Potential role of cadmium in varicocele-associated infertility and its relation to smoking

To study the possible role of cadmium in varicocele-associated infertility and its relation to smoking. Patients: the study was performed on twenty infertile men with clinically evident varicocele [grade II and III]; half of them were smokers. In addition to another twenty fertile men without clinical varicocele and with normal semen parameters served as a control; half of them were smokers measuring Cadmium level in the seminal plasma using the atomic absorption spectrophotometer. Statistically significant observed differences in seminal parameters between the studied cases and their control regarding decreased sperm concentration and motility, in addition to increased abnormal sperm morphology among cases [P=0.0001, 0.0001 and 0.02 respectively]. A statistically significant high level of cadmium is demonstrated in seminal plasma of non smoking cases as compared with their non smoking control [p<0.0001], and in seminal plasma of smoking control in comparison to non smoking control [p<0.002]. Moreover, the level of cadmium detected in seminal plasma of infertile smokers was higher than that of smoking control [P=0.001]. Partial correlation between cadmium and seminal parameters of the studied cases and control, in the present study, revealed that cadmium is correlated with sperm concentration and motility even after adjustment for smoking, non smoker/ even smoker, [P=0.009 and 0.003 respectively]. the current study supports that environmental exposure to cadmium leads to its accumulation in seminal plasma of patients with varicocele-associated infertility. High level of cadmium is associated with impairment of seminal parameters. In addition, cigarette smoking exacerbates the detrimental effect of varicocele on semen quality and the fertility potential by more accumulation of cadmium in seminal plasma

Prevalence of staphylococcus aureus superantigen genes among Egyptian children suffering from atopic dermatitis

Researchers reported high carriage rate of S.aureus on skin of Atopic dermatitis [AD] patients with suggestion of local production of exotoxin causing the inflammatory condition. The objective of this study was to identify prevalence of S. aureus on skin of AD children and to test for presence of superantigen genes using multiplex PCR. 118 swabs from AD children and 40 swabs from apparently healthy children were subjected to routine microbiologic culture. Revealed S. aureus isolates have been further subjected to Multiplex PCR for detection of superantigen gene sequences. S. aureus strains have been isolated from 40 out of 118 AD patient [33.8%] and in 26 out of 40 skin swab among the control group [65%]. Detection of superantigen gene sequence positivity by multiplex PCR was 82.5% in S. aureus isolates from AD patients which is statistically significant higher than the controls 0% [X[2]=42.9]. Our study agree with studies accusing S. aureus carrying superantigen genes as one of the causes triggering atopic dermatitis evidenced by absence of these genes in strains isolated from healthy children versus a high rate of detection in strains isolated from AD children. Our novel observation that S.aureus not carrying superantigen coding gene have no role in triggering AD could lead to new preventive approaches

Chlamydia trachomatis in idiopathic subfertile males

Chlamydia trachomatis genital infection is the most common of all the sexually transmitted diseases worldwide. The prevalence in Egypt was found to be five percent. Asymptomatic infection is common in males and may lead to many complications. Infection is also possibly implicated in idiopathic infertility. The aim of this study was to assess the role of Chlamydia trachomatis infection in idiopathic subfertile males in Alexandria, Egypt, and its impact on semen analysis parameters. Eighty male patients with idiopathic oligoasthenospermia and forty healthy males with proven fertility and normal seminal parameters were subjected to two tests: PCR for the detection of Chlamydia trachomatis DNA in the semen, and ELISA for the detection of Chlamydia trachomatis IgG and IgM in the serum. Four of the semen samples tested in infertile males were positive for Chlamydia trachomatis on PCR testing. Each control group had only two PCR positive results. There were two positive results in those patients for IgG tested in serum using ELISA. While in the two control groups, four and two cases were positive [X[2] = 3.48, p = 0.201 - non significant]. PCR Positive results total amounted to 5% of the entire studied population [X[2] =0.044, p = 0.97 - non significant]. No significant correlations could be made between idiopathic male infertility and the positivity of the tests carried out. In conclusion, Chlamydia trachomatis plays little or no role in the pathogenesis of idiopathic infertility in the male population of Alexandria

Weekly paclitaxel / carboplatin with concurrent thoracic radiation followed by paclitaxel / carpoplatin consolidation for postoperative stage II and IIIA non-small-cell lung cancer

