Prerequisites for histopathological evaluation of reduction mammoplasty specimens: Recommendations based on an audit in a tertiary care hospital

Objective: To recommend prerequisites for the histo-pathological evaluation of reduction mammoplasty [RM] specimens based on an audit in a tertiary care hospital

Methods: All reduction mammoplasty specimens received at department of pathology, in a tertiary care hospital over a 3 years period were re-evaluated retrospectively. Medical records were checked for age, family history of breast cancer, indication for surgery and radiological evaluation. Pathology reports were reviewed for number of blocks sampled and diagnosis. A prerequisites protocol was developed based upon deficiencies and impediments noted

Results: We received a total of 26 cases of reduction mammoplasty. Only 2 [7.69%] specimens were from males. The age of the patients ranged from 26 to 50 years. Indication for surgery was provided in all [100%] of cases, with macromastia being most prevalent indication. Family history of breast carcinoma and radiological evidence was absent or not provided in all cases. The number of blocks prepared were in range of <4 in 17 [73.91%], 5-8 blocks in 5 [19.23%] and 8-12 blocks in 4 cases [15.38%]. The main histopathological finding was fibrocystic change, [n = 12, 46.15%]. Specimen radiography was not conducted in any case

Conclusion: There is a need to stratify RM cases as high, moderate and low risk of breast cancer based on family history of breast carcinoma, clinical and radiological evaluation. The high risk cases should be oriented, with margins inked and extensive sampling done. Specimen radiography should be carried out in younger patients in which mammography is not recommended

Interactions of spodoptera littoralis haemocytes following injection with the entomopathogenic fungi: Beauveria Bassiana and Nomuraea Rileyi

This study compared the cellular interactions of Spodopteralittoralis haemocytes with two virulence-different entomopathogenic fungi: Beauveriabassiana and Nomuraearileyi. Using light and transmission microscopy, five types of haemocytes namely, prohaemocytes [PRs], plasmatocytes [PLs], granulocytes [GRs], spherule cells [SPs] and oenocytoids [OEs] were identified in the 6[th] instar larvae. PRs and PLs were found in the haemopoietic tissue.Intra-haemocoelic injection of blastospores induced ultrastructural alterations in the cytoplasm and nucleiof circulating haemocytes of treated larvae. Different responses were observed in the populations of haemocyte types following injection with the tested fungi. The most important changes were the decrease of the numbers of GRs aiccompanied with increase inSPs at 12-48h following injection with B. bassiana, whereas,a decrease of PLs with a commitment increase inSPs and OEs were observed at most time intervals after injection with N. rileyi. Both fungi provoked a decrease of the total number of haemocytes at 48h followed by an increase at 72h post-injection. In vivo assay showed that the GRs and PLs actively phagocytised fungal blastospores. There was a time-dependent decrease and increase in the phagocytosis activity after injection of B. bassiana and N. Rileyi, respectively .In B. bassiana-injected insects, the numbers nodules increased significantly at 6-48h in comparison with the controls post-injection. In N. rileyi-injected insects, nodules increased significantly only at 72h post-injection.No cellular encapsulation was observed in any of the examined insects

Incidence, treatment and visual outcomes of non-infectious keratitis as a postoperative complication of laser-assisted in-situ keratomileusis [LASIK]

To study the incidence, treatment, and visual outcomes of Non-Infectious Keratitis as a Postoperative Complication of Laser in-Situ Keratomileusis [LASIK]. The files of 3500 post-LASIK patients [6326 eyes] were reviewed for the development of Non-Infectious Keratitis. Incidence, management regimens, and final best spectacle corrected visual acuity [BSCVA] were reported. Post-LASIK Non-Infectious Keratitis was diagnosed in 149 eyes [2.35%]. The Keratitis was classified as diffuse lamellar keratitis [DLK] in 89 eyes [1.4%] and 60 eyes [0.94%] as localized debris-related Keratitis [LDK]. The occurrence of post-LASIK Non-Infectious Keratitis was 2.35%, with DLK being the common diagnosis overall, with 92.6% of patients achieving < 20/20 BSCVA. The best way for prevention of DLK is to eliminate defined predisposing factors for DLK. Close follow-up during the early postoperative period

