Stenosing Intracardiac Mass of the Mitral Valve: A Case Report and Review of the Literature

Introduction: Benign intracardiac tumours are the most common of the 5% of primary tumours and account for 90% of intracardiac tumours. Myxoma, which is the main benign tumour, rarely localizes to the mitral valve, in the order of 1-5%, associated with severe symptoms and enormous complications. The objective is to report a rare and severe case of mitral valve myxoma resulting in severe obstruction of the valve orifice. Presentation of Case: A 65-year-old Moroccan woman, without profession, the diabetic patient presented with progressive dyspnoea, in whom transthoracic echocardiography (TTE) completed by transesophageal echocardiography (TEE), a cardiac magnetic resonance imaging (MRI), a cerebro-throracoabdominopelvic Positron emission tomography-scan (PET-scan) showed a cauliflower-shaped mass embedded in the small mitral valve, evoking the diagnosis of myxoma, confirmed by the anatomopathological examination. A lumpectomy with mitral valve plasty was performed in association with coronary artery bypass surgery for a tri truncal lesion. The evolution was marked by an improvement in the clinical and echographic state. Discussion: Myxoma is the first benign tumour encountered in women between the 3rd and 6th decade, whose diagnosis is evoked by a TTE, better by a TEE or more, by a computed tomography (CT scan) or even a cardiac MRI which specifies the visualization of the soft parts with all the internal details of the myxoma, whose confirmation is carried out on the histopathological analysis of the operating room. Conclusion: The management was based on complete resection of the tumor associated with mitral valve plasty.

T-lymphocytes subsets variation in breast cancer Egyptian patients

In this work, we investigate T-lymphocytes subsets in breast cancer patients among Egyptian populations to evaluate the immune response towards cancer and understanding their behavior towards tumor and normal cell growth before the influence of chemotheraputic agents under simple immune system response At first stage of disease. T cells are capable of in vivo expansion and provide protection for the immune effector cells re-populating the host. Survival of these cells and long-term memory development in patients with malignancy are necessary for improving clinical benefits of immunotherapy. By measuring CD4 and CD8 we recognized that no change in the helper T cells and Cytotoxic cells in these patients who were prepared to receive chemotherapeutic agents at the first stage and in the control group. T cells have been found with either deficient or normal functional activity in both groups these heterogeneous results greatly confuse the role played by CD4 T cells and CD8 responses. Immunological measures of white blood cell, lymphocyte, CD3+, CD4+, and CD8+ counts, 40 patients were divided into a control group [15] and patients group [25]. Total T-cell, helper T-cell and suppressor T-cell counts which [P<0.05], as well as control T-cell function [P < 0.05] when compared with normative data, were found some significant increase CD4 cells and CD4/CD8 ratio in cell count most of cases no changes to the total leukocyte lymphocyte CD3+and CD8+ count. Our study points out that immune response began to defend against tumor cells after a brief period of tumor stimulation but is still not sufficient to induce strong immune response. These data invite us to focus on period which immune system needs to respond which may help in deciding the possibility of immune therapy and determine when immune therapy can start

Medulla of kidney – A Postmortem Grossmorphological Study in Bangladeshi People.

In Bangladesh prevalence of kidney diseases is increasing day by day and it was observed that renal medulla is affected less in earlier period of life but in late period it becomes affected more. Moreover renal mass changes with age which affecting the medullary mass and consequently the number of medullary pyramids. So the present study was carried out to evaluate anatomical features of medulla and to count the medullary pyramids with age related changes in the number of the pyramids in Bangladeshi people. Study type: Cross sectional analytical type of study. Place and period of study: Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh from January 2004 to June 2005. Materials and methods: A total of 70 fresh human kidneys of both sexes and sides were collected from the morgue of Mymensingh Medical College at postmortem. The selected cases were between 5 to 60 years of age. The samples were divided into 3 different age groups (A: 05-15 years, B: 16-35 years, C: 36- 60 years) to observe the variations in number of medullary pyramid of kidney in different age groups. Results: Among three groups, highly significant (<0.001) differences were found statistically in the number of medullary pyramid. Conclusion: There were changes in the number of medullary pyramid of kidney in different age groups.

Neonatal orbital abscess.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28‑day‑old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

Spectrophotometric studies using ion-pair formations of Ranitidine hydrochloride in pure and in Pharmaceutical forms with some dyestuff reagents.

