Study of the role of C reactive protein measurement in reducing the rate of negative explorations for acute appendicitis

Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices unnecessarily removed remains high [15-30%] despite several techniques and investigations used to improue our diagnostic accuracy. Many studies investigated the role of raised C-reactive protein in improving the diagnosis of acute appendicitis with con-jlicting results. This study emphasizes the impact of a normal [rather than raised] serum C-reactive protein in reducing the rate of negative explorations. In a double blind study, blood for the measurement of serum C-reactive protein [CRP] was collected pre-operatively from 156 patients just before going to the operating room for appendicectomy. The histopathology of the 156 appendices were grouped into positive [acute appendicitis] and negative [normal appendix]. White blood count [WBC], CRP and the histopathology findings were correlated. In patients with histopathologically proven acute appendicitis both the WBC count and serum CRP level were significantly raised [P=0.025 and P<0.0001 respectively]. Serum CRP level was normal in 26 out of 30 negative explorations [normal appendix on histopathology]. The specificity and sensitivity of serum CRP was 86.6% and 93.6% respectively. A normal preoperative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix Deferring surgery in this group of patients would probably reduce the rate of unnecessary appendicectomies

Study of thyroid hormones concentrations in egyptian patients with chronic active hepatitis postvirus C Infection

Serum total T3 [TT3], serum free T3 [FT3], serum total T4 [TT4], serum free T4 [FT4] and serum thyroid stimulating hormone [TSH] were assessed by radio-immunoassay in [30] Egyptian patients with chronic active hepatitis [CAH] post -virus C [group I] and [30] normal healthy subjects [group II]. Our results showed highly significant decrease [P<0.01] of TT3 and FT3 concentrations in the diseased group as compared to normal control group Also, our findings showed highly significant increase [P<0.01] of TT4, FT4 and TSH concentrations in cases with CAH post-virus C when compared to normal control group. In present work, upon doing matrix correlation, the results showed significant moderate negative correlations were observed between FT3 concentration [pg /ml], and SGOT [lu /L] and SGPT [lu /L] while non significant weak correlations were found between FT3 concentration [pg /ml] and total bilirubin [mg /dl] and prothrombin activity. Also, the findings showed significant moderate positive correlations were detected between FT4 concentration [pg / ml] and SGOT [lu /L] and SGPT [lu /L] while non significant weak correlations were observed between FT4 concentration [pg / ml] and total bilirubin [mg / dl] and prothrombin activity [seconds]. Lastly, there was noted significant moderate negative correlation between total serum protein [gm /dl] and FT3 [pg/ml] concentrations In conclusion, thyroid function affection may associated with CAH post virus C and this affection is directly proportional to the degree of hepatic damage

Platelet activation and leucocyte-platelet aggregation in patients with venous stasis ulceration [VSU]

48 subjects were included in this study. They are classified into 3 groups: group 1-16 patients with venous stasis ulceration [VSU] of the leg due to chronic venous insufficiency [CVI] group II-16 patients with varicose veins of the leg without VSU and group III-16 normal healthy controls without evidence of venous diseases. Full detailed history and physical examination for all was done. The venous status for all patients was documented by means of duplex ultra-sonography and descending venography. Blood samples were drawn from the superficial veins of the leg just proximal to the ulcer from the patients with VSU, and from the superficial veins of the lower part of the leg from patients with V.V. without VSU [Local blood Samples]. Blood was also drawn from the antecubital vein from all [48] subjects [systemic blood Samples]. Whole-blood flowcytometry was used to analyse the samples before and after activation with a panel of agonists for evidence of platelet activation and the formation of leucocyte - platelet aggregation either monocyte - platelet aggregates or neutrophil - platelet aggregates patients with venous stasis ulceration [VSU] had a greater number of monocyte platelet aggregates in both the arm and leg samples than did the patients with V.V. without ulceration and than did the control subjects [P<0.01]. Furthermore, systemic blood samples from patients with venous stasis ulceration stimulated with either thrombin-receptor agonist peptide [TRAP], Adinosine diphosphate [ADP], or phorbol myristate acetate [PMA] formed more monocyte - platelet aggregates than did patients with varicose veins without ulceration and than did control sujbects samples [P<0.05]. No significant differences were found between the patients with V.V. without ulceration and control sujbects in platelet activation and leucocyte - platelet aggregation either before or after agonist stimulation. Also, there are no differences in platelet activation or neutrophil-platelet aggregate formation were noted among the three groups. Patients with VSU have an increase in the number of monocyte - platelet aggregates in systemic venous blood as well as in local venous blood [adjacent to venous stasis ulcer], implicating the monocyte as the leucocyte involved in the pathogenesis of VSU. No association was identified between the presence of a venous stasis ulcer and either neutrophil-platelet aggregation or the activation of individual platelets. Because platelet activation is necessary for the formation of monocyte-platelet aggregates, these data also suggest that monocyte-platelet aggregation is a more sensitive marker for in-vivo platelet activation than is the identification of individual activated platelets

Study of hypothalamic - pitluitary- gonadal -axis HPG] in insulin dependent diabetic [IDDM] patients

The influence of long term diabetes [5-10 years] on the hypothalamic pituitary gonadal axis was studied in 40 adult [113DM] patients [20 males and 20females] and 30 healthy volunteers [20 male and 10 female] as a control. Plasma level of LH, FSH, and [testosterone and prolactin. in male and progesterone in female] were measured in both diabetic and control subjects. They were also measured in diabetic patients after oral administration of clomiphene citrate in a dose 50 mg /day for 10 days. Results revealed the following. The base line plasma LH and FSH in diabetic patients showed different data in males and in females. In males. there were significant increase in the level of LH, FSH and prolactin compared to the control group. This increase was correlated with a significant decrease in. the level of testosterone, concluding that diabetes Mellitus has a degenerative changes on. the tests .decreasing the testosterone level and consequently by the negative feed back mechanism the level of LH and FSH was increased In females, the base line level of LH, FSH, and progesterone were significantly decreased which may be due to the effect of diabetes on the [HPGA]. On the other hand, after treatment with clomiphine citrate in males, there was significant increase in LH, FSH but with no change in testosterone level. These data added further support to our conclusion that the effect of diabetes is mainly at the testicular level more than central since the treatment increased the negative feed back mechanism leading to further increase in LH level. The data in the female patients after treatment showed significant increase in plasma t LH, FSH, and progesterone. But concerning the increase in progesterone level it can not reach the control level, concluding that the [IDDM] affect the female reproductive function both centrally at the level of [HPGA] and locally at the level of the gonads. As a result of these data, clomiphen citrate can be used in female patients but it is considered of limited value in male diabetic patients