Polymerase chain reaction versus conventional methods in the diagnosis of vaginal trichomoniasis

A total of 200 females of whom 120 had manifestations of vaginal trichomoniasis and 80 asymptomatic ones were studied. In 54/120 symptomatic female [45%] and in 28/80 asymptomatic ones [35%], T. vaginalis was diagnosed by wet mount of bedside vaginal swab samples of 120 samples from symptomatic females, T. vaginalis was detected in 93 [77.5%] when cultured onto InPouch and 95 [79.16%] in modified thioglycolate media. Culturing 80 samples of asymptomatic females showed T. vaginalis in 35 [43.75%] onto either media. T. vaginalis genomic DNAs was amplified by PCR from 130 [65%] by using TVA5-TVA6 primer pair in 95 [79.16%] samples of 120 symptomatic females, and in 35 [43.75%] samples of 80 asymptomatic ones. Difference between groups was statistically significant. The motile trichomonads was detected by wet mount in 82/130 positive cultures giving 63.07% sensitivity and 100% positive predictive value [PPV]. Flagellates were not detected by wet mount in any negative culture, giving 100% specificity and 59.32% negative predictive value [NPV]. The wet mount diagnostic accuracy [DA] was 76%, without false-positive, but false negative was 48/130 [36.93%]. DNA was amplified from 129/130 positive culture by TVA5-TVA6 primer pair, giving 99.23% sensitivity. No amplification was detected from one positive culture. DNA was not amplified from 69/70 negative culture using TVA5-TVA6 primer pair, giving 98.57% specificity, 99.23% PPV, 98.57% NPV and 99% DA

Parasitiosis in handicapped children in an Egyptian blind asylum

Examination of visually handicapped children and their serving staff revealed in a descending order Enterobius vermicularis, Giardia lamblia, Entamoeba histolytica, Hymenolepis nana, Ascaris lumbricoides, Cryptospodium parvum, Tricocephalus trichura and Strongyloides stercoralis. Head lice were encountered. But, neither blood parasites nor protozoan infective agent in water for human consumption

case of castor bean poisoning

Castor beans, sometimes used in traditional therapies, contain ricin one of the most toxic substances known. It may cause an acute and potentially fatal gastroenteritis in addition to neurological and ophthalmological lesions. Poisoning may also lead to delayed visceral damages; however, the latter is quite rare. The toxicity is dose related and depends on the amount of castor beans ingested. There is no specific treatment and symptomatic management to reduce the load of the toxin needs to be initiated quickly and early when a case of poisoning is suspected so that serious complications will be avoided. Increasing the awareness of the population to the dangers of ricin would be a way to avoid the utilisation of castor seeds in traditional therapies. Here we are reporting a case of mild poisoning after ingestion of a single castor bean. The patient, who presented at Nizwa Hospital, Oman, fortunately recovered completely as the ingested dose was quite small

Carpal tunnel decompression: a randomised controlled trail of endoscopic versus open release

