Incidence of human cytomegalovirus in breast carcinoma tissues is associated with a higher expression of growth factor receptor-bound protein 2

Background: female mammary carcinoma is the second most common cancer incidence among women and the fifth most common leading cause of cancer death worldwide. Premenopausal young women are more frequently targeted by inflammatory breast cancer (IBC), which is the most lethal form of breast cancer. The human cytomegalovirus (HCMV) has been identified as one of the viral infection with a higher frequency in carcinoma tissues of IBC than in non-IBC. The adaptor protein growth factor receptor-bound protein 2 (Grb2), was found to be upregulated in HCMV-infected cells and play as crucial role in cancer progression. Objective: this study aimed to assess the expression level of Grb2 in carcinoma tissues of IBC and non-IBC with HCMV infection. Patients and Methods: overall, 135 female diagnosed with breast carcinoma were enrolled in this study. Using conventional and real time polymerase chain reaction (PCR), we determined the incidence of HCMV and assessed the expression level of Grb2 mRNA in the breast cancer tissue samples. Results: Grb2 mRNA was significantly upregulated in HCMV+ IBC higher than in HCMV+ non-IBC. According to the molecular subtype, Grb2 mRNA was significantly higher upregulated in breast carcinoma tissues of HCMV+ hormonal positive (HP) than in triple negative (TN) counterparts. Conclusion: HCMV infection is associated with a high expression of Grb2 mRNA in IBC and that HP HCMV+ mammary carcinoma tissues confer upregulated Grb2 mRNA, suggesting a potential role of HCMV infection in enhancing of Grb2 mRNA expression in breast cancer with HP

Knee trauma: MR imaging

To assess the role of MRI in evaluation of patients suffering from trauma. The study was conducted on 30 patients who had history of knee trauma and subjected to MRI examination. MRI showed bone contusion or fracture in 27 patients, the commonest site was found in lateral femoral condyle followed by medial femoral condyle and intercondylar eminence of tibia. All patients showed soft tissue injuries, the commonest injury was knee effusion followed by tear of anterior cruciate ligament and medial meniscus. MRI is the imaging modality of choice to assess knee trauma. It showed bony, cartilaginous, ligamentous and soft tissue injuries. It could characterize the nature of post traumatic knee collections

Management of subependymal giant cell astrocytoma in patients with tuberous sclerosis

The clinical records, radiological investigations and operative notes of six patients who had been diagnosed as having the clinical triad of the tuberous sclerosis in the form of seizures, mental retardation and sebaceous adenomas, with the typical CNS finding that develops subependymal giant cell astrocytoma, and who subsequently underwent surgical removal of the lesion. From April 1998 to April 2004 at Nasr Institute Hospital. There were 4 male patients [66.67%] the mean age was 13 years and 2 female's patients [33.33%] the mean age was 18 years. Medical treatment was the first line of treatment by antiepileptic drugs to control the seizures, with dermatological treatments and other drugs to control the intracranial pressure. All cases were operated on because of evidence of the tumor growth on the serial radiological examination with signs of obstruction of the ventricular system. All tumors removed underwent neuropathological examination and disclosed typical aspects of subependymal giant cell astrocytomas. Using new neurosurgical techniques such as microsurgery to routinely excise a growing mass, before hydrocephalus appears

Role of titanium mesh in the reconstructive surgery after skull bone defects

The clinical records, radiological investigations and operative notes of twenty patients who had been diagnosed as having skull bone defects and who subsequently underwent surgical reconstructive technique with titanium mesh from April, 2000 to April, 2004 at Nasr Institute Hospital. There were 14 male patients [70%] the mean age was 36 years and 6 female's patients [30%] the mean age was 39 years. The initial presentation and the major clinical findings among these patients are skull bone defects for different causes; 80% of patients [16 cases] had past history of head injuries followed by skull bone defect, underwent the reconstructive procedure secondarily, as that reflected the timing of their referral, and 20% of the patients [4 cases] had oncology surgery was performed underwent reconstruction with the use of titanium mesh. In the present series of patients, the implant has been used for coverage of small, medium and large sized cranial defects in various locations. This experience suggests that the titanium mesh offers a safe, cosmetically equivalent alternative to standard other cranioplasty materials while ease of implantation shortens operation time and better quality of life for patients. We describe our surgical technique in which the titanium mesh is used and report our experience with it

