Urine carcinoembryonic antigen determination in urinary bladder bilharziasis predicts carcinoma in patients with premalignant lesions. observations of 43 Egyptian cases

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen [CEA]. Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 nonbliharzial cases, in addition to 10 normal control cases. A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial, versus 62% in nonbilharzial bladder carcinoma cases. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial patients were higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels. In conclusion, urinary CEA is more useful than serum CEA in the early detection of urothelial carcinoma particularly if provoked by bilharziasis. Its level is also correlated with the tumor stage

outcome of surgical decompression for carpal tunnel syndrome yields better functional results than conservative management and steroid injection

Surgery for carpal tunnel syndrome is reserved for severe cases or for those having intractable and longstanding symptoms. Non-surgical treatment modalities include hand splinting, ultrasound, oral non-steroidal anti-inflammatory drugs, local steroid injection, and some physiotherapeutic measures. The objective of this study is to evaluate the effectiveness of non-surgical treatment versus standard surgery in improving clinical outcome. Twenty seven patients with carpal tunnel syndrome were categorized into three groups [12, 9 and 6 patients respectively]. Group I received conservative management, and intra-canal injection of Triamicinolone Acetonide was added to group II. Open release of the carpal ligament was kept for patients of Group III. Treatment was given for the recommended period for each modality, and the follow up was for 6 months. Assessment was for the degree of pain relief and improvement in hand grip strength using the ppi scale and a dynamometer. Except three, all patients were females and the disease affected the right hand more than the left. After 6 months, results were: In group 1I 36% improvement of pain, but with no affect on hand grip strength. In group II, relief of pain reached up to 75% of patients with 12.76% average increase in hand grip strength. In group III surgery gave 82% improvement of pain with 20.5% average increase in hand grip strength. Open surgical release of the transverse carpal ligament should not be confined to patients with severe symptoms only. Conservative treatment is reserved for patients that either refuse surgery, or are unfit for surgery. Endoscopic release is not recommended for the time being