Signet ring cell carcinoma of the rectal stump in a known ulcerative colitis patient

ABSTRACT Colorectal carcinoma (CRC) is the third most commonly diagnosed cancer worldwide and is the second most common cause of cancer-related deaths. However, the Omani population shares the major burden as the most prevalent carcinoma. The disease is comparatively higher in males than females. Patients with pre-existing risk factors, including inflammatory bowel disease, are at increased risk of developing neoplasia. Among the various histopathological subtypes of adenocarcinoma in the rectum, signet ring cell carcinoma is the rarest and accounts for approximately 1% of the cases. Given the aggressive nature of this tumor, advanced presentation, stage, and poor prognosis, regular endoscopic surveillance is essential. Hereby, we report a rare case of signet ring cell carcinoma arising in the rectal stump in an already diagnosed and operated patient of Ulcerative colitis.

Prevalence and associated factors of Dog Bites: A cross-sectional study among Primary School Children in Madawaki District Gusau, Nigeria

@#Introduction: Dog bite is a global public health concern because it is the main risk factor for human rabies and it particularly affects children. In Nigeria, most dog bites are from stray dogs and their vaccination status remains unknown. Thus, this study aimed to investigate the prevalence and associated factors of dog bite among public primary school children in Madawaki district Gusau, Nigeria. Methods: A cross-sectional study was conducted using an unequal stratified sampling technique among 999 children aged 11 to 13-year-old at seven public primary schools from September 2017 to January 2020. A self-reported history of dog bites, socio-demographic characteristics, knowledge on interaction with dogs, knowledge on the implication of dog bites, risk behaviours of children and dog ownership were collected using a validated questionnaire. Results: The prevalence of dog bites was 54.5%. The predictors of dog bite among the children were being a male (Adjusted Odds Ratio; AOR = 2.252; Confidence Interval; CI = 1.719, 2.949), dog ownership by respondent’s family (AOR = 1.456; Cl = 1.089, 1.946), dog ownership by neighbours of the respondents (AOR = 1.752; Cl =1.334, 2.303), total score for knowledge on interaction with dogs (AOR = 0.884; Cl = 0.858, 0.911), and total score for risk behaviours of children (AOR = 1.020; Cl =1.004, 1.035). Conclusion: Poor knowledge on interaction with dogs, children’s risk behaviours around dogs, dog ownership and being male were the factors associated with a high prevalence of dog bite among primary school children from this study. These factors should be considered in order to develop an effective awareness campaign in schools to reduce the prevalence of dog bites among children.

Anatomical Variations Of Inca Bone In Adult Human Egyptian Skulls

Background: The Inca bone is integral part of the occipital bone of the skull in its interparietal region andappears during radiological examination of the skull.Aim of the work: This study aimed to estimate the incidence rates and variations of interparietal (Inca) andpreinterparietal bones in adult human Egyptian skulls .Materials and methods: In the present study 60 dry human Egyptian skulls (37 males and 23 females) wereexamined to determine the incidence rates of Inca and preinterparietal bones with detailed measurements forInca bone in mm using electronic digital caliber.Results: The incidence rates of Inca and preinterparietal bones were higher in male skulls than female skulls andthe interparietal or Inca bone was observed in only 4 skulls ( 6.66% ) while the preinterparietal bone wasobserved only in 2 skulls ( 3.33 %) .Conclusion: The presence of the Inca and preinterparietal bones was rare in the human Egyptian skulls andtheir incidence rates were higher in male skulls .

Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

Background@#For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. @*Methods@#Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 µg/kg dexmedetomidine (maximum volume 4 mL/side). @*Results@#The modified children’s hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. @*Conclusions@#Addition of dexmedetomidine 0.5 μg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

Dose fractionation schemes for palliative external beam radiotherapy on painful bone metastasis from breast cancer

Background: The efficacy of palliative external beam radiotherapy (PRT) for relief of metastatic bone pain had been well established, a single fraction is as effective as multiple fractions in relieving bone pain, but variation exist among the radiation oncologist in our environment on the ideal dose per fraction regimen. Methods: We retrospectively reviewed data from breast cancer patients treated with PRT using linear accelerator for metastatic bone pain in University College Hospital Ibadan between 2005 and 2009. The extracted information includes bio-data, presenting symptoms, metastatic sites, and bone pain assessment before and after four weeks of PRT using visual analogue pain scale (VAS), radiation doses, fractionation numbers and number of re-irradiation. Results: There were 161 eligible breast cancer patients who were treated with PRT secondary to painful bone metastases between 1st January 2005 and 31st December 2009. Majority were females with only 1.2% male patients (Figure 1). Table 1 showed demographic characteristics of treated patients with mean age of 45.2 years, pain was the major presenting complaint (92.5%) and multiple bony metastases constituted the highest metastatic presentation (52.2%). Table 2 shows patient's responses to PRT treatment for pain relief (complete responses of 88.8% and 11.2% partial responses). No significant association between patient's responses to PRT and magnitude of radiation doses delivered. However, fractionation sizes were significantly associated with re-irradiation p-value < 0.05. Conclusion: No differences exist between various dose fractionation schemes in terms of relief from painful bony metastases. However, shorter dose fractionation schemes are associated with re-irradiation of previously irradiated sites

Palliative external beam radiotherapy for advanced breast cancer patients with brain metastasis in the university college hospital Ibadan

Background: Brain metastasis is a dreaded complication that significantly reduces the quality of life in breast cancer patients. The treatment options are limited by the inability of many chemotherapeutic agents to cross the blood­brain barrier. Surgery also has a limited role, except in few selected patients with oligometastasis. Therefore, whole-brain radiotherapy (WBRT) remains the available option that gives a gratifying result. However, the benefit of this treatment modality in our resource-poor environment needs to be investigated. Materials and Methods: The data of breast cancer patients with brain metastasis who were treated with WBRT using cobalt-60 equipment between 2005 and 2009 were retrospectively collected from the departmental medical record unit. The information extracted included biodata, presenting symptoms, imaging modality for confirmation of brain metastasis, treatment records, performance status pre-WBRT and 4 weeks post-WBRT, and other supportive treatments. Results: A total of 52 female patients were reviewed between 2005 and 2009. The mean age of patients was 44.7 years. The common clinical features on presentation were headache, nausea, and visual impairment in 30.8% of patients with the WHO performance status score ranging between 2 and 4. Patients with more than three brain deposits accounted for 71.2% of all the brain metastases. The mean radiation dose used for WBRT was 30 Gy in 10 fractions, and total responses recorded were 86.5% with 53.8% complete improvement in patients' performance status 4 weeks after WBRT treatment. Conclusion: WBRT is an effective treatment modality for patients with brain metastasis in our resource-poor environment. However, improvement of patients' performance status declined with advancing age

Carboxymethylchitosan nanofibers containing silver nanoparticles: Preparation, Characterization and Antibacterial activity.

Herein we prepare antibacterial composite from carboxymethylchitosan (CMCS) nanofibers and silver nanoparticles (AgNPs) by using poly (vinyl alcohol) (PVA) as reducing, capping and fiber aiding material and investigated to be used in biomedical applications. The AgNPs has spherical shapes and its diameter ranged from 15 to 25 nm and distributed within the prepared nanofibers. The electrospinning parameters from the effect of the CMCS and PVA mass ratio, extrusion rate and field were studied. The optimum condition for electrospinning were 7% for CMCS and 8% from PVA. UV-vis, TEM and XRD used to characterize AgNPs whereas FTIR and SEM used to characterize nanofibers. Results showed that ultra-fine fibers were generated after addition of PVA to CMCS in different mass ratios to from 8 wt. % concentration solutions. Electrospun PVA (AgNPs)/CMCS nanofibers showed good antibacterial effects towards Gram-positive and Gram-negative bacteria. Antibacterial activities of electrospun nanofibers increased by increasing both CMCS and AgNPs content in the electrospun nanofibers.