Simple, rapid and sensitive spectrophotometric procedure is suggested for the determination of ranitidine hydrochloride (RNH) drug in pure form and in pharmaceutical formulations. The method was based on the ionpair formations of RNH with different dyestuff reagents such as methyl orange (MO), bromocrysol purple (BCP), eriochrome cyanine R (ECR) and alizaraine red S (ARS). The obtained ion-pairs were measured spectrophotometrically at 408, 420, 330 and 326 nm by using BCP, MO, ECR and ARS reagents, respectively. Beer’s plots were linear in the concentration range of 5-200, 20-350, 10-150 and 10-180 μg mL−1 RNH, with correlation coefficients not less than 0.9991, 0.9996, 0.9993 and 0.999 using BCP, MO, ECR and ARS reagents, respectively. The Sandell sensitivity was found to be 0.813, 0.462, 0.541and 0.630 μg cm−2 for BCP, MO, ECR and ARS, respectively. Standard deviation (SD = 0.024-0.028, 0.018-0.023, 0.016-0.021 and 0.023–0.029) and relative standard deviation (RSD% = 0.123-0.943, 0.0102-0.82, 0.118-0.145 and 0.132-0.178%) (n = 4) values using BCP, MO, ECR and ARS reagents, respectively, were obtained. These results were also confirmed with percent recovery of 99.78–100.52%, 99.86-101.12%, 99.82–100.31% and 100.18-101.25 % for BCP, MO, ECR and ARS reagents, respectively. This method was successfully applied for determination of RNH in aciloc tablet. The calculated t- and F- values (95% confidence limit) indicate no significant differences between the proposed and official methods.

Bronchopulmonary dysplasia in ventilated neonates :incidence and risk factors

Bronchopulmonary dysplasia occurs in neonates who need supplemental oxygen at 36 weeks gestational age and those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Mechanical ventilation is an invasive life support procedure that may cause lung injury through a combination of oxygen toxicity, barotrauma, and volutrauma. Alveolar development is interrupted and parenchyma destroyed leading to emphysematous changes, decreased lung compliance, and impaired gas exchange. There is a positive correlation between ventilator settings, duration of assisted ventilation and development of BPD. The aim of the study was evaluation of the incidence of bronchopulmonary dysplasia among ventilated neonates and determination of associated risk factors. A retrospective study conducted in the Neonatal Intensive Care Unit Cairo University over the period from January 2007 to December 2008. It included 633 ventilated neonates out of 3321 total admissions [19.06%]. All data were collected from patient's records. Patients were diagnosed to have bronchopulmonary dysplasia if they needed supplemental oxygen at 36 weeks gestational age or those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Patients were classified to 2 groups: BPD group and non BPD group. Bronchopulmonary dysplasia [BPD] developed in 221633 ventilated neonates [3.48%]. Twenty of them had gestational age between [28 - 32] weeks [90.90%],14/22 were males [63.63%], 13/22 were delivered by CS [59.09%], BPD developed in 18/290 [6.2%] neonates ventilated by SIMV from start, 3/178 ventilated by NCPAP followed by SIMV [1.7%], 1/165 ventilated by NCPAP only [0.61%], with P-value 0.002 [significant]. Eleven neonates out of 22 BPD cases [50%] were discharged. Twenty one out of 285 neonates diagnosed as respiratory distress syndrome [7.4%] developed BPD. In BPD group, Mean Fraction of inspired oxygen was 60.68 +/- 16.90, compared to 33.24 +/- 21.57 in non BPD group P value < 0.001 Highly Significant [HS]. Mean PIP in BPD group was 21.94 +/- 4.22 and 21.32 +/- 5.26 non BPD group, P Value 0.63. Mean PEEP was3.94 +/- 0.24 in BPD group and3.79 +/- 0.45 in non BPD group, P value 0.17. Mean Rate was 39.29 +/- 8.27 in BPD group compared to 36.23 +/- 12.10 in non BPD group, P value 0.32. Mean Flow was 7.83 +/- 0.71 in BPD group and 7.66 +/- 0.57 in non BPD group, P Value 0.25. Mean I/E Ratio was 0.40 +/- 0.02 in BPD group and 0.38 +/- 0.03 in non BPD group, P value 0.04 [significant]. Mean birth weight in BPD group was 1.22 +/- 0.21 compared to 2.27 +/- 0.80 in non BPD group, P value <0.001 [H.S.]. Mean duration of ventilation was 35.77 +/- 4.07 days in BPD group compared to 6.36 +/- 4.07days in non BPD group, P value<0.001 [H.S]. Mean length of hospital stay was 39.36 +/- 4.58 days in BPD group compared to 8.12 +/- 5.68 days in non BPD group, P value <0.001. In conclusion; The use of NCPAP is associated with a lower incidence of BPD compared to SIMV. The least required oxygen should be delivered to minimize oxygen toxicity and reduce the incidence of chronic lung disease

