Evaluation of triple screening test in prenatal diagnosis of Down syndrome

To evaluate the triple screening test [using AFP, beta-HCG and uE3] in prenatal diagnosis of Down syndrome through comparing the results of the test with the outcome of pregnancy. We will also compare these results with the results of the double test [using AFP and beta-HCG] or MSAFP test to evaluate the value of combining beta-HCG, alpha-fetoprotein [AFP] and unconjugated estriol with maternal age in this three-analyte maternal serum screening program for Down syndrome. This study was conducted on 50 pregnant women, 35 years or older. Their gestational age ranged from 14th to 19th week of pregnancy detected through 1st day of last menstrual period. Blood samples were taken from them for measurement of alpha-fetoprotein, HCG and unconjugated estriol. Risk ratio was calculated for Down syndrome detection using three protocols: MSAFP alone, MSAFP and HCG, MSAFP, HCG, and unconjugated estriol [triple test] using Prisca software [DPC, France]. The [cut-off] median MoM values in pregnancies with Down syndrome were 0.73 [AFP], 2.02 [beta-HCG] and 0.74 [uE3]. After labour, the newborns of selected women for the study were evaluated clinically for diagnosis of Down syndrome. The results of all tests done before labour are compared with the clinical evidence of cases to evaluate them. The detection rate of triple test, double test, MSAFP test was 75%, 50%, 25% respectively. The false positive rate was 40%, 75% and 94% respectively. The correlation coefficient between each test and actual outcome of pregnancy was 0.626 for triple, 0.267 for double and 0.146 for MSAFP test. Using cut-off value 1:190 kept the same detection rate for triple test and lowered the false positive rate to 25%. Triple screening test using AFP, HCG and uE3 has the upper hand over MSAFP and double test in detection of Down syndrome as it has the highest detection rate and lowest false positive rate. The value of correlation coefficient means that other factors or analytes need to be added to improve the detective power of the tests. It is strongly recommended to lower the cut-off value to be 1:190 instead of 1:270. These results need to be evaluated on a more large scale

Immediate breast reconstruction using latissimus dorsi and transverse rectus abdominus myocutaneous [TRAM] flaps

During a period of 12 months, ten women with stage II cancer breast underwent modified radical mastectomy and immediate breast reconstruction[IBR]. Six women had Latissimus Dorsi myocutaneous flaps while four patients had TRAM flaps. In the Latissimus Dorsi flap group, two patients were moderatly obese, two patients were mildly obese and 2 patients were of average body weight. While in the TRAM group, two patients were mildly obese and 2 patients were of average body weight. Operative time [Of the reconstruction only] in the Latissimus Dorsi group ranged from 1.5 to 2.5 hr. [mean 1.8 hr] and each patient received either one or two units of blood. While in the TRAM group, operative time [Of the reconstruction only] ranged from 2 to 3.5 hr. [mean 3.25 hr] and each patient received blood transfusion [range 2-4 units]. In patients of both groups there was no complete flap loss nor fat necrosis. Partial flap loss occured in 2 patients of the Latissiums Dorsi group as a small skin zone loss in the lateral edge, both of them was managed by debridement and repeated dressing. In patients of the TRAM group, partial flap loss in zone [IV] occured in 2 patients, both was managed by debridement and secondly sutures. Regarding donor site complications, seroma appeared in 2 patients of the Latissiums Dorsi group [managed by aspiration] but did not appear in the TRAM group. Wound dehiscence occured in 3 cases of Latissimus Dorsi group, but did not occur in the TRAM group. Haematoma developed in one patient of the TRAM group. Chemotherapy started after 3-4 weeks of operation regardless of the state of the wound. Patients were followed up for 6-12 months [mean 8 months]. All patients in both groups were satisfied and pleased with their reconstructed breasts. From this early experience it is concluded that: [A] Immediate breast reconstruction could be done for patients with cancer breast with excellent patient satisfaction and could be an attractive and encouraging factor for patients who are afraid of being devoid of their breasts to accept mastectomy. [B] Immediate breast reconstruction could be performed without delay in chemotherapy plan and without compromising the flap viability or management of complication. [C] The Latissium Dorsi flap is suitable for patients who refuse an abdominal scar or who are not candidates for a TRAM flap. [D] The TRAM flap is suitable for patients with relatively large breasts and those with average body weight or mild obesity

Effect of cortisol administration on growth of long bones of young immature rats

A histomorphometric study was carried out on 24 weanling albino rats to investigate the effect of cortisol administration on the growth of long bones during the growing period of life. The data revealed that administration of cortisol during the growing period had an inhibitory effect on the rate of bone formation and growth with a subsequent delay in body weight gain. Histologically, the data displayed a considerable reduction in the proliferative zone of the cartilaginous disc, a decrease in the amount of trabecular bone formation along with cortical bone deposition and scarcity of the collagenous and non- collagenous proteins of the bone matrix. Meanwhile, the morphometric data indicated a constant significant reduction of the length of the cartilaginous disc and the thickness of the cortical bone of shafts as well as a significant increase in the number of osteoclasts in the cortisol treated rats. Accordingly, the findings seem to be correlated to explain the retarding effect of cortisol on bone formation and growth that could be referred, in part, to a direct effect on bone cells

Experimental studies on burn toxins and the protective effect of convalescent burn serum

The present work was done to prove the presence of toxic factor or factors in the burned skin. Doses of 0.2 ml of toxins extracted from burned skin caused death in 100% of mice. Below this dose, the lethality in mice decreased. LD[50] in this series is approximately 0.13 mg/ml solution of the toxin material. Sera obtained from convalescent burned patients revealed the protective effect against lethal burn injury or injection of a lethal dose of burn toxin in mice

Ischemic optic neuropathy in rheumatoid arthritis, [case report]

Fundus lesions in rheumatoid arthritis due to vasculitis affecting the eye are rare. Our patient was a 58 years old female who presented with seropositive. Erosive rheumatoid arthritis during a period of exacerbation of her arthritis, she developed impairment of vision in the right eye due to ischaemic optic neuropthy and the most likely cause of this was rheumatoid vasculitis. The disc was treated with corticosteroid and immunosuppressive drugs but there was very little improvement of her vision. Other causes such as malignant hypertension, diabetes mellitus, systemic lupus erythematosus, polyarteritis nodosa, progressive systemic sclerosis, dermatiomyositis and temporal arteritis were excluded