T-lymphocytes subsets variation in breast cancer Egyptian patients

In this work, we investigate T-lymphocytes subsets in breast cancer patients among Egyptian populations to evaluate the immune response towards cancer and understanding their behavior towards tumor and normal cell growth before the influence of chemotheraputic agents under simple immune system response At first stage of disease. T cells are capable of in vivo expansion and provide protection for the immune effector cells re-populating the host. Survival of these cells and long-term memory development in patients with malignancy are necessary for improving clinical benefits of immunotherapy. By measuring CD4 and CD8 we recognized that no change in the helper T cells and Cytotoxic cells in these patients who were prepared to receive chemotherapeutic agents at the first stage and in the control group. T cells have been found with either deficient or normal functional activity in both groups these heterogeneous results greatly confuse the role played by CD4 T cells and CD8 responses. Immunological measures of white blood cell, lymphocyte, CD3+, CD4+, and CD8+ counts, 40 patients were divided into a control group [15] and patients group [25]. Total T-cell, helper T-cell and suppressor T-cell counts which [P<0.05], as well as control T-cell function [P < 0.05] when compared with normative data, were found some significant increase CD4 cells and CD4/CD8 ratio in cell count most of cases no changes to the total leukocyte lymphocyte CD3+and CD8+ count. Our study points out that immune response began to defend against tumor cells after a brief period of tumor stimulation but is still not sufficient to induce strong immune response. These data invite us to focus on period which immune system needs to respond which may help in deciding the possibility of immune therapy and determine when immune therapy can start

Role of avastin in management of central serous chorioretinopathy

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy [CSC]. Prospective interventional series non-comparative study. Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt. The study included 20 eyes of 20 patients with central serous chorioretinopathy [CSC], Out of them 10 eyes with acute CSC [group I], 6 eyes with chronic CSC [defined as symptoms present for longer than 6 months] and four eyes with recurrent [defined as more than one episode of the disease] chronic and recurrent cases are considered in one group [group II], all patients were injected with intravitreal Avastin [IVA] 1.25 mg [0.05 mL] of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity [BCVA], IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography [FA] and optical coherence tomography [OCT] imaging is used for measurement of central retinal thickness [CRT]. Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 [range 1-3 injections] 6-8 weeks intervals and follow up for 6 months [range 5-7 months]. All finding at baseline and each follow up visit were reported and compared. The mean age of all patients was 40.3 years +/- 6.5 [range 25-50 years], 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 [log MAR 0.48] and improved to 20/30 [log MAR 0.18] with statistically significance difference change [P<0.003] and in [chronic and recurrent group], the mean baseline VA was 20/80 [log MAR 0.60] and improved to 20/40 [log MAR 0.30] with statistically significance difference change [P<0.002]. The mean baseline CRT for all patients was 486 +/- 86 micro m [range, 386-580], decreased to 316 +/- 56 micro m [range, 276-368] after 1 months with statistically significance difference change [P<0.02] and to 272 +/- 52 micro m [range 220-338] at last follow up with statistically significance difference change from the baseline [P<0.001]. Intravitreal Avastin [IVA] injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC

Laparoscopic guided transcervical hysteroscopic tubal cannulation in the treatment of proximal tubal block

Proximal tubal obstruction [PTO] represent up to 25% of tubal disease in infertile women. Hysteroscopic tubal cannulation, tubal reanastamosis and IVF are the available modalities for the treatment of PTO The aim of this study is to evaluate the value of treatment of PTO using hysteroscopic tubal cannulation under laparoscopic guidance. Randomized study, Bab El Sharia University Hospital. Thirty infertile patients [either primary or secondary infertility] due to PTO as evidenced by hysterosalpingography were recruited from infertility clinic. Duration of infertility, history of pelvic inflammatory disease and any methods of contraception were asked for. Immediately after menstruation combined laparoscopy and hysteroscopic tubal cannulation were done for each patient. Hysteroscopic tubal cannulation successfully re-established tubal patency in forty [83.33%] out of forty eight tubes originally diagnosed with PTO. No significant relation between success of recanalization and either of duration of infertility, history of PID, method of contraception or type of infertility. There was significant relation between incidence of tubal perforation and duration of infertility as well as history of IUD

Role of staging laparoscopy in the treatment of hepatic malignancy

The present study evaluated the use of laparoscopy in the staging of hepatic malignancy. Twenty patients have underwent staging laparoscopy prior to a planned laparotomy for resection of a hepatic malignancy that was deemed resectable by computed axial tomographic scan and ultrasonography. Patients who underwent laparoscopy alone had shorter mean hospital stay than historical controls who underwent laparotomy alone. It has been concluded that diagnostic laparoscopy should precede laparotomy for planned resection of hepatic malignancies

