CXCLIO, CCL5 and CCL11 chemokines as predictors for interferon-induced thyroiditis in chronic hepatitis c patients submitted for

Background: Interferon alpha [IFN-q is widely used as a therapeutic agent for Hepatitis C [HCV] infections. Chemokines (including CXCLIO, CCL5 and CCLll] have been identified to play an important role in endocrine autoimmune diseases and particular attention has been raised by studies demonstrating CXC chemokines over expression in Hashimoto thyroiditis. Objective: Study serum levels of CXCLIO, CCL5, and CCLll chemokines as predictors for interfer on-induced thyroiditis in HCV patients submitted for antiviral therapy. Patients and Methods: Seventy two patients with HCV Infection selected from 100 patients submitted for INF-alpha and ribavirin therapy were recruited into; group 1 comprised 59 patients with negative anti-thyroid peroxidase antibodies [ATPO], group 2 comprised 13 patients with positive ATPO, Twenty healthy adults were included as control Thyroid function, auto-antibodies and serum chemokines [CXCLIO, CCL5, and CCLll, assayed by a quantitative sandwich immunoassay] were performed before therapy, after 12 and 24 weeks of treatment. Results: In comparison to group 1, group 2 patients had significantly higher ANA [P=0.03S], ATPO, CXCLIO and CCL5 [all P= 0.000] and significantly lower TSH [P=0.30] before therapy; higher ATPO, CCL5 [all P= 0.001] and lower TSH [P= 0.034] after 12 weeks; higher ATPO and lower TSH [all P= 0.001] after 24 weeks of therapy. Thyroiditis occurred in 10.2 % of group 1 and 38.5 % of group 2 patients after 12 weeks of therapy without significant difference between the two groups. After 24 weeks of therapy, group 2 patients had significantly higher number of thyroiditis [53.8 %] than group 1 [11.9 %] [P=0.001]. Significant increase of CXCLIO was found in patients with thyroiditis [P<0.05] at the end of therapy. Conclusion: As HCV infection might contributes to the initiation of thyroid autoimmunity and interferon induced thyroiditis is a frequent complication of IFN-a therapy, HCV infected patients could be subjected to thyroid screening by utilizing some chemokines as CXCLIO, CCL5 in addition to ATPO for identification of those who are prone to thyroiditis during IFN-a therapy?

Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study

To determine the incidence, risk factors and clinical relevance of incidental parathyroidectomy during thyroidectomy. A total of 207 consecutive patients with benign and malignant thyroid disorders undergoing unilateral or bilateral thyroidectomy were included prospectively in the present study. Patients were divided into two groups according to incidental parathyroidectomy. 210 thyroidectomies were performed. Group A included 26 patients with incidental parathyroidectomy and group B included 181 patients without incidental parathyroidectomy. The parathyroid tissue in the resected specimens was found in intrathyroid [57.7%], extrathyroid [23.1%] and central node compartment [19.2%] sites. On multivariate analysis, two factors sustained their significance independently; reoperation for recurrent goitre [p=0.001] and concomitant central neck dissection [p=0.001]. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia between the two groups [p = 0.55]. Reoperation for recurrent goitre and concomitant central neck dissection for cancer thyroid may increase the risk of incidental parathyroidectomy. Incidental parathyroidectomy is not usually associated with symptomatic postoperative hypocalcemia. Most of removed parathyroid glands are intrathyroid, so incidental parathyroidectomy may be unavoidable

Proximally based versus distally based gluteus muscle flap in treatment of end stage fecal incontinence

To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end stage fecal incontinence. Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap [group III] was carried out in ten patients while, a distally based flap [group I] was done in the other ten. Patients were followed up for 6 - 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging [MRI]. Overall, 6/10 patients [60%] in group I and 8/10 patients [80%] in group II were clinically improved with down staging of their incontinence scores from C3 to 0 [P 0.003 and 0.0001 respectively]. This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month postoperatively showed disruption in three patients. Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty

Thyroid surgery: use of ligasure vessel sealing system versus conventional knot tying method

The aim of this study was to compare the use of conventional knot tying vs. LigaSure Vessel Sealing System [Valley lab, Boulder, Colorado] in patients undergoing thyroid surgery. We hypothesized that the use of LigaSure would reduce the time of operation without more complications. This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. 110 patients were operated upon by the same team of surgeons using conventional knot tying in 55 and LigaSure in 55 patients for hemostasis. The medical records of patients enrolled regarding age, sex, histopathological diagnosis, type of operation performed [lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy]; the operation time, intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, as well as the postoperative pain and outcome were reviewed and compared. The two groups had nearly similar demographic data. We have noticed that patients in the LigaSure[TM] group had significant lower operating times [P = 0.000], lower intraoperative blood loss [P = 0.000], less postoperative pain and early pain-free return to normal activity and return to work [P = 0.0001]. LigaSure Vessel Sealing System was as safe as conventional knot tying method for thyroidectomy, with the benefit of a reduced operating time, decreased postoperative pain and early pain-free return to normal activity and return to work

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation, 5-fluorouracil and oxaliplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006, 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a fourfield technique to a dose of 50.4Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130mg/m[2] on day 1 plus 30 minute infusion of 100mg/m[2] L-folinic acid and continuous infusion of fluorouracil 350mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction. Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [67.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%] the operative specimen was sterilized and in 2/44 patients [4.5%] only very few residual malignant cells difficult to find microscopically were detected. Pathological downstaging was diagnosed in 70.5% [31 out of 44 patient]. Local and distant progression occurred later in 9 patients and the 2-year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were 12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological downstaging and sphincter-saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation. 5-fluorouracil and oxallplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006. 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a four-field technique to a dose of 50.4 Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130 mg/m[2] on day 1 plus 30 minute infusion of 100 mg/m[2] L-folinic acid and continuous infusion of fluorouracil. 350 mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [6 7.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%]. the operative specimen was sterilized and in 2/44 patients [4.5%]. only very few residual malignant cells difficult to find microscopically were detected. Pathological down staging was diagnosed in 70.5% [31 out of 44 patients]. Local and distant progression occurred later in 9 patients and the 2- year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were .12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. - Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological down staging and sphincter saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen