Secondary ameloblastic carcinoma of the jaw: a case report

Odontogenic carcinomas are rare tumors mainly classified as malignant ameloblastoma, ameloblastic carcinoma, or primary intraosseous carcinoma. The former two terms have been long used as synonyms in literature. The term ameloblastic carcinoma is used to describe those ameloblastomas in which there is histological evidence of malignancy and overall histological pattern of ameloblastoma. The maxilla is an unusual location for these tumors. Less than 70 cases have been reported in literature. This is a report on a 50 years old female patient with a recurrent ameloblastoma of the right maxillo-mandibular region. The tumor was initially diagnosed as ameloblastoma based on small excisional biopsies. The biopsies concerned a small part of the tumor, probably in the component exhibiting classic ameloblastoma precursor. Complete tumor resection revealed areas of cytological atypia, necrosis and invasion to surrounding bone and soft tissue in a background of ameloblastoma. These features justified the final diagnosis as "secondary ameloblastic carcinoma

Bilharziasis and bladder cancer: a time trend analysis of 9843 patients

To explore any changes in bladder carcinoma during 37 years period, in regard to: its frequency, bilharzia association, histological profile and demographic data. This is a retrospective study on 9843 patients treated at the National Cancer Institute [NCI], Cairo University, during the years 1970-2007. Three groups were selected: series [A] included 3212 patients during 1970-1974, series [B] 3988 patients during 1985-1989 and series [C] 2643 patients during 2003-2007. For statistical analysis, data of series [A], [B] and [C] were compared to determine the significance of difference [p value 0.005]. A significant decline of the relative frequency of bladder cancer was observed from 27.63% in the old series to 11.7% in the recent series. Bilharzia association dropped from 82.4% to 55.3%. There was a significant rise of transitional cell carcinomas from 16.0% to 65.8%, becoming at present the most common tumor type, with a significant decrease in squamous cell carcinomas from 75.9% to 28.4%. There was an increase in the median age of patients from 47.4 years to 60.5 years and a decrease of male: female [M/F] ratio from 5.4 to 3.3. The decline in the relative frequency of bladder cancer is associated with a decline in bilharzia egg positivity in the specimen and is probably related to better control of bilharziasis in the rural population in Egypt. This was accompanied by a change in the histological profile of tumors, with significant predominance of transitional cell carcinoma and an increase in the age of patients, a pattern rather similar to that in western reports

Missed breast carcinoma; why and how to avoid?

Despite the advances in mammography techniques, it still has a number of limitations. It is estimated that about 10 to 25% of lesions are overlooked in mammograms out of which about two thirds are detected retrospectively by radiologists and oncologists. Causes of missed breast cancer on mammography can be secondary to many factors including those related to the patient [whether inherent or acquired], the nature of the malignant mass itself, poor mammographic techniques, provider factors or interpretive skills of radiologists and oncologists [including perception and interpretation errors]. The aim of this study is to investigate the aforementioned factors hindering early breast cancer detection and in turn lowering mammographic sensitivity and to outline the major guidelines to overcome these factors aiming to an optimum mammographic examination and interpretation by radiologists and oncologists. We conducted this multicenter study over a two-year interval. We included 152 histopathologicaly proven breast carcinomas that were initially missed on mammography. The cases were subjected to mammography, complementary US, MRI and digital mammography in some cases and all cases were histopathologically proven either by FNAB, CNB or open biopsy. Revision of the pathological specimens of these 152 cases revealed 121 infiltrating ductal carcinomas, 2 lobular, 4 mucinous, 14 inflammatory carcinomas, 6 carcinomas in situ [3 of which were intracystic], 2 intraductal papillary carcinomas and 3 cases with Paget's disease of the nipple. In analyzing the causes responsible for misdiagnosis of these carcinomas we classified them into 4 causative factors; patient, tumor, technical or provider factors. Tumor factors were the most commonly encountered, accounting for 44.1%, while provider factors were the least commonly encountered in 14.5%. Carcinomas were detected using several individual or combined complementary techniques. These techniques mainly included double reading, additional mammography views, ultrasound and MRI examinations. Forty four carcinomas were detected on double and re-reading by more experienced radiologists. Additional mammographic views were recommended in 35 [23%] cases. Complementary ultrasound examination was performed for all 152 cases [100%] and showed a higher sensitivity than mammography in carcinoma detection. It was diagnostic in 138 [90.8%] cases only. In the remaining 14 cases, further MRI and biopsy were performed. Why can breast carcinoma be missed? Four main factors are responsible for missing a carcinoma: [1] Patient factors [Inherently dense breasts or acquired dense breasts]. [2] Tumor factors [subtle carcinoma, masked carcinoma, multifocal carcinoma and multicentric carcinoma]. [3] Technical factors [bad exposure factors, malpositioned breasts and bad processing quality]. [4] Provider factors [bad perception and misinterpretation]. How to avoid missing a breast carcinoma? Review clinical data and use US and other adjunct techniques as MRI and biopsy to assess a palpable or mammographically detected mass. Be strict about positioning and technical factors. Try to optimize image quality. Be alert to subtle features of breast cancers. Always consider the well defined carcinoma. Compare current images with multiple prior studies to look for subtle increases in lesion size. Look for other lesions when one abnormality is seen. Judge a lesion by its most malignant features. Double reading and the use of computer aided diagnosis [CAD] and finally FFDM [Full Field Digital Mammography]. Close cooperation between the oncologist, radiologist and pathologist is essential to avoid missing any case of breast carcinoma

Immunohistochemical expression of CD10 in cutaneous basal and squamous cell carcinomas

CD10 is a zinc-dependent metallopeptidase known as common acute lymphoblastic leukemia antigen [CALLA]. Although CD10 expression has been investigated in some cutaneous tumors, to our knowledge, data regarding its expression in cutaneous epithelial neoplasms are very limited. We aimed to determine the immunohistochemical expression of CD10 in basal cell carcinoma [BCC] and squamous cell carcinoma [SCC] and to associate it with the available clinicopathological parameters in both tumors. This study included 16 SCC and 21 BCC cases [17 solid type, 2 morphea type and 2 adenoid basal types]. BCC cases were divided into 12 cases with microscopic infiltrative base and 9 cases with well-circumscribed base. The localization of anti-CD10 to the tumor and/or stromal cells was determined in each case. Positive CD10 staining was identified as brown cytoplasmic, with or without cell membrane staining. In all the 16 SCC cases, tumor cells failed to stain with CD10 in contrast to the stromal cells that showed CD10 expression in 13 cases [81%]. In BCC cases, the expression of CD10 was noted in tumor cells in 10 cases [47.6%] and in stromal cells of 20 cases [95.24%]. Most of CD10+ [7/10] BCC showed well-circumscribed deep margin, however, most of CD10- cases [9/11] showed infiltrating base [p=0.030]. BCCs with infiltrating deep margins [12 cases] tended to show CD10 negative basaloid cells [9/12] and CD10 positive stromal cells [12/12] [p=0.0003]. From our results we suggest that CD10 might be a useful immunohistochemical marker to differentiate between BCC and SCC. At least, if tumor cells were CD10 positive, this would favor BCC over SCC. Absence of CD10 in all the SCC and in infiltrating BCC together with its overexpression in the surrounding stromal cells might confer invasive properties to such tumors, However, its relation to other poor prognostic factors needs larger studies to be confirmed

Studies on relationship between schistosomiasis and viral hepatitis infection

This study was carried out on 100 schistosomal patients and 20 apparently healthy individuals served as control. The schistosomal cases were divided into 3 groups. GI, 45 cases with early intestinal schistosomiasis, GII, 30 cases with hepatosplenomegaly, GIII, 25 cases with hepatosplenomegaly and ascitis. All cases and control group were subjected to careful history taking, clinical examination, stool examination by modified formol ether concentration technique, proctosigmoidscopy and rectal snip for non egg passers [ascitic group], detection of antinHCV antibodies and HBsAg by MEIA technique. Evaluation of liver functions [ALT, AST and serum albumin] and liver biopsies were taken to study ultrastructural changes by electron microscope. The results revealed that all schistosomal cases were negative for HBsAg while 5% of control group were positive for HBsAg and the difference was statistically high significant. The antinHCV antibodies were detected in 40% of schistosomal cases and in 20% of control group and the difference was statistically insignificant. The antin HCV antibodies were detected in 11.1% of group I, in 53.3% of group II and in 76% of group III and the difference was statistically high significant. Examination of liver biopsies by electron microscope showed that in case of intestinal schistosomiasis there was normal hepatocyte. In case of intestinal schistosomiasis and HCV coinfection there were moderate irregularity of nuclear shape, moderate chromatin condensation on the inner surface of nuclear envelop, prominence of nucleolus and has eccentric position, saccular dilatation of endoplasmic reticulum, moderate mitochondrial ballooning and normal intercellular space. In case of late stage of schistosomiasis and HCV coinfection there were marked fibrosis and collagen deposition, marked irregularity of nuclear envelop, marked condensation of chromatin on the inner surface of nuclear envelop, prominent nucleolus, marked ballooning of mitochondria and loss of its cristae and saccular dilatation of endoplasmic reticulum. The author concluded that patients coinfected with schistosomiasis and HCV were characterized by more severe liver disease

Role of mast cells and cytokine profile [TNF-alpha, IFN-gmma, IL4 and IL-4 mRNA] in different types of leprosy

The aim of this study was to compare the number and the distribution of mast cells in biopsies taken in non reactional and reactional periods of the leprosy lesions. In addition, the expression of cytokines profile was analysed. 60 patients with leprosy were classified into three groups. Group I [non reactional leprosy included 38 patients, Group II [type I reaction] TIR included 13 patients, and Group III [type II reaction] TIJR included 9 patients. Cytokine profile was detected by determination of TNF-alpha, INF-gamma, IL-4 in the serum. In addition, IL-4 mRNA was determined in whole blood of all studied groups. Multiple punch biopsy specimens were taken from individual patients; for the examination of intra-lesional variation in mast cell numbers, specimens were taken from the centre of the lesion, the edge of tile lesion, and from the apparently unaffected skin outside the lesion at a point 2 cm from the nearest identifiable margin of the lesion. Comparison of INF-gamma and TNF-alpha in the sera of the different studied groups showed a significant difference between the groups, with a tendency to decrease in levels more in group III. Positive correlation between IFN-gamma and TNF-alpha, was detected. In addition, comparison of IL-4 and mRNA for IL-4 in the sera of the different studied groups showed a significant difference between the groups, with a tendency to increase in levels more in group III. Positive correlation between serum IL-4 and mRNA for IL-4, was observed. Density of mast cells in skin lesions of the different studied groups showed an insignificant difference between all groups as regards the centre of the lesion, while a significant difference was detected between group III and both groups I and II as regards mast cell density in the periphery and interstitium. The number of mast cells tends to increase from TT up to LL. A positive correlation was detected between mast cell density and IL-4 mRNA [r=0.57], while other studied cytokines did not show such a correlation. The cytokine profile is Th1 predominant in non reactional and TIR leprotic patients, while it shows Th2 predominance in TIIR leprotic patients. According to the pattern of cytokine production, mast cells are closely related to CD8+ T cells and IL-4mRNA leading to increased density of mast cells in skin lesions from TT up to LL, which in turn controls the out come of the disease

noninvasive index for diagnosing fibrosis and/or cirrhosis in patients with chronic hepatitis C

Chronic hepatitis C is one of the most prevalent infectious hepatic diseases in our locality. Histological examination of the liver is an integral part of the evaluation of patients with chronic hepatitis C. There are many non invasive approachs to assess the degree of liver fibrosis and/or cirrhosis in chronic hepatitis C patients. to construct one simple model consisting of routine laboratory data to predict both significant fibrosis and cirrhosis among patients with chronic hepatitis C. A total of 32 patients with positive hepatitis C virus [HCV] antibodies. All were subjected to thorough clinical evaluation, liver function tests, abdominal ultrasonography and liver biopsy with grading of hepatic fibrosis and steatosis. Platelet count and Aspartate amino transferase [AST] were the most important predictors of significant fibrosis and cirrhosis. The severity of liver fibrosis has correlated significantly with the gradual increase of AST level [P<0.001] as well as the decrease of platelet count [P=0.001]. AST to platelet ratio index [APRI] has correlated significantly with the stage of fibrosis. This index had a higher correlation coefficient than platelet count or AST level alone

[Comparison of the diagnostic accuracy of pipelle biopsy, dilatation and curettage and hystrectomy in detection of endometrial lesions]