Immediate transposition of a latissimus dorsi muscle for correcting a postquad-rantectomy breast deformity

With the aim of improving cosmetics after quadrantectomy, an immediate transposition of latissimus dorsi muscle was carried out. Cosmetic breast changes in transposed and non-transposed patients were evaluated by a Moire topography camera. In five patients, the breast deformity has been corrected only by conization of the residual breast tissue and the breast deformity in other five patients has been corrected by transposed latissimus dorsi muscle. Postoperative appearance and topography showed satisfactory symmetry of breasts in the transposed patients when compared with the non-transposed patients. It has been concluded that the immediate transposition of latissimus dorsi muscle is useful for preventing post quadrantectomy breast deformity

Transanal local excision of selected low rectal cancers

To determine if transanal local excision [TALE] of selected early low rectal cancer is an effective alternative to more radical resection and to determine the need for adjuvant radiotherapy in patients, a retrospective analysis of eight cases over a period of six years was done. Local recurrence occurred in one of three T1 cases, two of five T2 cases. Two of the patients with local recurrence did not receive irradiation while one has received. Two of them had salvage resection and one is alive with no evidence of disease at 21 months post-salvage. Recurrence-free survival at five years was 80% in the irradiated patients and 48% in the unirradiated. Transanal local excision of selected low rectal cancers combined with adjuvant radiotherapy results in low recurrence rate and is, therefore, an effective alternative to more radical resection

Elevated thrombomodulin plasma level in preeclampsia as a measure of disease severity

This study was carried out to assess the relationship between serum thrombomodulin and preeclampsia. Venous plasma samples were collected from 78 pregnant women; 18 women with severe preeclampsia, 21 women with mild preeclampsia and 39 normotensive healthy women with singleton pregnancies in the third trimester. The effect of preeclampsia on thrombomodulin release from endothelial cells was tested. Thrombomodulin levels were measured with specific immunoassays. Plasma thrombomodulin levels [mean +/- standard error of the mean] were elevated in pregnant women with severe preeclampsia [16.8 +/- 2.2 compared with 9.1 +/- 0.6 [matched control] n/ml]. Also, serum thrombomodulin levels correlated positively with serum creatinine and serum uric acid levels. In severe preeclamptic pregnancies, serum thrombomodulin levels were significantly high; therefore, elevated serum thrombomodulin levels can serve as a clinically important marker in the differentiation of the severity of preeclampsia

Laparoscopic appendectomy does not change the incidence of postoperative infectious complications

It is not clear whether the laparoscopic approach does decrease the incidence of postoperative infectious complications after appendectomy. One hundred twenty nine patients were randomized, 67 with laparoscopic [LA] and 62 with open appendectomy [OA]. Patients in the OA group had a Mc Burney incision, LA was performed in the Lithotomy position. Acute appendicitis was confirmed in 85 percent of patients. The appendix was perforated in 5 patients of the LA versus 2 of the OA group. No conversion to the open procedure was necessary. The median operating time was 35 minutes in the LA group and 31 minutes in the open group [P=0.58]. The median postoperative hospital stay was shorter after Laparoscopic than after open surgery [2 days versus 5 days P= 0.026], where as the time required for return to work was not significantly different [14 versus 15 days]. There were 5 [7.4 percent] patients with superficial wound infection following LA and 6 [9.6 percent] after OA [P=0.67]. Intra-abdominal fluid collections were found in 2 [2.9 percent] patients following LA and 3 [4.8 percent] patients following OA [P =0.60]. In the LA group, 3 patients presented with intra abdominal hemorrhage and another 3 developed a paralytic ileus that was treated conservatively. Laparoscopic appendectomy is as safe as and as effective as the open procedure, however it does not decrease the rate of postoperative infectious complications

