Immunohis1ochemical cyclooxygenase-2 [COX-2] and cd31 expression in breast carcinoma with correlation to clinico-pathological parameters

Breast cancer is the most'common cancer in Egyptian women. COX-2 seems to be involved in malignant transformation and tumor progression by affecting cell proliferation, mitosis, cell adhesion, apoptosis, immune surveillance, and angiogenesis. Angiogenesis is an important key step in tumor progression. Microvascular density [MVD], a surrogate marker of angiogenesis can be assessed by CD31 staining. This study aims to: 1. Evaluate COX-2 and CD31 expressions in breast cancer. 2. Determine the correlation between COX-2 and CD31 with the clinico-pathological parameters in ductal breast carcinoma. This study included 74 specimens of breast lesions. Patient's age, tumor size and local aggressive changes, history of recurrence and/or presence of distant metastasis were obtained. Hematoxylin and Eosin [HandE] stained sections were evaluated for histopathological tumor type, tumor grade, presence or absence of normal hyperplastic, in situ component, lymphocytic infiltration, lymphovascular invasion, and axillary lymph node status. COX-2 and CD31 immunostaining was done to detect their expression using the avidin-biotin peroxidase method. COX-2 increased with increasing grade of ductal carcinoma in situ [DC1S] and invasive ductal carcinomas [IDC] [P< 0.05 and P< 0.002 respectively]. COX-2 expression increased progressively along the continuum of neoplastic changes from normal breast epithelium to IDC [P< 0.01]. There was significant correlation between COX-2 and tumor size [P< 0.05], tumor grade [P< 0.002], lymphovascular invasion [P< 0.03] and lymph node metastasis [P< 0.02]. CD31 staining was observed along the cell membrane of endothelial cells of microvessels in all breast specimens. The median CD31 MVD count was 10 for normal breast, increased insignificantly to 17 in hyperplastic lesions, and reached 19 for DCIS, and 66.5 in IDC [P < 0.000]. There was significant increase in MVD between different grades of IDC [P < 0.01] but not in DCIS. Positive correlation was present between COX-2 and CD31 in DCIS and in IDC [P< 0.000 for each]. COX-2 was increased with poor prognostic parameters; tumor size, tumor grade, lymphovascular invasion and lymph node metastasis. CD31 increases with increasing grade of IDC. These findings might imply for new therapeutic strategies in order to prevent progression of DCIS to IDC and to improve cancer therapy

Mild and moderate degrees of acute normovolemic hemodilution [ANH] for blood conservation in major gastro-intestinal surgery

Sixty patients were included in this prospective study to compare the effect of mid and moderate degrees of hemodilution on the homologous blood requirements in major gastro-intestinal surgery. The patients were classified into two groups according to the level of hemodilution [mild [group I] and moderate [group II] degrees]. The target hematocrit [Hct], level planned to be around 32 and 28%, at the start of surgery, then 25 and 22% intraoperative; while Hct of 27% was the postoperative transfusion trigger with transfusion of autologous or homologous units. Hemodilution started at five minutes after anesthesia and re-transfused when the target hematocrit reached with autologous units, then homologous blood. Total anesthesia time was longer in group II and the volume withdrawn by hemodilution was [781 +/- 154 and 1734 +/- 142] in the two groups, respectively. Homologous transfusion was less in group II regarding both patients number [12/30 and 5/30] and blood units number [19 and 7 units] in the two groups, respectively. In the postoperative period, 4/30 and 1/30 patients required transfusion to reach Hct of 27%. On discharge, the hemoglobin levels and platelet count was satisfactory in both groups and platelet count was higher in group II [28.4 +/- 1.9-307.5 +/- 67.7 versus 28.9 +/- 2.8-250.8 +/- 73.4]. The complications occurred can not be attributed to hemodilution per se

Surgical repair of iatrogenic bile duct injuries

Bile duct injury perhaps is the most fearful complication of open cholecystectomy [OC] or laparoscopic cholecystectomy [LC]. The management of bile duct injuries remains a challenge for most surgeons. The purpose of this study was to evaluate the outcome of patients who underwent immediate or late repair of iatrogenic major bile duct injuries as ligation, transection, or resection. This study included 20 patients, 18 [90 percent] after cholecystectomy [14 OC and 4 LC], and 2[10 percent] after other abdominal surgeries. Bile duct injuries were recognized immediately in 3 patients [15 percent] [2 after OC and one after LC], and 17 patients [85 percent] presented later after the primary surgery. Five patients [25 percent] to whom OC was done presented with an ongoing bile leak [2 with external leak and 3 with internal leak]. Twelve patients [60 percent] presented with obstructive jaundice [9 after OC and 3 after LC]. Open surgical repair in the form of, end-to-end, cholecystojejunostomy, choledochojejunostomy, or hepaticojejunostomy was done. End-to-end anastomosis was done for 5 cases [25 percent]. Cholecystojejunostomy was done for the 2 cases [10 percent] that presented with bile duct obstruction after other abdominal operations. Among the 20 patients in this study, the level of obstruction or injury was classified as Bismuth type 1 in 12 cases [60 percent], Bismuth type 2 in 5 cases [25 percent], and Bismuth type 3 in 3 cases [15 percent]. Bismuth 4 and 5 types were not seen among the studied cases. The 5 patients [25 percent] to whom end-to-end anastomosis was done, failure was seen in 4 of these 5 cases [80 percent] and was corrected by reexploration and repair by hepaticojejunostomy. Choledochojejunostomy and hepaticojejunostomy showed no failures, but late stricture developed on long-term follow up [3 years] in 4 cases [20 percent]. The overall success was 80 percent after revision in 4 cases to which end-to-end anastomosis was done. Major bile duct injuries after cholecystectomy and other abdominal surgeries are a considerable surgical challenge. Surgical reconstruction of the extra hepatic bile ducts induced iatrogenic injuries and strictures after cholecystectomy using hepaticojejunostomy, mucosa to mucosa repair, is associated with successful outcome and better long-term result, but end-to-end repair is followed by high rate of failure, and it is better to be avoided

Management outcomes in blunt abdominal trauma in children: [a prospective study]

Clinical pathways now highlight both observation and operation as acceptable initial therapeutic options for management of blunt abdominal trauma in children. The purpose of this study was to evaluate treatment trends and end results of blunt abdominal trauma in children. Sixity child were admitted to trauma and emergency department of Sohag university hospital in the period from October 1998 To March 2000. The age ranged from 1 To 14 years old [42 male, 18 female]. According to clinical examination and radiological investigations, patients were classified into two groups the first group [40 cases] was subjected to abdominal exploration and the second group [20 cases] was subjected to non-operative treatment. The first group: splenectomy was done for 21 cases [15 cases of grade 5, 6 cases of grade 4 splenic injury]. Hepatic tear was found in 4 cases, where suturing was done in 2 cases while homeostatic agents were applied in 2 cases. Biliary injury was found in 2 cases and intestinal injury was found in 13 cases. The second group: the non-operative management was successful in 9 out of 12 cases with grade 1, 2 and 3 of splenic trauma [75% success rate] while it was successful in 6 out of 8 cases of hepatic trauma [75% success rate]. The operative management was mandatory in blunt abdominal trauma in children if there was haemodynamic unstability or positive diagnosis of haemoperitoneum by one of different methods of investigation. The conservative management was successful in splenic injuries using the criteria of AAST [American Association for the Surgery of Trauma] if there was haemodynamic stability plus absence of other associated abdominal injury. It was also successful in hepatic injuries in specific conditions

Nissen fundoplication for the treatment of chronic asthmatic patients

This study was applied on 30 adult patients [21 males and 9 females] presented by chronic bronchial asthma and symptoms of GERD who were refractory to conservative anti-asthma medical lines. Clinical assessment, X-ray chest, esophagography, pulmonary function tests before and after bronchodilators, tests to confirm GERD and upper GI endoscopic examination including lower esophageal multiple biopsies were done to all cases. Six out of 30 patients underwent Nissen fundoplication as a selected surgical anti-reflux technique. Esophagitis was detected in 96.6% of cases, endoscopic evidence of GERD was shown in 63.3%, anti-reflux treatment together with bronchodilators have caused clinical reversibility of airway obstruction by 20% or more as proved by pulmonary function parameters tested. Anti-reflux conservative treatment has achieved good response in 24 patients. Regarding the 6 patients who were subjected to surgery, 5 of them showed marked clinical and pulmonary functions improvement with decreased frequency of exacerbations, reduction of bronchodilator dose and disappearance of reflux symptoms. One patient failed to show clinical response