Cerebral vasospasm detection by TCD after supratentorial brain tumours surgery

Serial transcranial Doppler ultrasonography [TCD] studies were carried out in 74 patients, who had been operated due to supratentorial brain tumours. Among 74 cases have been 32 gliomas, 21 meningiomas and 21 metastasis. The objective of this study was to assess if cerebral vasospasm develops by TCD after supratentorial brain tumour surgery. Vascular spasm was defined when mean flow velocities[MFV] exceeded 120 cm/s in MCA and 90 cm/s in ACA. In the most publications the MFV of 120 cm/s is accepted as lower limit for vasospasm in MCA[2, 3, 8] and this value is about 70% higher than normal value [40 - 60 cm/s]. The cerebral vasospasm has been stated in 16 cases [22%] - 11 gliomas, 4 meningiomas and metastasis out of 74 patients. The cerebral vasospasm has been more intense in ACA on the operated [lesion] side than in MCA and on the non-operated [opposite] side. Cerebral vasospasm should be taken into account as a cause of postoperative worsening also after brain tumour surgery

Management of occipital encephalocele

The clinical records, hematological and radiological investigation and operative notes of five patients [four females and one male] operated on were done. All cases were full-term newborns with a weight ranging from 2.270 to 3.552 g. The patients' mothers mean ages were 24.4 years [19-32 years]. A surgical intervention was done for all cases, an elliptic skin incision surrounding the occipital encephalocele was made along a vertical axis. The ellipse was performed narrow enough to allow skin closure at the end of the procedure, but broad enough to resect the total of the encephalocele. Ventriculo-peritoneal shunt operation was done for three cases that had hydrocephalus, but the other two cases had no hydrocephalus and did not develop after the operation. All cases discharged without any neurological deficit

Managementof interacrnial arachnoid cysts

The clinical and radiographic findings , surgical treatment and outcome in 8 patients with intracanial cysts are reviewed , were done at Nasr Institute, within three years [between 1999 and 2002] .There were 3 females and 5 males, ranging in age from a 5 years to 56 years, six patients were children below the age of 15 years. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imagine scans were diagnostic in all cases, in addition to CSF study. Surgical intervention were done for all cases, by cystoperitoneal shunting with placement of a low pressure shunt. In addition to ventriculoperitoneal shunting in tow cases. There is one case came with history for initial operation consisted of craniectomy for fenestraion and drainag of posterior fossa cyst at Jordan and recurrence of the cyst occws. All cases discharged without any neurological deficit. The results in this series show that cystoperitoneal shunting is the treatment of choice for most intracranial aracnoid cysts

Arthroscopic anterior cruciate ligment reconstruction, patellar tendon versus four strand hamstring graft

This study included 40 male patients in the patellar tendon group and 40 patients [39 male and one female] in the hamstring tendon group. The rehabilitation program was standard in both groups, with immediate knee motion and early weight bearing. Preoperatively, no significant difference between the two groups was noted with respect to age, level of activity, duration of injury, degree of laxity and symptoms of instability. Patients were evaluated using the Lysholm knee score and the international knee documentation committee [IKDC] scores. The average follow up period was 24.6 months for the patellar tendon and 21.2 months for the hamstring tendon group. The final evaluation showed no difference between both groups with satisfactory result in 90% of PT group and 87.5% in the STG group as evaluated by Lysholm. Also, the IKDC evaluation showed no significant difference with 80% of PT group and 90% of the STG group. No significant difference was noted between the two groups with respect to ligament stability, functional evaluation and return to sports activity. Although thigh atrophy and loss of terminal degree of extension was more among patients of the PT group, the difference was not significant

Proximal open wedge tibial osteotomy fixed by puddu osteotomy plate combined with arthroscopic microfracture in medial gonathrosis of the knee with varus defomity

The material of this study consisted of 22 patients, 18 females and 8 males with a mean age of 46.4 years [range 35-50 years]. Preoperative physical examination included assessment of pain, tenderness, range of motion, varus deformity and presence of instability. Standing anteroposterior radiograph of both knees was performed to determine the degree of the tibio-femoral varus angle. All patients had arthroscopic debridement and micro-fracture for the degenerative cartilage combined with proximal open wedge osteotomy fixed by Puddu osteotomy plate. Autogenous bone graft was used to fill the wedges in all patients. Postoperatively the knee was mobilized in a CPM, patients were allowed non-weight bearing ambulation with knee brace. Partial weight bearing started at 6 weeks and full weight bearing at average 12 weeks. The combination of arthroscopic debridement and micro-fracture with proximal open wedge osteotomy fixed by Puddu wedge plate provided a simplified technique for treatment of medial gonarthrosis of the knee with varus deformity in patients less than 50 years old

Assessment of the patello femoral joint following ACL reconstruction, using patellar tendon graft versus hamstring quadrupled graft

The aim of this work was to study the effect of anterior cruciate ligament [ACL] reconstruction on the patello-femoral [PF] joint, comparing between the Patellar tendon [PT] graft and Hamstring [STG] quadrupled graft. The material consisted of 40 patients who had arthroscopic ACL reconstruction by PT and 37 patients by using STG graft. The minimum follow up period following surgery was one year in both groups. Patients were investigated clinically and radiologically regarding the PF joint. Anterior knee pain was present in 45% and 13.5% in both the PT group and the STG group with a significant difference. Patellar irritability and patellar crepitus were higher among the PT group. Flexion contracture was present in 20% and 5.4% in both PT and STG group respectively. There was a positive correlation between PF pain and patellar irritability, flexion contracture, and patellar crepitus in the PT group. Radiological investigation showed, a significant patellar tendon shortening [65%] among the PT group as compared from the preoperative status, measured by Insall/Salvati ratio. There was a significant decrease in the Merchant congruence angle [CA] in the PT group as compared from the preoperative recorded value. There was a significant correlation between PF pain and patellar tendon shortening, but not with the recorded CA in the PT group. The STG group did not show significant changes in the PT length, or CA. The Lateral patellofemoral angle and the sulcus angle did not show significant changes preoperatively or postoperatively

Arthroscopic treatment of articular cartilage damage of the knee using a limited abrasion chondroplasty and microfracture

Fifty patients with limited extent of chondral damage of the femoro-tibial joint treated by arthroscopic debridment, limited abrasion chondroplasty and micro-fracture of the exposed bone. There were31 men and 19 women with an average age 45.7 years [range 22-65 years]. The duration of symptoms ranged between one to 10 years with a mean of 5.2 years. Patients were followed for an average 25.6 months [range 13 - 48 months]. The overall end result showed that 78% had either excellent or good result and remains good until last seen. There was significant improvement in pain, abilities for work activities, squatting, range of motion and swelling. Worst results were obtained in patients above 50 years, with affection of both condyles, associeated patello-femoral osteoarthritis and malalignment. The best result was found in patients below age of 40 years, with no varus deformity and a shorter period of complaints. There was no correlation between the outcome and the degree of damage of the articular cartilage and associated meniscal tears or ACL injuries. In Conclusion, The functional outcome was encouraging in most of the cases following the above procedure. The key for success is the proper selection of patients with limited disease and no malalignment. Microfracture is a cost-effective technique available to all arthroscopic surgeons using proper instrumentation with complications

Arthroscopic evaluation after anterior cruciate ligament reconstruction, correlation to the clinical findings

Twenty-two patients underwent arthroscopic evaluation after anterior cruciate ligament [ACL] reconstruction using bone-patellar tendon-bone graft [BPTB]. The time interval between second look arthroscopy and reconstruction was 17.1 months [range 11 to 36]. They were all males with an average age 25.6 years [range 20 to 38]. The procedure for reconstruction was arthroscopically assisted in 15 patients and by miniarthrotomy in 7 cases. The purpose of this study is to assess the correlation between the subjective and objective clinical finding with the finding at second look arthroscopy. The finding at second look arthroscopy showed, 8 cases had excellent graft, 11 cases had a moderately insufficient graft and 3 cases had a poor graft finding. The preoperative Lyshoim score was 64.3 points and the average post-operative Lysholm was 91.1 points. The final clinical end results showed excellent result in 14 cases, good in 6 cases and fair in 2. Preoperatively all cases complained of instability, postoperatively 3 cases had mild instability in sports activity, with no statistically significant correlation to the arthroscopic finding result. All cases with excellent arthroscopic result had a negative pivot shift test, 7 cases had a negative Lachman. Among the moderate insufficient group, 7 cases with a mildly positive Lachman, and 2 had a mildly positive pivot shift test. There was a positive correlation between the arthroscopic finding result and the laxity of the knee but a negative correlation to the stability. There has been an increase in the incidence of patello-femoral degenerative changes with no significant correlation to the arthroscopic graft result. In conclusion: ACL reconstruction using BPTB graft will not result in an arthroscopically normal ACL in the majority of cases but the knee function and stability have been restored. In spite of the good functional result and patient's satisfaction, the arthroscopic findings were disappointing

Arthroscopic subacromial decompression using bursal approach

Impingement of the rotator cuff beneath the coraco-acromial arch has been recognised as one of the common causes of chronic shoulder pain. Open anterior acromioplasty as described by Neer [1972] has proven highly effective and was widely accepted for treatment of stage II impingement lesions. Subacromial arthroscopic decompression becomes a popular procedure for those cases. Recently the direct attack technique using a bursal approach without entering the shoulder joint has been used successfully. In this paper, a preliminary report about the technique, results, advantages and limitations is presented

Treatment of subdural empyema

The clinical records and the hematological, biochemical and radiological investigations as well as the operative notes of 11 patients operated upon for subdural empyema were evaluated. The most common sites of primary infection were the paranasal air sinuses in five patients, the middle ear infection in three patients, complications of meningitis in two patients and no apparent source could be identified in one patient. With an early diagnosis by contrast-enhanced CT and urgent surgery, excellent results can be achieved by burr hole placement or small craniotomy and this approach was recommended as an easy and safe choice

Study of abnormal coagulation profile in brain tumor patients during surgery

The perioperative time pattern of routine coagulation parameters and the specific hemostasis activation marker D-dimer in 24 consecutive patients [nine females and fifteen males] undergoing elective surgery for brain tumor removal were estimated. Computerized tomography scans and/or nuclear magnetic resonance images were routinely obtained preoperatively to detect tumor size, location and intracranial bleeding. Blood samples were drawn at baseline one day before surgery and again after the scalp incision was closed as well as one and seven days postoperative in 1: 10 volume of 3.8% Na, citrate, centrifuged at 2200G and C and the supernatant plasma was apportioned. Prothrombin time [PT], aPTT and fibrinogen were measured on a coagulometer and fresh samples of antithrombin III [AT III] on analyzer. Levels of cross-linked fibrin degradation products [D- dimer] were measured by enzyme-linked immunosorbent assay from thawed samples stored at -70 C for a maximum of two month

Percutaneous retrogasserian glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia

Approximately two percent of patients with multiple sclerosis [MS] develop trigeminal neuralgia. In multiple sclerosis, Plaque within brainstem may cause trigeminal neuralgia that is often poorly responsive to microvascular decompression. For multiple sclerosis trigeminal neuralgia patients who are refractory to medication regimens, percutaneous trigeminal operations have been advocated. This study was done at Johns Hopkins University Hospital in the United State of America. During the 4-years period from 1995 to 1998, 42 patients suffering from trigeminal neuralgia with MS were treated with percutaneous glycerol rhizotomies [28 females, 14 males, median age 54 years]. These patients represented a subset of 448 patients who had this procedure for trigeminal neuralgia during the same period. The majority of patients without MS were older; 72% above the age of 57 years. Percutaneous retrogasserian glycerol rhiztomy [PROR] is performed with the patient awake but under intravenous sedation. There was no major morbidity related to glycerol rhizotomy and no mortality. The pain relief occurred, it did so immediately in approximately half the patients, over 1-2 weeks in the other half. Detailed follow-up three months or more after surgery was available for all the patients. The follow-up 31 of these patients [73.8%] had complete pain relief and required no medications for trigeminal neuralgia. An additional five patients [11.9%] achieved pain control in conjunction with reduced medication intake. Six patients [14.2%] had inadequate pain relief although three initially had complete pain relief lasting 3, 5, and 10 months respectively. Two of these six patients with inadequate relief were uncontrolled with medication and required subsequent surgical procedures. The patients evaluated for any trigeminal sensory changes, a descriptive assessment of facial numbness was used. Thirty patients [71.4%] continued to have normal facial sensation after glycerol rhizotomy. Finally, single or repeated percutaneous glycerol rhizotomy is a safe, well tolerated, and efficacious procedure for most patients with trigeminal neuralgia related to multiple sclerosis. The development of marked facial hypoesthesia is rare, and usually only observed after multiple rhizotomies

