Role of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic head lesions, Egyptian experience

Pancreatic carcinoma is one of the leading cancer morbidity and mortality worldwide. Endoscopic Ultrasound [EUS] provides good direct visualization of the pancreas and EUS-FNA raises the accuracy for diagnosing pancreatic malignancies. US-FNA is another established method for diagnosing pancreatic malignancies. To determine the Role of Percutaneous US-FNA and EUS-FNA in diagnosis of pancreatic lesions. 131 patients with pancreatic masses were included in the study and sub-classified into 2 groups according to the imaging tool used, US-FNA [group I] and EUS-FNA [group II]. Using the appropriate statistical tools, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic accuracy were calculated for both groups. It was 88.2%, 93.9%, 96.8%, 97.5% and 90.1% respectively in group I. It was 77.8%, 100%, 100%, 75% and 86.7% respectively in group II. US-FNA/EUS-FNA are safe reliable tools for diagnosis of pancreatic lesions

Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of pancreatic masses

Pancreatic Cancer is a very aggressive tumor with an extremely poor prognosis. Early diagnosis, accurate preoperative staging and better adjuvant treatment remain a challenge. Abdominal ultrasound, abdominal CT, EUS and ERCP are common tools used for imaging of pancreatic cancer. Fine needle aspiration has made significant contribution to the diagnosis of cancer pancreas. The aim of the present work was to evaluate the role of ultrasound guided fine needle aspiration cytology [FNAC] in the diagnosis of pancreatic masses and in the differentiation of cancer pancreas from benign lesions. In addition to that, the level of serum CA 19-was measured to assess its accuracy in differentiating cancerous from benign lesions. This cross sectional study included forty patients with pancreatic lesions. They were subjected to full clinical examination, laboratory tests [including serum level CA 19- 9], abdominal ultrasound, percutaneous sonar guided FNAC of pancreatic lesions, endosonography and surgical interference [was done to 32 patients]. Thirty three patients proved to have pancreatic malignancy while seven patients proved to have pancreatitis. Ultrasonography [US] showed a sensitivity of 70%, specificity of 86% and accuracy of 73% for malignancy detection. Adding CAI9-9 to ultrasound raised the sensitivity to 94%, specificity remained 86% and accuracy to 93%. Adding FNAC to US raised the sensitivity to 85%, specificity remained 86% and accuracy to 91%. EUS showed a sensitivity of 90%, specificity of 100% and accuracy of 91%. Adding CA to EUS showed a sensitivity of 94%, specificity of 100% and accuracy of 91%. Adding FNAC to EUS showed a sensitivity of 97%, specificity of 86% and accuracy of 97%. The combination of EUS, serum CAI9-9 level and sonar guided fine needle aspiration showed an accuracy of 97% in the diagnosis of pancreatic lesions. These investigatory tools are cheap and available and thus may be an excellent alternative to EUS guided fine needle aspiration which is expensive and available in only a few centres

Ureteral segmental replacement using peritoneal graft in a dog model

Ureteral replacement has always been a challenge. In this article, we tried to assess the outcome of segmental ureteral replacement using a free peritoneal tubal graft in a dog. Transperitoneal exploration of the upper urinary tract of 6 Mongrel dogs was performed and creating a free peritoneal graft. A 2cm segment of right upper ureter was excised, while the left ureter was left as a control. This segment was replaced by a peritoneal tube around a 6 F double-J ureteral stent which was removed after one month. Follow up intravenous urography [IVU] and abdominal ultrasonography were done prior to autopsy. All animals were sacrificed 3 months after the initial procedures for gross and histopathological assessment. All animals survived the entire follow up of 3 months without serious complications. Two months after stent removal, follow-up IVU and abdominal ultrasonography revealed that variable degrees of hydroureteronephrosis were noticed on the right kidney and ureter with normal left side. At the time of sacrifice, there was moderate to severe hydroureteronephrosis above the level of the periotoneal tube in all animals. Abdominal adhesions and narrowing of the ureteral lumen at the site of the graft were observed. Histopathological interpretation showed that the urothelium was creeping over the mesothelial graft with focal inflammation and fibrosis in all cases while local osseous metaplasia of the graft was noticed in three dogs. Ureteral replacement by peritoneal tube was unsatisfactory despite the usage of ureteral stent. Further studies are needed to evaluate the use of peritoneal patch graft or other biomaterials for ureteral reconstructions

