Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer / Papel diagnóstico da elastografia ultrassonográfica nas metástases de linfonodos em pacientes com câncer de cabeça e pescoço

Abstract Introduction: Ultrasonography is the easiest non-invasive method to diagnose lymph node metastases in patients with head and neck cancer. However, since CT scans are often preferred in the evaluation of primary tumours of these patients, information about lymphatic metastases may also available in these patients. Therefore, ultrasound is not routinely employed in the evaluation of these patients. However, elastography technique, a recent development in ultrasound technology, could make use of ultrasonography in these patients even more widespread, even though it is still not widely used today. Objectives: The aim of this study was to evaluate the role of sonographic elastography in the diagnosis of lymph node metastasis of head and neck cancer. Methods: Twenty-three patients diagnosed with head and neck cancer and scheduled for surgical treatment including neck dissection were included in the study. All patients underwent neck examination by palpation, ultrasound elastography and computerized tomography with contrast. To compare the diagnostic performance of palpation, ultrasound elastography and computerized tomography, the findings of each examination method were compared with the histopathological examination results of neck specimens. Results: 15 (65.2%) patients had a primary tumour in the larynx; 7 (30.4%) in the oral cavity; and 1 (4.3%) in the parotid. 7 (30.4%) out of 23 patients underwent bilateral neck dissection. In total, 30 neck dissections were hereby taken into account during study. Ultrasound elastography showed higher accuracy (83.3%) and higher sensitivity (82.4%) than palpation and computerized tomography, but the specificity of ultrasound elastography was lower (84.6%) than palpation and computerized tomography. Conclusions: Ultrasound elastography is helpful for the diagnosis of lymph node metastases in patients with head and neck cancer. Due to its non-invasive character, it can be used safety in combination with other radiological techniques to support or improve their diagnostic performance.

Resumo Introdução: A ultrassonografia é o método mais fácil e não invasivo para diagnosticar metástases em linfonodos em pacientes com câncer de cabeça e pescoço. No entanto, como as tomografias computadorizadas são frequentemente preferidas na avaliação de tumores primários desses pacientes, as informações sobre metástases linfáticas também se tornam disponíveis. Portanto, a ultrassonografia não faz parte da avaliação de rotina desses pacientes. Entretanto, a técnica de elastografia, um desenvolvimento mais recente na tecnologia de ultrassom, poderia tornar o uso da ultrassonografia mais difundido nesses pacientes, embora atualmente ainda não seja amplamente usado. Objetivo: Avaliar o papel da elastografia ultrassonográfica no diagnóstico de metástases em linfonodos em casos de câncer de cabeça e pescoço. Método: Foram incluídos no estudo 23 pacientes diagnosticados com câncer de cabeça e pescoço e com tratamento cirúrgico programado, inclusive esvaziamento cervical. Todos os pacientes foram submetidos a exame cervical por palpação, elastografia ultrassonográfica e tomografia computadorizada com contraste. Para comparar o desempenho diagnóstico da palpação, elastografia ultrassonográfica e tomografia computadorizada, os achados de cada método de exame foram comparados com os resultados do exame histopatológico de amostras obtidas do pescoço. Resultados: Dos pacientes, 15 (65,2%) apresentaram tumor primário na laringe; sete (30,4%) na cavidade oral; e um (4,3%) na parótida. Sete (30,4%) dos 23 pacientes foram submetidos a esvaziamento cervical bilateral. Foram considerados durante o estudo 30 pescoços. A elastografia ultrassonográfica mostrou maior acurácia (83,3%) e maior sensibilidade (82,4%) do que a palpação e a tomografia computadorizada, mas a especificidade da elastografia ultrassonográfica foi menor (84,6%) do que a palpação e a tomografia computadorizada. Conclusões: A elastografia ultrassonográfica é útil para o diagnóstico de metástases de linfonodos em pacientes com câncer de cabeça e pescoço. Graças ao seu caráter não invasivo, pode ser usada com segurança em combinação com outras técnicas radiológicas para apoiar ou melhorar o desempenho diagnóstico.