Chemical and biological assessment for Egyptian surface freshwater environment with reference to human activities

The Egyptian freshwater was assessed in the River Nile, branches, main canals and certain drainages in eight Governorates, over eight successive seasons starting from spring 2008. Chemical assessment was made through ten parameters and the biological one was made through macro-invertebrates information. Results showed that means of Cd, Pb, Cu, Hg, Mn, Fe, Ni, Na, K and Ca varied in watercourses seasonally within somewhat narrow ranges, which may exceed the level of concern but with some elevations in branches, Rayahs and canals during certain seasons. Sites showed chemical levels over the permissible one or those gain total points

Surgical experience with a huge supratentorial primitive neuroectodermal tumour in a 3 years old boy.

The concept of Primitive Neuroectodermal Tumor (PNET) has been evolving for many years, since its nomenclature has been done. A 3 years old boy presented with unable to stand and walk, vertigo, vomiting and visual disturbances. MRI of brain revealed suggestive of malignant tumour with intratumoral hemorrhage involving the frontotemporo- parietal region. A gross total removal of tumor was achieved through craniotomy. The pathological finding was consistent with PNET. This case is an exclusive one as it was huge size. Supratentorial PNETs are rare tumour and carry poor prognosis. Newer modalities of treatment should be tried to improve survival.

Extent of Mesoappendix of Vermiform Appendix in Bangladeshi People.

Background: The mesentery of the appendix extends almost to the appendicular tip along the whole tube or may not be to the tip. The mesoappendix has a free border which carries the blood supply to the organ. Failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation occurs during inflammation. Objective: This cross sectional study was carried out to advance our knowledge regarding the extent of mesoappendix in Bangladeshi people and also to find out the variations in the anatomical positions of the vermiform appendix in Bangladeshi population and their distribution according to the sex. Methods: A total of 100 (60 male and 40 female) specimens of vermiform appendix were collected of different age and sex during postmortem examination in the morgue of Mymensingh Medical College from July 2006 to June 2007. Data was collected by convenient sampling technique. Results: In this study pelvic position of the vermiform appendix were common in both sexes. The two thirds extension of mesoappendix was found in 45% cases where as in pelvic position it was 26 (14 male and 12 female) cases. Half and whole extension of mesoappendix were found in 31% and 24% cases respectively. Among half extension of mesoappendix, retrocaecal position were found to be more (12) than other positions. In whole extension of vermiform appendix pelvic position were found to be common (16) than others. Conclusion: This study provides certain basic information of extent of mesoappendix of vermiform appendix of Bangladeshi population which is responsible for vascularization of the organ and severity during inflammation.

Long-term outcome of adult acute lymphoblastic leukemia in Lebanon: a single institution experience from the American university of Beirut

The most important studies about outcome of acute leukemia come from developed countries, whereas most of the patients with this disease are in developing countries. We report predictive and prognostic factors in patients with acute lymphoblastic leukemia [ALL] in a tertiary care center in a developing country. We retrospectively reviewed the records of adult patients with acute leukemia who were referred to the American University of Beirut Medical Center between 1996 and early 2006. Of 105 patients, 36 [34%] patients were diagnosed with ALL, and included 19 [53%] males and 17 [47%] females with a median age of 34 years [range, 14-79 years]. Induction chemotherapy with curative intent was administered to 34 [94%] patients. Twenty-seven patients received intrathecal chemotherapy as prophylaxis [n=24] or as treatment for CNS disease [n=3]. Twenty-eight patients [82%] achieved complete remission [CR] after induction chemotherapy. The median overall survival [OS] time was 22 months and the five-year OS for ALL patients was 38%. The median disease-free survival [DFS] time was 12 months, while the five-year DFS was 38%. Multivariate analysis showed that age <40 years, WBC <30x10[9]/L, achievement of CR after first induction, and CNS prophylaxis were predictive factors for OS and DFS. Despite limitations and the relatively low socioeconomic status of the Lebanese population, OS [38%] and DFS [38%] are quite similar to international data. Trends toward a higher CR and DFS in adults are due to intensified consolidation chemotherapy, the use of stem cell transplantation, and improvements in supportive care