Improving Dye ability and antimicrobial properties of Cotton Fabric.

To improve the dyeability and antimicrobial activity of cotton, the cotton was treated. Firstly, Carboxymethylation was carried out in the cotton fibers to form alkali cellulose. Due to carboxymethylation, the alkali cellulose modifies the crystalline structure of cellulose and increases the accessibility of fibers to chemicals by swelling. Secondly, it padded in a solution content (5 % nano zinc oxide, 4% citric acid) or (6 % titanium isopropoxide, 4% citric acid) or in a solution of 5 % nano zinc oxide, 6 % titanium isopropoxide, 4% citric acid or in a solution of 7% nano zinic oxide, 7% titanium isopropoxide, 4% citric acid, at wet pick up of ca 100%, then dried at 85 °C for 5 min., and cured at 100 °C for 3 min, the latter, we use these fabric in dyeing with synthesized acid dye and commercial basic dye finally, we measure antimicrobial activity for these fabric toward Gram negative and Gram positive.

Inpatients' satisfaction toward nursing services in the medical and surgical wards of Rizgary Teaching Hospital, Erbil, Iraq

Background and objective: Patients' satisfaction toward nursing care is an important indicator of the quality of nursing services. This study aimed to assess patients' satisfaction with nursing services provided in Rizgary Teaching Hospital and to find out the factors that are associated with levels of satisfaction

Methods: A cross-sectional study was conducted in Rizgary Teaching Hospital in Erbil city, starting from January 17th, 2014 to March 11th, 2015. A convenience sampling method was used to recruit 200 patients [100 males and 100 females] from medical and surgical wards. Patients aged >/=15 years, who were admitted to medical and surgical wards for >/=48 hours were included. A structured questionnaire designed by researchers was completed through direct interview. Chi-square test of association [or Fisher's exact test] was us compare proportions. A P value of

Results: The study showed that 40.5% of patients were highly satisfied with the nursing services, only 20.9% of those with secondary education or higher were highly satisfied [P = 0.005], and 80% of those with high income were highly satisfied [P = 0.001]. There was no significant association between patients' satisfaction and patients' age, marital status, occupation, residence, the length of stay, and type of ward. A relatively poor rate of satisfaction [20.5%] was observed regarding the information provided by nurses before the medical care or drug administration

Conclusions: Less educated patients were more satisfied with nursing services. The majority of patients were unsatisfied with the information provided by nurses before medical care or drug administration

Association of obesity with vitamin D deficiency and the clinical implications.

Background: Obesity is a complex disorder which leads to health problems like diabetes, hypertension and hyper cholesterolemia. It has been reported that obesity is associated with vitamin D insufficiency due to decreased bio-availability. The aim of the present study is to investigate whether vitamin D deficiency can be a causative factor for obesity in Saudi women above 40 years. Methods: 100 Saudi female patients above 40 years who came to the outpatient department of Arar central hospital were selected for the study. Patients who were on immunosuppressive drugs, with hormonal disorders and with impaired renal function were excluded from the study. The data was collected using a questionnaire which included the socio demographic details, height, weight and medical history and the serum vitamin D levels were assessed. Results: 69% of the Saudi women were obese (BMI >30). 84% (n=58) of the obese women had vitamin D deficiency (<50 nmols/l) while 69.6% of the overweight women had vitamin D deficiency. 43.5% (n = 30) of obese women had diabetes, 44.9% (n=31) of obese women had hypertension. The association between obesity and vitamin D deficiency was not significant. Conclusions: No significant association was found between obesity and vitamin D deficiency indicating that vitamin D deficiency has no significant role in causing obesity in Saudi women above 40 years.

Effect of adipose derived stem cells on ovariectomised Wistar rats.

