Case-control study of sarcoidosis in Alexandria

The present case control study of sarcoidosis was designed to reveal some' epidemiological features, clinico-radiological presentations and possible factors affecting both the severity of the disease and the outcome of corticosteroid therapy. The study included 104 patients with sarcoidosis and 104 control subjects. The diagnosis of sarcoidosis was established when clinico-radiological findings were supported by histopathological evidence of non caseating epitheliod cell granulomas. Data were collected from patients and controls during an interview using a pre-designed questionnaire. The mean age of disease occurrence was 34.2 years with a slight higher Incidence in women and it was not common among smokers. Dyspnea and cough were the main presenting complaints, while skin lesions were the most common extra-pulmonary presentation. Stage I was the predominant radiological finding, complete remission was the outcome of corticosteroid therapy in 70.19% of patients. Occupational exposure to aluminum, zirconium or beryllium, low socioeconomic state, family history of sarcoidosis, past history of tuberculosis and the delay in the diagnosis may affect both the severity of the disease and the outcome of corticosteroid therapy. We identified some epidemiological features of sarcoidosis in Alexandria and their relations to the clinico-radiological presentations of the disease and the response to corticosteroid therapy

Assessment of CD44S and CD44V6 in colorectal carcinoma [immunohistochemical study]

The last few years showed an increase in the incidence of colorectal cancer in our country. From 20% to 50% of patients are susceptible to death within 5 years of diagnosis, usually as a result of metastasis. Tumor growth, invasion and metastasis may be enhanced by alteration in the expression of certain adhesion molecules such as CD44s and CD44 v6. In an effort to detect the difference in the immunohistochemical expression of CD44s and CD44 v6 glycoproteins in colorectal carcinomas and correlating this expression with other clinicopathological parameters, we studied 55 cases of colorectal carcinomas resected from patients who underwent surgery at Assuit university Hospital in the period from 2003 to 2004. Forty five cases were conventional adenocarcinoma and 10 cases were of mucinous carcinoma type. The mean age was [44.9 +/- 2.5] with male predominance in cases of conventional adenocarcinoma, while the mean age was [33.4 +/- 2.67] in mucinous carcinoma with female predominance. Most of the cases were of stage B with only 11 cases of stage C and no cases of stage A. Positive staining for CD44s was detected in 81.8% of cases, in contrast to 69% positive cases for CD44v6. CD44s showed statistically significant higher mean of IRS [immunoreactivity score] in mucinous carcinoma than in adenocarcinoma while the opposite was noticed for CD44v6 but without statistical significance. There was inverse relation between IRS for CD44s and tumor grade, while IRS of CD44v6 showed direct relation with the grade. CD44v6 IRS exhibited upregulation with increasing stage and statistically significant higher level in tumors with infiltrating borders. In conclusion, CD44s had a significant relation to the type of colorectal cancer as its mean of IRS increased in mucinous carcinoma than in conventional adenocarcinoma which may indicate their better prognosis. CD44v6 may be an indicator for the metastatic potential of the tumor as its expression showed upregulation with progression of the stage and grade of the tumor and increased in tumors with infiltrating border

Respiratory muscle performance in chronic obstructive lung diseases and interstitial lung fibrosis

Respiratory muscle performance and breathing pattern were studied in 10 patients with chronic obstructive pulmonary disease [COPD] and 12 patients with interstitial pulmonary fibrosis [IPF]. Data of the present study revealed that patients with COPD had respiratory muscle weakness and diminished endurance as evidenced by decrease in maximal expiratory pressures [PE max=42% pred., PI max.=53% pred.] and the critical value of the tension time index of the diaphragm [TIdi=0.12]. The pattern of breathing in COPD showed an increase in tidal volume [TV=617 ml], respiratory frequency [F=22/m], minute ventilation [VE=12.8 L/m], and the mean inspiratory flow [VT/Ti=606 ml/sec], while there was a decrease in the inspiratory duty cycle [Ti/Ttot=0.37]. Patients with IPF had also respiratory muscle weakness as manifested by decreased PE max [49% pred.] and PI max [68% pred.], while endurance was not much affected [TIdi=0.1]. Breathing pattern in IPF showed decrease in TV [478 ml], and increase in F [36/m], VE [16 L/m], and VT/Ti [669 ml/sec], while Ti/Ttot was within normal [0.42]. It was concluded that respiratory muscle dysfunction and abnormal breathing pattern are important features in COPD and IPF and therefore should be included in the clinical and physiological evaluation of these patients

Transbronchial biopsy without fluoroscopy in diffuse lung diseases

Transbronchial biopsy [TBB] is a useful procedure to obtain an alveolar specimen in the evaluation of diffuse lung infiltrates, the use of fluoroscopy during the procedure has been controversial. In the present study, TBB without fluoroscopy was performed in 20 patients with diffuse bilateral lung infiltrates of unknown etiology as an outpatient procedure. All patients were observed for two hours after the procedure and discharged if stable. The overall diagnostic yield was found to be 75%, the highest yield was achieved in sarcoidosis, other interstitial diseases [100%], and metastatic neoplasm [75%]. Complication rate was low [10%]. One patient developed mild pneumothorax which did not necessitate tube insertion, and another one suffered from fever which responded to antipyretics. This report suggested that TBB without fluoroscopy in the lower lobes in diffuse lung diseases is a safe diagnostic procedure with reasonable yield and could be done as an outpatient procedure