Impact of water quality and soils on the molluscicidal activity of the plants A gave attenuata and A gave fihifera

The effect of water quality, salinity, an organic compound [Na[2]EDTA] and soil types [alluvial and sandy] on the molluscicidal activity of the two plants A gave attenuata and A gave filjfera against Biomphalaria alexandrina snails under laboratory conditions were studied. The LC[50] of the two tested plant molluscicides against B. alexandrina in all tested water samples [Nile, irrigation and drainage water] were lower than the tap water [as a control]. Thus, the molluscicidal activity of the two plants slightly increased when tested at the studied water samples. LC[50] values of the plant A. altenuata against B. alexandrina for the Nile water and drainage water were 50 and 54.5 ppm, respectively compared to 68 ppm for tap water. The corresponding values of A. fiIfera were 50, 54.5 and 60 ppm respectively. The molluscicidal activity of the two tested plants was not affected by the salinity levels used. Slight effect of the organic compound Na[2]EDTA on the molluscicidal activity of the two plants was recorded. However, the tested soils [alluvial and sandy] had a significant reduction in molluscicidal activity of A. attenuata and A. filifera against B. alexandrina. Thus, only 20% mortality of treated snails was recorded for LC[50] of A.attenuata in the presence of sandy soil, while no death was observed at alluvial soil. TLC analysis reveled only three bands for A. alt enuata mixed with sandy or alluvial soil compared to 6 bands for the crude plant. For A filifera only two bands appeared by mixing with sandy soil, whereas with alluvial soil no bands appeared

Splenic Mass and its Relation to Age Sex and Height of the Individual in Bangladeshi Peoples.

The aim of this study was to establish the standard weight of the normal spleen in Bangladeshi people. One hundred and twenty human cadavers of which eighty seven male and thirty three female were dissected to remove spleen with associated structures. Collected specimens were tagged with specific identification number, and divided into five groups according to age, sex and height of the individual. Gross and fine dissections were carried out after fixing the specimen in 10% formal saline solution. Weight of the spleen was measured by analytical balance and expressed in gram and findings of the study were compared with the findings of national and global studies. This cross sectional descriptive study was carried out in the Department of Anatomy of Mymensingh Medical College, Mymensingh. In this study maximum mean weight of spleen was 86.35 gram in male and 85.33 gram in female in 31 – 45 years age group. Minimum mean weight of spleen was 47.37 gram in male and 38.83 gram in female up to 15 years age group. The weight of spleen increases with age of the individual. Mean weight of spleen in male was 73.43 gram, which was higher than the mean weight of female spleen (59.17 gram). According to height of individual the mean weight of spleen was maximum 84.32 gram in 165.01 to 180 cm height group and minimum in 54.87 gram in up to 120 cm height group which indicate that weight of the spleen increases with height of the individual. In conclusion, the weight of the spleen depends on the age, sex and body height of the individual.

Origin and Position of Cystic Artery in Bangladeshi Corpse.

This cross sectional descriptive morphological study was done to see the site of origin of cystic artery supplying the gallbladder in Bangladeshi people to increase the knowledge regarding variation anatomy in our population. Sixty post mortem tissue blocks containing liver and gallbladder along with surrounding structures were collected from 40 male and 20 female cadavers of different age groups and fixed in 10% formal saline solution. This study was carried out in the Department of Anatomy in Mymensingh Medical College, Mymensingh , from July 2007 to June 2008. Gross and fine dissections were carried out to study the different origin of cystic artery and its topographic relationship with adjacent structures. In the present study, findings were compared with the findings of Western researchers. In the present study, the so-called typical origin of the cystic artery from right hepatic artery was 90% and in 10% cases it was found to arise from other sources. Out of 10%, 3% arise from left hepatic artery, 3% from junction between right and left hepatic artery, 2% from hepatic artery proper and 2% from gastro duodenal artery.

Mass of the Vermiform Appendix in Bangladeshi People.

