Radionuclide-assisted sentinel lymph node localization and biopsy in management of early invasive breast cancer

The value of sentinel lymph node[s] [SLN[s]] biopsy rests on the concept that a single lymph node [sentinel node] is the first of a group of lymph nodes that receives drainage of a specific body segment. In theory, by surveying this single node, tumor movement from the primary site can be predicted for the remainder of the lymph node basin. Should the sentinel node be free of tumor, the remaining lymph nodes of the basin are presumed to be negative, and the patient may be spared unnecessary axillary lymph node dissection. This study was conducted at 3 different centers during the period from December 2002 till May 2006. The study involved 60 females with early invasive breast cancer [T[1]-T[2], Clinically N[0] M[0]]. Localization of SLN[s] was performed by the combination of 3 techniques; operative lymphoscintigraphy, and intraoperative isosulfan blue dye mapping and hand-held gamma probe. After localization and excision of sentinel lymph nodes, axillary dissection, as well as, surgical management of the primary tumor was done. The specimens of SLN[s], non-SLN[s], and the primary tumor were examined separately for histopathology. Correlation between SLNs involvement and non-SLN[s] involvement was done. Among the 60 patients with early invasive breast cancer, the overall SLN[s] localization was successful in 90% cases. The sensitivity, the specificity, the predictive value positive test, the predictive value of negative test, as well as the accuracy of the histopathological yield of the SLN[s] biopsy were found to be 91.3%, 100%, 100%, 93.9% and 96.3% respectively. SLN[s] localization and biopsy is a good predictor of the histopathological status of axillary lymph nodes and can prevent unnecessary axillary dissection in early stages with node negative invasive breast cancer. The use of lymphoscintigraphy and gamma probe facilitates localization of SLN [s] and increases its accuracy

Serum leptin level in type 1 diabetes mellitus

Diabetes mellitus is the most common endocrine metabolic disorder of childhood. Leptin a hormone produced by adipocytes is essential for proper growth and development. Acting primarily on the hypothalamus, and has effects on appetite, energy expenditure and the neuroendocrine axis. The present study was designed to estimate serum leptin levels in type 1 diabetes mellitus and its correlation to age, sex, growth and BMI. The study was conducted on 20 patients [8 males and 12 females] with IDDM and 10 healthy children as control group [8 males and 2 females]. They were subjected to full history taking, clinical examination, assessment of weight, height, and BMI Serum leptin was measured by ELISA technique, Fasting, and two hours post prandial Blood glucose and serum insulin level were measured. Our results show: serum leptin level was insingnificantly lower in males than females, there was significant positive correlations between leptin level and body weight and BMI. positive correlation between serum leptin and serum insulin levels. But no significant correlations was found between serum leptin and Blood glucose level

Zinc supplementation in acute diarrhea, does it affect copper status?

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children. In randomized double blind controlled clinical trial we evaluated the adverse effect of zinc supplementation on serum copper when used for treatment of mate infants and children [age 3-36 months] suffering from acute diarrhea. The study was carried out at Diarrheal Disease Research and Dehydration Center [DDRRC] at Bab El-Sha'reya University Hospital for one year. One hundred cases with some dehydration according to WHO classification were admitted to hospital and randomized to received either zinc or placebo for 14 days. The following investigations were performed at admission: serum Na, K, zinc, copper and hemogram. All cases were asked to come for follow up visit at the end of therapy [14 days from admission data]. At follow up visit serum for zinc and copper was investigated. At admission serum zinc and copper were within normal range in both zinc and placebo groups and without statistically significant difference. The mean duration of diarrhea for zinc treated group was shorter than that in placebo group [46.2 +/- 22.2 versus 48.9 +/- 23.9 hours] but the difference between the two groups was not statistically significant. Only 80 cases were followed up. On follow up visit serum copper was lower in zinc group than that in placebo group but the difference was not statistically significant. It is concluded that zinc supplementation for 14 days in management of acute diarrhea has no effect on serum copper

Fecal lactoferrin, fecal leukocytes and occult blood in the diagnostic approach to childhood invasive diarrhea

This study was carried out on 60 children with acute diarrhea, from pediatric department faculty of medicine, A-Azhar University, from November 2002 to Jne 2003, their mean age was [3+1.5] years. To evaluate the value of fecal lactoferrin, [F.LF] fecal leukocytes [F.L] and fecal occult blood [O.B] in the diagnostic approach to childhood invasive diarrhea. Our results showed that 20% had campylobacter, 16.5% with shigellosis 9.2% had E. Coli, 6.6 with Salmonellosis, 9.2% had entamebia, 5% with giardia, 3.3% with cryptosporidium and 31.6% with no pathogen. Also our results revealed the sensitivity of individual tests was 97.12%, 78.7% and 68.95% in FL.F, O.B and F.L. respectively. On the other hand the negative predictive values in combined tests was 100% in both FLF+FL and FLF + OB while it was 87.9% in FL+OB. So FLF showed a greater over all sensitivity than FL or OB for detecting invasive pathogen and the combination of FLF or FL and of FL.F or OB or both yielded sensitivities and negative predictive value close to 100%. Conclusion FLF was the most accurate index test, it may be viewed as the screening test of choice to avoid expensive stool culture in the diagnostic approach to invasive diarrhea