Recent studies have suggested the superiority of concurrent chemoradiotherapy and the efficacy of paclitaxel/carboplatin in adjuvant non-small-cell lung cancer [NSCLC]. In view of those results, we conducted this phase II trial to examine the safety and efficacy of administration of radiosensitizing paclitaxel/carboplatin weekly with concurrent thoracic radiation therapy [XRT] followed by consolidation paclitaxel/carboplatin for stage II and IIIA NSCLC. Patients with resected NSCLC, pathological stage II or IIIA, Nl-N2 with or without positive margin received paclitaxel/carboplatin weekly during thoracic radiotherapy. All patients received 50.4Gy in 28 fractions for 6 weeks [1.8Gy/d, 5 days/wk]. A boost of 10.8Gy in six fractions was given for extracapsular nodal extension or positive margin. Four weeks after radiotherapy, the patients received two courses of consolidation paclitaxel/carboplatin every 3 weeks. Treatment compliance was acceptable, with 96% compliance for radiation therapy and 92% for chemotherapy completion. The median duration of follow-up was 30 months. The 3-year actuarial survival and progression-free survival rates were 56% and 44%, respectively. Loco-regional failure was a component of first failure in 24% of patients. Toxicities were acceptable. The results of this study suggest that weekly paclitaxel/carboplatin concurrent with radiotherapy is safe and acceptable adjuvant treatment for stage II and IIIA resected NSCLC patients. A randomized phase III trial comparing this treatment regimen with standard therapy seems warranted

Concurrent cisplatin / radiation followed by adjuvant cisplatin / paclitaxel in treatment of patients with stage IB grade 3,IC and IIA endometrial carcinoma

Postoperative radiotherapy [RT] is the most commonly used adjuvant treatment in high risk endometrial carcinoma [HREC], it reduces the incidence of pelvic relapses but doesn't improve survival. This study was conducted to evaluate the efficacy and safety of concomitant weekly cisplatin and postoperative RT in HREC [stages IB grade 3, 1C and IIA] followed by adjuvant cisplatin and weekly paclitaxel. Eighteen patients with pathologically confirmed endometrial carcinoma were enrolled in this study. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy [TAH-BSO] and surgical staging. Five patients [28%], 4 patients [22%] and 9 patients [50%] presented with stages IB grade 3, 1C and IIA respectively. All patients received cisplatin once weekly during the 6 weeks of RT. After the chemo-radiation course, 4 additional adjuvant courses of cisplatin and paclitaxel were administered. Between May 2000 and March 2002, a total of 18 patients with pathologically confirmed endometrial carcinoma, presented to Radiation Oncology and Nuclear Medicine Department, Ain Shams University Hospitals, were enrolled in this study. Their median age was 59 years. No severe toxicity was encountered during concomitant chemoradiation. Grade 3 hematological toxicities, leucopenia, neutropenia and anemia were recorded in one patient [5.6%] each during adjuvant chemotherapy. Two patients [11%] relapsed with distant metastases and one patient [5.6%] developed pelvic recurrence. Median time to progression was 67 months. Five year disease free survival and the 5 year overall survival were 89% [95%, CI: 74-100]. Concomitant cisplatin and postoperative RT followed by adjuvant cisplatin and weekly paclitaxel is safe and acceptable treatment in patients with HREC. This study verifies the feasibility of this treatment to potentially reduce the incidence of local and distant relapses in order to improve survival. Randomized phase III studies with large number of patients are necessary to evaluate the benefits of this approach

Smoking as a risk factor for renal impairment and proteinuria: a case control study

In this study, the aim is to examine the association between current smoking status and indicators of kidney affection shown by reduced GFR and elevated urine protein/creatinine ratio in a population free of hypertension and diabetes mellitus, The study was carried out on 190 subjects [90 smokers and 100 non smokers]. Both smokers and non smokers were not diabetics nor hypertensives. For each subject serum creatinine [an indicator of GFR] and protein/creatinine ratio in urine [an indicator of proteinuria] were determined. Smokers were classified according to smoking index, which equals number of cigarettes smoked per day multiplied by the number of years of smoking, into: mild smokers [smoking index <200], moderate smokers [smoking index 200-600] and heavy smokers [smoking index >600]. In our study, the socio-demographic characteristic of the study population were matched and there was no statistically significant difference between smokers and non smokers as regards residence, education, occupation and marital status. Males represent 95.6% and females represent 4.4% of the smokers while males represent 97% and females represent 3% of the non smokers. Smokers were more likely to have higher diastolic blood pressure and serum creatinine and lower GFR. In spite of the limited number of the study sample results pointed to the negative effect of smoking on kidney. There was a relation between smoking and renal impairment. A dose-response effect on GFR was shown with lifetime exposure to smoking. The relation between smoking and proteitnuria was less significant. However, one of the few females, who shared our study and was mild smoker, had been with proteinuria. This gives some relation between smoking and proteinuria especially in females. However. longitudinal studies with clear identification of abnormal glucose metabolism and hypertension will be required to provide the missing evidence for causality. The fact that smoking is an important renal risk factor trust be taken into consideration in the management of patients with renal disease. A concerted effort to encourage renal patients to give up smoking. Effective programs aimed at stroking prevention and cessation are highly needed

Treatment of favorable, early-stage hodgkin's disease in children and adolescents using vamp and low-dose, involved-field radiation

to evaluate outcome and assess, toxicity of children and adolescents with, early-stage, favorable Hodgkin's disease treated with vinblastine, doxorubicin, methotrexate, and prednisone [VAMP] and low-dose, involved-field radiation, Patients and twenty-four patients with clinical stages I and IIA, favorable [nonbulky] Hodgkin's disease were treated with four cycles of VAMP chemotherapy and 15Gy involved field radiation for those who achieved a complete response, or 25.5Gy for those who achieved a partial response to two cycles of VAMP with a median follow-up of 49 months [range, 74 to 66 months], the overall and event-free survival were 95.8% and 87.5%, respectively. The only factor associated with longer event-free survival was the number of initially involved sites. Risk-adapted, combined-modality therapy using only four cycles of VAMP chemotherapy with 15 to 25.5 Gy of involved-field radiation for patients with early-stage/favorable Hodgkin's disease is highly effective and without demonstrable side-effects. These results indicates that patients with stages I and IIA, non-bulky, and involving less than three Ann Arbor sites can be cured with limited therapy that does not include an alkylating agent bleomycin, etoposide, or high-dose extended-field radiation therapy

Organ preservation in patients with invasive bladder cancer: initial results of an itensified protocol of transurethral surgery and radiation therapy plus concurrent cisplatin and 5-fluorouracil

Thirty patients with muscle-invading or high risk T1 [G3, associated carcinoma in situ, multifocality, >5 cm] bladder cancer were subjected to a protocol of transurethral resection of the bladder tumor [TURB], followed by concurrent cisplatin [20 mg/m2/day, 20 minutes infusion] and 5-fluorouacil [5 FU] [600 mg/m2/day, continuous infusion] administered on days 1-5 and 29-33 of radiotherapy [total dose to the bladder 55-60 Gy]. The response was evaluated by restaging TURB six weeks later. In case of invasive residual or recurrent tumor, salvage cystectomy was recommended. Twenty-one patients had no detectable tumor at restaging TURB and 12 patients were continuously free from tumor in their bladders. A superficial relapse occurred in three patients and a muscle-invasive relapse in six patients. The overall survival and survival with preserved bladder were 67% and 47%, respectively, at three years. The hematologic grade 3/4 toxicity occurred in 90% 13% and grade 3 diarrhea occurred in 7%

Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer

The combination of fluorouracil and leucovorin has until recently been standard therapy for metastatic colorectal cancer. Irinotecan prolonge survival in patients refractory to treatment with fluorouracil and leucovorin. We tried to compare a combination of irinotecan, fluorouracil and leucovorin with bolus doses of fluorouracil and leucovorin as first-line therapy for metastatic colorectal cancer. Between January 2000 to December 2001, 30 patients with metastatic colorectal cancer were enrolled, 15 received irinotecan [125mg/m[2]/week x 4 weeks q 6 weeks], 5-FU [500 mg/m[2]/week x 4 weeks q6 weeks iv bolus], and LV [20 mg/m[2]/week x4 weeks q 6 week iv bolus] and 15 patients received 5-FU [425mg/m[2]/d x 5 days q 4 weeks iv bolus] and LV [20mg/m[2]/d x 5 days q 4 weeks iv bolus]. End points included progression -free survival and overall survival. The progression-free survival was longer for the triple-drug therapy than for the two-drug therapy [7 months versus 4 months]. The median survival was also longer in the triple-drug therapy [14 months versus 12 months]. Grade 3/4 neutropenia and mucositis were more common with the two-drug therapy, whereas grade3/4 diarrhea and vomiting were more with the triple-drug therapy. Combining irinotecan with 5-FU/LV was associated with higher rates of tumor regression, progression-free survival and overall survival, and this regimen should be tested as adjuvant treatment in stage III colon cancer

Neoadjuvant chemotherapy using vinorelbine,epirubicin, and methotrexate [VEM] in locally advanced breast cancer