Background: Various clinical trials are going to determine the efficacy of human Adipose Derived Stem Cells (hADSCs) in the treatment of degenerative diseases including osteoporosis. Stem cell therapy for osteoporosis is aimed at inducing new bone formation by the proliferation and differentiation of bone progenitor cells. The therapeutic potential of hADSCs has to be investigated in animal models of osteoporosis before suggesting it as a therapeutic option. Methods: hADSCs were cultured in the Dulbecco’s Modified Eagle’s Medium (DMEM) supplemented with 4 mM L-glutamine and 110 mg/l sodium pyruvate, 10% Fetal Bovine Serum (FBS), 1% penicillin–streptomycin and non-essential amino acids. For osteogenic differentiation of hADSCs, cells were cultured as above then were exposed to osteogenic induction medium for seven days. Intravenous infusion of osteogenesis induced hADSCs was given to 20 ovariectomised Wistar rats three months after ovariectomy (test group) and 20 ovariectomised rats were kept as controls. Rats were sacrificed 35 days after infusion and tibial cross sections at the level of tibio-fibular joint were stained with H&E & Masson’s trichrome. The digital slide images were viewed using Aperio Image Scope software. Results: The results showed that there was new bone formation in the test group, indicated by osteoid formation and osteoblasts. There was significant increase in the cortical thickness in the test group when compared with the control group. There was no significant increase in trabecular volume when compared to the control group. Conclusions: hADSCs after osteogenic induction may have the potential to enhance new bone formation and may be useful in the treatment of osteoporosis.

Chitosan nanoparticles loaded antibiotics as drug delivery biomaterial.

Herein we describe the preparation, characterization and utilization of chitosan nanoparticles for the intracellular delivery of the poorly cell-penetrating antibiotic e.g. Ciprofloxacin, Chlortetracycline hydrochloride and Gentamycin sulfate to improve their treatment of bacterial infections. Chitosan nanoparticles were prepared via the ionic gelation of chitosan with tri polyphosphate anions. Several parameters were studied to optimize the particle size of chitosan nanoparticles, here we select the concentration of chitosan and the concentrations of sodium tri poly phosphate (TPP) as optimizing parameters and the other factors stay constant such as pH of solution and ultrasonication time. Chitosan nanoparticles formed characterized by using FT-IR and transmission electron microscope (TEM). Results show that chitosan nanoparticles and its loaded antibiotics kill and inhibits the growth of gram (+) and gram (-) bacteria tested due to nanoparticles structures, and the antibacterial activity increased with increasing the anti biotic content.

Selective IgA deficiency among children with recurrent infection

Aim of the study: to evaluate the incidence of IgA deficiency among children suffering from recurrent infections that were suspected to have a primary immunodeficiency disorder from the Assiut Pediatrics University Hospitals, in a hope that this would be the first step to establish a wider epidemiological study including the whole suspected primary immunodeficiency [PID] patients in the country

Methods: This study included 80 cases suffering from recurrent infections that were suspected to have a PID disorder from the Assiut Pediatrics University Hospitals. And eight apparently normal infants and children, age and sex matched that were enrolled as control in the period from July 2011 to May 2012. All children included in the study were subjected to the initial evaluation of immunocompetence which includes a clinical history and physical examination, and investigated for complete blood picture, ESR, Plain chest X-ray when indicated, Screening for serum level of IgA by Enzyme Linked Immuno-sorbent Assay [ELISA] and Radial Immuno-Diffusion [RID]. Patients with proved IgA deficiency were assayed for IgG and IgM

Results: Out of the 80 patients studied, 4 [5%] patients [group I] had laboratory evidence of IgA deficiency; three of them had IgG and IgM within normal level so they were diagnosed as selective IgA deficiency and one [25%] patient had low IgG and normal IgM level so that was diagnosed as common variable immunodeficiency disorder [CVID]. The mean values of age at onset of symptoms, age at diagnosis and the diagnosis lag were 10, 37.25 and 27.25 respectively

