Immunohis1ochemical cyclooxygenase-2 [COX-2] and cd31 expression in breast carcinoma with correlation to clinico-pathological parameters

Breast cancer is the most'common cancer in Egyptian women. COX-2 seems to be involved in malignant transformation and tumor progression by affecting cell proliferation, mitosis, cell adhesion, apoptosis, immune surveillance, and angiogenesis. Angiogenesis is an important key step in tumor progression. Microvascular density [MVD], a surrogate marker of angiogenesis can be assessed by CD31 staining. This study aims to: 1. Evaluate COX-2 and CD31 expressions in breast cancer. 2. Determine the correlation between COX-2 and CD31 with the clinico-pathological parameters in ductal breast carcinoma. This study included 74 specimens of breast lesions. Patient's age, tumor size and local aggressive changes, history of recurrence and/or presence of distant metastasis were obtained. Hematoxylin and Eosin [HandE] stained sections were evaluated for histopathological tumor type, tumor grade, presence or absence of normal hyperplastic, in situ component, lymphocytic infiltration, lymphovascular invasion, and axillary lymph node status. COX-2 and CD31 immunostaining was done to detect their expression using the avidin-biotin peroxidase method. COX-2 increased with increasing grade of ductal carcinoma in situ [DC1S] and invasive ductal carcinomas [IDC] [P< 0.05 and P< 0.002 respectively]. COX-2 expression increased progressively along the continuum of neoplastic changes from normal breast epithelium to IDC [P< 0.01]. There was significant correlation between COX-2 and tumor size [P< 0.05], tumor grade [P< 0.002], lymphovascular invasion [P< 0.03] and lymph node metastasis [P< 0.02]. CD31 staining was observed along the cell membrane of endothelial cells of microvessels in all breast specimens. The median CD31 MVD count was 10 for normal breast, increased insignificantly to 17 in hyperplastic lesions, and reached 19 for DCIS, and 66.5 in IDC [P < 0.000]. There was significant increase in MVD between different grades of IDC [P < 0.01] but not in DCIS. Positive correlation was present between COX-2 and CD31 in DCIS and in IDC [P< 0.000 for each]. COX-2 was increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion and lymph node metastasis. CD31 increases with increasing grade of IDC. These findings might imply for new therapeutic strategies in order to prevent progression of DCIS to IDC and to improve cancer therapy

Proliferative index and p53 expression in breast carcinoma and their correlation to clinico-pathological parameters

Background: Breast cancer is the most frequently diagnosed cancer and the most common cause of cancer deaths in women worldwide. Ki67 is a biomarker that reflects cell proliferation. Despite a clear understanding of the structure and properties of this protein, its functional role remains elusive. Gene expression alteration confers the potential for invasive growth in the preinvasive stages of breast cancer. Altered expression of the tumor suppressor gene p53 is frequently seen in carcinomas of the breast and correlates with poor prognosis. This study aims to investigate Ki67 and p53 expressions in benign, preinvasive and invasive breast lesions and to correlate their expressions with the clinico-pathological parameters

Materials and Methods: This study included 74 specimens of breast lesions. Ki67 and p53 immunostaining expression was detected using avidin-biotin peroxidase method

Results: Ki67 and p53 increased progressively along the continuum of neoplastic changes from normal breast epithelium to invasive ductal carcinomas; IDC [P<0.000 and 1:1<0.01 respectively]. There was significant positive correlation between Ki67-labeling index [LI] and either tumor grade or lymph node metastasis in IDC [11<0.03 and P<0.02 respectively]. P53 expression increased with increasing grade of both ductal carcinoma in situ [DCIS] and IDC [P<0.01 and P<0.002 respectively]. There was significant correlation between p53 and tumor size, lymphovascular invasion, and lymphocytic infiltration [P<0.05, P<0.02. P<0.03 respectively]. There was positive correlation between Ki67 and p53 in both DCIS [r= 0.845, P<0.001] and in IDC [r-0.697, P<0.02] of the breast

Conclusion: Ki67 and p53 increased progressively along the continuum of neoplastic changes from normal breast epithelium to DCIS and IDC. Ki67 and p53 were increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion, lymphocytic infiltration, and lymph node metastasis