The current study has been designed to compare the diagnostic value of pipelle sampling as a simple and cost effective method with that of more complicated and expensive methods in the detection of pathologies in abnormal uterine bleedings. In 60 patients scheduled for hysterectomy due to persistent uterine bleeding, endometrial sampling was done twice, once with pipelle and then by D and C prior to the hysterectomy. First the pathological reports of pipelle and D and C specimens were compared with each other and then both were compared with hysterectomy as the gold standard. In all cases pipelle was passed to the uterine cavity without any need for cervical dilatation and anesthesia. The most frequent results in all tree kinds of sampling were proliferate endometrium and early secretary phase respectively. According to the pathological reports, pipelle and D and C in 89% of the cases, pipelle and hysterectomy in 80% of the cases and D and C and hysterectomy in 90% of the cases showed agreement, that shows so significant difference in diagnostic accuracy among three methods. Considering high agreement between pathological reports of pipelle biopsy as an outpatient method and those of D and C and hysterectomy, pipelle sampling is suggested as the first diagnostic procedure, while D and C and hysterectomy that necessitate anesthesia and take more time and expense should be reserved for just special cases

Inguinal Sentinel Node Biopsy in Epidermoid Carcinoma of the Anal Canal: a Pilot Study

It has been well established that the primary therapeuticapproach to anal squamous-cell carcinoma ischemoradiotherapy. Inguinal lymph node (LN) status isan important prognosis indicator and the presence ofmetastases in the inguinal LN is an independent markerof the local failure and overall survival. The appropriatemanagement of patients with primary anal cancer andclinically uninvolved groins remains controversial.Nowadays there is no reliable diagnostic method toaccurately determine nodal status of the inguinal region.This study was conducted to evaluate the feasibility of anovel assessment method of the nodal status of theinguinal region in patients with epidermoid carcinomaof the anus and anal margin. We advocate that sentinellymph node biopsy is a safe and feasible technique todetect metastases in inguinal nodes.

Colonic bilharzioma - dramatic complication of schistosomiasis: report of ten cases

Bilharzioma implies a localized mass of fibrous and inflammatory tissue, which usually contains many eggs, frequently involving serosa and mesentery. Bilharzioma is probably caused by reaction to numerous eggs produced by one or more pair of worms in a single site. The aim of this study is to present the management of a group of patients had colonic bilharzioma presented with abdominal masses and intestinal obstruction. Ten patients presented with abdominal masses and intestinal obstruction. Complete blood count, urinalysis, stool analysis, and abdominal ultrasonography done in all the patients of the study. Barium enema done in 5 patients. Abdominal computed tomography done in 6 patients. All the patients of the study had been subjected to laparotomy. There were 7 males and 3 females, their ages ranged from 8 to 42 years [mean 14.2 years]. All the patients had abdominal pain [100%], 6 patients presented with abdominal mass [60%], and 4 patients presented with intestinal obstruction [40%]. There was microcytic hypochromic anemia in 9 patients [90%] and leukocytosis with eosinophilia in 7 patients [70%]. Abdominal US revealed presence of lymphoma versus teratoma in 6 patients [60%] and signs of intestinal obstruction in 4 patients [40%]. Barium enema revealed presence of multiple polyps throughout rectosigmoid colon, with loss of haustrations and spasm of descending colon in 3 cases. CoIonic wall thickening with narrowing and rigidity of the ascending colon in 2 cases. Abdominal CT revealed presence of colonic wall masses suggestive of lymphoma in 6 cases. In laparotomy, there were 4 rectosigrnoid bilharzioma, bilharzioma of the transverse colon down to the upper rectum in 3 patients and ascending colonic bilharzioma in 3 cases. Histopathology confirmed presence of bilharzial granuloma in all surgical specimens. Always consider bilharzioma in differential diagnosis of abdominal masses and intestinal obstruction, especially in countries where it is endemic. Rectal examination is an important and integral part of abdominal examination in such cases and biopsy is a must in presence of palpable nodules

Role of concurrent helicobacter pylori infection to hepatitis C virus in Egyptian patients with liver cirrhosis