Clinicopathological spectrum of gall bladder cancer in Kashmir - an institutional study

Gallbladder cancer is a highly aggressive malignancy that usually presents at an advanced incurable stage. It is the fifth most common gastro-intestinal tumor and leads to approximately 2800 deaths in United States annually. This was a retrospective study carried out in the Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, a 650-bed super speciality hospital in Kashmir valley. We reviewed the histopathological records of all the patients who were diagnosed as carcinoma gallbladder from Dec 2009-Dec 2013. Gross findings and histopathological findings were noted from the departmental archival material and clinical records of the patients including the clinical presentation, laboratory investigations, radiological investigations, pre-operative diagnosis and intra-operative findings, were retrieved from the hospital records. We analyzed 57 cases of carcinoma gallbladder for their clinicopathological features It included 19 males and 37 females. In our study, adenocarcinomas accounted for 87.5% of total carcinomas. Incidentally, all but one patient where gall stones were found, adenocarcinomas were seen. We have 4 patients of squamous cell carcinoma. In our series we have a single case of small cell carcinoma which was positive for neuroendocrine markers. In our study, gall stones were seen only in 8 cases [14%] of the total cases

Pharmaceutical representatives' beliefs and practices about their professional practice: a study in Sudan

Pharmaceutical representatives are an important promotional tool for pharmaceutical companies. This cross-sectional, exploratory study aimed to determine pharmaceutical representatives' beliefs and practices about their professional practice in Sudan. A random sample of 160 pharmaceutical representatives were interviewed using a pretested questionnaire. The majority were male [84.4%] and had received training in professional sales skills [86.3%] and about the products being promoted [82.5%]. Only 65.6% agreed that they provided full and balanced information about products. Not providing balanced information was attributed by 23.1% to doctors' lack of time. However, 28.1% confessed they sometimes felt like hiding unfavourable information, 21.9% were sometimes or always inclined to give untrue information to make sales and 66.9% considered free gifts as ethically acceptable. More attention is needed to dissemination of ethical codes of conduct and training about the ethics of drug promotion for pharmaceutical representatives in Sudan

Influence of milk and some Sudanese meals on the dissolution of ciprofloxacin tablets

For a drug to be effective, it must be released from the dosage form, fully dissolved in the gastro-intestinal fluids, be stable as solution in the gastrointestinal fluids, pass through the gastrointestinal barriers into the mesenteric circulation without being metabolized, pass through the liver into the systemic circulation unchanged and reach its site of action. Food is one of the factors which interfere with these processes. The effect of Sudanese meals will be different due to their high contents of fats, proteins and fibers. This study aimed to determine the influence of milk and some Sudanese meals [Foul - Vicia faba -, "Gorrassah with damaa" and "Kissraa with sharmoot"' on the dissolution of ciprofloxacin HCI tablets and hence bioavailability. The influence of milk and the mentioned Sudanese meals on the dissolution of ciprofloxacin was studied using paddle dissolution apparatus. The dissolution of the drug was measured in the presence of each meal individually using U.V.- visible spectrophotometer. The samples were taken with 5 minutes intervals up to 30 minutes. The results obtained were compared to the results of the dissolution of this drug in simulated gastric fluid in fast state [0.1 N HCl]. The study revealed that the dissolution of ciprofloxacin in Sudanese meals is lower than its dissolution in milk- whose reduction of dissolution of ciprofloxacin was mentioned in a lot of studies world-wide. The order of the influence of Sudanese meals, used in the study, was foul followed by kissraa then gorrasah which showed that the influence was directly proportional to the viscosity of the meal. Using two different volumes of foul, the study revealed that influence of meals on the dissolution of ciprofloxacin was significant even small amounts were used

Antimicrobial and phytochemical screening of three commonly used medicinal plants

In the present study, antimicrobial activities of nine extracts from three medicinal plants indigenous to Sudan and commonly used in traditional medicine, namely Terminalia brownie, Acacia seyal and Tephrosia opollinea, were tested against four standard bacterial strains: Bacillus subtilis, Staphylococcus aureus, Eseherichia coli and Pseudomonas aeruginosa, and three fungal strains: Aspergillus niger, Aspergillus flavus and Candida albicans. The results exhibited that the chloroformic and methanolic extracts had prominent activity against most of the tested microorganisms. On the other hand, the benzene extract was devoid of any antimicrobial activity against all tested organisms. Due to the prominent antimicrobial activity of Terminalia brownie, it was subjected to an in-depth phytochernical investigation. Column chromatography of the methanolic extract resulted in the isolation of a crystalline compound [Tb/1]. The chemical structure Tb/1 was elucidated by infra-red coupled with nuclear magnetic resonance [1HNMR and 13CNMR] and electron impact mass spectrophotometer [ElMS] as beta-Lupeol. This compound was not previously reported from T. brownii. It exhibited a high antifungal activity against C. albicans

