Significance of serum angiogenin assay as a novel marker for diagnosis of hepatocellular carcinoma in liver cirrhosis: a comparative study

Background: Hepatocellular carcinoma [HCC] is the third most common cause of cancer-related death worldwide. Angiogenin [ANG] is a potent angiogenic factor first isolated from the culture medium conditioned by colon carcinoma cells. Many reports have demonstrated an elevated serum ANG level in patients with various malignancies including colorectal carcinoma, melanoma, and pancreatic carcinoma. These results pointed to serum ANG as a novel marker for the diagnosis, progression, and aggressiveness of malignant tumors

Objective: The aim of this study was to evaluate the clinical significance of serum ANG as a novel marker for the diagnosis of HCC in liver cirrhosis and compare it with serum alpha-fetoprotein [AFP]

Patients and methods: The study included 40 patients who were divided into group I and group II. Group I included patients with HCC and group II included those with liver cirrhosis. Group III included age-matched and sex-matched apparently healthy controls. Patients in group I were further classified according to the TNM system into subgroup Ia, which included patients with tumor size less than or equal to 2 cm, and subgroup Ib, which included patients with tumor size greater than 2 cm. All individuals were subjected to an assay for evaluating the serum level of AFP and serum ANG

Results: For the diagnosis of HCC, serum AFP showed a sensitivity of 91.7% and specificity of 80%, whereas serum ANG showed a sensitivity of 95.8% and specificity of 85.7%. In discriminating patients with early hepatic cancer from those with more advanced stages, serum AFP showed a diagnostic sensitivity of 70% and specificity of 89.8%, whereas serum ANG showed a diagnostic sensitivity of 90% and specificity of 85.7%

Conclusion: Serum ANG is a promising marker for the diagnosis of HCC, being superior to serum AFP in both sensitivity and specificity. Moreover, serum ANG efficiently discriminates early from late stages of HCC

Effect of life style and system of medical study on anxiety among medical students at Ain Shams University

Background: High levels of anxiety have been previously reported among medical students. Medical students confront various stressors throughout their training as academic and psychosocial stressors which may be reflected on their health

Objectives: To study the effect of life style and the medical study on anxiety among medical students, and describe methods of coping with anxiety

Methods: One thousand and thirty four students from different grades in the Faculty of Medicine Ain Shams University were included in this cross-sectional study. A self administered questionnaire collected information about sociodemographic factors, smoking, caffeine, alcohol, and psychoactive substance use among students. Medical study system; as exams, private lessons, and ways of spending leisure time during vacation were inquired as well as midday nap and eating habits

Results: Coffee drinking, eating more than usual, taking hypnotics and CNS stimulants were significantly higher among students with anxiety. Students suffering from anxiety reported spending their vacation in studying more than others [79.3%, 69.9% respectively, P=0.001] and practicing sports during vacation less than others [43.4%, 54.7% respectively, P=0.001]. Students with severe grades of anxiety practiced sports less frequent [28.8%] than those with less severe grades [46.7%] [P=0.001], reported more alcohol consumption [5.7%, 1.3%, P=0.01]. Student's perception of unfair exams in the evaluation system was highly reported by students with less severe grades of anxiety [55.8%, 38.7% respectively, P=0.001]. Also those who didn't desire medical study initially were more among students with less severe grades of anxiety [84.7%, 73.9% respectively, P=0.005]. Inability to study was significantly more frequent among students with anxiety than those without [69.2%, 29%, P=0.000], and was more in those with severe grades of anxiety [48.3%, 26.4% respectively, P=0.000], an increase in body weight was more reported by students with anxiety. Reading Koran and praying [37%] were the major ways of coping with stress among students; followed by crying [20.1%], sleep and relaxation [12.5%] and others. In conclusion, the most important risk factors for anxiety found in this study were spending vacation in studying instead of practicing sports, consumption of caffeine and using hypnotics and CNS stimulants. Additionally, approximately one third of anxious students pray and read Koran as an adopting strategy to cope with stress