Correlation of micro vessel density [MVD] and proliferation index [PI] with clinico-pathological parameters in breast carcinoma

Background: One of the greatest challenges in breast cancer management is to accurately predict the outcome for each patient. Microvessel density [MVD] correlated closely with increasing number of tumor cells shed into the bloodstream and development of metastasis. Because proliferation status closely correlates with tumor aggressiveness, proliferation index [PI] is considered as an established prognostic marker for various tumors. We aimed to: 1. Study WVD and PI by assessing immunohistochemical profiles of CD31 and Ki67 respectively and their probable role in breast cancer progression. 2. Assess values of CD31 and Ki67 in relations to clinico-pathological prognostic parameters

Subjects and methods: Immunostaining was done to detect CD31 and Ki67 expressions in 74 specimens of breast lesions

Results: Both CD31 and Ki67 increased progressively along the continuum of neoplastic changes from normal breast epithelium to invasive ductal carcinomas; IDC [P<0.000 for each]. CD31 expression was positively correlated with minor size [p< 0.04], increasing grade [P<0.01], lymphovascular invasion [p<0.01] and lymph node metastasis [P< 0.05] in IDC. There was significant positive correlation between Ki67 expression and increasing grade [P<0.03] and lymph node metastasis [P<0.02] in IDC. Positive correlation was present between Ki67 and CD31 in ductal carcinoma in situ [DCIS] and in IDC [P<0.02 and P<0.001 respectively]

Conclusion: Our findings indicate that aggressive tumors are more capable of angiogenesis and proliferation which are poor prognostic signs in IDC. These findings might open the door for new therapeutic strategies to prevent progression of DCIS to IDC

Evaluation of some histochemical and immunohistochemical criteria of round cell tumors of bone

The differential diagnosis of round cell tumors of bone [RCTB], Ewing sarcoma, smallcell osteosarcoma, mesenchymal chondrosarcoma, osteoblastoma, chondroblastoma, primary bone lymphoma, and multiple myeloma still remains a challenge. Given the significant differences in treatment, an accurate diagnosis is crucial. This study aimed to evaluate some histochemical and immunohistochemical criteria of RCTB. Periodic acid-Schiff [PAS], CD99, CD138, osteocalcin, and leukocyte common antigen [LCA] were evaluated in 113 patients with RCTB. PAS was positive in neoplastic cells of all Ewing sarcomas, 27% of osteosarcomas, 92% of chondrosarcomas, all osteoblastomas and chondroblastomas, and the osteoid tissue of all osteosarcomas and osteoblastomas. CD99 was positive in all Ewing sarcomas, in 11, 4, and 11% of osteoblastomas, multiple myelomas, and bone lymphomas, respectively. CD99 was higher in Ewing sarcoma than in other RCTB [Po0.0001]. Osteocalcin was positive in neoplastic cells of all osteosarcomas, osteoblastomas, and 20% of chondroblastomas, 84, and 78% of osteoid of osteosarcomas and osteoblastomas, respectively. CD138 was positive in all multiple myelomas, 12% of Ewing sarcomas, 20% of osteosarcomas, 44% of osteoblastomas, 8% of chondrosarcomas, and 40% of chondroblastomas. CD138 was higher in multiple myeloma [Po0.0001] than in other RCTB. LCA positivity was higher [Po0.01] in bone lymphomas [100%] than in multiple myelomas [73%]. PAS negativity excludes multiple myeloma and bone lymphoma from other RCTB that could be differentiated by LCA and CD138. CD99 positivity confirms the diagnosis of Ewing sarcoma. PAS could detect areas of osteoid in osteosarcoma and osteoblastoma. Osteocalcin suggests an osteogenic tumor origin: osteosarcoma/ osteoblastoma. Double negativity of CD99 and osteocalcin suggests a chondrogenic tumor origin: chondrosarcoma/chondroblastoma

Serum prohepcidin, iron and hepatic iron status in chronic hepatitis C in Egyptian patients

