Histological, immunohistochemical and quantitative analysis of collagen in patients with direct inguinal hernia

Abnormal collagen metabolism is thought to play an important role in the development of abdominal hernia. This is underlined by detection of altered collagen metabolism and structural changes of the tissues in patients with inguinal hernia. Was to study collagen synthesis defect in patients with direct inguinal hernia. Specimens were obtained from skin, transversalis fascia and sacs from forty two adult male patients with direct inguinal hernia and from 30 control adult patients without hernia during appendectomy. Sections from the specimens were stained with haematoxylin and eosin and Masson's trichrome stains, for light microscope. Furthermore, immunohistochemical study for collagen type III and histological quantitative analysis of total collagen were done. Other specimens were processed for electron microscopic study. Histological study of the tissues of patients with direct inguinal hernia revealed that the collagen fibers appeared loosely packed, widely separated and there was decrease in bundle formation. The immunohistochemical study showed an increase in type III collagen fibrils in comparison to that of controls. Also, there was a significant decrease in the amount of total collagen content compared to the control group. The electron microscopic study revealed degenerative changes in the fibroblasts associated with loosely packed collagen fibrils. These changes were detected in all studied tissues. We concluded that the substitution of collagen type I by collagen type III that has less tensile strength predisposes to development of direct inguinal hernia. We also concluded that inguinal hernia may be a local manifestation of a systemic disorder of collagen metabolism

Preoperative interleukin-6 in colorectal cancer patients: correlation with carcinoembryonic antigen, tumour stage and outcome

The significance of preoperative serum inter-leukin-6 [IL-6] level in the progression of colorectal cancer has not been fully elucidated. Our aim was to investigate its role and identify its prognostic significance. Forty three consecutive patients, who underwent radical resections for colorectal cancer lesions in a period of 1.5 years from Aug. 2004 till Feb. 2006 were recruited in this study. Blood samples were obtained before surgery to determine the serum concentration of IL-6 and carcinoembryonic antigen [CEA]. Serum concentrations of human IL-6 were determined by enzyme-linked immunosor-bent assay [ELIZA] and CEA was measured by immunometric method. The relationships between their elevations and both the clincopathological factors and prognosis of patients were investigated. Serum samples [for IL-6 assay only] from 25 sex- and age-matched normal healthy individuals were used as controls. The mean serum IL-6 concentration [9.57 +/- 7 pg/mL, range 2.4-45 pg/mL] was significantly higher than that in normal individuals [mean value: 3.52 pg/mL, range 0.45-9.96 pg/mL, p<.001]. Elevated serum CEA [>5.0 ng/mL] was present in 44.2% of patients, while serum IL-6 levels in CRC patients were more frequently elevated [69.8% of patients, p=.001]. Linear regression analysis showed a significant association between serum values of both IL-6 and CEA [r=.773; r[2]=.597; p=.001]. The mean IL-6 serum concentration in CRC patients with stage III was 13.3 +/- 8.47 pg/mL while the mean level in patients with stage I and II was 6.3 +/- 3 pg/mL [p=.001]. Patients with an IL-6 serum concentration of more than 9.5 pg/ml had a significantly shorter 2-year survival [55%] than patients with an IL-6 serum concentration of 9.5 pg/ml or less [93%], [p=001]. IL-6 is potentially a better marker for advanced colorectal carcinoma than CEA. High preoperative levels were associated with high CEA, advanced tumor stage and poor outcome. IL-6 may have a role as an indicator of metastases that appear after resection of the primary colon cancer. This may help to identify high risk patients more likely to benefit from adjuvant therapy

