Platelet and neutrophil cross-talk-mediating cancer growth and metastasis in patients with urinary bladder cancer

The initial selectin-dependent events that mediate tumor cell tethering to platelets, leukocytes, and vascular endothelium can regulate the extravasation and colonization of metastatic cells into distant tissues. We aimed to clarify the role of selectin-selectin ligand interactions in tumor growth and progression in patients with bladder cancer. Thirty patients with bladder cancer were the participants in this study classified as follows: locally invasive group [n = 10], urinary bladder cancer group with regional lymph node involvement [n = 10], and urinary bladder cancer group with regional lymph nodes and distant metastasis [n = 10]. Flow cytometry was used to determine both the platelet surface expression of P-selectin [CD62P] and the neutrophil surface expression of PSGL-1 [CD162], whereas enzyme-linked immunosorbent assay was used for the assay of soluble P-selectin. Neutrophil PSGL-1 expression among the different groups studied was not statistically significant. However, there was enhanced platelet activation as evidenced by increased platelet surface expression of P-selectin together with an increase in its soluble form, which was more prominent with advancement of the disease, especially in patients with distant metastasis. Also, a strong positive correlation was found between platelet P-selectin and its soluble form with the tumor grading. In addition, stepwise multiple regression analysis showed that both P-selectin and platelet count are significant independent determinants for the stage of bladder cancer, suggesting augmentation of P-selectin-ligand interaction. These data preclude that disease progression in patients with bladder cancer is dependent on the complex interaction between P-selectin and its ligand. Targeting of these molecules may represent a unique approach to tumor therapy and prevention of metastasis

Impact of neutrophil apoptosis on haemostatic activation in chronic liver disease patients

Recent studies suggest the impact of apoptosis on the mechanisms leading to hypercoagulability. We aimed to clarify the potential role of neutrophil apoptosis in neutropenia and hypercoagulable state encountered in chronic liver disease patients. This study was conducted on fifteen normal controls and fourty five patients with chronic liver disease classified according to modified Child Pugh classification into, Child A, B and C groups [15 cases each]. Studied Haemostatic parameters include, prothrombin time, partial thromboplastin time, tissue factor, protein C antigen, protein S antigen, and markers of haemostatic activation [prothrombin fragment 1+2, thrombus precursor protein and D-dimer]. Flowcytometric study was done for quantitative assay of neutrophil apoptotic subpopulations to detect the percentage of early and late apoptotic, and necrotic neutrophils using AnnexinV-FITC/Propidium iodide dye. Semiquantitative assay of apoptotic neutrophils showing DNA fragmentation was performed on neutrophil culture using terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labeling [TUNEL] test. In addition to enzyme linked immunosorbent assay for soluble Fas [APO-1/CD95] in culture supernatant. The results revealed a rise in the neutrophil apoptotic and necrotic markers with progression of the disease, and they were inversely correlated with the absolute neutrophil count. The apoptotic neutrophil cells showed a significant positive correlation with several haemostatic parameters [tissue factor, prothrombin fragment 1+2, thrombus precursor protein and Ddimer], which further incriminate the apoptotic mechanisms in the hypercoagulable state encountered in this clinical setting. Enhanced neutrophil apoptosis and necrosis in patients with chronic liver disease may explain in part the mechanism of neutropenia in these patients and may be one of the important factors which drive the haemostatic balance towards the hypercoagulable state

Doppler ultrasonogragshic evaluation of portal circulation in patients of portal hypertension treated by splenectomy, devascularization and oesophageal transection