Guidelines for management of minor head injury

The generally accepted definition of minor head injury includes Glasgow Coma Scale [GCS] scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. To assess the risk of a significant intracranial neurosurgical and neurological complication after apparently minor head injury, the authors collected data prospectively on 950 patients who had sustained a transient posttraumatic loss of consciousness or other neurological function and who had a Glasgow Coma Scale [GCS] scores of 13, 14, or 15 in the emergency room. This study is based on 950 consecutive patients admitted to El Hossin and Sayed Galal University Hospitals during the 14-month period beginning in April, 1996, and ending in May, 1997. Skull x-ray films and/ or CT scans were obtained in all patients in this study. Abnormal radiographic findings were defined as the following: 1] skull fracture [including depressed skull fracture]; 2] intracranial hematoma or contusion; and 3] traumatic subarachnoid hemorrhage. After evaluation in the emergency room, 538 [51.1%] patients were admitted and staying in the hospital. Some of these patients had relatively uncomplicated injuries that required neurological observation while other patients required a neurosurgical procedure. Neurosurgical interventions were defined as placement of an craniotomy for evacuation of a clot. Operative procedures were required in the 48 patients with minor head injury; there are 12 patients had depressed skull fractures, 14 patients had acute epidural hematoma and 22 patients had burr holes for chronic subdural hematoma. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury

Variants of tetralogy of Fallot and associated anomalies, a study of 125 patients

Associated cardiac anomalies and variants of tetralogy of Fallot are common findings. They may be identified by echocardigraphy or during cardiac catheterization and angiography. In 125 patients [ps] studied, associated anomalies were present in 70. Right sided aortic arch was the most common anomaly [34 pts], left to right atrial communication in 64 pts [58 pts had a patent foramen ovale, 5 pts a secondum defect and I had a primum defect]. Miscellaneous anomalies like patent ductus arteriosus, persistent left superior vena cava, anomalies of big arteries and abnormal coronary arteries were present in 16 pts. Variation of the tetralogy were present in the form of associated valvular pulmonary stenosis and or pulmonary supravalvular narrowing or obstruction. Selective pulmonary arteriography or right ventricular outflao tract injection was performed in 98 patients [group A], and only apical right ventriculogram in 27 patients [group B] with this anomaly. Forty seven patients [48%] of the first group [group A] had other obstructions more than infundibular narrowing, of these 42 pts had Valvular stenosls, 38 pts had a hypoplastic pulmonary artery, l9pts had right or left branch stenosis and 2 had an absent pulmonary artery branch. Valvular pulmonary stenosis was only seen on left lateral right ventricular angiogram in group-B, while other pulmonary supravalvular narrowings were not well visualized. In conclusion, associated anomalies are common with tetralogy of Fallot and they can be discovered by echocardiography. Their presence and extent should be confirmed by cardiac catheterization. Multiple levels of right ventricular outflow obstruction can not be asssessed except by the outlow right ventriculogram or by pulmonary arteriography which was safe and important for the correct diagnosis of pulmonary arterial anatomy. The correct diagnosis of tetralogy of Fallot with its variants and associated anomalies is of help in planning surgical approach