Management of venous hypertension complicating haemodialysis access in patients with chronic renal failure

As survival for patients with renal failure continues to improve, the complexity of vascular access procedures and the complications from these procedures will continue to increase. Venous hypertension is one of the most distressing complication in patients creating ar-teriovenous fistula resulting in swelling of the ipsilaterai arm, cyanosis as well as formation of collaterals on the chest wail when associated with central venous stenosis or obstruction. From April 2002, to April 2004, 519 patients with end stage renal disease [ESRD] on regular haemodialysis with already functioning vascular access. There were 21 patients [4.2%] presented with variable degrees of oedema and venous hypertension. The patients were classified clinically into three groups: Group A : included cases with mild oedema. Group B : cases presented with moderate and painful oedema Group C : cases presented with extensive oedema of the whole limb, oedema of the ipsilateral breast, congestion, discolouration of the affected limb and cases with collaterals on the shoulder and anterior chest wall of the affected side, 21 patients representing [4.2%] of the studied cases presented with variable degrees of venous hypertension, 7 males [33%] and 14 females [67%]. All patients presented with oedema, 12 patients associated with bluish discolouration of the skin, 6 patients with increased venous pressure and one patients with venous ulcer. 14 patients had AVF without central venous line and 7 patients with history of ipsilateral central venous line. Venous dialysis pressure was > 150mmHg in 6 patients and normal in 8 patients, not measured in 6 patients. Management of patients by limb elevation and compression therapy lead to improvement of symptoms in only 4 cases. Endovascular procedures were done in 10 cases using PTA without stent in 9 cases and PTA with stent in one case. Surgery was applied for 16 cases, 3 patients underwent surgical bypass using synthetic graft for one patient and autogenous vein graft for 2 cases. Ligation of the distal veins was performed for 7 cases. Ligation of the fistula was done in 5 cases and surgical revision in one case. Venous hypertension resulted from proximal venous obstruction or stenosis or by distal venous reflux. Early detection and treatment of venou hypertension is essential to provide adequate care for chronic renal failure patients. Percutaneous Angioplasty for stenosed central vein is the method of choice in management of venous hypertension in well selected cases and surgical bypass using autogenous vein or synthetic graft is a good alternative when complete obstruction of central vein or failed endovascular technique

Infrainguinal percutaneous transluminal angioplasty [PTA] for limb salvage

Infrainguinal PTA is progressively increasing as a treatment modality for limb salvage. To evaluate its technical success, complications and clinical effectiveness up to 6 months, the results of 43 selected patients with limb threatening ischemia treated over the period from March 1996 to September 1999 were reviewed. All procedures were done in the operating room. Technical success of PTA with optional stenting was 83.7% [36/43] and 83.3% [30/36] of the successful interventions resulted in a significant clinical improvement. Six months follow up of 21 patients showed that clinical improvement was maintained for all patients originally treated for ischemic ulcers or gangrene, but for only 22.3% [2/9] of patients originally treated for rest pain. In infrainguinal PTA is a simple alternative in selected patients with critical limb ischemia. Procedure related complications are minimal, manageable and does not affect a subsequent bypass if needed

Vascular access for hemodialysis in the pediatric population

In this study, retrospective data of 106 patients with a total of 120 procedures over a seven-year period were collected. Patients were divided into groups according to the procedure that was selected for them. The primary radiocephalic group [52 patients] had 80% primary success rate and 75% long-term patency rate. Brachial artery based group [42 patients] showed 86% primary success rate, 64% long-term patency rate and 15% revision rate. Basilic vein transposition group [nine patients] showed 88% primary success and long-term patency rate

Comparative study of thoracoscopic versus open surgical approach for upper dorsal sympathectomy

