role of capsule endoscopy in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding is mostly recurrent and originates in the small bowel, which can be only partially examined by conventional endoscopy. Capsule endoscopy has revolutionized the evaluation of obscure gastrointestinal bleeding [OGIB]. The diagnostic yield of capsule endoscopy in OGIB was a main concern of many studies. The aim of this study is to assess the diagnostic yield of capsule endoscopy in cases of OGIB. Capsule-related complications and degree of inter-observer variation will be recorded as well. 54 consecutive patients suffering from OGIB, whether occult or overt, were subjected to capsule examination and data analysis. The majority [74.1%] presented with obscure overt bleeding. Examination was complete in 68.4%. The commonest lesions were angiodysplasias [17.5%]. Examinations were negative for lesions in 35.1% and hampered by limitations in 19.3%. The capsule diagnostic yield was 56.1%, while capsule retention occurred in 3.5%. The inter-observer agreement for the cause of bleeding was 91.2%. Capsule endoscopy proved helpful in solving the mystery of OGIB. It succeeded in diagnosing the cause of bleeding and directing further management with good compliance, high proportion of inter-observer agreement and low incidence of complications

Post-kidney transplant malignancy in Egypt has a unique pattern: a 3-decade experience

The prevalence and type of post-transplant malignancy vary among different transplant units. We hereby report on our 30-year single center experience. Between March 1976 and January 2007, 1866 kidney transplantations were carried out [1390 males and 476 females, mean age = 29.84 +/- 10.47 years]. Recipients who developed post-transplant malignancy [74 patients] were evaluated. Furthermore, characteristics of this group were compared to those of the malignancy-free recipients [1792 patients]. Seventy four patients [3.97%] developed 76 malignancies. Kaposi sarcoma was the commonest type [36.8%]. The majority of patients had cutaneous lesions and mortality was relatively low [10.7%]. Skin/oral cancers were the 4th among post-transplant malignancies [9.2%]. The majority of cases were basal cell carcinoma. In our series, two variables were identified as independent risk factors for the development of post-transplant malignancy: age and prior blood transfusion. In conclusion, posttransplant malignancy represents a continuous challenge for the outcome of kidney transplantation. Nevertheless, its prevalence and type vary due to many factors including environmental and genetic factors. In our series, Kaposi sarcoma was the commonest type dictating further evaluation of its preventive strategies and newer therapies

Independent value of DNA ploidy as a prognostic indicator in patients with nonmetastatic renal cell carcinoma

Several studies performed on tumours from different organs have shown that DNA ploidy is art additional predictor for survival. However the significance of DNA ploidy as an independant prognostic for patients with renal cell carcinoma [RCC] is less clear. Therefore purpose of this study is to assess if DNA flow cytometry data in RCC valuable prognostic information. One hundred sixty-eight consecutive patients were selected from 226 patients with RCC who underwent nephrectomy at our institution between 1983 and 1995. All patients were free of metastatic or locally irresectable disease preoperatively. DNA content was analysed by flow-try. DNA ploidy of the tumour tissue was compared with tumour pathologic stage [TNM 1997], grade, histological subtypes and disease related survival rates. Different prognostic factors were studied us-both univariate and multivariate analyses. Of the 168 tumours analysed, 92 [54.8%] displayed diploid and 76 [45.2%] had aneuploid pattern. Statistical correlations were between DNA ploidy pattern and each of tumour size, stage and grade. Significant high incidence of tumour recurrence was observed among patients with aneuploid tumours [46%] when compared with that diploid population [17, 4%] [P<0.001]. According to univariate analysis, tumour size, stage, grade and DNA ploidy had significant impact on patients outcome. On rnultivariate analysis, DNA ploidy in addition to tumour stage and grade were sign4ftcant independent prognostic factors. DNA ploidy is a reliable prognostic factor for RCC and yields considerable information for patient management and predicting clinical outcome

Some histochemical stromal characterizations in colorectal epithelial tumors

Stroml changes may play an important role in progression, invasion and prognosis of colorectal tumors. Biopsy specimens of colorectal tumors were evaluated for stromal char- acterizations. Section stained with Haematoxyline and eosin [HandE] were examined as regard the presence of tumor infiltrating lymphocytes [TILs] and tumor associated eosinophilic infiltrate [TE]. The number of TILs were larger in earliest stages of colorectal cancers and decreased with the presence of metastasis. The prognosis of carcinomas was better for those with higher eosinophilic infiltration Expression of gelatinase A type of Matrix Metalloproteinases [MMP2] was assessed histochemical in both adenomas and carcinomas. Cytoplasmic expression of MMP-2 is significantly high in colorectal carcinomas [56%] compared to adenomas [20%]. [p=0.006]. A positive relation- ship between MMP-2 expression and tumor grade, Dukes' stage and nodal status was reported. The staining in density of MMP-2 in adenomas was either moderate [50%] or weak [50%]. On the other hand, 28.6% of carcinomas were strongly stained, 39.3% were moderately stained and 32.1% were weakly stained

Haemolytic anaemia after ABO-mismatched living-donor kidney transplantation

ABO.mismatched transplants are used frequently. Acquired haemolytic anaemia have been reported after ABO mismatched transplantation. Among 214 ABO.unmatched living-donor kidney transplants tS, 10 cases with cyclosporine based therapy developed haemolysis All studied patients had pre-transplant non specific blood transfusion and received kidneys from one haplotype HLA mismatched living donors. There were 164 males and 50 females. while the mean age was 30.41 years. CsA was stopped in patients treated with triple Immunosuppression while the patients received Pred-CsA were switched to conventional immunosuppression 6 patients were transfused with washed O cells and no plasma exchange was required. The prognosis was excellent in 9 patient, and one died from severe haemolysis. The haemolytic anaemia was more frequent among blood group A recipients [60% of our cases] and more severe among recipients with blood group B. Univariate analysis demonstrated significant impact for recipient age. donor sex, number of pretransplant blood transfusions. primary immunosuppression, time to onset of diuresis, recipient and donor blood groups. On the other hand, multivariate analysis restricted the significance to blood group of donor and recipient. time to onset of diuresis and primary immunosuppression. ABO unmatched kindray transplantation had no impact on patient survival, mean while the graft survival appeared to be better among unmatched ABO group in comparison to the same blood group recipients

Gastric pull-up after total pharyngolaryngectomy

In this study, 50 patients with hypopharyngeal carcinoma underwent gastric pull-up following total laryngopharyngectomy. The postoperative mortality was 10% and the postoperative morbidity was mainly due to pleural injury, hemorrhage, minor fistulae and mediastinitis. It was found that fistulae occurred in 16% of the cases, hemorrhage in 4% and abdominal wound dehiscence in 4%. The perioperative mortality was 10% in the cases