Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE

Identification of lipstick smear by energydispersive X-ray analysis and spectrophotometer

Lipstick smear is one of the most frequently encountered trace evidence at the crime scene. It is one of the variable samples to prove the relationship between the suspect and victim or the crime scene. So, the present study was done on 100 different types of lipstick. In this study a combination between visual comparison, energy dispersive X-ray analysis and spectrophotometer have been shown to be suitable for analysis, characterization and discrimination of small quantities of lipsticks, which may be encountered in forensic field. Visual comparison of lipstick smears in the present study classified them into six groups; light red, 22 samples; dark red, 20; pink, 18; orange, 4; light brown, 15 and dark brown, 21. By energy dispersive X-ray analysis, the present study revealed 10 elements such as Aluminum, Silicon, Sulphur, Chloride, Potassium, Calcium; Titanium, Iron, Cupper and Zinc. The level of each element differed in different types of lipstick smears. Spectrophotometeric analysis of lipsticks revealed an absorption spectrum ranging between [200-800nm], providing a fingerprint for qualitatively identifying the lipsticks. Also this method was used for quantitative analysis purposes. The amount of visible light or other radiant energy absorbed by a lipstick solution was measured; it depended on the concentration [50 ug/ml, 100 ug/ml, 150 ug/ml], which gave different absorbance levels in the same wavelength. The present study concluded that spectrophotometric method could be applied to traces from lipstick smears. Simultaneous measurement of transmittance profiles in visible and ultra violet regions enabled us not only to evaluate their colours in visible region but also to clarify the chemicals by the transmittance profiles in ultra violet region, because the latter region reflects the characteristics of dyestuffs. On the other hand, the non-destructive method [energy dispersive X-ray analysis] was more suitable for identification of trace amount of lipsticks for forensic investigation because X-rays analysis was performed directly on materials bearing the stain

Embrytoxic effects of 2-methoxyethanol in albino rats

2-Methoxyethanol [2-M.E.] is an alkyl derivative of ethyleneglycol. It is used widely as a solvent in many industrial and domestic products as industrial coating, liquid soap, fingernail polish and an antifreeze additive in hydraulic fluids and jet fuel. So, the present study was conducted on mature female rats to assess the embryotoxic effects of 2-M.E. Sixty mature pregnant rats were randomly divided into six groups each often rats. The first group was used as a control. The second, third and fourth groups were given 250, 500 and 1000 mg/kg of 2-M.E, applied topically on the skin from the 6 th to 15 th day of pregnancy. The fifth group was given 1000 mg/kg 2-M.E. applied topically on the skin from the day 10 th to 12 th day [3 repeated doses]. The sixth group was given 2000 mg/kg 2-M.E applied topically on the skin in the 12 th day of gestation as a single dose. All foeti of the treated dams were subjected to morphological, skeletal and histopathological study. The study revealed a significant decrease in foetal body weight and crown-rump length of all treated groups as compared to control group. As regard to the reproductive outcome of the present study, there was a significant increase of resorped foeti per litter, which reached the maximal degree of resorption in-group IV [1000 mg/kg as a repeated dose from the 6th to 15 th day of gestation]. The present study revealed a significant increase in congenital malformation as absence of anterior abdominal wall, skull defects, exencephaly and kinked tail in-group III that received 500 mg/kg as compared to control and other treated groups. Subcutaneous haemorrhage was observed in groups II, III and VI. Also, limb hyperflexion was obvious in groups V. VI and II. However, protruded tongue was found in groups II and III only. Skeletal abnormalities detected in this study included polydactly, brachydactly, incomplete ossification of all body bone with skull defect, decrease number of ribs and decrease number of bones of sternum. The present study demonstrated histopathological changes in both liver and kidney in the form of marked dilatation of blood vessels, degeneration and necrosis of some cells with marked congestion between the cells. Finally this study concluded that 2-M.E has high dermal absorption with a wide variety of embryotoxicity. Also, the morphological, reproductive variables and skeletal abnormalities as well as the histopathological changes induced by 2-M.E vary according to the dose, duration of exposure and the period of organogenesis. Women in reproductive age ought to be restricted from working areas of 2-M.E. exposure to avoid its embryotoxic effect

Gender differences in the Egyptians by osteometric measurements of the second cervical vertebrae [C2] with scanning electron microscopic examination of the vertebral body trabeclae