Prevalence of celiac disease in patients with type 1 diabetes mellitus

Celiac disease is an autoimmune disorder in genetically susceptible individuals after ingestion of gluten. Early diagnosis and treatment of celiac disease could potentially prevent the development of serious complications like osteoporosis, small bowel lymphoma, and infertility. Nowadays, the availability of non-invasive serological tests for celiac disease altered the classical diagnostic pathway, and allows screening of populations at particular risk of developing celiac disease. Celiac disease is associated with many other autoimmune disorders, type 1 diabetic patients may have the risk of developing celiac disease or one of its complication. to determine the prevalence of celiac disease in adult patients with type 1 diabetes mellitus attending the outpatient diabetic clinic of Alexandria University Main Hospital. 200 adult patients with type 1 diabetes mellitus screened for celiac disease by anti-endomysial [EMA] IgA antibodies, and anti-tissue transglutaminase [tTG] IgA antibodies, In addition, Anti-endomysial [EMA] IgG antibodies used to detect patients with IgA deficiency. Distal duodenal biopsy and histopathological examination was performed for any serologically positive patient. Eight [4%] patients showed positive results for all performed serological tests. They all confirmed to be celiac diseased by histopathological examination of distal duodenal biopsy. Anther three patients showed only weak positive liter for tTG-lgA and all of them revealed normal mucosal histopathological finding. Anti- endomysial [EMA] IgA assay showed optimal concordance with histopathological finding. In three patients of the celiac group; the disease was asymptomatic. Symptoms [anemia, fatigue, short stature, diarrhea abdominal distension, recurrent aphthus ulcer, and recurrent hypoglycaemic attacks] in a mild form were significantly higher in the diabetic-celiac group than that in diabetic non-celiac group. There were no significant differences between the diabetic-celiac group and diabetic non-celiac group as regard age, diabetic onset, duration, or glycemic control. Patients with type 1 diabetes mellitus have an increased prevalence of celiac disease. Because most cases are clinically unrecognized, consideration should be given to screening all patients with type 1 diabetes. EMA serological screening and confirmatory histopathological examination of distal duodenal biopsy remain the best screening strategy to detect celiac disease in patients with type 1 diabetes

prognostic significance of gelatinases [MMP-2 and MMP-9] expression in colorectal cancer in upper Egypt

Prognosis of colorectal carcinoma depends on many factors, such as: age and sex of patient-location, multiplicity, local extent and size of tumor-bowel obstruction or perforation as well as tumor microscopic type and grade -vascular and perinerual invasion, nodal and distant metastasis. The matrix metalloproteinases [MMPs] are a family of proteolytic enzymes strongly implicated in tumor invasion and metastasis, hence in tumor prognosis. The purpose of our study was to assess the role of MMP-2 and MMP-9 expression in colorectal tumorigenesis, invasion and metastasis, hence their prognostic values. Immunohistochemical analysis of MMP-2 and MMP-9 glycoproteins in colorectal cancer cells, an immunohistochemical score based on the intensity of immunoreactivity and proportion of immunoreactive cells that established for each MMP and correlation of this expression with the established prognostic factors. MMP-2 was expressed in 81.8% [strong expression in 40%] of cases, and MMP-9 expressed in 72% [strong expression in 35%] of cases. MMP-2 and MMP-9 are widely expressed in colorectal carcinoma suggesting significant diagnostic and prognostic values in these tumors. Increased levels of MMP-2 and MMP-9 protein expression in colorectal carcinoma tissue as compared to normal tissues suggest their association with colorectal tumor invasion and metastasis

Imprint cytology versus immunohistochemistry of sentinel lymph nodes in berast cancer with clinically negative axilla

The success of sentinel lymph node [SLN] biopsy in determining axillary lymph node status necessitates an accurate and rapid method for intraoperative examination of the nodes. The aim of this study was to evaluate the feasibility and accuracy of immunohistochemistry [IHC] of touch imprints in detecting axillary nodal metastasis. Sentinel lymph node biopsy was performed in 50 patients with clinical T1-2 No breast cancer. After harvesting, the SLN were bisected, imprinted and subjected to IHC. Results were compared with those of routine hematoxylin and eosin [H and E] and IHC examination of the same node. The SLN was the only site of metastasis in 15 patients [37.25%]. IHC staining of the imprinted SLNs is more accurate than H and E imprint or paraffin sections H and E and IHC stained. Immunohistochemistry was capable to detect micrometastasis in 4 paraffin sections of SLN. IHC of touch imprint is feasible and provide reliable results for intraoperative evaluation of SLN in patients with breast cancer. It is also more sensitive for detection of micrometastasis in paraffin sections

