Leukoscan [sulesomab-monoclonal antibody] scintigraphy in infectious bone and joint diseases

When clinical data are insufficient to diagnose infrction of bone or joints, nuclear scanning becomes crucial in making an accurate diagnosis. The efficiency of' technetium-99m antigranulocyte monoclonal antibody Fob fragment [leukoscan] was evaluated in 66 patients with suspected muscloskeletal infection and was compared with technetium- 99m methylene diphosphonate bone scan in 54 patients. The overall sensitivity of leukoscan and MDP bone scan was 94.4% and 86.5% respectively Specificity was 91.6% and 50% respectively, and accuracy was 94% and 85% respectively. Leukoscan is more accurate in detecting bone and joint infection with better sensitivity and specificity compared with MDP bone scan

Myoview [technetium-99m tetrofosmine] scintigraphy of parathyroid gland in primary hyperparathyroidism

Minimal surgical techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization of the parathyroid swelling. The preoperative accuracy of Tc-99m tetrofosmin was evaluated in 45 patients presented with primary hyperparathyroidism and compared with ultrasonography and Tc-99m pertechnetate studies / Thallium-201 [Tc-O[4]/TL-20I] subtraction. The overall sensitivity of Tc-99m tetrofosmin was 88.8% for double phase study and 91.1% for dual tracer subtraction and that for Tc-99mO[4]/TL-201 subtraction was 80% and US was 73.3% with high significant difference. High reliability and accuracy of Tc-99m tetrofosmin in pre-operative localization of parathyroid adenoma

Management of recurrent and / or metastatic well-differentiated cancer thyroid; retrospective and prospective study

The management of recurrent and / or metastatic differentiated thyroid carcinoma is a challenging task. Therapeutic intervention depends on the type of the initial treatment, the site and the extent of the disease. To investigate the patients who presented with local recurrence [LR] and/or distant metastases [DM] from differentiated thyroid carcinoma [DTC] and to evaluate methods of treatment and patients' response to therapy. The study included 90 patients who presented with local recurrence [69 patients, 77%] and/or distant metastases [21 patients, 33%]. Papillary carcinoma was the most common histopathology [61 patients]. Most of the patients who presented with recurrence had suboptimal primary treatment, 42 patients [4 7%] had hemi-thyroidectomy and 19 patients [21%] received no radio-active iodine therapy [RAI]. Patients were managed by combined modalities, mainly surgery and RAI apart from 6 patients who received external beam radiotherapy. The patients were followed up for 3 years using I-131 whole body scan and thy roglobulin level. Disease free survival [DFS] was 61% and 65% excluding the patients lost from follow up. Optimal management of patients with DTC is essential to minimize the incidence of recurrence. Surgery, RAI and to a lesser extent external radiotherapy play the main role in the management of patients with recurrent and/or metastatic DTC

Ultrasound-guided intraperitoneal cisplatin after the maximum cytoreductive surgery of pseudomyxoma peritonei

In the past, pseudomyxoma peritonei was considered an incurable disease and often no active treatment was given. With the advent of cyto-reductive surgery, including peritonectomy procedures and intra peritoneal chemotherapy, long-term survival of these patients became actually possible. To study the impact of the intraperitoneal hyperthermic chemotherapy [cisplatin], when locally administered in patients who presented with pseudomyxoma peritonei and were treated by extensive cyto-reductive surgery. Nine patients with and. peritoneal adenomucinosis or carcinomatosis arising from the appendix who presented with a clinical picture of pseudomyxoma peritonei were diagnosed, and treated by cyto-reductive surgery followed by 6 cycles of ultrasound-guided intraperitoneal hyperthermic cisplatin. Following aggressive surgical approach and intraperitoneal chemotherapy, 7 patients had 1 year disease free survival, achieved independent activity in daily living and had an improved quality of life. The other 2 patients developed recurrences at 8 and 10 months following the completion of treatment. No major [grade III] texicities were observed. Pseudomyxoma peritonei is a treatable condition that may result in long-term disease free survival. Successful management can be achieved by combining cyto-reductive surgery and intraperitoneal hyperthermic chemotherapy

Cost-effectiveness of low-dose continuous infusion gemcitabine plus cisplatin versus standard dose gemcitabine plus cisplatin in stage III and IV non-small cell lung cancer

The purpose of this study was to assess the efficacy of low-dose continuous infusion gemcitabine 200 mg/m[2] once weekly on three consecutive out of 4 weeks for 6 cycles compared to the standard-dose gemcitabine 1000 mg/m[2] plus cisplatin in stage III and IV non-small cell lung cancer. Experimental Forty patients of non-small cell lung cancer with stage III and IV who are indicated for chemotherapy received low-dose continuous infusion gemcitabine 200 mg/m[2] plus cisplatin compared to forty patients of non-small cell lung cancer with stage III and IV who received the standard dose gemcitabine 1000 mg/m[2] plus cisplatin. The maximum duration of infusion of gemcitabine in combination with cisplatin was 24 hours with a dose of 200 mg / m[2] / day once weekly on three consecutive out of 4 weeks for 6 cycles. Cisplatin was given once every cycle with a dose of 100 mg/m[2]. This was compared to the standard-dose of gemcitabine 1000 mg/m[2] combined with cisplatin 100 mg/m[2] every 3 weeks for 6 weeks. Severe stomatitis, oesophagitis and myelosuppression were the worst common dose-limiting toxicities. Febrile neutropenia was observed in 8 out of the 40 patients who had received low-dose continuous infusion of gemcitabine as they developed bacteraemia. Occasional nausea, vomiting and diarrhea were also reported in both arms. There were 6 complete responses and 4 partial responses in the arm who received low-dose continuous infusion compared to 8 patients who had complete response and 4 patients with partial response in the standard dose arm. Low-dose continuous infusion gemcitabine for 24 hours with a dose of 200 mg/m[2]/day once weekly on three consecutive out of 4 weeks for 6 cycles gives results that are comparable to those of the standard-dose of gemcitabine but with a higher toxicity profile