Upper dorsal sympathectomy has been performed for a wide variety of indications, the most common of which is palmer hyperhydrosis. With the development of video-assisted thoracic surgery, its application has extended to include thoracoscopic sympathectomy. In the present study we describe our experience with this recent technique and evaluate its results in comparison with the standard open surgical supraclavicular approach. Forty-five cases of thoracoscopic sympathectomy lucre studied in comparison with 20 cases of open supraclavicular sympathectomy performed for various indications. The two groups were well matched regarding age, sex, side of surgery, and indication for the procedure [p>0.05]. Relief of symptoms was achieved in 42 patients [93.3%] in the thoracoscopic group versus 18 patients [90%] in the open surgical group [p>0.05]. Recurrent hyperhydrosis occurred in one patient in the thoracoscopic group six months after the procedure. No perioperative deaths or major complications were encountered in either group. Horner's syndrome occurred in three patients in the thoracoscopic group and in two patients in the open surgical group [p>0.05]. Minor complications included surgical emphysema [one patient], and intercostal neuralgia [one patient] in the thoracoscopic group. In the open surgical group, minor wound complications [hematoma, ehylous discharge] occurred in two cases. The mean operative time was significantly shorter for time thoracoscopic technique compared to the open surgical procedure [32.9 +/- 11.6 mm. versus 73.3 +/- 33.3 min, p<0.0001]. The mean hospital stay was also significantly shorter for the thoracoscopic group compared to the open surgical group [1.12 +/- 0.4 days versus 2.81 +/- 2.5 days, p<0.0001]. In conclusion, time present study supports the superiority of the thoracoscopic approach for upper dorsal sympathectomy. Its technical ease, increased patient acceptance, minimal morbidity, and excellent results make it the approach of choice for this procedure

Chronic unclassified arteritis, a non-arteriosclerotic arterio-occlusive disease with a distinct clinicohistopathological entity

9 patients with characteristic clinical and histopathological features which are different from the known types of arteritis in literature were described. All the patients were non-diabetic males [mean age = 42.2 years]. The commonly affected arterial segment was the ilio-common femoral and the femoro-popliteal segments, with otherwise angiographically healthy arterial tree. Angiographically normal run-off arteries were always present. Operatively, the arteries has a fleshy thick wall which was rather friable with a variable degree of periarterial fibrosis. Immunohistopathological findings included a thick internal and external elastic lamina with variable patterns of chronic inflammatory cell infiltration and immune deposits of IgG and complement [C3] mainly

Value of intravenous streptokinase in treating femoral arterial thrombosis after pediatric cardiac catheterization

In order to evaluate the role of intravenous streptokinase in treating femoral arterial thrombosis after pediatric cardiac catheterization and its role in obviating vascular surgical thrombectomy, intravenous streptokinase in a loading dose of 1000 units/kg followed by an infusion at a rate of 1000 units/kg/hour was given to infants and children who developed femoral arterial thrombosis, after cardiac catheterization, not responding to 24 hours of adequate heparinization. A total of 520 consecutive children were catheterized between September 1989 and December 1992 at the Cardiology Department of Ain-Shams University. Out of the 520 patients, 240 patients had transarterial studies. Eighteen of these children had percutaneous balloon aortic valvuloplasty [PBAV] and 14 had percutaneous balloon coarctation angioplasty [PBCA]. There were 34 patients [14.1%] out of the total 240 patients who had a cool, pulseless extremity after catheterization. Nine patients [26.5%] improved with continued heparinization alone. The remaining 25 patients who did not respond to 24 hours of continuous heparinization, were treated with streptokinase and constituted the subjects of this study. In all of the 25 patients treated with streptokinase, except one 12-year-old female who underwent successful surgical femoral arterial thrombectomy, normal pulsations returned equal to those in the contralateral leg. Follow-up of 10 patients showed that the arterial pulsations in 50% of those treated with streptokinase were diminished as proven by Doppler vascular studies. Streptokinase is definitely effective in treating femoral arterial thrombosis not responding to heparinization after arterial catheterization, thus obviating the need for surgical thrombectomy in the majority of cases