To evaluate the role of VEM regimen in downstaging patients with locally advanced breast cancer to allow surgery

Patients and Methods: Between January 2000 to January 2002, 16 patients with locally advanced breast cancer were enrolled, they received VEM regimen [Vinorelbine 25 mg/irf, epirubicin 35 mg/rrf, and methotrexate 20 mg/m" given at day 1 and 8 every 28 days]. Responding patients after 4 courses received 2 more courses and then referred to surgery

Results: Downstaging was obtained in 86% of the patients with a pathological complete response ;raite of 8%. At 3D months mf follow-up, median survival Unas not teen reached. The most common lhematoI0jpc loxicity was neutropenia grade %

Conclusion: VEM represents an effective and well tolerated regimen for patients with locally advanced breast cancer

Preoperative combined modality therapy for clinically resectable nonmetastatic rectal adenocarcinoma

The incidence of local recurrence [LR] following curative surgery for rectal cancer has been reported to range from 10 to 60%. Recently, data from several clinical trials have suggested that LR can be reduced by op to 40% with pre-operative radiotherapy and even further if combined with chemoradiotherapy. Seventeen patients were included in the study; all had adenocarcinorria of the rectum. Sphincter-preserving surgery could be achieved in 11 of the patients [64.7%] while the remaining 6 [35.3%] had abdomino-perineal resection [APR].Pathologic staging after preoperative combined modality therapy for the 17 patients who underwent radical surgery was: Tl-4 NO-2 MO. The incidence of failure was as follows: local, 5.8 % [1/17]; abdominal, 11.7% [2/17]; and distant, 17.6% [3/17].Treatment with preoperafive combined modality therapy followed by surgery and postoperative 5-FU based chemotherapy is an alternative to postoperative combined modality therapy for patients with rectal cancer.Purpose: To determine the local control rale and acute ioxicity in patients with clinically resectable adenocarcinoma of therectum treated with preoperative combined modality therapy

Total hip replacement in Kuwait. Preliminary results of exeter hip prosthesis and remarks on ethnic and causative factors

This study presents clinical and radiological characteristics of 49 cemented total hip replacements of Exeter type in a series of 44 patients operated upon in Al Razi Hospital during the period 1992-1999. Different forms of secondary hip pathology accounted for most total hip replacements performed in this study Diagnostic and ethnic aspects were discussed. All patients were operated through a posterolateral approach using conventional Exeter [Howmedica] instrumentation and implant. Clinical analysis was performed using Merle d'Aubigne and Postel hip score. The method of radiological analysis is described. A single surgeon operated on all patients. During the observation period [m=3.5 years], none of the implants loosened and the average clinical score of 9.8 pts preoperatively had improved to 16.8 pts at the last follow-up. In contrast with studies done in Europe and North America, the predominant pathology among the Arabs was secondary to avascular necrosis, rheumatoid disease, or trauma. Primary osteoarthrosis was rare. Our preliminary findings are that, in the average follow-up of 3.5 years, the Exeter hip replacement gave satisfactory results. Further research is necessary to explain ethnic differences in occurrence of coxarthrosis

Hackethal stacked nailing treatment of diaphysed fractures of the humerus

This study was undertaken to evaluate the clinical and radiological results of the internal fixation of fractures of the humeral shaft using the Hackethal stacked nailing technique. Twenty patients treated with this technique in Al Razi Hospital were followed up until union, when clinical and radiological assessment was performed. Details of the surgical procedures are given. All fractures except one united. Clinical and radiological results and complications are presented. Bundle nailing continues to be a valuable, safe and low-cost option in selected cases of fractures of the humerus shaft. The indication for this fixation was transverse and short oblique fractures without comminution

Intralocal pinning for fixation of unstable fractures of the distal radius

The objective of this study was the clinical and radiological analysis of a series of thirty-four patients with 36 unstable fractures of the distal radius treated by intrafocal buttressing-pinning during the period between 1996-1997 along with a follow-up period of at least 32 weeks. Methods The technique uses dorso-ulnar, dorso-radial and lateral intrafocal K wires to support and stabilize fragments. Clinical and radiological results were evaluated according to Gartland and Werley modified by Sarmiento and Lidstroem. Results Good to excellent clinical and radiological results were achieved in 86% and 90% of cases respectively. Conclusion Intrafocal percutaneous pinning is an encouraging procedure for managing selected cases of comminuted lower radial fractures. It combines the advantages of a closed line of treatment with the advantage of stability achieved by surgical fixation