This study was done to measure the weight of vermiform appendix in Bangladeshi people to augment the data regarding variational anatomy in our setting. A total 100 vermiform appendix (male – 60, female – 40) were excised from cadaver of different age and sex during routine post mortem examination in the autopsy laboratory of Forensic Medicine Department of Mymensingh Medical College. This cross-sectional study was done by convenient sampling technique. The weight depended on length and thickness. The weight decreases gradually with advancing age probably decreasing number of lymphatic follicle and that replaced by connective tissue. Lymphatic follicles were examined and estimated by microscope. For convenience of differentiating the weight of vermiform appendix in relation to age and sex, specimens were categorized in four age groups (up to 20 year, 21 – 35 years, 36 – 55 years, 56 – 70 years). Mean weight of vermiform appendix was maximum in group – B (4.07 ± SE 0.82 gm) and minimum in group D (3.01 ± SE 0.74 gm). The weight range was from 2 gm (group – D) to 5.50 gm (group – B). Diameter of lymphatic follicle was largest 43.08 micrometer in group-A, and least diameter was 3.08 micrometer in group – D. The range of number of lymphatic follicle was 1 to 6. Mean number of lymphatic follicle in male was 4.48 & in female were 5.40.

Histomorphological study of lymphoid follicle of vermiform appendix.

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Relationship of uterine artery with ureter.

The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

An anatomical study on pyramidal lobe of thyroid gland in Bangladeshi people.

The study was done to see the incidence of pyramidal lobe of thyroid gland including its position, attachment, length and incidence of its association with levator glandulae thyroidae in Bangladeshi population. Sixty postmortem tissue blocks containing thyroid gland and its related neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of presence of pyramidal lobe, its attachments, length, breadth and association with levator gladulae thyroidae. In the present study, findings were compared with those of Western and Bangladeshi researchers. It was evident that, fifty percent of the thyroids possesses pyramidal lobe. Incidence was more in male (52.1%) than in female (41.7%). It also appeared from the observations that, this lobe was commonly situated on the left side. In the majority of cases (56.66%), base of the pyramidal lobes were attached to the upper border of the isthmus with or without encroachment on the adjacent part of the left lobe. The range of length and breadth of the pyramidal lobe was from 1.8 to 35mm and 1.3 to 19mm respectively. In 73.33% cases, pyramidal lobe was associated with levator glandulae thyroideae and in only 26.66% cases pyramidal lobe was found independently.

Morphological Study of Length, Breadth and Thickness of the Ovary at Different Age Group in Bangladeshi People.

The morphological study was done to see length, breadth and thickness of the ovary in different age group of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty two postmortem tissue block containing ovary and fallopian tube along with surrounding structures were collected from 62 female cadavers of different age groups and fixed in 10% formol saline solution. Gross & fine dissections were carried out to study these morphological parameters of ovary in different age group. In the present study, findings were compared with the finding of other researchers. In this study the mean length of ovary was maximum in found in group C (46-80 years) 4.32cm and minimum was found in group A (2-13 years) 2.81cm of both side. The mean breadth of ovary was maximum in group C 2.01cm and minimum was in group A 1.38cm. The mean thickness of ovary maximum was in group C 0.971cm and minimum was in group A 0.682cm of both sides. In statistical analyses significant difference between two groups was calculated by using students “t” test. A difference between two groups was considered to be significant when p<0.05. In the present study it is observed that the size of the ovary is not equal on both side of same individual.

Length of Human Vermiform Appendix in Bangladeshi People.

The study was done to find out the length of human vermiform appendix in Bangladeshi people to magnify the knowledge regarding the diverse length of human vermiform appendix in our population. A total 100 vermiform appendix were measured with different age and sex during routine postmortem examination in the autopsy laboratory of forensic medicine department of Mymensingh Medical College. This cross sectional study was done by convenient sampling technique. For convenience of differentiating the length of vermiform appendix in relation to different age and sex, findings were classified in four groups (up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years). Length of vermiform appendix was 2.6 cm to 14 cm. Mean length was 7.9 cm in female and 7.56 cm in male. The highest mean length of vermiform appendix in group A was 9.17 cm and lowest was 5.93 cm in group D.

Changes of placental diameter thickness and cotyledon in eclampsia.

The study was done to see the changes of placental diameter, thickness and number of cotyledons in eclapmsia. A total 45 placenta, 25 from eclamptic mother and 20 from normal pregnant mother were collected from Gynaecology and Obstetric department of Mymensingh Medical College and Hospital (MMCH). Study was done in Anatomy department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trend of less placental diameter in eclamptic group(p=0.0004). Cotyledon number was found to be significantly less in eclampsia (p=0.0001). However there was no significant difference in placental thickness in eclamptic placenta than that of normal group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005. The morphological changes in placenta are possibly due to reduced uteroplacental blood flow in eclampsia.