Interval debulking after neoadjuvant chemotherapy in uresectable advanced ovarian cancer

Primary debulking surgery followed by chemotherapy is the current treatment for [FIGO] stage IIIC ovarian carcinoma. However, patients with unresectable bulky tumors time unable to receive standard treatment and thus have a poor prognosis. Neoadjuvant chemotherapy could induce downstaging and thus improve operability by Interval debulking. The purpose of this study is to report our experience with primary debulking in advanced ovarian carcinoma and the role of neoadjuvant chemotherapy [NAC] and interval debulking [ID] in primary unresectable tumors. One hundred patients with FIGO stage IIIC ovarian carcinoma were prospectively treated at the National Cancer Institute [NCI], Cairo University between February 2000 and November 2003. All patients underwent surgical staging to evaluate tumor resectability. Resectable patients were treated by primary dehulking [PD] followed by 6 cycles of adjuvant chemotherapy. Unresectable patients were treated by NAC followed by ID and adjuvant chemotherapy. The two groups were investigated and compared with respect to tumor resection rates, magnitude of resection blood transfusions duration of surgery, postoperative hospital staty morbidity of .surgery and survival. Of 100 patients, 48 patients' were resectable with 34 [71%] patients achieving optimal cytoreduction Of the 52 patients who received NAC, ID was pemformed in 44 patients. Optimal cytoreduction was achieved in 35 patients [67%]. The rates of additional resections and morbidity were significantly reduced in ID group. The difference in the overall survival between the two groups was not statistically significant [p = 0. 712]. NAC followed by ID is feasible and can convert a high percentage of patients with unresectable tumors into patients free of macroscopic [disease. The magnitude of resections and morbidity are reduce after NAC and ID surgery. ID offers survival rates comparable to PD in advanced ovarian cancer. NAC and ID is an alternative treatmnent for patients with advanced unresectable ovarian cancer in whom the chamice of optimnal cytoreduction is low

in vitro study on the effect of degree of convergence angles and different surface treatments on retention of resin bonded full coverage prostheses

This study was directed to evaluate the effect of different degrees of convergence angle [10°, 15°, 20° or 25°] and different types of surface treatments of alloy [Sandblasting with 250 microns] [A1203], tin-electroplating and 9.6% hydrofluoric acid etching] on retention of resin bonded full coverage restorations. A total of sixty sound molar teeth were retained in self-cure acrylic resin blocks and divided into four main groups of 15 each. Each group was subjected to preparation with convergence angle [10°, 15°, 20° or 25°]. The four main groups were sub-divided into three sub groups of 5 each. The restorations of each one of these subgroups was subjected to sandblasting with 250 microns [A1[2]O[3]], tin electroplating or 9.6% hydrofluoric acid etching. All samples after treatment were cemented to its prepared tooth using adhesive resin cement and subjected to tensile test using Lloyd testing machine. The failure load was recorded in kilograms. From the results it was found that, elevation of convergence angle of the prepared tooth surfaces reduced the retentive strength of resin bonded full coverage restorations. Sandblasting using 250 microns [A1[2]O[3] produced a superior bond strength compared with tin electroplating and 9.6% hydrofluoric acid etching

Plasma and low density lipoproteins levels of fat- soluble vitamins in obese Egyptian girls

Obesity is an important health problem which is deeply rooted in human biologic system resulting in many complications namely atherosclerosis and coronary heart disease. This work was designed to investigate the antioxidant status of obese Egyptian girls. Lycopene, beta- carotene and alpha-tocopherol levels were analyzed in plasma and low density lipoprotein [LDL] fraction of plasma lipids as well as the fatty acids composition of LDL as a substrate for oxidative stress. Twenty two obese girls and ten age and sex matched healthy controls were included in this work. The plasma lycopene/total lipids, beta- carotene/total lipids and alpha-tocopherol/total lipids were significantly lower in the obese girls compared to controls Moreover, the three vitamins contents in LDL fraction were significantly lower than controls, although the plasma levels of the three studied vitamins showed no statistically significant differences in obese girls compared to control In obese girls group, LDL contained more polyunsaturated fatty acids [PUFA] compared to normal controls. When the peroxidizability index [PI] was calculated to estimate susceptibility of fatty acids to oxidative stress, obese girls had significantly higher PI values than normal controls. The LDL lycopene/PI, beta-carotene/PI and alpha-tocopherol/PI ratios were significantly lower in obese girls than controls. Significant negative correlations were found between the studied vitamins levels, their calculated ratios and their contents in LDL fraction when correlated to body mass index [BMI] of obese girls. The best parameters which can predict high BMI were found to be the P1 and lycopene/total lipids. These results indicate the increased susceptibility of LDL to oxidative stress in obese girls along with decreased levels of antioxidant fat-soluble vitamins. These findings may promote atherosclerosis or coronary heart disease later in their life

Plasma matrix metalloproteinase 1 [MMP1] and tissue inhibitor of metalloproteinase 1 [TIMP1]: potential diagnostic markers of prostate cancer progression

The purpose of this work was to evaluate the role of plasma matrix metalloproteinase 1 [MMP1] and tissue inhibitor of metalloproteinase 1 [TIMP1] in diagnosis and staging of prostate cancer patients. This study was conducted on 60 male patients [aged 48-80 years] and 20 age matched healthy individuals. Patients were classified according to clinical examination, prostate specific antigen [PSA] findings, pathological and radiological findings into : 25 patients with benign prostatic hyperplasia [BPH] and 35 patients with different stages of prostate cancer [PC] divided into : [13 PC with no metastasis, 13 PC with local metastasis and 9 PC with distant metastasis]. Plasma MMP1 and TIMP1 were assayed using sandwich immunoassay technique for all subjects. Serum total prostate specific antigen [TPSA] and serum alkaline phosphatase [ALP] were measured to all patients and control group. Free PSA and PSA index were performed for patients with TPSA between 4 and 10 ng/mL. PSA index was found to be superior to TPSA in discriminating patients with prostate cancer [p < 0.001]. There was no significant difference in plasma MMPI levels between different studied groups [p > 0.05]. Serum ALP was significantly increased in PC patients with distant metastasis than those with local metastasis; ALP was additionally found to be the best predictive marker for the presence of distant bone metastasis. Using ROC, Plasma ALP showed a diagnostic sensitivity for bone metastasis in prostate cancer patients of 100% at a cutoff of 90IU/L Median levels of plasma TIMP1 were found to be increased in PC patients [n = 35] over BPH [n = 25] [1600, 180 ug/L respectively]. Additionally, plasma TIMP1 median levels showed a progressive increase with malignant progression of PC being 400 ug/L in PC with no metastasis [n = 13], 2200 ug/L in PC with local metastasis [n = 13] and 4000 ug/L in PC with distant bone metastasis [n = 9], with a statistically significant difference between groups [p < 0.001]. There was a significant negative correlation between TIMP1 and PSA index in PC patients. TIMP1 also correlated positively with ALP in the same group. Mean-while, TIMP1 proved to best discriminate PC patients with metastasis [local and distant] from those with no metastasis. Accordingly, plasma TIMP1 is accurately correlated with staging of prostate cancer and is a promising marker of malignant progression of prostate cancer. Moreover, addition of ALP can effectively detect distant bone metastasis in PC patients

Cross linked telopelatide of type-1 collagen in adult patients with rheumatoid arthritis in correlation with disease activity

The aim of this study was to measure the serum level of cross-linked carboxy-terminal telopeptide of type-I collagen [ICTP] as a bone resorption marker in adult patients with rheumatoid arthritis. Moreover, the correlation between ICTP levels and the disease activity was assessed. Blood samples were collected from patients with active RA, inactive RA and healthy subjects matched for age and sex. The results showed that serum ICTP in ug/L was statistically significantly higher in case of active RA and inactive RA when compared with the healthy control subjects. Furthermore, serum ICTP was significantly higher in cases with active RA versus inactive RA. In conclusion, serum ICTP might serve as an indicator of rheumatoid disease activity. However, serum ICTP was not influenced by steroid administration in these patients

Supplementing Shamy bread with wheat germs

The extinsograph results showed that addition of up to 9% raw or defatted wheat germs have good potentialities to be used in supplementing 82% flour for shamy bread making. On the other hand, the use of toasted germs would have deleterious effects on dough qualities required for bread making. Although supplementing flour for shamy bread making with wheat germs tended to lower the final bread weight, the supplemented bread was preferred organoleptically. Freshness of the supplemented bread by raw or toasted germs was rated very close to, or higher than, the control. Addition of defatted germs caused a noticeable decline in freshness. The addition of 9% raw wheat germs to wheat flour [the recommended treatment] caused a 16.4% increase in bread protein, 16.6% in iron, more than 110% in zinc, and 108% in calcium

Enrichment of two types of biscuits by wheat germs.

