interplay between c-Myconcogene expression and circulating vascular endothelial growth factor, its antagonist receptor, funs-like tyrosine kinase 1 in diffuse large b cell lymphoma: relationship to patient outcome

Aim: is to assess the relation between c-Myc oncogene expression and angiogenic factors namely vascular endothelial growth factor [VEGF], funs-like tyrosine kinase 1[Flt-1] in patients with diffuse large B cell lymphoma [DLBCL] and their impact on the patient outcome

Methods: Forty Five DLBCL patients beside 10 normal controls were included. c-Myc oncoprotein was assessed by immunohistochemistry and sVEGF, and sFlt-1 were assessed by immunosorbent assay

Results: c-Myc over-expression was detected in 66.6% of DLBCL. The DLBCL patient group with positive c-Myc overexpression showed significantly higher sVEGF and significantly decreased sFlt-1 as compared to group with negative c-Myc over-expression [P=0.000, 0.009 respectively]. sVEGF was positively correlated to sLDH and .v./32 microglobulin [r =0.6, p;0.000, r =0.69, P= 0.000] respectively. The non-survived DLBCL group showed significantly higher expression of c-Myc, high concentration of sVEGF and lower concentration in sFlt-1 as compared to the living group [P=0.000 for all]

Conclusion: These findings confirm the in vitro based suggestion that c-Myc over-expression orchestrate the angiogenic mritch necessary for tumor progression. c-Myc over-expression, elevated sVEGF, and normal sFlt-1 at diagnosis are poor prognostic markers· in DLBCL patients

Insitu liver autotransplantation in dogs without venovenous bypass, novel technique for training on liver transplantation

Introduction: Living-related liver transplantation is gaining increasing acceptance in Egypt and is the only available liver transplantation technique as cadaveric grafts are not approved by law. However it needs high surgical skills regarding hepatic surgery, micro vascular anastomosis and training on small biliary anastomosis

Aim: Provide surgical team responsible for living-related liver transplantation with frequent training on a model very similar to that in human. The aim is to acquire the required surgical skills

Methodology: This technique was done in 9 adult mongrel dogs of both sexes weighing between 85-15 kg, in experimental animal house in Urology nephrology center. General anesthesia is used in all dogs with intubation. Through midline incision and insertion of ring retractor. Dissection of hepatic artery, portal vein. common bile duct and hepatic veins is done with preservation of IVC and isolated dissection of LHV and RHV. Division of HA, PV. CBD is then carried out followed by clamping RHV and LHV and anterior venotomy of LHV. Infusion of PV with cold ringer's solution at 4 C degree with drainage from LHV venotomy. Reanastomosis of HA, PV, CBD and closure of venotomy is done at the end with revascularization of the graft. Wedge liver biopsy was taken before portal clamping, at 30 min ischemia, after portal reperfusion and after arterial reperfusion. Postoperative fluids and antibiotics are given. Follow up for survival up toe months is done with scarification of living dogs for assessment

Results: All dogs survived the operation and up to 24 hours. One dog survived up to 6 months and scarified to assess success of technique. Biliary leak occurred in one dog and discovered after 2 weeks. Average survival in other dogs is 2 weeks. Minimal focal necrosis of the liver was noted after 30 min ischemia. Reperfusion changes are minimal mainly neutrophil infiltration and mild vacular degeneration

Conclusion: Liver transplantation in dogs is an excellent model for training surgical team responsible for liver transplantation as the number of cases is not enough to reach the high level of surgical experience required. It will be also valuable as research tool, to study ischemia and reperfusion injury