role of dynamic contrast enhanced and diffusion weighted MRI in characterization of suspicious breast masses

Background: early detection and diagnosis of breast cancer are mandatory for accurate management. Traditionally, mammography and ultrasound are the basic imaging techniques for the detection and localization of breast masses. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities

Aim of study: to evaluate the role of either diffusion weighted images-MRI or dynamic contrast enhanced MRI in differentiating malignant from benign breast lesions comparing with histopathology results

Patients and Methods: from November 2016 to July 2017, a total of 20 patients presented with suspicious breast lesions BIRADS [4and5] were included in the study. All participants underwent breast DWI and DCE-MRI. Results were compared with histopathological results as a standard final diagnostic method

Results: the study included 20 female patients with suspicious breast lesions, there was 15 [75%] malignant lesions while benign lesions, while benign lesions were 5 [25%] cases. DCE-MRI was found to have a sensitivity of 86.7% and specificity of 80%. ADC cutoff value was found to have a value of 1.143*10[-3], which was the best to differentiate between benign and malignant breast masses. DWI MRI was found to have sensitivity of 93.3% and a specificity of 80%

Conclusion: DW-MRI alone gave the same performance as in combination with DCE-MRI. The comparison of DWI and DCE-MRI provides a dramatic superiority in the sensitivity, specificity and accuracy of breast DWI-MRI over other modality

Using serum beta trace protein to estimate residual kidney function in hemodialysis patients

Aim of the work: residual kidney function [RKF] in end stage kidney disease [ESKD] patients contributes significantly to solute clearance. This improves survival as well quality of life in these patients. Kidney Diseases Outcomes Quality Initiative [KDOQI] guidelines suggest that hemodialysis [HD] dose can be safely reduced in those with RKF in the form of residual urea clearance [KRU] of 2 ml/min/1.73 m2 or more. However, measurement of RKU is difficult as it requires regular inter-dialytic urine collections. Simpler methods for measuring KRU and thus RKF are needed. Beta trace protein [BTP] has been proposed as alternative markers of RKF and RKU. Dialysis specific equations to estimate KRU based on serum BTP wererecentlydeveloped. This study aimed to compare measured KRU using inter-dialytic urine collection and estimated KRU using serum BTP

Patients and Methods: we included 60 ESKD patients in this study;they were divided into 2 groups. Group-1[G-1] had daily urine output <500ml and group-2[G-2] haddaily urine output >500ml. We estimated and measured KRU in both groups. Correlation between measured and estimated KRU in each group was done using Pearson correlation coefficient

Results: the estimated and measured KRU was strongly correlated in G-1 with r=0.746 at p<0.01, but it was week in G-2 with r=0.44 and p<0.05.Mean bias between estimated and measured KRU was 0.7 mL/min in G-1. In G-2 the mean bias was -0.54mL/min

Conclusion: KRU and thus RKF can be better estimated using serum BTP in patients with urine output >500mL than in patients with daily urine output200-500mL

Some biochemical markers for various stages of psoriasis including psoriatic arthritis

Psoriasis is a chronic inflammatory autoimmune skin disease, with a prevalence varying between 0.6% to 4.8% of the population worldwide. Psoriatic arthritis [PsA] is an inflammatory arthritis which can involve the musculoskeletal system and is characterized by negative rheumatoid factor. To evaluate the serum level of TNF-alpha, IL23 and oxidative stress [OS] markers in various stages of psoriasis including PsA. The psoriatic patients [N=30] were chosen with different clinical types of psoriasis including PsA, They were subdivided into four subgroups according to Schmitt and Wozel [2005] model of PASI score; mild[N = 8], moderate[N = 8], severe [N = 8] and PsA[N = 6]. The serum levels of TNF-alpha, IL23, NO, MDA, SOD and CAT were determined in all groups. The levels of TNF-alpha, IL23, MDA and NO were significantly higher in both Psoriatic and PsA patients respectively acc. to increase in PASI score in comparison to the control. On the other hand, the levels of SOD and CAT were significantly lower in both Psoriatic and PsA patients, respectively according to increase in PASI score than the control. The finding suggested that both Th1 and Th17 may play an important rule in the pathogenesis of psoriasis in addition to the rule of Oxidative Stress . Moreover, these markers can be used as biomarkers for various stages of psoriasis severity

Estimation of some heavy metals in polluted well water and mercury accumulation in broiler organs

The aim of this study was to investigate the relationship between the concentrations of heavy metals in well water and bioaccumulation of the most abundant metals in chicken tissues in some areas in the province of Mecca Almokaramah, Saudi Arabia. Among the heavy metals (Cd, Zn, Cr, Mn, Cu Hg, Pb and Ni) studied, mercury (Hg) revealed highest in concentration in well waters. The concentration of mercury in the ground water, beside in liver, kidney, muscle and blood samples of ten chickens from each of four poultry- production farms were estimated using atomic absorption spectrophotometer. The results showed that the kidney followed by liver had the highest bioaccumulation of mercury in all farm samples. The level of mercury in the ground water was 7.06µg/L. The relationship between mercury accumulation levels in the kidney and those in the liver tissues were proportionally correlated and altered with elevation in the antioxidant enzyme activities such as AST and ALT. These elevated enzymatic activities were induced by the level of toxicity. There was a significant elevation in the level of liver and kidney malondialdhyde (MDA), while the activities of antioxidant enzymes superoxide dismutase and catalase (SOD and CAT) were significantly decreased. Biochemical observations were supplemented by histopathological examination of liver and kidney sections.