Rheological studies showed that the addition of 15% defatted wheat germs to 72% extraction flour used to produce hard sweet biscuits [Petite Beurre] lowered the stability and increased the weakening of the dough making it more suitable for biscuit manufacture. The organoleptic results recommended that enriching Petite Beurre biscuits with defatted wheat germs should not exceed 10%. Such treatment increased the protein content by 22.8%, iron by 28.1% and zinc by 668.8% while calcium content decreased by 36.2%. Supplementing 72% extraction flour with up to 20% raw wheat germs for soft sweet biscuit [Soiree] manufacture had beneficial weakening effects on its rheological characteristics. Biscuit thickness and diameter and the organoleptic results indicated that enriching soft sweet biscuits with up to 20% raw wheat germs was recommendable. Such treatment increased the protein content of Soiree biscuits by 41.4%, the iron content by 79.3% and the zinc content by 541.3% while calcium content decreased by 63.8%. Hard sweet biscuits enriched by defatted wheat germs and soft sweet biscuits enriched by raw wheat germs are recommended as good sources of protein, iron and zinc

Arthritis as a presenting manifestation of acute leukemia in children

This study included 15 children coded as acute leukemia presenting with arthritis. This arthritis had no evident cause other than leukemia. It was present solely or as a part of a group of signs and symptoms. Thirteen children of them had acute lymphoblastic leukemia [ALL] while the other 2 had acute myeloblastic leukemia [AML]. They were 6 males and 9 females. The patients' ages ranged between 3 and 14 years [mean 8.2 +/- 3.4]. The duration of their arthritis on initial examination ranged between 4 and 24 weeks [mean 11.2 +/- 6.7]. This arthritis was persistent symmetrical polyarticular in 73.3% of patients and migratory in 26.7% of them. The knees, ankles and wrists were the most frequently affected joints. Radiological changes suggestive of leukemia were detected in only 5 patients [33.3%]. Laboratory investigations including the erythrocyte sedimentation rate, rheumatoid factor and anti-streptolysin O-titer were of no help for differentiating this group of patients from others with rheumatic diseases. This demonstrates the importance of considering leukemia as a possible etiological diagnosis in children presenting with arthritis

Ultrasonographic evaluation of the carotid arteries in smokers and non smokers

A total of 100 individuals were recruited for the study. Fifty-three smokers [group 1] and 47 [group 2] non-smokers of age, sex and weight matched were recruited for the study. Measurements of the carotid arteries intima-media thickness [CIMT] and detection of plaques are attempted in every individual under study. Significantly higher mean CIMT was not different between both groups in subjects below 35 years old, it was significantly higher in middle-aged [35-55 years], and older [> 55 years] smokers than in non-smokers. Assessment of plaque prevalence revealed more frequent occurrence in smokers with a percent of 33% as compared to only 19% in non-smokers. Plaques occurred at an earlier age in smokers, mean age of individuals with 1 or more plaques was 38 years compared to 49 years in non-smokers. The results of this demonstrate the efficacy of high resolution ultrasonography in detecting intima-media changes and the presence of plaques in asymptomatic individuals. The value of early detection of reversible changes in population at risk, such as smokers, cannot be underestimated

Cord blood lipoprotein cholesterol and its relation to the gestational age of the newborn