Patients with chronic hepatitis C [CHC] often have increased liver iron. Hepcidin has recently emerged as a key regulator for iron homeostasis. Therefore, we aimed to study the relationship between serum prohepcidin, serum iron indices, hepatic necro-inflammation, fibrosis and hepatic iron density and to determine the predictors of advanced fibrosis in these patients. Fifty CHC treatment naive patients and 20 healthy controls were enrolled in this study. Complete blood count, liver function tests, serum iron indices and serum prohepcidin were assayed. Liver biopsy was performed for all patients for assessment of necro-inflammatory activity, fibrosis and liver iron density. Thirty-four patients [68%] had mild fibrosis [stage 0, 1,2] and sixteen [32%] had advanced fibrosis [stage 3, 4]. All cases were positive for liver iron stain [68% mild, 32% advanced]. Mean serum prohepcidin level was significantly lower in CHC patients than healthy controls. In univariate analysis, prohepcidin was significantly associated with necro-inflammatory activity [P<0.05] and advanced fibrosis [P<0.05]. Multivariate analysis revealed that necro-inflammatory activity and liver iron density arc independently associated with stage of fibrosis. No significant correlations were found between prohepcidin and serum iron indices or liver iron score. Scrum prohcpcidin is reduced in CHC which may be one -not the only- factor leading to iron overload in these patients. Histological grading and hepatic iron density are independent predictors of advanced fibrosis. Further studies are needed to clarify the role of viral and host genetic factors in hepatic iron deposition

Immunohistochemical study of inducible nitric oxide synthase [iNOS] in peritoneal Tuberculous granuloma

Nitric Oxide [NO] is important in host defense against Mycobacterium tuberculosis in rodents, but the presence of high-output NO production in human tuberculosis has been controversial. This study aimed to investigate iNOS expression by peritoneal macrophages in TB peritonitis and to gain insights into the structural properties of peritoneal TB granuloma. Peritoneal biopsies were obtained from 28 undiagnosed cases of ascites and examined histopathologically by H and E stain. Accordingly, specimens proved to be TB peritonitis were then immunohistochemically stained for iNOS, the macrophage marker CD68 and CD3 and CD20 as markers of T and B lymphocytes respectively. Eight control cases of normal peritoneum were included. TB peritonitis was diagnosed in 16 cases. TB granulomas were found in 9/16 cases [56%] and a diffuse granulomatous reaction was found in the remaining7/16 cases [44%]. Immunoreactivity to iNOS and CD68 were intensely expressed in macrophage rich TB granuloma and in the diffuse granulomatous TB reaction. Most Langhans cells [multinucleated giant cells] showed strong reactivity to both CD68 and iNOS. In TB granuloma, CD3[+] cells were found at the periphery with few CD20[4] cells in its center. Control cases showed complete negativity for iNOS, CDS, very small number of CD68 and/or CD20 cells. In TB peritonitis, an increased local expression of iNOS in granuloma associated macrophages of untreated patients indicating excess NO production in the active stage of this form of Tuberculosis. Further studies are needed to test the therapeutic implications of NO in different forms of TB

Expression of adhesion molecule CD44V6 in salivary gland tumors

Salivary gland tumors are a morphologically and clinically diverse group of neoplasms which may present significant diagnostic and management challenges. Cell adhesion molecules [CAMs] are glyco-proteins that are present on the external surface of the cell membrane. CD44 is a cell adhesion molecule belonging to systemic IgCAMs family, and is remarkable for its ability to generate alternatively spliced forms, many of which differ in their activities. This remarkable flexibility has led to speculation that CD44, via its changing nature, plays a role in some of the methods that tumor cells use to progress successfully through growth and metastasis. To investigate the expression of CD44v6 in different types of salivary glands tumors and to correlate the results with some established prognostic factors. Sixty cases were studied. 21 were pleomorphic adenomas,, 9 Warthin's tumors, 6 monomorphic adenomas, 9 mucoepidermoid carcinomas, five adenoid cystic carcinomas, in addition to 10 normal controls. Clinical data were obtained from the referring clinical departments. The biopsy specimens were obtained by excision, true cut needle biopsy, or punch biopsy. Cases were selected by reviewing the hematoxylin and eosin [H and E] stained slides. Immunohistochemistry was done using the CD44v6 mouse monoclonal antibody raised against human species. CD44v6 was +ve in 46/60 [76, 7%] of salivary gland tumors studied; 35/40 [87.5%] benign salivary glands tumors and 11/20 [55%] malignant salivary gland tumors and this difference was statistically significant [P < 0.01]. CD44v6 was +ve in 16/21 [76%] of pleomorphic adenoma, in 9/9 [100%] of Warthin's tumors and in 6/6 of monomorphic adenoma. CD44v6 was +ve in 5/ 9 of mucoepidermoid carcinoma; 4/5 [80%] of low and intermediate grade mucoepidermoid carcinoma and in 1/4 [25%] of high grade malignant mucoepidermoid carcinoma. The 4 studied high grade malignant mucoepidermoid carcinoma were lymph node metastasis +ve. CD44V6 was +ve in 4/5 [80%] of adenoid cystic carcinoma. There was a statistically significant decrease in CD44v6 positivity [P < 0.03] in high grade malignant salivary gland tumors compared to low and intermediate grade tumors. There was also a statistically significant decrease in CD44v6 positivity [P < 0.01] in malignant salivary gland tumors received with lymph node metastasis compared with those lymph node metastasis negative cases. 1] Down regulation of CD44v6 plays an important role in malignant transformation of salivary gland tumors. 2] The degree of down-regulation is correlated, with progression towards higher grades and also with lymph node metastasis