Carpal tunnel Syndrome is the most common compression neuropathy of the upper extremity. Open carpal tunnel release [OCTR] with longitudinal incision reaching or crossing the wrist crease has been the golden standard of surgical treatment of carpal tunnel syndrome. Many reports indicated that the endoscopic carpal tunnel release [ECTR] techniques are associated with reducing postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. We conducted a randomised controlled trail to evaluate endoscopic 2-portal carpal tunnel release [ECTR] technique against the traditional open carpal tunnel release [OCTR]. One hundred and twenty two patients who were diagnosed to have carpal tunnel syndrome were randonised into 2 groups. In the trail ECTR group, there were 18 males [29%] and 44 females [71%]; their mean age was 44.6 years while the control OCTR group there were 18 males [30%] and 42 females [70%]; their mean age was 45.9 years. Patients were evaluated at baseline, 1,2,6 and 12 weeks and at 1 year after surgery for symptomatic relief by the Symptom Severity Scale[9] and incidence of serious complications [vascular or nerve injury] as well as McGill pain questionnaire[10], interval between the operation and return to their daily activities and work, scar tenderness and pillar pain, and grip strength which was assessed by a Jamar dynamometer as well as overall patient satisfaction. There was no significant difference in the Symptom Severity Score between both groups. However, there was one significant complication [laceration of a digital nerve] in the ECTR group while there was none in the OCTR group. McG ill pain score and grip strength were found to be significantly better in the ECTR group at 1, 2 and 6 weeks but almost identical at 12 weeks however scar tenderness and pillar pain was better in ECTR group at 12 weeks. The interval between surgery and return to usual daily activities and work was significantly less [P value < 0.01] in the endoscopic group than OCTR group. ECTR is associated with less pain and better function in the early postoperative period reflected by earlier return to usual daily activities and work as well as less scar tenderness and pillar pain. However these benefits may be outweighed not only with the higher expense of additional operative equipment and longer operating time but with a higher re-operation rate as well as a higher complication rate

Dot-ELISA copro-antigen and direct stool examination in diagnosis of giardiasis patients

A total of 200 cases aged 10-30 years complaining of symptoms suggestive of giardiasis in addition to thirty cross matched normal individuals as a control group was examined clinically and laboratory using stool examination and detection of Giardia coproantigen in faeces by the Dot-ELISA. Stool examination detected 39 cases [19.5%] while Dot-ELISA detected 49 cases [24.5%] with 100% sensitivity and 93.8% specificity. The common clinical findings were diarrhea, abdominal cramps, anorexia, underweight, pallor and manifestations of vitamin deficiency

Human hydatidosis granulosus in greater Cairo, Egypt: with general review

In this study, human cases [41] of proved hydatidosis granulosus were obtained from Al Kasr Al Aini University Hospitals from 2000-2006. They were 22 females with ages from 8 to 70 years and 19 males with ages from 5 to 75 years. The highly infected organ was the liver. Infection in other organs as lung, spleen, brain, eye, pelvic and bones of upper and lower limbs were reported. Most of the hydatidosis patients were from governorates of Giza [24 cases], Qalyobia [7 cases], Cairo [5 cases], Bani-Swef [3 cases], Sharkia [1 case] and Demiatta [1 case]. Biopsies of infected liver and lung were processed for the histopathological studies and photographed. The results were discussed on the light of work done before Egypt

Effect of computer-based training with mentally retarded delayed language children

The application of computer technology in the management of communicativedisorders represents a challenge. The purpose of this study is to evaluate the efficacy of the computer based therapy in mentally retarded delayed language children. Twenty delayed language children due to mild mental retardation were included in this study. They were classified into 2 groups, the first group received active language intervention sessions in addition to computer- based training. The second group received active language intervention only. Highly significant difference was noticed between the two groups as regards receptive semantics, expressive semantics, receptive syntax. Non-significant changes were found in pragmatics, phonology and social age

Isolated pelvic stopflow infusion technique for locally advanced gynaecological malignancy

