recurrence tendency. We suggest screening of patients with schistosomiasis for high risk HPV-16 and HPV-18, as they will need more strict treatment modalities and follow up besides, monitoring of their response to therapy. Further data are needed to study the relation between HPV and the reduction in cancer-specific survival, which is the ultimate goal of screening
ABSTRACT
To initially evaluate the possibility of electively repairing groin hernias in ascitic liver patients, to test the feasibility of the use of mesh in these patients and to evaluate mesh repair versus herniorraphy, 30 patients' [3 females and 27 males] with liver ascites and uncomplicated groin hernias were treated operatively for their hernias. They were divided into two groups: group I [Gp I]: 14 patients [9 indirect, 3 direct and 2 femoral] treated by herniorraphy and group II [Gp II]: 16 patients [10 indirect, 3 direct, 3 femoral] treated by polypropylene mesh placement with or without plug. All operations were performed under local anesthesia with preoperative prophylactic antibiotic cover. 23 patients were followed up: 11 in Gp I [4 to 24 months mean = 14.82 SD, 6.08] and 12 in group II [7 to 28 months mean = 14.42 SD, 5 98] Seventeen ascitic fluid samples were taken intra-operatively for bacteriological study. There was no operative mortality. Post operative complications included : temporary increase in ascites which occurred in 25 patients [12 in group [I], 13 group[II]]. In 21 cases. It responded to medical treatment and in three it required paracentesis. There was no deep wound infection. There were three cases of superficial wound infection [2 in group I and one in group II]. Scrotal hematoma and/or seroma occurred in four cases. A major attack of variceal bleeding occurred in a patient in the mesh group and was treated successfully. There was no spontaneous bacterial peritonitis. There were three recurrences: two in Gp I and one in Gp II. two of the recurrences were attributed to technical mistakes. Five [29.41%] of the bacteriological samples showed mono-microbial organisms i.e. bacterascites. Three were gram-ve two of them were E coli and one Pantoea spp. and two were Gram +ve Staph aureus [one was methicillin resistant] Findings indicate that elective groin hernia repair in liver patients with ascites is feasible even without prior peritoneovenous shunting with no mortality and an acceptable overall rate of complication. The use of mesh seems justified in -those patients with comparable of not superior, results to herniorraphy. Mesh placement was not associated with any increase in the rate of complications or wound infection .Although no spontaneous bacterial peritonitis occurred in this .study, caution should be taken and long antibiotic cover is probably important to avoid this fatal complication because bacterascites was found in 29 41% of the patients
Subject(s)
Humans , Male , Female , Hernia, Femoral/surgery , Surgical Mesh , Postoperative Complications , Wound Infection , Recurrence , Liver Diseases , AscitesABSTRACT
This study was done to elucidate the role of Chlamydia trachomatis in chronic prostatitis and its association with other conventional bacterial agents commonly accused as causing chronic prostatitis and to evaluate prostatic massage [PM] as a technique for diagnosis of chronic prostatitis. Also, the study evaluated two recently developed chlamydial antigen detection tests: Clearview test [CV] [Unipath, Bedford, UK] and Chlamy-check-1 test [Veda-Lab, France] as compared with standard Direct Fluorescent Antibody [DFA] test [Kallestadt, Sweden] in male urine samples and expressed prostatic secretions [EPS]. The therapeutic effect of doxycycline regimen was assessed in treatment of chronic chlamydial prostatitis. From the results obtained it was concluded that C. trachomatis should be considered as an etiological agent in chronic prostatitis either solely or in combination with other bacteria. The low sensitivity of both CV and Chlamy-check-1 tests limit their diagnostic value on samples from men. DFA was the most reliable technique for detection of Chlamydia trachomatis giving on overall incidence of 55%. This emphasizes the important role of C. trachomatis in chronic prostatitis