Role of apoptosis proteins survivin, BAX and BCL-XL in laryngeal squamous cell carcinoma progression

We used immunohistochemistry to investigate a potential role of SVV as an early predictor of malignant transformation in precancerous and cancerous lesions of the larynx, we also sought to examine the expression of Bcl-X[L] and Bax in laryngeal SCC analyze the relationships between their expression and prognostic factors including site, histological grade, clinical staging and lymph node metastasis. This study included 6 normal laryngeal mucosae, 7 dysplastic laryngeal epithelia, 5 in situ laryngeal carcinomas, and 32 hiopsied laryngeal SCC. Clinical evaluation was done. Specimens were forma I in-fixed, paraffin-embedded, stained with H and E, classified and graded according to WHO classification, [2005] and immunostained to detect Survivin and Bcl-X[L]. and Bax proteins using the avidinbiotin peroxidase method. Survivin expression gradually increased significantly 'with advance of laryngeal carcinoma through the sequence of dysplasia, in situ carcinoma and infiltrating carcinoma [P < 0.04]. There is a statistically significant increase in Survivin expression with increasing tumor grade [P < 0.03] and with advance in clinical staging [P < 0.01]. Regarding lymph node metastasis SVV was more expressed in laryngeal SCC exhibiting lymph node metastasis [P < 0.02]. Bax expression was decreased significantly in infiltrating laryngeal carcinoma [P < 0.04] compared with premalignant lesions of the larynx. In contrast, Bcl-X[L] was increased significantly with the advance of laryngeal. carcinoma through dysplasia, carcinoma sequence [P < 0.02]. There was no statistically significant difference in either Bax or Bcl-X[L] expression considering tumor differentiation, advanced clinical staging or lymph node metastasis. Survivin plays cm important role in the initiation of laryngeal cancer and its progression towards higher grades, invasion and metastasis. Bax and Bcl-X[L] play their role early in cancer initiation but have nothing to do as the tumor progresses to higher grades, infiltrates deeply, or giving lymph node metastasis

Role of survivin in glioma progression: a clinico-pathological study

Gliomas are among the most aggressive of all human malignancies. Glioblastoma multitbrme is the most malignant histopathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. Gliomas are among the most aggressive of all human malignancies. Glioblastoma multiforme is the most malignant histo-pathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. This study included 34 glioma patients. Clinical evaluation including age, sex, clinical presentation and location of the tumor, was done. Sections from glioma specimens were stained with H and E, classified and graded according to WHO classification, [2000] and then immunostained to detect Survivin protein expression. The study included 34 glioma cases. Survivin was expressed to a variable extent in most groups of gliomas [in 21/24, 1/4, 1/1 and 5/5 cases of astrocytomas, oligodendrogliomas, mixed oligoastrocytoma and ependymomas respectively]. Survivin expression showed gradual up-regulation with increasing grade of astrocytomas from pilocytic astrocytomas [66.7%] [right arrow] diffuse astrocytomas [77.8%] [right arrow] anaplastic astrocytomas [100%] [right arrow] glioblastoma multiforme [100%]. This study showed that there is a strong correlation between the distribution and staining intensity of Survivin protein expression and the tumor grade [P< value< 0.01 and < 0.00 respectively]. Also there is a strong correlation hetueen Survivin protein expression as evidenced by immunoreactivity score [IRS] and tumor grade and proliferative activity [P value< 0.00 and <0.002 respectively]. Survivin plays an important role in the initiation of gliomas and their progression towards higher grades