This study included 45 patients who were classified into 2 groups: Group I included 25 patients with locally advanced ovarian cancer; 8 patients received the standard chemotherapy and/or radiotherapy, 9 patients received isolated pelvic stop-flow infusion [IPSFI] with the intent of palliation and 8 patients received preoperative IPSFI with the intent of understaging, followed by surgical resection. Group II included 20 patients with locally advanced cancer cervix; 7 patients received the standard chemotherapy and/or radiotherapy [control group], 6 patients received IPSFI with the intent of palliation and 7 patients received preoperative IPSFI with the intent of understaging, followed by surgical resection. IPSFI was accomplished by placement of balloon- occlusion catheter in the aorta at L3 vertebral body level via the common femoral artery. Cytotoxic agents were infused into the aorta distal to the occlusion catheter through a pigtail catheter placed in the other limb. After 10-20 minutes, the aortic balloon was deflated and removed. So, it was concluded that isolated pelvic stop flow infusion improves the outcome of patients with advanced gynaecologic malignancies, as it enhances resectability, radio responsiveness and eradicates micrometastasis. PSFI with cisplatin and bleomycin, followed by radical surgery and postoperative radiotherapy is effective in treating advanced gynaecologic malignancies. PSFI increased tumour exposure to high drug concentration with minimal side effects and thus may be appropriate for patients with locally advanced gynaecologic malignancies

efficacy of the accent method of voice therapy in management of vocal folds nodules

Vocal fold nodules are benign bilateral masses caused by voice abuse. Accent Method [AM] is one of the holistic approaches of behaviour readjustment voice therapy. This study is conducted in order to evaluate the efficacy of the AM in patients with vocal fold nodules. Ten patients with vocal fold nodules are distributed into two groups. Group 1 [G1] is given the full aspect of AM, that is, voice hygiene advice plus the accent exercises. Group 2 [G2] received only voice hygiene advice. After full assessment a follow-up evaluation was done at mid intervention and at the termination of the therapy. The difference in improvement between G1 and G2 at the end of the study was generally significant in favor of G1

Evaluation of pelvic stop-flow infusion in the managment of patients with locally advanced urinary bladder and rectal malignancies

Control of pelvic cancer may improve the quality of life in such patients and result in longer survival even in the presence of cancer outside the pelvis. Systemic chemotherapy and radiation therapy has failed due to high resistance of the tumour and poor vascularisation. Regional pelvic chemotherapy, by isolated regional perfusion, has been used by several groups in an effort to control advanced bladder and rectal malignancies. In the last 10 years, however, less emphasis has been placed on perfusion and more on intra-arterial chemotherapy alone or in conjunction with chemofiltration. Although their initial technique used an open occlusion of the aorta and inferior vena cava, they subsequently adapted the use of balloon occlusion- catheter. The aim of this work is to evaluate the applicability, efficacy, and safety of Pelvic Stop-Flow Infusion [PSFI] in the management of patients with locally advanced bladder and rectal malignancies. To complete our study in this field after our successful initial experience in management of locally advanced cancer cervix and ovaries. The study included 45 patients with locally advanced or recurrent cancer bladder and 45 patients with locally advanced or recurrent cancer rectum. Patients are classified into 2 classes: Class 1: Including 45 patients with advanced or recurrent cancer bladder previously treated by surgery, radiotherapy and/or chemotherapy. They are divided into 3 groups [Group I: [Control group]: included 15 patients whom received conventional chemo/radiotherapy. Group II: [Palliative group] included 15 patients, whom are not candidates for surgical interference. They received PSFI with the aim of palliation. Group III: [Pre-operative group]: included 15 patients, whom are candidates for surgery after receiving PSFI with the aim of under-staging. The type of surgery might be definitive, cytoreductive, or palliative. Class II: Including 45 patients with advanced or recurrent colorectal cancer previously treated by surgery, radiotherapy and / or chemotherapy. They are divided into 3 groups, each of them included 15 patients: Group I: [Control group], Group II: [Palliative group], Group III [Pre-operative group]. As first described by Aigner, 1993, the technique entails exposure of the Femoral artery and vein via a longitudinal incision in the groin, then arteriotomy and venotomy were done for admitting the large bore, rigid catheters. A more simplified our technique, the percutaneous balloon infusion, is the one we used. Serial pelvic and systemic blood samples were collected during the infusion period, and pelvic- to systemic drug- exposure ratio was determined. Tumour response was evaluated 8-12 weeks after completion of aortic stop-flow infusion cycle [s] with clinical examination, tumour volume response [by abdomino-pelvic CT], pain response, histological response, tumour marker response, laparotomy finding, disease frees survival [as regard further metastasis and local recurrence], procedure related complications, chemotherapeutic toxicity, and overall survival. Our study found that: In Cancer bladder patients treated with palliative pelvic stop-flow: 10/15 cases [66.6%] shown reduction of size, and 8/15 patients [53%] shown improvement of pain. In Cancer bladder patients treated with pre-operative pelvic stop-flow: 12 out of 15 cases [80%] shown reduction of size, with a highly significant P- value = 0.005 [9/12 underwent radical cystectomy, the remainder underwent palliative resection], and 9 patients [60%] shown improvement of pain. In colorectal cancer patients treated with palliative pelvic stop-flow: 11/15 patients [73.3%] shown reduction in size, and 7/15 patients [46.7%] shown improvement of pain. In colorectal cancer patients treated with preoperative pelvic stop-flow: 13 out of 15 cases [86.6%] shown reduction of size, with a highly significant P- value 0.003, [5/13 underwent abdomino-perineal resection, 3/13 underwent low anterior resection, and 2/13 underwent abdomino-perineal resection and liver metastectomy, the remainder 3 patients underwent palliative resection] Also 8/15 patients [53.3%] shown improvement of pain. The stop-flow method is introduced to markedly reduce blood flow to target tissue, and higher drug delivery than either simple intra-arterial or intravenous infusion. [2] Retarded blood flow may improve response not only by lengthening exposure time, but also by induced tissue hypoxia and low cellular pH. [3] Our technique is a new, easy, low cost procedure that can be done as a one-day procedure in the angiography room

