Antisperm antibodies in women with unexplained infertility

Unexplained infertility occurs in many couples of childbearing age, immune mechanisms have been postulated in this disorder for the last few decades. Circulating antibodies against spermatozoa present in serum and seminal plasma have been especially implicated. This autoimmunity against spermatozoa has been investigated in males, while the isoimmunity [in the females] has got low attention. Fifty women with unexplained infertility and twenty fertile women were involved in this case-control study. ELISA test was used to detect antisperm antibody [ASA] from cervical mucus [CM] and serum specimens of both groups of women. CM was collected at mid-cycle period and dissolved mechanically [not by bromeline]. Thirty percent of infertile women have IgG-ASA in their serum and 20% have IgA-ASA in the CM, while 22% of fertile women have IgG-ASA in their serum and no fertile women have any titer of IgA-ASA in their CM specimens. Only CM-IgA-ASA of infertile women showed significant statistical correlation with cellular property of CM, which was scored according to Insler score. It is concluded that ELISA test is more sensitive and specific than microagglutination tests for detection of serum and secreted ASA. Also, secretory IgA-ASA are more indicative amid have potential role in immunological infertility as iso- immunity than IgG-ASA. Therefore, it is strongly recommended that immunological infertility should be considered as an important cause of infertility and have to gain a special interest by clinicians

Surgical management of adenocarcinoma of the esophagogastric AEG junction

This study was performed to analyze the surgical results of 66 patients with adenocarcinoma of the esophagogastric AEG Junction subjected to curative resection. Between Sep. 2000 and Sep 2003, 66 patients with AEG including 20 type I, 16 type II and 30 type Ill were subjected to surgical resection in NCI Cairo University, South Egypt Cancer Institute [SECI] Assiut University, Nasser institute and Aswan Cancer Center. Patients with type I tumors [distal esophagus] underwent total esophagogastric transhiatal transthoracic or through three fields approach [abdominal, thoracic and cervical] or .subtotal esophagectomy with thoracic reconstruction. Patients with type Ill [gastric cardia] anderwent total or proximal gastrectomy with either transhiatal or transthoracic reconstruction For type II tumors [true cardia], total esophagectomy, subtotal esophagectomy, proximal gastrectomy with distal esophagectomy or total gastrectomy with distal esophagectomy were done with transhiatal, transthoracic or three field approach. Pathology, TNM stage, surgical approach, morbidity, mortality and survival were studied among the 3 groups. There were 54 male patients and 12 females with a median age 53 teams twenty patients [30.3%] had type I tumors, 16 [24.2%] had type II tumors and 30 [45.5%] had type Ill tumors twenty seven [41%] [20 type is 7 type II] underwent total esophagectomy or subtotal distal through transhiatal, trans thoracic or abdominal, thoracic and cervical approach Thirty nine patients [59%]. including thirty patients with type III and 7 patients with type II underwent gastrectomy 27 [41%] total and 12 [18%] proximal gastrectomy. Postoperative mortality was 9% and morbidity was 228.7% Overall survival [OS] was 88% at 12 months and 44.6% at 24 months while disease free survival [DFS] was 69.4% and 20.7% respectively. Lymph nodes [+ve vs-ve] and stage [I+II vs Ill+IV] grade percent of ve abdominal lymph nodes and total abdominal and mediastinal lymph nodes had prognostic significance while type of tumour, surgical approach, type of R resection, surgical margin size of the tumour and mediastinal lymph nodes were non significant on univariate analysis. while the abdominal lymph nodes were the only significant variable on multivariate analysis. Adenocarcinoma of the cardia is associated with poor survival. Early diagnosis remains the prerequisite for curative treatment. The classification of AEG into type I, II and III provides a useful tool for selecting the surgical approach

Intestinal parasites, including Cryptosporidium species, in Iraqi patients with sickle-cell anaemia

Stool samples were obtained from individuals admitted to three hospitals in Basra during November 1997-May 1998. Of 40 patients with sickle-cell anaemia, 25 [62.5%] had parasitic infections. In the apparently healthy comparison group, 26 of 175 individuals [14.8%] had intestinal parasitic infections, a statistically significant difference. The most common intestinal parasites isolated in the sickle-cell patients were Blastocystis hominis [36%] and Giardia lamblia [28%]. The isolation rate of Cryptosporidium species in sickle-cell patients [5%] was not significantly different from that in apparently healthy individuals [1.14%]. We report for the first time the isolation of Isospora belli from a sickle-cell patient in Iraq and the Mediterranean region