Pre-operative chemo-radiotherapy followed by surgery compared to surgery alone in patients with stage II and III esophageal cancer

Current primary treatment options for esophageal cancer are surgery only or concomitant chemo-radiotherapy [CRT] and the long-term survival of patients with locally-advanced disease is rare. Pre-operative concomitant CRT seems to be beneficial, mostly in patients who achieve a complete pathologic response [pCR] after CRT. In this study the efficiency and toxicity of pre-operative CRT in patients with locally-advanced esophageal cancer was analyzed as well as the influence of CRT on the survival. Thirty patients with stages II and III esophageal cancer were randomly assigned to surgery alone and another 30 patients were assigned to surgery after 80 mg/m[2] cisplatin on day 1, 800 mg/m[2] fluorouracil on days 1 - 4, with concurrent radiotherapy of 45 Gy given in 22 fractions over 4.5 weeks. The primary end-point was progression-free survival and the secondary end-points were overall survival, tumor response, toxic effects, patterns of failure and quality of life. Progression-free survival and overall survival did not differ between both groups [PFT P=0.16, Median survival P=0.34]. The chemo-radiotherapy and surgery group had more complete resections with clear margins than did the surgery alone group [24 of 30 [80%] versus 14 of 30 [47%], P= 0.001], and had fewer positive lymph nodes [11 of 30 [37%] versus 20 of 30 [67%], P= 0.012]. Neo-adjuvant chemo-radiation [NCRT] followed by surgery is associated with a small non-statistically significant improvement in the overall survival. Whether this benefit is sufficient to warrant the considerable expense and risk associated with NCRT should be the subject of further larger randomized trials

Estrogen recceptor-beta in cancer prostate: clincal and immunohistochemical study

The role of estrogen and its receptors in the etiology and progression of prostate cancer [PC] is poorly understood. This study was designed to determine the patterns of estrogen receptor-beta [ER-beta] expression in malignant human prostate and its association with the clinical outcome. Fifty radical prostatectomy specimens from patients with clinically localized PC were assessed for ER-beta expression using immunohistochemistry [IHC]. Out of the 50 cancer specimens, only 8/50 [16%] were ER-beta positive. Statistically, the ER-beta presence in PC specimens was studied in relation to the different prognostic variables. The ER-beta positivity was statistically significant in association with the prostate gland-confined tumor [p=0.4794], the seminal gland invasion [p=0.0001], pelvic lymph node metastasis [p=0.0080] and Gleason grade [p=0.0044]. The disease relapse was significant in association with the ER-beta immuno-positivity [p=0.1179]. On the other hand there was no significant association with prostatic specific antigen [PSA] level and surgical margins invasion [p=0.9746 and 0.9017 respectively]. We demonstrated that the ER-beta expression in prostate cancer is associated with higher Gleason grade tumours and with higher metastatic potential. The ER-beta could be one of the key processes leading to uncontrolled growth of prostate epithelial cells

Management of peptic ulcer and enterogastric reflux following conventional gastrojejunostomy and "UNCUT" roux gastrojejunostomy

"Uncut" Row gastrojejunostomy had been described for management of postgastrectomy alkaline reflux gastritis and delayed gastric emptying, bus not as primary treatment of chronic duodenal ulcer. This work aims at assessment of enterogastric reflux after truncal vagotomy and uncut Roux gastrojejunostomy in management of chronic duodenal ulcer. Out of 29 patients with chronic duodenal ulcer. 12 were managed by truncal vagotomy [TV] and uncut Roux gastrojejunostomy [UCRGJ], while 17 patients were managed by truncal vagotomy and conventional gastrojejunostomy [GJ]. Enterogastric reflux [EGR] was assessed in both subgroups, before and after surgery, using milk-HIDA scan, and the results were compared to 20 matching healthy controls. EGR showed insignificant increase follows TV+UCRGJ, while it was significantly higher after TV+GJ 3-9 months after surgery, As well the mean EGR was significantly higher in patients with TV+GJ compared to those with TV UCRGJ and controls [16.3 +/- 9.58% Vs 2.6 +/- 3.5% and 1.4 +/- 2.53%] [F=39.931, p=0.000]. Also, patients with TV +UCRGJ had a significantly lower incidence of abnormal EGR compared to those with TV+GJ [16.7% Vs 88.2%] [X[2]=14.854, p=0.00012]. "Uncut" Row gostrojejunostomy is a physiological procedure to be performed as a primary management of chronic duodenal ulcer, as it is not associated with increased enterogastric reflux