Significance of P21 and C-mye expression in urinary bladder lesions

Immunohistochemical tissue expression of the anti- proliferative marker P21 and the oncogenic marker C-myc were estimated in 40 cases with non-neoplastic and neoplastic urinary bladder lesions with or without schistosomal infection to assess the significance of their expression as a diagnostic tool in patients with higher risk of developing cancer bladder. P21 expression was detected in 50% of simple cystitis cases and all cases with premalignant changes were positive for P21 immunoreactivity expressed into about 16% of urothelial cells. Eighty-five% of malignant cases expressed P21 in 48-55% of urothelial cells without significant variance between different histologic tumor types. Extent of P21 expression inversely correlated with bilharzial association, upgrading of malignancy and tumor invasiveness. C-myc was detected in 80% of simple chronic cystitis cases [75% cytoplasmic, 25% cytoplasmic and nuclear expression] and in all cystitis cases with premalignant changes [as cytoplasmic and nuclear expression]. Eighty-nine% of cancer cases were C-myc positive with predominance of nuclear expression to be seen in 16.74 and mixed with cytoplasmic expression in another 58.3% of positive cases. Malignancy upgrading and invasiveness raised C-myc positivity. It was concluded that P21 expression increases in an attempt to check cellular proliferation, while the increase in the oncogen C-myc goes ahead. Loss of P21 and increased C-myc expression in a malignant lesion is a predictor of malignancy progress to higher grade or stage

Immunohistochemical alterations of the small penile arteries in impotent patients

This study included 20 organically impotent men. All patients were subjected to history taking, general and local examination, biothesiometry test, papaverine and phentolamine test, duplex, rigiscan and cavernosometry examination. The study also included five control cases from the postmortem room. For all included cases, an open biopsy was taken from the cavernous tissue of the mid shaft of the penis. The prepared histologic sections were stained by hematoxylin and eosin stain, PAS [periodic acid Schiff] and Ulex Europeans agglutinin type-1 lectin [UEA-1] immunostaining to detect the changes in the endothelial cells. Based on the results, it was concluded that the endothelial alterations in the vascular spaces of the corpora cavernosa in impotent patients are functional rather than morphological

use of various serum indicators as markers for the extent of muscle necrosis in acute limb ischaemia; an experimental study

This experimental study aimed at the determination of an objective parameter that could help differentiate between severe but reversible acute limb ischaemia and irreversible muscle damage. The experiment included 16 dogs that were divided into 4 groups [plus a control group of 7 dogs]. These dogs were subjected to acute ischaemia of one pelvic limb. The duration of ischaemia was considered as followed; group [1] 3 hours, group [2] 6 hours, group [3] 12 hours and group [4] 21 hours. A systemic venous sample was obtained at the end of the duration of ischaemia and was assessed for the following; myoglobin, creatine kinase [CK], lactate dehydrogenase [LDH] and aspartate aminotransferase [AST]. At the end of duration of ischaemia, a gastrocnemius muscle biopsy was also taken from each of the ischaemic limbs for assessment of the extent of muscle ischaemia and necrosis. Comparisons were made between various marker levels at different intervals and their control levels. For each marker, levels at various ischaemic intervals were also compared to one another. The results revealed increase in levels of the markers at different intervals with a peak value at 6 hours [of statistical significance for all with the exception of LDH], followed by a subsequent decline to lower levels mostly comparable to the 3- hour ischaemic period levels