Immunohistochemical study of INOS in peritoneal tuberculous granuloma

The human tuberculous granuloma provides the morphological basis for local immune processes central to the outcome of tuberculosis. Nitric Oxide [NO], produced by the inducible nitric oxide synthase [INOS], is important in host defense against Mycobacterium tuberculosis in rodents, but the presence of high-output NO production in human tuberculosis has been controversial. Because of the scarcity of information in human patients especially in peritoneal tuberculosis, the present study aimed to: 1-investigate iNOS expression by peritoneal macrophages in TB peritonitis. 2- gain insights into the structural properties of peritoneal TB gronuloma. Laparoscoy was done for 28 patients with undiagnosed ascites and peritoneal biopsies were obtained and examined histopathologically by H and E stain. Accordingly, specimens proved to be TB peritonitis were then iminunohistochemically stained for iNOS, the macrophage marker CD 68 and CD 3 and CD 20 as markers of T and B lymphocytes respectively. Eight Control cases of peritoneum removed with surgically excised organ specimens [e.g. with excised tumors] were included. TB peritonitis was diagnosed in 16 cases. TB granulomas were found in 9/16 cases [56%] and a diffuse granulomatous reaction was found in the remaining 7/16 cases [44%]. Immunoreactivity to iNOS and the macrophage marker CD 68 were intensely expressed in macrophage rich TB granuloma and in the diffuse granulomatous TB reaction. Most Langhans cells [multinucleated giant cells] showed strong reactivity to both CD 68 and iNOS. The expression intensity of iNOS and/or CD 68 was stronger in diffuse and premature-stage granulomas than in late-stage granulomas [caseating granuloma]. In TB granuloma, CD 3 cells were found at the periphery with few CD 20[+] cells in its center. While in diffuse granulomatous TB reaction, CD 3[+] lymphocytes were diffusely dispersed in the lesion with few CD 20[+] lymphocytes. Control cases showed complete negativity for iNOS, CD 3, very small number of CD 68 and/or CD 20 cells. In TB peritonitis, the distribution of different immune cells in the granuloma is similar to that described in pulmonary TB granulomas. An increased local expression of iNOS in granulomas associated macrophages of untreated patients indicating excess NO production in the active stage of this form of Tuberculosis. Further studies are needed to test the therapeutic implications of NO in different forms of TB

Immunohistochemical analysis of the immune cells in bilharzial granuloma of the urinary bladder

Urinary bilharziasis represent a major health problem in Egypt. It is characterized by the formation of localized collection of immune cells i.e. granulomas. In this investigation, we hypothesized that the evolution of the bilharzial ganuloma is associated with recruitment of immune cells of diverse cell lineage. To explore this hypothesis and to fill this existing gap in the literature, We carried out this investigation. Granuloma cell population was immunohistologically examined in thirty cases of cellular bilharzial granulomas using immunoperoxidase staining methods and antibodies targeting antigens for B cells [CD20]. T cells [CD3]. Histiocytes [CFD68] and cytotoxic T cells [Granzyme B]. The mean values of positive cells in the cellular bilharzial granulomas were: 45.5 +/- 5.6 for CD68 cells: 14.8 +/- 1.1 for CD3 T cells; 9.1 +/- 1.1: for CD20 B cells and 1.5 +/- 0.8: for Granzyme B T cells with cytotoxic activity. The numerical dominance of CD68 cells suggests their critical role in the evolution of these lesions. Our study was the first to report immunophenotypic profile of the bilharzial grnauloms