The diagnosis delay ranges from 2 months to 7 years. Parents' consanguinity was evident in our study, since 3/4 [75%] patients of group I were the products of consanguineous parents while the ratio was lesser in group II18/76 [23.7%] patients. The current study showed that patients with severe infections had significantly lower IgA levels, younger age and had earlier onset of recurrent infections than patients with less severe infections. There was no specific sex predilection in patients with IgA deficiency. There were no significant differences in both the total leucocytic, absolute lymphocyte and neutrophil counts or hemoglobin level in patients with selective IgA deficiency when compared to patients with normal IgA levels. The duration of infections was significantly longer in patients with selective IgA deficiency [mean: 11.5 days] when compared to patients with normal IgA levels [mean: 9.18 days]

Modified radical mastectomy or quadrantecomy and axillary clearance for management of early breast cancer

For the most part, surgery for patients with breast cancer is the first treatment. The surgical management has undergone extensive transitions over the past century. Breast conserving surgery [BCS] is a treatment modality for early-stage breast cancer that causes less physical disfigurement and psychological trauma to the patient. This study has been carried out to compare modified radical mastectomy [25 patients [group 1]] and quadrantectomy with axillary clearance [25 patients [group 2]], for 50 patients with stage I and stage II breast cancer. There were no statistical differences between both groups, regarding age, menstrual history, history of contraceptive pills, parity status, family history, tumour site as well as histopathological findings. Postoperative wound edge ischaemia was found in 3 [12%] of patients in group 1. Wound seroma occurred in 5 [20%] of patients in group 1 and 2 [8%] of patients in group 2. Wound infection occurred in 4 [60%] patients in group 1 and 2 [8%] of patients in group 2. Parasthesia and wound numbness occurred in 8 [24%] patients in group 1 and 3 [12%] of patients in group 2. There were no cases of upper limb oedema in this study. Regarding to cosmetic results in group 2, 15 patients [60%] showed excellent results, 7 [28%] showed good results; 3 [12%] showed fair results and no patients showed poor results. There were no postoperative recurrence or death from breast cancer during the follow up period [30 months] in our patients. Since breast conservation surgery yielded results similar to mastectomy, its use should be extended

Clinico-pathological study of intra-mammary lymph nodes in breast cancer

Axillary lymph node status considered the most significant factor for breast cancer outcome and treatment decision are based on the presence or absence of nodal disease. Intramammary lymph nodes [IMLNs] can be a site of regional spread. Is this a marker for more aggressive disease. This prospective study has been completed on 30 patients with [IMLNS] of breast cancer at the surgical oncology unit Al-Azhar University from February 2000 to February 2008. Their age ranged from 27 to 90 years with an average of 55 years in positive intramammary lymph nodes and their age ranged from 38 to 92 years with an average of 62 years in negative intramammary lymph node. Intramammary lymph nodes were identified in 30 breast cancer patients, with metastatic spread in 10 patients and benign IMLNs described in 20 patients. Patients without intramammary lymph nodes were excluded in this study. Positive intramammary lymph nodes were associated with more aggressive disease, including higher rates of invasive versus non invasive cancer [10% ductal carcinoma - in - situ [DCIS] with positive IMLNs versus 25% with negative IMLNs]. Lymphovascular invasion [60% vs 10%] and a higher rate of axillary lymph node involvement [75% vs. Patient with positive IMLNs were also more likely to undergo mastectomy [80% vs. 55%]. IMLNs metastasis is a marker for disease severity, recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLNs is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection-preoperative mammography and lymphoscientigraphy help identified these extra-axillary metastases

Clinico-pathological study of pelvic lymph node dissection in radical cystectomy for the treatment of bladder cancer [T2-T4]