Impact of preoperative endoscopic biliary drainage on the outcome of patients undergoing whipple's operation for periampullary carinomas

Fifty patients with obstructive jaundice due to periampullary carcinomas who are candidates for surgical resection were selected for this study. They were 31 males [62%] and 19 females [38%] with mean age 55.5 years, range from 32 to 70 years. After preoperative work up for assessment of the operability and fitness for operation all patients were subjected to pancreaticoduodenectomy after randomization into 2 groups. Group [A] included 25 patients subjected to the operation without preoperative endoscopic biliary drainage and group [B] included 25 patients subjected to the operation after preoperative endoscopic biliary drainage.Hospital mortality occurred in 3 patients [6%], 14 patients [28%] developed complications. The average hospital stay was 10.2 days differences between the two groups were evaluated statistically. We concluded that preoperative biliary drainage should be reserved only for patients in whom surgery with intent for cure has to be postpond and in patients with border line resectable tumours requiring downstaging protocol

Efficacy of pre-operative chemotherapy and sequential radiation therapy in irresectable rectal carcinoma

To evaluate the toxicity and relative response rates of addition of cisplatin to 5-fluorouracil and leucovorin preoperative induction chemotherapy followed by local radiotherapy in irresectable rectal cancer and their impact on radical resectability and sphincter preservation. Between January 2002 and April 2006, 29 patients with locally advanced unresectable rectal cancer received two cycles of 5-fluorouracil 600mg/m[2], I.V 6h infusion D[1]-D[5] and D[22]-D[26], Leucovorin 20mg/m[2], I.V 1h infusion D[1]-D[5] and D[22]-D[26] and cisplatin [CDDP] 60mg/m[2], I.V 6h infusion D[1] and D[22] after good hydration. Radiation treatment was administered after two weeks of the second cycle of chemotherapy. The dose was 45 Gray in 25 fractions over 5 weeks prescribed at isocenter of the plan to include the rectum and the draining lymph node chains. Tumor dimensions were assessed by CT scan before the start and 4 weeks after chemoradiotherapy. Tumor response classification was based on the standard World Health Organization criteria. Complete response [CR] is complete disappearance of the disease. Partial response [PR] is a decrease of 50% of the sum of the products of the greatest perpendicular diameters [SPD]. Progressive disease [PD] is appearance of a new lesion or an increase of 25% in SPD. Stable disease [SD] is no change in SPD or a change not reaching PR or PD. Overall response rate [ORR] is CR plus PR. Our regimen was well tolerated. The main toxicity to it was grade II hematological and grade II and III GIT toxicities in 31% and 65.5% respectively. PR occurred in 58.6% [17/29], SD in 20.7% [6/29] and PD in 20.7% [6/26]. Anterior resection of the rectum with total mesorectal excision and sphincter preservation was done in 37.9% [11/29], abdomino-perineal resection in 31.05% [9/29] and palliative colostomy in 31.05% [9/29]. Radical resectability was achieved in 62.1% [18/29] and cytoreductive surgery in 6.9% [2/29]. After 2 years follow up of resected cases, the 2 years disease free survival was 60% [12/20] with 25% [5/20] local recurrence rate and 15% [3/20] distant metastases to the liver. Our pre-operative combined modality therapy seems to have potential advantage in tumor response, local control and sphincter preservation with tolerable acute and chronic toxicity. Sequential use of chemo-radiotherapy needs more studies to estimate the maximum tolerable dose of chemotherapy and radiotherapy with least side effects

Efficacy of pre-operative chemotherapy and sequential radiation therapy in unresectable rectal carcinoma