The portal hypertension with bleeding oesophageal varicose is a major medical problem in Egypt, the risk of death from 10% to 40% in these patients due to massive secondary heamorrhage. Splenectomy, Devascularization and Oesophageal Transection is one of the most important lines was used to treatment of bleeding oesophageal varices in patients suffering from portal hypertension particularly after failure of upper gastrointestinal tract endoscopy. The doppler Ultrasonography is simple,non invasive investigation to determine the blood vessels diameter, direction of blood flow, blood volume and degree of vascular congestion. The portal circulation evaluated pre and post operative by doppler Ultrasonography in 50 patients [41 males and 9 females] suffering from portal hypertension and oesophageal varices [Child A or Child B] and treated by Splenectomy, Devascularization and Oesophageal Transection to determine the degree of correction of the hemodynamic state. The portal vein diameter decreased after the operation by 1.5 mm, cross sectional area by 0.42 cm while its flow velocity increased after the operation by 3.22 ' cm/sec Its flow volume increased after the operation by 49.2ml/min and its congestive index decreased after the operation by 0.07cm/sec.So the operation is effective in the treatment of portal hypertension and oesophageal varices as it improves liver blood flow and liver perfusion. It also eradicated oesophageal varices

Relation between thrombin activatable fibrinolysis inhibitor and haemostatic alterations in patients with chronic liver disease and portal vein thrombosis

Recently, a new inhibitor of fibrinolysis was discovered which down regulates fibrinolysis after its activation by thrombin and was therefore named thrombin activatable fibrinolysis inhibitor [TAFI]. We aimed at evaluating TAFI level in chronic liver disease [CLD] and its relationship to important haemostatic parameters namely: tissue factor [TF], prothrombin fragment 1+2 [Fl+2], thrombomodulin [TM], protein C [PC], protein S [PS], thrombus precursor protein [TpP] and D-dimer [D-di] in a trial to clarify the role of TAFI in haemostatic alterations frequently encountered in CLD. The study included 35 CLD patients [Chid B or C], 15 [out of them] were complicated by portal vein thrombosis [PVT], in addition to 15 healthy controls. Significant reduction in TAFI level was detected in CLD patient with and without PVT in comparison to controls, however a significantly higher values were noticed in patients complicated by PVT when compared to those without thrombosis. Correlation analysis demonstrated a strong correlation between TAFI level and other measured parameters namely PT, PTT, PC, PS and D-dimer in PVT group. It could be concluded that TAFI plays a crucial role in regulation of coagulation and fibrinolysis. Reduced TAFI level in patients with CLD could result in up regulation of fibrinolysis. High TF level, associated with decreased natural anticoagulants namely PC and PS accompanied by a higher TAFI level and its increased activation could play a role in the development of PVT as a complication of CLD

Surgical management of hydatid liver cysts; inra-operative pair, cysto-pericystectomy and omentoplasty

Liver hydatid cysts caused by Echinococcus granulosus presents medical, veterinary and economic problems worldwide. In an attempt to eradicate liver hydatid cysts by eliminating the parasite, disappearance of the residual cavity, preventing complications and recurrence, the present study was done in Theodore Bilharz Research Institute on 36 patients. They were 11 females and 25 males with age ranging between 18-55 years old. All patients were sub to a full history taking and clinical examination, a full battery of hematological, biochemical, immunological and radiological investigations. Intra-operative Puncture Aspiration Injection and Re-aspiration [PAIR] was performed to all cysts before surgical intervention. Total cysto-pericystectomy [CPC] was done in 25 patients with both open and closed technique. Partial cysto-pericystectomy was done in 11 patients due to firm adherence of the cyst to the liver structures. Omentoplasty [OP] was performed to fill all cavities accompanied with external open system drainage tube. There were no mortalities in this study. Post operative complications were found in 7 patients. Cystectomy and omentoplasty related complication were found in 3 patients, General surgical complications were found in 1 patient. Biliary related complications occurred in 3 patients in the form of biliary leak in 2 patients and biliary fistulae in 1 patients. All these complications responded well to conservative management. A combination of different radical and conservative surgical modalities in the same sitting in the form of intra-operative Puncture Aspiration Injection and Re-aspiration, cystopericystectomy and omentoplasty could be considered the surgical method of choice with no mortality

Zinc variation during liver regeneration following partial hepatectomy in schistosomiasis [experimental study]