Endovascular treatment of infra-aortic atherosclerotic arterial disease

Endovascular therapy has an important and definitive role for patients with critical limb ischemia. It easily revascularizes inflow and outflow lesions with minimal morbidity and mortality. One hundred and thirteen patients with critical limb ischemia underwent endovascular procedures either alone or combined with surgical bypass [n=29] with no procedure-related mortality. All patients had angioplasty while 8 of 12 patients with aortic bifurcation disease, 22 of 28 with iliac disease, and 28 of 44 with femoropopliteal disease had stent placement as well. Initial success rates were 100% for the aortic bifurcation group, 96.3% for the iliac group, and 90.7% for the femoropopliteal group. Two-year patency rates were 83.3% for the aortic bifurcation group, 85.2% for the iliac group, and 72.1% for the femoropopliteal group. Twenty nine patients underwent simultaneous iliac endovascular and infrainguinal bypass procedures. This group included 21 angioplasty of the common iliac artery with stent placement in 16 patients and 8 angioplasties of the external iliac artery with stent placement in 4. Pemoropopliteal bypass was performed in 18 patients using vein grafts in 14 patients and synthetic polytetrafluoroethylene grafts in 4 patients. Femorotibial bypass was performed in 11 patients using vein grafts. The initial success rate for this simultaneous endovascular and surgical bypass was 93.1% and the 2-year patency rate was 75.9%. Our results demonstrate that endovascular therapy is a low-risk procedure with satisfactory initial and 2-year success rates

Study of central nervous system involvement in children with acute leukemia in relation to different immunophenotypes before and during treatment

Central nervous system [CNS] involvement remains a problem in acute Ieukemias [AL] despite the fact that prophylaxis with intrathecal [IT], systemic high dose chemotherapy and radiotherapy have greatly reduced its incidence. The relationship between the immunophenotypes of AL and development of CNS disease is controversial. The present study included 40 children with newly diagnosed acute leukemia, 36 patients with ALL and 4 patients with AML. They were 23 males and 17 females. Their age ranged from 2-12 years with a mean age of 6.06 +/- 2.59 years. A panel of monoclonal antibodies were used for classifying the Ieukemias into different immunophenotypes. The most common immunophenotype of ALL cases [56%] was early pre-B [CD19, CD22 and CD10]. No CD10 [CALLA] negative cases were detected in our series. Two cases showed cytoplasmic immunoglobulin [Clg] indicating a more mature pre-B immunophenotype. T cell immunophenotype was detected in 14 cases mainly CD2, CD3 and CD7.AML immunophenotype was detected in 4 cases showing CD13 and CD33. Seven cases [17.5%] showed clinical symptoms and signs of CNS involvement at initial diagnosis whereas 8 cases [20%] showed blast cells in CSF. The majority [75%] of CNS disease cases [6 out of 8 cases] had a T cell immunophenotype, while 25% [2 out of 8 cases] were 8 cell lineage. The difference between the 2 groups was significant [P=<0.001]. During follow-up, 5 cases developed CNS relapse. Four of them [80%] were of T cell immunophenotype and only one case [20%] was of B cell lineage [pre 8 cell ALL]. Only one case of CNS relapse did not have CNS disease at initial diagnosis and was of T cell immunophenotype. Four of CNS relapse cases occurred early in the first year of the disease. In view of the poor prognosis of patients with CNS disease and relapse and the higher incidence of these events in T cell ALL children, these patients may need intensive systemic and CNS directed therapy to improve their outcome

Prognostic value of combined stapedial muscle reflex [Acoustic reflex], electro-neuronography and facial nerve latency test in patients with Bell's palsy

In this study, 20 patients with idiopathic facial nerve palsy were evaluated by electroneuronography [ENOG], facial nerve latency test [FNLT] and stapedial muscle reflex [acoustic reflex]. The study aimed to define the value of these tests as prognostic tools in Bell's palsy. The ENOG test results indicated that when the amplitude of the compound muscle action potential varied between 51% and 95% of the normal value, the neuronal damage was slight. When the muscle action potential decreased to a value below 51% of normal values, the prognosis for recovery was worse. FNLT results indicated that as the latency time extended, the recovery grade of the facial nerve worsened. The comparison with the index of facial nerve functional recovery showed that these two tests had a high percentage of correctness. Acoustic reflex measurement helped in determining the site of lesion and in the follow up of the patients. A combination of test battery was important, so that the determination of the lesion may be as correct as possible