Chronic hepatitis C virus [HCV] infection is a leading cause of end-stage liver disease worldwide. It has been shown that helicobacter pylori [H. pylori] plays an important role in chronic gastritis, peptic ulcer disease, and gastric malignancies and its eradication has been advocated. The association between H. pylori infection and cirrhosis in patients with hepatitis C virus was documented in different parts of the world, nevertheless, no conclusive data is available in Egypt In the present study, the status of helicobacter pylori infection was sought in 90 patients with chronic HCV and in 66 HCV free healthy controls. The results showed that the H. pylori positivity was increased significantly [P = 0.03] in the HCV infected patients than of healthy controls where H. pylori infection was found in 50 out of 90 [55.6%] of HCV infected patients versus 26 out of 66 [39.4%] of healthy controls. In HCV infected patients, the incidence of H. pylori infection was increased significantly [P = 0.04] from chronic active hepatitis to cirrhosis. H. pylori was present in 6/18 [33.3%], 10/21[47.6%], 16/27 [59.3%], 18/24 [75.0%] in chronic active hepatitis, Child A, Child B, and Child C respectively. More importantly, the incidence of H. pylori infection in HCV infected patients was increased very significantly [P = 0.003] with increasing of Meld score. The prevalence of H. pylori was documented in 9/28 [32.1%] in patients with Meld score . In conclusion, our results collectively reflect a remarkable increasing of H. pylori prevalence with advancing the hepatic lesions and the eradication treatment may prove beneficial in those patients with chronic hepatitis C

Endometrial Pathology in a Teaching Hospital in North-Central Nigeria - A Histopathological Survey

The study was a 5 year histopathological survey of endometrial biopsies seen at the University of Ilorin Teaching Hospital ; Ilorin; North Central Nigeria from January 1st 1997 to December 31st 2001. It aimed at identifying the morphological patterns of endometrial disorders; prevalence of these disorders and the histopathological changes associated with the clinical diagnosis in Ilorin; Nigeria. Eight hundred and eighty two slides of cases of endometrial disorders recorded in the register of the Department of Pathology; University of Ilorin Teaching Hospital; Ilorin; North Central Nigeria were reviewed. Clinical data on each of the cases was retrieved from request cards. The pathological reports and clinical data were recorded noting the age; clinical history; morphological description of lesions and the histological types. The mean age of the studied group was 28 years. The commonest indication for endometrial sampling was infertility (55.3

value of trnsrectal power doppler ultrasonography in cancer prostate

In attempt to assess the usefulness of transrectal power Doppler ultra-sonography [PDU] for improving the diagnoses of cancer prostate in-patients with abnormally elevated PSA, forty male patients with a mean age 65 years were assessed using a digital rectal examination [DRE], transrectal ultrasonography [TRUS] and [PDU]. All cases of prostatitis were excluded. The vascularity on PDU was graded on a scale of 0-3 where grade 0 negative and grade 1-3 was considered positive Transrectal needle prostatic biopsies were obtained from hypoechoic lesions or hyspervascular lesions under TRUS and PDU and systematic biopsy was taken in all cases. The results of PDU, DEE and TRUS were evaluated according to histopathological examination of needle biopsy. Prostatic biopsy confirmed prostate cancer in 11 patients out of 40 patients [27.5%], PDU was positive in 16 patients, of whom 10 had prostate cancer [62.5%], all those but one having prostate cancer were positive on PDU. Thus PDU had a higher sensitivity of 90.9% [10/11], than DRE [54.5%] and TRUS 72.7% and PDU had a higher negative predictive value in 95.8%, while 85% with TRUS and 80.7% for DRE. So, PDU increases the sensitivity and negative predictive value of TRUS in detection of cancer prostate if is it used as a routine investigation with conventional TRUS. This does not need any added manipulations. PDU is more useful for detecting prostate cancer in-patients with abnormally high serum PSA levels and if PDU is negative, needle biopsy may be avoided especially if PSA is not conclusively high

Evaluation of human neutrophil chemotactic cytokine [IL-8] role in the development of lupus nephritis: correlation with disease activity and pathological type

Aim of the work: was to evaluate the human neutrophil chemotactic cytokine [IL-8] role in the development of Lupus nephritis [LN] and its correlation with disease activity and pathological type. this study was conducted on 20 patients with lupus nephritis and 20 controls with matched age and sex. Patients were subjected to thorough history taking, and clinical examination, routine investigations including CBP, ESR, and renal function tests [blood urea, serum creatinine, and creatinine clearance] and 24 hours urinary protein. Level of anti-ds DNA was measured in SLE patients. IL-8 measurement in both serum and urine was done using ELISA technique. Renal biopsies were taken from all patients and were studied for histopathological changes, cellular infiltration and sings of activity. IL-8 was not detected in the serum of any patient with LN. Urinary IL-8 were elevated in patients with WHO class IVa, IVb, IVc, IIIa, and IIa. The highest levels were detected in class IVb, and undetected in any patient with class IId, IIIa and I, and some patients with class IIa. Urinary IL-8 was increased significantly in patients with glomerular cell proliferation, fibrinoid necrosis, cellular crescents, hyaline deposit and interstitial inflammation and leukocyte exudation. Urinary IL-8 correlated well activity index. IL-8 produced locally in LN and may be involved in the pathogenesis of glomerular and tubulo-interstitial diseases. IL-8 in urine is correlated well with activity index, thus its measurement in urine in LN patients may be a useful tool for monitoring disease activity

Does schistosomiasis interfere with application of knodell score for assessment of chronic hepatitis C?

Schistosoma mansoni [SM] is a significant etiology of liver disease in many countries. Chronic hepatitis C is a major health problem worldwide. Association of schistosomiasis and chronic hepatitis C is not uncommon especially in areas where the two diseases are prevalent. The possible synergistic relationship between both conditions is a point of controversy. Also, the assessment of degree of necroinflammatory injury and stage of fibrosis in patients with mixed schistosomiasis and chronic hepatitis C is not a settled issue. The present study is a trial to highlight this problem. 185 individuals [25] pure schistosomal affection, [100] pure HCV, and [60] mixed HCV and schistosomal [HCV+S] were included. These were selected from 222 biopsied patients with chronic liver disease attending the liver unit of Internal Medicine Department, Mansoura University July 1999-May 2000. They were subjected to rectal snip and serological test for schistosomiasis, liver functions, HBV, HCV serological markers, serum qualitative PCR and liver biopsy. .Masson trichrome stain was performed to assess fibrosis. Immunohistochemical staining for HBsAg and HBcAg were performed. Modified Knodell score was applied to assess the biopsy. Five out of the 25 pure schistosomal and only 2 of the mixed group revealed schistosomal granuloma. 30% of pure HCV and 33% of mixed [HCV+S] patients were found to be cirrhotic. No significant statistical difference was identified between the two groups as regard necroinflammatory injury and Knodell score [p= 0.81]. Also, no significant difference was identified as regard stage of fibrosis [p=0.77]. Schistosomal hepatic affection does not lead to more severe or progressive disease in patients with chronic hepatitis C. Also, it does not interfere with assessment of necroinflammatory injury or fibrosis stage as determined by Knodell score

Environment and occupation as risk factors in a group of mesothelioma patients

This work studies the effect of environmental and occupational exposures on a group of mesothelioma patients from the National Cancer Institute in Cairo, Egypt, as well as their effects on certain pulmonary function tests. From October 1997 through April 1998, twenty-two mesothelioma patients were interviewed and examined. Information was collected about sociodemographic characteristics. Also, the subjects' environmental and occupational exposures were investigated. These patients were diagnosed pathologically by biopsy from the tumor site. Computerized Tomography scanning of chest was done to all patients. Pulmonary function tests including ventilatory functions, diffusion tests and blood gases were done to all patients. Fifty nine percent of are living in El Maasara near to the large factory using asbestos cement. I.e. [residential exposure]. On trying to find out the effect of combined risk factors [occupation and environment] on the occurrence of the disease, it was found that those patients with combined risks complain at an earlier age period with a mean of [40 +/- 11.66] years in comparison to the other groups with no statistically significant difference. Patients with occupational and environmental risks had the least occupational duration than the other groups and the difference was statistically significant. By C T scan, 63.64% of cases had right pleural effusion and 36.63% had left pleural effusion. Ventilatory function tests showed that 45.45% of cases had restrictive pattern, 36.37% had combined restriction arid obstruction, and 18.18% had an obstructive pattern. Diffusion test using carbon monoxide [DL co] showed diffusion defects in 80.95% of the examined group., Blood gases show a decrease in the Pa O2 with a mean of [74.73% - 9.15]. Although we are able to identify clear residential exposure to asbestos in 60% of cases, other cases [40%] could be exposed to other risk factors as viruses, erionite and ionizing radiation

Study of intercellular adhesion molecule-I in patients with liver cirrhosis and chronic hepatitis: association with disease severity and activity

This study was carried out in Benha University hospital on 20 patients with liver cirrhosis [Group I], 25 patients with chronic hepatitis [Group II] and 20 healthy controls. Thorough history and clinical examination was done to all subjects. Abdominal ultrasonography and the following laboratory investigations were performed to every subject: AST, ALT, serum albumin, serum bilirubin, Prothrombin time [PT], HCV Ab, HBs Ag, HBc Ab [IgG]. HBe Ab and serum level of intercellular adhesion molecule- 1 "sICAM- 1". Liver biopsy was done to patients only. Assessment of disease severity was judged by Child-Pugh classification. Assessment of disease activity was done by histopathological staging and by ALT and AST levels. Our work showed that serum level of sICAM- 1 was significantly high in both patient groups compared to controls, and this elevation was attributed to both increased hepatic production and defective hepatic clearance. The serum level of sICAM-1 correlated significantly with both disease severity and activity. Our study showed that serum level of sICAM-1 can be used as a screening non-invasive test with high specificity [100%] and sensitivity [94.6%] to detect patients with chronic liver diseases. On the other hand we failed to find a significant difference in the serum level of sICAM-1 between the two patient groups. Therefore, serum level of sICAM-1 has a poor diagnostic value with low specificity [78.6%] and sensitivity [43.5%] to differentiate patients with chronic hepatitis from patients with cirrhosis

role of CT in nodular lung lesions

One of the most frequent indications for thoracic CT is the detection and characterization of lung nodules. CT is more sensitive than plain chest radiography or whole lung tomography for detecting pulmonary nodules. CT will find up to 40% more nodules than will whole lung tomography, which will find 20% more nodules than plain chest radiography. The problem remains that most small uncalcified nodules are benign. Biopsy is needed to prove benignancy or malignancy unless unequivocal calcification is present. CT can aid in the search for calcification in some cases. Patients with malignancies having a high incidence of lung metastases should be considered for CT scans whether the plain chest radiography is normal or abnormal. This includes primary bone tumours, soft tissue sarcomas, renal cell carcinomas and melanomas. All patients with known tumours should receive CT regardless of plain chest radiographic findings. CT is used in many protocols to follow progression of tumour. Of practical notes, solitary pulmonary nodules seen on chest CT and appearing more than 1 year after the discovery of an extrathoracic neoplasm are more often a bronchogenic carcinoma than a metastatic lesion. CT adis in finding multiple nodules when they are present, as well as in obtaining biopsy proof of the disease process

Evaluation of prostate - related complaints by transrectal ultrasonography, digital rectal examination and prostatic specific antigen

120 male patients with mean age of 55.1 +/- 8.1 years [40 - 78 years] presented with symptoms of prostatism. Symptoms were quantified using the American Urological Association [A.U.A] symptom score. They were subjected to digital rectal examination [D. R. E], prostates specific antigen estimation [P. S. A] transrectal ultrasound [TRUS] and biopsy was obtained from suspicious lesions by the biopsy gun and examined for histopathology. The results were analysed statistically. The results showed three groups of echopattern, isoechoic [46.2%]: hyperechoic [6.7%] and hypoechoic [29.1]. DRE suspected 6 lesions to be malignant. All proved to be hypoechoic by TRUS and confirmed malignant histologically. Of all the hypoechoic lesions biopsy, 8 patients including the six patients suspected by DRE had prostatic carcinoma. Sensitivity of DRE in detection of prostatic carcinoma was 75%, PSA [100%] and TRUS [100%] Specificity reached 93.3% in DRE but decreased to 87.5% using PSA and 70.8% by TRUs

Comparison between colposcopically directed punch biopsy and large loop excision of the transformation zone [LLETZ]

The study comprises [40] women with suspected cervical intraepithelial neoplasia CIN attending the colposcopy clinic at Ain Shams Early Cancer Detection unit. All women were subjected for colposcopy. directed punch biopsy and large loop excision of the transformation zone [LLETZ]. Colposcopy was satisfactory in all women, punch biopsies were adequate for pathological examinations, the excised transformation zones were also adequate. The results of LLETZ did not agree with that of punch biopsies in [25% of cases. The pathology detected by punch biopsy was superior than LLETZ in 20% of cases. LLETZ revealed pathology greater than punch biopsy in [5%] of cases. Punch biopsy is an adequate method of diagnosis specially for smaller lesions, concerning larger, ones, it is better to have more than one biopsy or LLETZ