Pelvic lymph node status considered the most significant factor for invasive bladder cancer [Il-TV] outcome and treatment decision are based on the presence or absence of nodal disease. To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectorny with urinary diversion for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. This prospective study has been completed on 50 patients with invasive bladder cancer [T2-T4] and radical cystectorny with urinary diversion and pelvic lymph node dissection was done at the Surgical Oncology Unit, Al-Azhar University from February 2000 to February 2006. Their age ranged from 38 to 67 with an average of6l years, 40 males and 10 females. Regional pelvic lymph node dissection includes internal iliac, external iliac, and obturator nodes. The study evaluates the impact of pelvic lymph node involvement and the number of nodes removed during surgery on survival of patients. Lymph node metastases were detected in 15 patients [30%]. The average number of nodes removed in the node positive and node negative patients was 13.7 and 14.4, respectively. Although no difference was found in disease specific survival in the node negative patients when stratified by the number of nodes removed [13 or more versus less than 13], a significant survival advantage was found in the node positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of the patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes. In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival

value of clinical and pathological profiles of gastric cancer in Egypt

Stomach cancer is the 4[th] common cancer but the 2[nd] cause of cancer related death. This prospective study has been completed on 25 patients with invasive gastric cancer at Bab-Elsharea University Hospital and Beni-Suef University Hospital. Fifteen of them were males and 10 were females, their ages ranged from 31 to 68 years with an average of 57 years. All cases were clinically laboratory and radiologically assessed. Subtotal gastrectomy was performed for 17 patients [68%], while total gastrectomy was done for 8 patients [32%].In this study we reevaluate the surgical management of stomach cancer, the extent of gastric resection and the lymphadenectomy, hoping to answer the following questions is 4 cm safety margin applicable to all stomach cancer patients? is D3 gastrectomy should be done for every stomach cancer patient? And what is the clinicopathological factors affecting PN stage and infiltration length of the tumour?. The inclusion criteria includes differentiated gastric tumours, T2, local or locoregional disease with no ascites or peritoneal deposits, radical gastrectomy is done [total, proximal or lower] according to the site of the primary tumour, with lymphadenectomy one level beyond the level of palpable lymph node [D2 or D3]. Patients are classified according to the pathological lymph node stage [Japanese classification] "PN" into PNI when LN metastasis is confined to NI, PNII when LN metastases is confined to N2 and the patient are classified PNIII when LN metastasis are present in the N3. From all clinicopathological criteria studied; sex, smoking, tumour morphology, tumour grade, serosal invasion, T-stage and tumour size have significaht relation to the lymph node metastasis and PN stage other factors as age of the patient, presentation, histopathological type of the tumour, gastric mucosal abnormalities as presence of peptic ulcer, gastritis or metaplasia and the site of the tumour show no significant relation to the PN stage. The studied group are also classified according to the microscopic infilteration length into patient with infilteration length less than 2 cm and patient with infilteration length between 2 and 4 cm and the last group of patient have infiltration length more than 4 cm. The clinicopathological factors are compared in the above groups. Age of the patient, tumour morphology tumour grade, Laurence tumour classification, tumour size, lymphatic vessel invasion and serosal invasion, all these factors are significantly correlated to the microscopic infiltration length while patient sex. presentation, tumour size tumour histopathological type, gastric mucosal abnormality and other organ infiltration, all these factors are not significantly correlated to the microscopic infiltration length

Evaluation of combined graded compression ultrasonography with alvarado score in the diagnosis of acute appendicitis

Decision making in cases of acute appendicitis may be difficult specially for junior surgeons. Radiological investigations do not appear to be helpful. In some studies, the Alvarado scoring system was helpful in minimizing unnecessary appendicectomies. The aim of this study was to evaluate Alvarado score and its combined use with graded compression ultrasonography in the diagnosis of cases suspected to have acute appendicitis. All patients who were admitted with a provisional diagnosis of acute appendicitis between [first of May 2004 to the last of April 2005], in Surgical Emergency Department Alexandria Main University Hospital were prospectively entered into this study. The study included 377patients between the ages of 10 and 76 years. They were prospectively evaluated on admission using the Alvarado Score to determine whether or not they had acute appendicitis all equivocal cases were subjected to graded compression ultrasonogra

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication