Kappa and lambda determination by single colored immunohistochemistry and chromogenic in situ hybridization techniques in B-cell malignancies

Background: kappa and lambda light chains detection in bone marrow trephine sections help in the determination of B-cell clonality through evaluation of light chain restriction

Aim of the Work: was to compare the efficacy of single color detection-based immunohistochemistry [IHC] and chromogenic in situ hybridization [CISH] in evaluating kappa/lambda expression in tissues harboring B-lymphoid lesions

Patients and Methods: Forty patients were enrolled in this study. They were divided into three groups chronic lymphocytic leukemia [CLL/SLL] group I [n=13], non-Hodgkin lymphoma [NHL] group II [n=24] and hairy cell leukemia [HCL] group III [n=3]. The 24 NHL cases comprised of [11 diffuse large B-cell lymphoma, 6 mantle cell lymphomas, 3 marginal zone lymphoma, 2 lymphoplasmacytic lymphoma, 1 follicular lymphomas and 1 Burkitt's lymphoma]. Kappa and lambda light chains were detected in their bone marrow trephine sections using single colored immunohistochemistry, chromogenic in situ hybridization and the results were compared to the flowcytometry as reference method

Results: Light chain restriction [LCR] was detected by FCM in 100% of the cases followed by CISH [52.1%; 12/23] of the cases and finally IHC [43%; 18/40]

Conclusion: Both conventional CISH and IHC are effective in determining monoclonality in cases of mature B- cell neoplasm that has plasmacytic differentiation and with high amount of cytoplasmic Ig light chains such as MZL and LP. However, they are not effective in determining monoclonality in cases with low amount of Ig light chain such as cases of pregerminal and germinal center lymphoma. Yet, CISH is more informative than IHC due to the lack of background staining which allowed for greater discrimination between absence and presence of monoclonality

effect of tadalafil on right ventricular function in patient with pulmonary hypertension undergoing mitral valve surgery assessed by tissue doppler and TEI index

Pulmonary artery hypertension is a disorder with limited treatment options and poor prognosis. We studied the effect of tadalafil, a selective phosphodiesterase type 5 inhibitor, in patients with this disease. In fifty patients subjected to mitral valve surgery [26 males, 24 females] aged 19040 years, with pulmonary artery hypertension, 10 mg tadalafil single dose was given to 25 patients after induction of anesthesia, and its effect was compared to a placebo given to the other 25 patients, all fifty patients had a comprehensive Transoesophageal echo examination including tissue Doppler and Tie index. Tadalafil resulted in a marked improvement in right ventricular function as regards tissue Doppler and Tie index [0.3110.05] compared to [0.34 +/- 0.02] in control group [p value =0.01] and pulmonary artery pressure [52.6 +/- 12.17] compared to control group [59.60 +/- 11.31] [p value =0.04]. 10 mg Single dose tadalafil was well tolerated and had a beneficial effect in patients with pulmonary artery hypertension undergoing mitral valve surgery

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

Hemostatic disturbances in hepatitis B virus infection patients

This study was conducted on 20 patients [14 males and 6 females] with chronic hepatitis B virus infection and their ages ranged between 30-50 years and 10 control males. The aim of this study was to assess the hemostatic abnormalities in chronic hepatitis virus infection. All patients were subjected to full history, clinical examination, abdominal ultrasound and laboratory investigations [CBC, LFTS, HBsAg, PT, APTT and coagulation factors I, II, V, VII, VIII, IX, XI and XII]. The results of this study revealed that higher level of factors VII, VIII and factor XI and decreased level of factors IX and XII reflecting the lesser degree of prolongation in PT and APTT. It was concluded that abnormal hemostasis is a common complication of lever diseases and determination of its underlying pathogenesis is essential foe rational management. Vitamin K coagulation factor IX was diminished