The aim of this study was to determine the extent of down staging, resectability rate, sphincter preservation and toxicity to preoperative chemotherapy with sequential radiation therapy in the treatment of locally advanced unresectable rectal carcinoma. Between January 2002 and February 2003, 29 patients with a diagnosis of locally advanced unresectable rectal cancer received two cycles of 5-fluorouracil 600 mg/m2, i.v. 6 hr infusion D1-D5 and D22-D26, leucovorin 20 mg/m2, i.v. 1 hr infusion DI-D5 and D22-D26 and cisplatin [CDDP] 60 mg/m2, i.v. 6hr infusion D1 and D22 after good hydration. Radiation treatment was administered after two weeks of the second cycle of chemotherapy. The dose was 45 Gray in 25 fractions over 5 weeks prescribed at iso-center of the plan to include the rectum and the draining lymph node chains. Tumor down-staging occurred in 11 out of 29 patients to whom abdominal resection with sphincter preservation was done and 9 patients with locally advanced rectal cancer were rendered operable and underwent abdominoperineal resection, while the rest of the patients remained inoperable. A total of 3 local recurrences out of 20 resected cases was developed within one year of follow up in the group of patients who underwent anterior abdominal resection, while distant metastases to the liver occurred in three patients whom were inoperable

Common bile duct stones-endoscopic management experience in 107 cases

In this study, 107 patients with common bile duct stone[s] were selected for endoscopic management. The success rate of cannulation of the common bile duct was 97.1%. Endoscopic sphincterotomy was done in 104 patients, stone[s] extraction after endoscopic sphincterotomy was achieved in 73 patients using different endoscopic approaches, basket extraction in 38 cases, balloon extraction in 35 cases and mechanical manual lithotripsy, which was used successfully in 22 patients. The mechanical manual lithotripsy increased the ability to clear CBD stone[s] from 70.19% to 91.3% at the initial endoscopic session. The early complications of ERCP and its therapeutic applications were bleeding in three cases, pancreatitis in four cases and cholangitis in two cases. Late complications included cholecystitis in four cases and recurrent CBD stones in three cases. The overall success rate for CBD stone[s] clearance was 92.5%, while the overall morbidity after ERCP and its therapeutic applications was 16.3%. There was no recorded mortality

Value of transrectal ultrasonography in the assessment of azoospermic patients before ICSI

The purpose of this article is to evaluate the role of ultrasonography of male reproductive system, especially scrotal and transrectal ultrasonography in the management of infertile males before ICSI as a predictive value for sperm recovery in testicular sperm extraction [TESE]. In this study selected group of 140 infertile men with azoospermia were examined with scrotal and transrectal US. According to clinical and transrectal examination, these patients were subdivided into two groups. Group I of 64 patients had evidence of major obstructive abnormalities of male genital tract system and group II of 76 patients had no or minor non obstructive transrectal US abnormalities. All the 140 patients in the last two semen analysis have azoospermia which persists in spite of medical or surgical treatment. In group I, five patients had congenital bilateral absence of the vas deferens, two have congenital unilateral absence of the vas deferens and congenital obstructive pathology of the contralateral duct system. Proximal or distal duct system obstruction was diagnosed in 57 cases. These patients have a normal FSH level and small volume of ejaculate, and significantly higher testicular volume. In 61 patients of them [95.3%] testicular sperm were found in testicular biopsy. The other 76 patients in Group II were subdivided into two categories according to the presence or absence of minor non-obstructive transrectal abnormalities. In the 30 patients who had additional abnormalities thought to be directly related to semen deficiency 17 cases [56.7%] showed sperms in testicular biopsy. These patients have FSH at the upper level of normal with testicular volume at lower level of normal and with low ejaculate volume. In the remaining 46 patients with high level FSH, low testicular volume in US with normal ejaculatory volume and within normal transrectal US, only 19 cases [41.3%] showed sperms in testicular biopsy