This study has been performed in order to define standards to determine the sex of the Egyptian remains. Osteometric information was obtained from dens, facets and vertebral canal of the second cervical vertebrae. Ninety-two normal second cervical vertebrae were taken from 64 male and 28 female Egyptian cadavers with their age ranged from 24 up to 68 years. Nine measurements [dens height, anterior and posterior body heights, maximum and minimum anteroposterior and transverse dens diameters, anterior facet width and height of dens] were estimated for the dens. Also, five measurements of the facets [right and left superior articular facet widths and lengths and inter-facet width] and two for the vertebral canal [antero-posterior and transverse diameters] for each second cervical vertebra were estimated and statistically analyzed. Small cubes [0.5cm3] from the body of second cervical vertebrae were cut and prepared for the examination of the vertebral trabecvilar bones by scanning electron microscope. The present study revealed significant differences between males and females as regards the osteometric measurements of the dens, facets and vertebral canal of the second cervical vertebrae. Multivariant discriminant analysis showed that a discriminant function consisting often variables could be used to identify the sex, The variables were right superior articular facet length, anterior facet width of dens, minimum transverse dens diameter, minimum antero-posterior dens diameter, dens height, anterior facet height of dens, maximum antero-posterior and transverse diameters of the vertebral canal, maximum antero-posterior dens diameter and inter-facet width. 100% of the sensitivity and specificity of the cut off point of the studied variables were observed in maximum antero-posterior diameter of the vertebral canal, right and left superior articular facet lengths, anterior facet width and height of the dens. On the other hand, the lowest percentage of sensitivity and specificity [59.4% and 57.1% respectively] of the cut off point was noticed in anterior body height. Moreover, in this study scanning electron microscope revealed gender difference in the width of the vertebral body trabeculae and in the numbers of the bone marrow spaces. So, these results can help in identification of Egyptian's sex from dens, facets and vertebral canal of the second cervical vertebrae as well as the vertebral trabeculae when no other human remains are available. Also, the present study suggests that this anthropometric database can be used in mathematical modeling of the vertebral column and identification of Egyptian's sex

Occult malignancy in patients with idiopathic deep venous thrombosis

The relationship between deep venous thrombosis [DVT] and malignancy has long been recognized and documented, patients diagnosed with malignancy are clearly at risk for the development of venous thromboembolism and conversely some patients with deep venous thrombosis have subsequently been discovered to harbor an occult malignancy. This is a prospective study of 51 DVT patients who presented to Ain Shams University Hospitals between January 1997 and December 2000. These patients were chosen out of 188 DVT cases because of absence of any major thrombotic risk factor, their ages were over 40 years, and non were previously diagnosed with any form of malignancy. All patients were screened for any signs of occult cancer, which included careful history taking, thorough physical examination, laboratory screening including tumor markers, and abdominal ultrasonographic examinations. After the first level of screening; suspicious cases were subjected to the second level of specific laboratory, radiological, or endoscopic tests to reach a final diagnosis. Malignant neoplasms were detected in 11 cases [21.5%]. Carcino-embryonic antigen [CEA] and endoscopy were key in diagnosing 2 cases of early colon cancer and 2 cases of adenomatous colonic polypi. Cystoscopy followed by biopsy detected 2 cases of early urinary bladder cancer, and high levels prostate specific antigen, transrectal ultrasound and biopsy were used to diagnose cancer prostate in one patient. Biopsy of palpable axillary and cervical lymph nodes attracted our attention to one case of cancer breast, and one case of non-Hodgkin lymphoma. Oncofeotal proteins and scrotal ultrasound led to diagnosing one case of early testicular tumor. Computerized tomography scans of the abdomen discovered one case of cancer body of the pancreas. The most striking finding was that most of these cases were in the early stages of malignancy. These findings underscore the importance of screening for occult malignancy in idiopathic DVT patients especially in the elderly population and regardless of the cost, since we are sometimes rewarded by finding cancer at an early stage, giving the patient the best chance for survival

Medicolegal aspect of voice analysis in prolonged endotracheal intubation versus laryngeal mask airway

Voice print analysis has been utilized in many different situations. The present study was designed to compare the changes of voice analysis in the first 24 hours after insertion of laryngeal mask airway [LMA] with those produced by endotracheal intubation. By using spectrum analyzer, we measured the frequency and the intensity level before and after anaesthesia at different intervals up to 24 hours from full recovery. There were significant differences between LMA and endotracheal intubation in the 2 variables [frequency and intensity]. Also the result demonstrated that both LMA and endotracheal intubation affected the voice print, but LMA caused little vocal changes than tracheal intubation and versus 24 hours after full recovery. The study suggest that the voice print must not be taken except after 24 hours from general anaesthesia

Estimation of sex from calcaneus verus metatarsal bones in Egyptians

Although cranial and pelvic bones are the preferred skeletal materials used by Forensic anthropologists to assign unknown individuals to their most probable sex, these remains may be unavailable. In the present study, lateral and anterophosterior radiographs of the ankles and foot of 120 Egyptians aged 20 up to 50 years were analysed with regard to sexual dimorphism. Length, height, minimal height, Bochler's angle, tuber plantar angle and front angle were measured from each calcaneous. Also, the length and mid shaft diameter were taken from all metatarsals. There was obviously a greater difference between males and females in the linear measurements of calcaneus than in angels. Sexual dimorphism was most distinct in length and midshaft diameter of metatarsals. The present study suggests that radiographs of the ankles and foot are convenient, rapid, cheap and non invasive means for estimating sex in skeletal cases as well as cases where there are intact soft tissue

role of laminin immunolabelling in the management of basal cell carcinoma

The aim of the present study was to assess laminin production and distribution in basal cell carcinomas in relation to clinical presentation and behaviour. Of 30 cases with B.C.C., 12 expressed a peripheral linear pattern of laminin immunostaining [type I] whereas 18 cases expressed short discontinuous intratumoral labelling in relation to cell membranes [type II]. Type I labelling was recorded more frequently in primary cases, while type II labelling was more frequently recorded in recurrent and extensive cases. Based on correlation with clinical data, it was concluded that type II tumors with type II laminin immunolabelling are more aggressive and should be subjected to prompt surgical excision