Inflammatory bowel disease: diagnostic and therapeutic modalities

Inflammatory bowel disease [IBD] is chronic conditions of unknown origin that result from continuous or intermittent inflammation of a part of the intestinal wall. The main classic types of IBD are ulcerative colitis [UC], Crohn's disease [CD] and indeterminate colitis that cannot be classified accurately as UC or CD with pure colonic involvement. The aim of this study is to highlight this rare disease in our locality including; clinical feature, investigations, indication of surgical interference, operative procedures, histopathological examination, and postoperative complications. Twenty nine patients were included in this study from January 2000 to May 2006. Histopathological examination proved to be UC in 18 patients and CD of the intestinal tract in 11 patients. Patients were subjected to history, tarnsclinical examination, and routine laboratory investigation, abdominal X-ray in an erect position, barium enema, intravenous urography, sigmoidoscopy and colonoscopy. Biopsy was taken, and CT and MRI were done in selected cases. All patients subjected to medical and/or surgical treatment according to their finding. Their mean age was 49.4 +/- 2.1 years [range 12 -65 ys]. Female to male ratio was 2:1. The main clinical manifestations were abdominal pain in 27 patients [93.1%], bleeding per rectum in 14 patients [48.3%], mucus discharge in 10 patients [34.5%], and chronic diarrhea in 6 patients. Palpable abdominal mass was found in 3 patients. Extra-abdominal manifestations were loss of weight in 15 patients [51.7%], pallor in 11 patients [37.9%], lower limb edema in 7 patients and skin changes 4 patients. Twenty three patients [79.3%] were received medical treatment; 18 patients [62.1%] UC and 5 CD but the remaining 6 patients [20.7%] admitted to emergency department. Successful treatment with complete cure was achieved in 12 patients [41.4%]; 10 patients had UC and 2 CD while surgery was done in 17 patients [58.6%]; 9 patients had CD and 8 UC. Right hemicolectomy was done for 7 of them and limited resection anastomosis was performed in the other 2 patients. Total colectomy with terminal ileostomy was carried out in one patient and subtotal colectomy with ileorectal anastomsis in 7 patients. Postoperative intestinal fistula detected in one patient and right hemicolectomy was done. Wound infection occurred in 3 patients and one of them developed burst abdomen. IBD is not rare in our locality and its treatment still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Proper assessment of IBD requires cooperation of gastroenterologists, radiologists, histopathologists and surgeons

Celiac disease, TB enterocolitis and giardiasis among children with chronic diarrhea: the accuracy of ANT-EMA and tTG expression in the diagnosis of celiac disease

Chronic diarrhea is one of the most common causes of referral to a gastroenterology clinic. Chronic diarrhea may result from many different causes; celiac disease is one of them. Other important causes in our locality are infections such as TB and Giardiasis. This work was planned to: 1-Determine the frequency of celiac disease, TB enteritis and Giardiasis among children referred to the gastroenterology unit with the complaint of chronic diarrhea and to evaluate the different methods used in the diagnosis of each disease. 2- Verifying the diagnostic accuracy of immunohistochemical tTG expression versus serum anti-endomysial antibodies [EMA] in celiac disease [CD] diagnosis. The study included 92 patients with chronic diarrhea. Their ages ranged from 6 months to 15 years. They were 56 males and 36 females, admitted to the Pediatric Gastroenterology Unit, Assiut University Hospital during the period from January 2005 to December 2006. Besides full history and thorough clinical examination, the following investigations were done for all cases: stool analysis for three consecutive days, CBC, ESR, total proteins and serum albumin, tuberculin test, accelerated BCG test [in tuberculin negative cases], serum anti-EMA. Upper GIT endoscopy with duodenal biopsy and aspiration and tissue staining by H and E and by Immunohistochemical [anti-tTG moAbs] to detect tTG antigens in biopsy specimens. Lower GIT endoscopy with biopsy sampling and histopathological examination of biopsy specimens was also done. Out of the total patients, 18 cases [19.5%] were positive for celiac disease AEM antibodies while 16 were positive by tTG immunostaining of biopsy specimens. Fourteen patients [15.2%] had tuberculous enterocolitis while 12 [13%] had biopsy proven Giardiasis. On the other hand 48 patients [52.1%] had other undiagnosed causes of chronic diarrhea. A very high index of suspicion for CD should be maintained for patients who present with chronic diarrhea or iron deficiency anemia. The best method for diagnosis of celiac disease in such patients is serological testing followed by a small-bowel biopsy. The diagnosis of intestinal tuberculosis is difficult due to the lack of specific symptoms and signs. Colonoscopy with ileoscopy is a useful method for diagnosis of intestinal TB. Gastrointestinal endoscopy with biopsy examination is an important method of diagnosis and follows up of children with Giardiasis