This study aimed to estimate the serum level and hepatic content of zinc in experimental schistosomiasis as well as their alteration during liver regeneration following partial hepatectomy. The included animals were divided into two groups, schistosomal [40 hamsters] and non-schistosomal [33 hamsters]. The hamsters, either infested or not, were subjected to 35% partial hepatectomy [left lateral lobe hepatectomy]. Scarification of animals, collection of blood samples and regenerating liver tissue were done at two days, one, two and three weeks after hepatectomy. The serum level and hepatic content of zinc were estimated biochemically. The rate of hepatic regeneration was studied by histopathological examination and measurement of DNA content in the liver remnant. Hypozincemia with decreased hepatic zinc content was reported in schistosomal group preoperatively. Their DNA content [175.8 ug/g] had significant lower level when compared with the non-schistosomal group [335.75 ug/g]. During liver regeneration, serum zinc declined sharply; however the highest hepatic concentration and peaked DNA content were recorded in the first 48 hours following partial hepatectomy in schistosomal group. The mean liver weight reached a maximum of only 72.3% of its preoperative weight

Cervical lympho-venous shunt versus denver shunt in management of intractable ascites [analysis of 170 cases]

The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results

Study of congenital toxoplasmosis in Egyptian newborns

Five hundred cord blood samples of normal, full term, apparently healthy newborns of both sexes and of different social classes were studied for Toxoplasma antibodies. Eighty nine cases [17.8%] showed a seropositivity for IgG antibodies while specific IgM antibodies were found in 3 cases. A significant higher percentage of seropositivity was found among newborns whose mothers had a previous history of abortion [p <0.01], still birth, permaturity or delivery of infants with congenital anomalies [p <0.001]. The relation between seropositivity and maternal lymphadenopathy and/or fever during pregnancy was highly significant [p <0.001]. Also, a highly significant [p< 0.001] relationship was observed between mothers contact with cats and seropositivity for toxoplasmosis. No statistical differences were found in the seropositivity between the 2 social classes studied, nor between the sexes. The study ensured that the problem of congenital toxoplasmosis in Egypt should be seriously considered and emphasized the importance of serological screening before and during pregnancy for those women who are at greater risk and of newborns

Thrombosed arterio-venous fistulae for hemodialysis

Patients with recurrent thrombosis of access arterio-venous fistulae were selected to clarify the cause of their shunt failure. Antithrombin III being the most important physiological normal circulating anticoagulant which causes progressive irreversible destruction of thrombin in plasma, has been estimated in 43 patients and 20 normal controls. Every patient was subjected to determination of Antithrombin III [ATIII] level by functional assay, 2 weeks course of 5 mg Warfarin/day, re-estimation of ATIII level and then to construction of a new A -V fistula under maintenance dose of 2 mg Warfarin/day. The ATIII time in the patients [25.67 +/- 12.05 sec] was significantly lower than in controls [31.27 +/- 7.66 sec]. After warfarin therapy it increased significantly [30.37 +/- 8 sec] as compared to that before therapy. Patients who had reduced ATIII time showed dramatic response to warfarin therapy and ATIII increased to become within normal or even higher, but no significant change was observed in patients with normal or high ATIII. After three months follow up the new fistulae were patent in all the 12 patients who had low ATIII time which was improved by warfarin in contrary to those with normal or high ATIII time only 15 new shunts were patent out of 31 cases

study of fibronectin in malnourished children

Three groups were studied herein. The first group comprised 22 malnourished infants. The second group comprised 10 infants selected from the first group and followed up after treatment. The third group comprised 12 healthy infants as control. After taking a full clinical history and doing a thorough clinical examination, cases and control were subjected to the following investigations: Complete blood picture, serum albumin, the estimation of plasma fibronectin level by single radial immuno-diffusion, which was repeated twice for the second group, then statistical analysis of the data obtained. Plasma fibronectin showed a marked decrease in cases of malnutrition, which was reversed by treatment of malnutrition. The plasma fibronectin showed a positive correlation with serum albumin which also showed a marked decrease in cases of malnutrition. The lowering of plasma fibronectin in cases of malnutrition showed a statistically significant difference from that of the control, while the rise after treatment showed an insignificant difference from the control i.e. it reached to the normal level