Leptin production after mild-moderate and severe aerobic muscular exercise in females

The discovery of a fat melting hormone produced by the fat cell named leptin gave birth to the lipostatic theory of body weight control. Leptin informs the hypothalamus how much fat the body has and the hypothalamus takes action to resist changes in the body fat mass and the body weight. Study the effect of different intensities of muscular exercise [mild-moderate and severe] on serum leptin level and body composition. Post graduate students from the faculty of physical education for girls for each one control serum leptin level and body composition [body mass index, percentage body fat and body fat mass] were estimated and similar data were obtained after finishing each form of the muscular exercise training which was 4 weeks as mild, 4 weeks as moderate and 4 weeks as severe muscular exercise, the results reveals significant reduction in serum leptin level where the control [before exercise was 14.66 +/- 4.84 ng/ml after mild it decreased to 12.7 +/- 4.47 ng/ml, after moderate it reached 10.1 +/- 3.52 ng/ml and finally after severe exercise it decreased to 7.65 +/- 2.87 ng/ml. The reduction in serum leptin level was associated with significant reduction in body fat mass where it was 5.89 +/- 2.09 kg/m[2] reduced to 5.65 +/- 2.01 kg/m[2] after mild exercise and to 5.39 +/- 2.01 kg/m[2] after moderate exercise till it reached 4.99 +/- 1.67 kg/m[2] after severe exercise. There was a significant correlation between the reduction in the body fat mass and serum leptin level the highest correlation was after moderate muscular exercise where r = 0.8 and P= 0.002. From the present study we conclude that muscular exercise succeeded to decrease the body weight which was associated with a decrease in the body fat mass, the decreased body fat mass led to decrease in the serum leptin level. After moderate exercise there was the highest correlation between fat cell mass and serum leptin level, r= 0.6 and P = 0.05. So people do not need to do severe muscular exercise to get a significant reduction in body fat size with parallel reduction in serum leptin level that would resist weight gain

Nutritional and Biochemical significant studies on Friesian diary cows productivity