Total cholesterol [TC], triglycerides [TRG], high density lipoprotein cholesterol [HDL-C] and low density lipoprotein cholesterol [LDL-C] were determined in 59 cord blood samples during delivery of 33 term neonates [>37 weeks of gestation] and 26 preterm neonates. The preterm group was further subdivided into a group of older preterms [13 cases] with gestational age 34-36 weeks and a group of smaller preterms [13 cases] with gestational age 31-33 weeks. The mean of TC and LDL-C exhibited a statistically significant increase in both preterm groups when compared to the full term group [P <0.01]. The increase was more in the smaller preterms. The decreased LDL-C in full term neonates is probably due to the increased rate of uptake of LDL-C for steroid hormone production by the fetal adrenals near term. HDL-C showed no statistically significant difference in the three groups. TRG showed a statistically significant increase with the increase in gestational age [P <0.01]. The calculated atherogenic indices TC/HDL-C and LDLC/HDL-C were significantly increased in the preterm group of neonates when compared to the full term. Both indices of the preterm group were compared using the ANOVA test and it was found that LDL-C/HDL-C was the best parameters that showed a significantly higher F-ratio. Thus, being a sensitive index, it can be used in the early detection of cases of genetically determined hyperlipidemias at birth

Uraemic pleural effusion before and after maintenance hemodialysis

Six chronic uraemic patients were studied to evaluate pleural effusion that developed before or during chronic haemodialysis. The effusion was considered to be uraemic in origin as no evidences of other causes were present. Each of fever, pleuritic pain, pericardial rub and hiccough occurred in three patients and pleural rub in 2. All patients had dyspnoea and hypoxaemia. There was no correlation between BUN, creatinine, or other blood chemicals and the appearance of effusion. The effusion was left sided in three patients, right sided in one and bilateral in two. It was serous in four patients, serosanguineous in one, and haemorrhagic in one. The pleural fluid contained more lymphocytes than neutrophils. Elevated proteins and LDH levels gave the effusion the characteristics of an exudate. Maintenance dialysis for five to seven weeks resulted in resolution of the pleural effusion in three patients, its stabilization in two but failed in one patient with haemorrhagic effusion in both pleural and pericardial sacs

Respiratory manifestations of heart stroke in the pilgrims

This study was carried out on 136 cases of heat stroke during Mecca pilgrimage of 1981. Clinical, radiological, ECG and laboratory studies including blood gases, acid base, electrolytes, enzymes, hepatic and renal functions and some hematological studies were done. Respiratory involvement was evidenced by the presence of disturbed rate or rhythm of breathing in all cases and the common finding of cyanosis [62%] X-ray chest for 82 cases revealed the presence of lobar or broncho-pneumonia in 31.4% and atelectasis of right upper lobe in two cases. Pulmonary edema was found in six cases. Hypoxemia was present in all measurements. Hypocapnia was present in the majority of cases [87.7%], while hypercapnia was found in three emphysematous and an obese patients. Serum electrolytes showed that sodium level was normal in 68.3%, low in 21.5% and high in 10.2%, while potassium level was low in 58%, none in 41.3% and high in only a case of acute renal failure [0.7%]. The multisystem involvement was evident. A relatively low mortality of 20% reflects the value of prompt diagnosis and immediate treatment

Effect of Nifedipine on Bronchial Asthma before and after exercise

Ten asthmatic patients were studied in this work. A preliminary work up included history taking and clinical and radiologic examination of the chest. Serum calcium, ECG, spirometric and arterial blood studies were performed in 2 settings on 2 separate days before and after administration of 10 mg nifedipine both at rest and after exercise. Nifedipine prevented exercise induced asthma in the 3 patients who had this experience and all patients tolerated the exercise test with much less dyspnoea after its administration. Significant improvement occurred in FEV[3] [P < 0.001], MEFR [P < 0.01], MMFR [P < 0.02] and Pa0[2] [P < 0.01] both at rest and after exercise following nifedipine premedication. A significant increase in FEV[1] [P < 0.01] and MVV [P < 0.01] occurred only after exercise under the effect of the drug. Serum calcium and Q-Tc interval were within normal limits before nifedipine and showed no significant changes after its intake

respiratory effects of ketamine in asthmatic patients

Clinical and pulmonary function studies including blood gas measurements were done on 20 volunteers: 10 controls and 10 asthmatics for evaluation of the respiratory effects of ketamine. During anaesthesia two asthmatic patients got apnea, 2 got cough while in controls one got apnea and another got cough. No dysrrhythmia developed in both groups. Pulmonary function and blood gas studies showed that ketamine does not significantly alter lung function in asthmatic patients. It can be concluded that ketamine can be safely given to asthmatic patients