Microbiology in children with chronic suppurative ottitis media in Al-Salam hospital at Sadah governorate

The identification and eradication of the bacterial pathogens involved in C.S.O.M. would provide the basis for setting up regional epidemiological surveillance centers and allow improve management of patients when the usual antibiotic therapy fails to produce satisfactory results; provide an optimal environment for surgery by treating C.S.O.M. to convert active into inactive disease and lastly avoidance complications sequelae and provide a good quality of life are a major care goals. Specimen for bacteriological examination was obtained aseptically directly from the middle ear of 143 patients with C.S.O.M. treated in the pediatric outpatient clinic in Al-Salam Hospital at Sadah Governorate [rural area] in Yemen. Cultures of ear discharges and determination of significant bacterial counts were performed by semiquantitative methods. Standard diagnostic microbiological methods for identification the isolates were used. Antibiotic susceptibility tests were performed in significant isolates using stoke's method. The total number of children included in the study was 134. Eighty-nine [66.42 percent] were male and [33.58 percent] female. The mean age was 4.6 years. Sixty-one [45.52 percent] were below 3 years, 37 [27.61 percent] were between 4-6 years, 28 [20.90 percent] were between 7-9 years and 8 [5.97 percent] were between 10-12 years. The peak incidence of C.S.O.M. among preschool children in this study was 98 [73.13 percent] of cases and this show us how the problem is big. The commonest causative bacterial pathogens of the included children with C.S.O.M. were proteus species in 47 [35.07 percent], staphylococcus aureus in 36 [26.87 percent] and pseudomonas aeruginosa in 30 [22.39 percent]. Less common bacterial pathogens were isolated in the form of E-coli in 10 [7.46 percent], staphylococcus epidermidis in 6 [4.48 percent], streptococcus viridans in 3 [2.24 percent] and streptococcus pyogen group A in 2 [1.49 percent]. Highly resistance of all pathogens to Chloramphenicol was found in [98.51 percent], and Penicillin-G [90.30 percent], followed by Oxacillin [85.56 percent] and Tetracycline in [85.02 percent]. High sensitive to all pathogens to Gentamicin was found in [90.30 percent], followed by Amikacin [55.97 percent], and Cephalothinin [53.75 percent]. This study supports the medical side of management of C.S.O.M. to prevent the complications, to provide a good life quality for children with C.S.O.M. and to provide a sterile environment for surgical management of C.S.O.M

Ovarian failure related eeffects after hysterectomy with ovarian conservation

The age of ovarian failure was determined in 50 women who had previously undergone hysterectomy with bilateral ovarian conservation and 30 women who had undergone spontaneous menopause. The mean age of ovarian failure in the hysterectomized group was 43.36 +/- 0.75 years which was significantly lower than the non-hysterectomized group [53.25 +/- 6.68 years]. The age of ovarian failure was not related to the indication of hysterectomy

Comparison of interleukin 8 with C-reactive protein in maternal serum in intra-amniotic infection at term

In comparing serum C-reactive protein level with other indicators of intrauterine infection [e.g. white blood cell count, differential count, maternal temperature, fetal heart rate], C-reactive protein [CRP] level appears to be more sensitive but less specific in identifying chorioamnionitis. In this study, C-reactive protein was positive in 77% of positive placenta for histopathological signs of infection. C-reactive protein was found to have a sensitivity of 76%, specificity of 85%, positive predictive value of 90%, a negative predictive value of 66% and a test of accuracy of 80%. The present study showed that maternal serum interleukin-8 [IL-8] level could be used as more reliable method for screening histological chorioamnionitis than conventional markers of infection. The sensitivity of interleukin-8 level was 92%, specificity 100%, positive predictive value 100%, negative predictive value 87.5% and test of accuracy 95% when using 47 pg/ml as a cutoff value. It is evident that maternal serum interleukin-8 level is superior to C- reactive protein as regards sensitivity, specificity and predictive values [both positive and negative]. Also, interleukin-8 serum level elevated earlier than other clinical signs of infection or elevations of serum C-reactive protein