Proper nutrition for diary herds assesing the high yield. Adequate crurde protein content of the dairy ration is important to maintain the high productivity. This importance is maximized if it maintain sufficient level of degradable and undegradable intake protein. Dietary calcium and phosphorus must be enough and in balanced manner to enable the high producing cows to meet their requirements for lactation and / or pregnancy. Metabolic profile results showed that reduced milk yield may be -due to failier in maintenance adequate level of certain blood constituents due to dietary insufficiency of their parent nutrients

Iron enriched bread: interaction effect of calcium, zinc and cupper on iron bioavailability

In the present study, wheat flour [82%] was enriched with iron alone in the form of ferrous sulfate and ferric ammonium citrate at different levels [4, 8 and 15 mg Fe/100g] or with calcium, zinc and cupper in addition to iron. Results obtained revealed a minor effect of added minerals on phytic acid content, which was found to decrease in the dough during fermentation, lonizable iron content of bread showed increased values in bread, especially those enriched with low levels of iron [4 mg Fe/100g] in the form of ferric ammonium citrate, while addition of high levels [15 mg Fe/100g] was found to reduce soluble iron. Addition of calcium, zinc and cupper also reduced the soluble iron. Feeding the enriched bread diets to anemic rats for 6 weeks indicated maximum body weight gain as well as feed efficiency in the rats fed the low levels of iron while those given the high levels as well as those containing calcium, zinc or cupper showed decreasing values for body weight gain and feed efficiency. Hemoglobin levels of all groups of rats fed the enriched diets were significantly increased [15.3 - 17.19 g/dl], whereas hematocrit values indicated non- significant differences as compared with the control

Serum erythropoietin level in cases of normocytic normocytic anaemia in hepatic fascioliasis

In Egypt human fascioliasis is an increasing health problem especially in the Nile Delta. This study was conducted on 35 anaemic patients with fascioliasis, 20 anaemic patients with schistosmiasis [parasitic control group] and 10 persons [healthy control group].Serum erythropoietin "EPO" and ferritin were measured using a sandwitch ELISA technique, also other ferrokinetic parameters were done .In patients with fascioliasis, EPO level [19.05 +/- 13.3 mU/ml] was significantly higher than those of healthy control [7.23 +/- 1.6 mU/ml] and of schistosomiasis [12.3 +/- 2.85 mU/ml] groups [P < 0.001]. Serum ferritin was significantly higher in fascioliasis group [384.8 +/- 51.1 ng/ml] than in schistosomiasis [174.7 +/- 83.4 ng /ml] and in healthy control [117.5 +/- 29.5 ng/ml] groups. [P < 0.001]. Other ferrokinetic studies showed low serum iron, subnormal transferrin saturation, low total iron binding capacity, inspite of adequate iron stores shown by high serum ferritin, these findings together with normal reticulocytic count were similar to those found in the anaemia of chronic disorders.The presence of anaemia inspite of high EPO level and adequate body iron stores may be explained by unresponsiveness of bone marrow to high EPO level which may be due to blocking the action of EOP by some cytokines as interleukin-1, tumour necrosis factor, and gamma interferon which were proved to be abundant in hepatic fascioliasis, or it may be due to an inhibition of bone marrow by large amount of proline which is usualy present in hepatic fasioliasis after treatment, cases of hepatic fascioliasis showed a good improvement of all parameters which were more or less comparable to those of healthy control. Normocytic normochromic anaemia

The use of island radial forearm flap for local hand coverage

Extensive skin loss of the hand often necessitates creation of a flap for reconstruction and cover. At King Fahd Hospital of the University in Al-Khobar, we have treated 13 cases of hand injury with radial forearm flaps. We found it easy to reconstruct the tissue loss by a reliable flap of optimal thickness which has a good arc of rotation and provides a supple surface. The donor site morbidity is minimal in our hands. The procedure should be adopted for extensive and tedious hand injuries when the appearance and function are both important after reconstruction