Upper and lower gastrointestinal endoscopy in children attending Sohag University Hospital: indications and results

Gastrointestinal disorders in children represent a broad spectrum of acute and chronic conditions including congenital, infectious, inflammatory metabolic and rarely neoplastic disorders. The development of endoscopic instruments to evaluate different parts of the gastrointestinal tract improved significantly the information about diseases affecting the gastrointestinal tract and its management. The addition of endoscopic examination to the investigations of gastrointestinal disorders in children has greatly transformed the practice of pediatric gastroenterology. The present study included 197 children referred for endoscopic examination during the period of October 2002 to September 2005, aged from 3 months to 16 years [average 5.7 years] and 55% of them were males. Referral to the pediatric endoscopy unit was a part of investigating various gastrointestinal disorders. One hundred thirty two patients [67%] were referred for upper gastrointestinal endoscopy while 65 patients [33%] for lower endoscopy. The results showed that, out of 50 patients who presented with [UGIB, 34% had esophago gastric varices: 32% were esophageal and 2% fundal varices. Injection sclerotherapy was done successfully for 5 patients with varices. The second common endoscopic finding in patients with UGIB was erosive and/or hemorrhagic gastritis [28%] followed by duodenitis [8%] and esophagitis [6%]. A combination of esophago-gastro-duodenitis was detected in 6% of the patients. Out of the 30 patients presenting with unexplained vomiting gastritis was the most common endoscopic and histological findings followed by esophagitis and duodenitis. In patients with suspected malabsorption, upper endoscopy revealed pale mucosa in 32% and edematous mucosa in 28% of the cases. In 40% of the cases, no abnormalities could be found. Biopsy examination revealed villous atrophy in 64% and a picture compatible with Crohn's disease in 28%. However, in 8%, no histological abnormality was detected. In patients with unexplained recurrent abdominal pain, UGIE revealed abnormalities in 55% [30% gastritis, 15% duodenitis, and 10% duodenal ulcer]. However, in 45% no abnormality could be detected. Histological abnormalities were found in 90% of cases; 45% active gastritis and Helicobacter pylori [HP] organisms in the antral region, 30% active gastritis without HP and 15% active duodenitis with the HP in the antral region. Collectively, HP organisms were detected in 60% of cases with unexplained RAP. Esophagitis was detected endoscopically and histologically in all cases with dysphagia. In two cases, impacted foreign bodies [a coin and a hair pin] were detected and removed successfully during the same endoscopic examination. Bleeding per rectum was the most frequent cause to do colonoscopy in children. Endoscopically, polyps were the most common detected abnormality [47.37%] followed by colonic inflammation [31.58%]. Histologically, benign juvenile polyps were the most common [28.95%] followed by bilharzial polyps [18.42%], nonspecific colitis [15.79%] and lastly allergic colitis [15.79%]. Endoscopic examination of children with bloody diarrhea revealed various lesions including erythema, edema, mucosal ulceration and/or white exudate in the rectum and colon in 86.67% of the cases. Biopsy examination showed a picture of pseudo-membranous colitis in 53.33%, and ulcerative colitis in 13.33%. In 12 patients with unexplained lower abdominal pain, endoscopy revealed erythema, erosions and minute ulcers in 4 of them while biopsy examination revealed nonspecific proctocolitis in 8 cases. Pediatric gastrointestinal endoscopy is a valuable and informative diagnostic procedure and can be performed safely with the use of intravenous sedation. Therapeutic maneuvers can be also applied as foreign body removal, sclerotherapy and polypectomy. Gastrointestinal bleeding is the commonest indication for endoscopic examination in children. Variceal bleeding represents the major cause of upper gastrointestinal bleeding while colonic polyps are the commonest cause of lower gastrointestinal hemorrhage. Helicobacter pylori infection is increasingly recognized in children and needs further studies to identify its relations to different gastrointestinal complaints in such children. Antibiotics induced diarrhea and pseudo-membranous colitis represent a problem in pediatric practice particularly in infants. Hence, antibiotic prescription should be done according to standardized guidelines. Endoscopic examination can demonstrate definite organic lesions that are necessary for diagnosis. However, a negative endoscopy with normal findings has its role in either reassurance of parents and diagnosis of functional disorders