Risk of lymphoedema following the treatment of breast cancer

This study included 20 female patients who had lymphoedema following a variety of treatment for operable breast cancer .Our study was assessed in the surgical department of El Minia University Hospital from 1992 to 1997.Patients who had been followed for at least one year after breast surgery were eligible for inclusion in the study, while those with bilateral breast cancer were excluded. Lymphoedema was assessed in two ways: subjective [patient plus observer impression] and objective [physical measurement]. Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing difference in size of the operated and normal arm. Arm circumference measurement were inaccurate. Subjective lymphoedema was present in 15 percent whereas objective lymphoedema [a difference in limb volume >200 ml] was present in 80 percent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery [P <0.05], axillary radiotherapy [P<0.001] and pathological nodal status[P<0.10]. The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radio therapeutic complication, total dose of radiation, time interval since presentation, drug therapy, surgery to breast, radiotherapy to the breast and tumor T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone or axillary sampling plus radiotherapy [0 percent], while axillary clearance alone was [25 percent]. The incidence after axillary clearance plus radiotherapy was significantly greater [33.3 percent, P<0.001]. Axillary radiotherapy should be avoided in patient who have had a total axillary clearance

Unusual abscess pattern following dropped gallstones during laparoscopic cholecystectomy

Laparoscopic Cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. Between 1995 and 1998, 200 laparoscopic cholecystectomy were performed at El-Minia Surgical Department, 3 patients [1.5 percent] subsequently developed abscesses as a consequence of dropped stones during the Laparoscopic Cholecystectomy, while 2 [1 percent] other patients developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. This experience closely resembles that of the other centers and points out the existence of late postoperative complications following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies from avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of surgery with or without placement of a drain in the subhepatic space does not prevent this complication

Extra-amniotic saline infusion plus intracervical foley catheter balloon versus intravaginal misoprostol for inducing labour in patients ith intrauterine fetal death

This study was carried out on 106 pregnant women with a late fetal death to assess the effectiveness of extra-amniotic saline infusion plus intracervical Foley catheter balloon with intravaginal misoprostol in ripening of the cervix and inducing labour. The patients were randomly assigned into two groups: Group one included 52 patients received a dose of 50 ug intravaginally and group two included 54 patients r and omized to extra-amniotic saline infusion [EASI]. A size of 18 Foley catheter was inserted through the cervix. The results have shown that there were no significant differences in maternal age, parity, gestational age or indications for the induction between the two groups. EASI group required augmentation with syntocinon more frequently than intravaginal misoprostol group [22.2%] compared with 7.7% [RR 3.2, 95% CI 1.6-6.5]. The induction-to- delivery interval [ +/- SD in EASI group was 13 +/- 5.3 hours which was significantly shorter than the intravaginal misoprostol group, 15.3 +/- 5.3 hours. The extra-amniotic saline infusion group had a significantly lower initial dilatation; however, at eight hours, this group was significantly more dilated than that of misoprostol group [22 vs 7], respectively, with a mean final bishop score of 6.7 +/- 2.1 vs 5.4 +/- 2.1 in the EASI and misoprostol group, respectively. Maternal morbidity was more or less similar in extra-amniotic saline infusion group and intravaginal misoprostol group

Clinical and therapeutic studies on parasitic gastroenteritis in sheep

Screening of 600 sheep for gastro-intestinal helminths revealed that 395 were harbouring nematodes eggs with an overall incidence of 65.83 percent. Lambs aged 3-12 month were more susceptible for parasitic infestation [71.74%] followed by animals over 2 years old [63.15%]. The highest rate of infection was noticed during autumn and winter while moderate drop was observed during spring and summer seasons. Haemonchus contortus, Tri-chostronylus spp., Ostertagia spp, Bunstomum spp., Chabertia ovina, Stronyloides papillosus, Nematodirus spp. Oesophogostomum spp. and Trichuris ovis were identified through faecal culture. The antihelmintic efficacies of ivermectin, fenbendazole, oxfendazole and thiabendazole were tried. All durgs were being effective as reducing the faecal egg counts of trichostro-ngylus spp. from nil to 7 days after medication. Thiabendazole failed to remove Trichuris ovis burdens while a cure rate of 100 percent was obtained by ivermectin injection. Strongyloides papillosus infection was reduced by 100% and 90.63% with ivermectin and fenbendazole respectively. Significant decrease [P < 0.05] of erythrocytic count, haemoglobin content, packed cell volume percent, serum total proteins and serum albumin and significant increase [P < 0.05] of total leucocytes, eosinophils, neutrophils, immature neutrophils, monocytes and serum globulins were the noticeable changes in sheep naturally infected with gastrointestinal nematodes. These changes were more or less normalized after the end of treatment depending upon the type and severity of infection and the efficacy of antihelminthic used. Significant decrease of RBCs, Hb content, serum total proteins, serum albumin as well as leucocytosis were the noticeable changes in sheep naturally infected with gastro intestinal nematodes