First record of schistosoma intercalatum in upper Egypt; an abnormal locality and presentation simulating lymphoma

Schistosomiasis due to Schistosoma intercalatum is highly restricted to the Western regions of equatorial Africa. Its main clinical manifestation is rectal bleeding. A case is described of a 14 year old boy living in Upper Egypt who was presented to General Surgery Department, Sohag University Hospital, South Valley University, complaining of vague abdominal pain, rectal bleeding, multiple abdominal masses and splenomegaly. Laparotomy revealed moderate splenomegaly, multiple hepatic focal lesions, mesenteric and paracolic lymphadenopathy, and multiple nonobstructing colonic masses. Splenectomy was done, multiple lymph node biopsies and wedge liver biopsy were taken. Endoscopic rectal biopsy was also done. The primary diagnosis was abdominal lymphoma with hepatic and splenic involvement. Histopathological examinations of these biopsies revealed congested spleen and multiple bilharzial granulomata effacing the whole lymph nodal architecture, infiterating the portal tracts of the liver, and surrounding terminally spined-eggs of the rectal wall. Staining of the rectal specimen by Modified Ziehl-Neelsen showed red coloration of the egg-shell characteristic of S. intercalatum. We here announce the first record of S. intercalatum in Upper Egypt, Sohag Governorate and also report all interesting unusual presentation of S. intercalatum schistosomiasis by abdominal lymph node enlargement simulating lymphoma

Laparoscopic versus open cholecystecystectomy for acute calculous cholecystitis; which is better?

Laparoscopic cholecystectomy [LC] has become the treatment of choice for elective cholecystectomy, but controversy persists over use of this approach in the treatment of acute calculous cholecystitis. To assess the feasibility, safety, and outcome of laparoscopy in management of patients with acute calculous cholecystitis and to determine whether it is a boon or bust in comparison with open cholecystectomy [OC]. This study included 84 patients [38 males and 46 females] who met criteria for acute calculous cholecystitis. Their age ranged from 19 to 65 year with average of 47 years. They were randomized to be treated by LC [40 patients] or OC [44 patients]. Operation time, postoperative pain, length of hospital stay, intraoperative and postoperative complications were the main outcome measures used to compare the two studied groups. In LC group, the rate and reasons for conversion to OC were also studied. The two randomized groups were similar in demographic, physical, and clinical characteristics. There was no significant difference in the operation time between LC and OC [89.9 min +/- 19.9 vs.83.9 min- +/- 8.2, P: 0.2]. Postoperative analgesia was better in the LC than in the OC with median score [VAS] of 2 points vs.4 points in the two groups respectively and the mean analgesic requirements was 160mg +/- 40 vs.240mg +/- 60 in the two groups respectively [P: 0.0004]. The length of hospital stay for patients who underwent successful LC was significantly shorter than the open group [2.2 days +/- 0.82 vs.6.4 daysfl. +/- 1.6, P: 0.0001]. Operative complications were higher in the LC group than in the OC group. By far the commonest was gallbladder perforation with spillage of bile and or stones [25%]. Bleeding occurred in five patients in the LC group [12.5%] and in two patients in the OC group [4.5%]. There were no deaths or bile duct injuries in either group. Postoperative complications were higher in the OCR than in the LC. By far the commonest were wound related complications [11.4%]. Wound sepsis occurred in five cases in OC group [11.4%] and in two cases in LC group [7.7°%]. Incisional hernia and intestinal obstruction each occurred in one case in the OC [2.3%]. In LC group, 14 patients required conversion to OC [35%], in 10 of them [71%] the cause was obscure anatomy and dense adhesions of inflammation. Male gender represents the majority of converted cases [64%]. LC is feasible and safe method for treatment of patients with acute calculous cholecystitis,. However it is not without risks and might not be suitable for every patient