Review of Domain Wall Dynamics Engineering in Magnetic Microwires.

The influence of magnetic anisotropy, post-processing conditions, and defects on the domain wall (DW) dynamics of amorphous and nanocrystalline Fe-, Ni-, and Co-rich microwires with spontaneous and annealing-induced magnetic bistability has been thoroughly analyzed, with an emphasis placed on the influence of magnetoelastic, induced and magnetocrystalline anisotropies. Minimizing magnetoelastic anisotropy, either by the selection of a chemical composition with a low magnetostriction coefficient or by heat treatment, is an appropriate route for DW dynamics optimization in magnetic microwires. Stress-annealing allows further improvement of DW velocity and hence is a promising method for optimization of DW dynamics in magnetic microwires. The origin of current-driven DW propagation in annealing-induced magnetic bistability is attributed to magnetostatic interaction of outer domain shell with transverse magnetization orientation and inner axially magnetized core. The beneficial influence of the stress-annealing on DW dynamics has been explained considering that it allows increasing of the volume of outer domain shell with transverse magnetization orientation at the expense of decreasing the radius of inner axially magnetized core. Such transverse magnetic anisotropy can similarly affect the DW dynamics as the applied transverse magnetic field and hence is beneficial for DW dynamics optimization. Stress-annealing allows designing the magnetic anisotropy distribution more favorable for the DW dynamics improvement. Results on DW dynamics in various families of nanocrystalline microwires are provided. The role of saturation magnetization on DW mobility improvement is discussed. The DW shape, its correlation with the magnetic anisotropy constant and the microwire diameter, as well as manipulation of the DW shape by induced magnetic anisotropy are discussed. The engineering of DW propagation through local stress-annealing and DW collision is demonstrated.

Pharyngeal flap for a poorly repaired cleft palate with posterior palatal defect.

OBJECTIVE: Posterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI. METHODS: Thirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed. RESULTS: Significant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively. CONCLUSION: A modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.

Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double-blind study.

BACKGROUND: Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4 ) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. METHODS: A randomized double-blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 µg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. RESULTS: VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. CONCLUSION: Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4 . No significant adverse effects to the parturients or newborns.

The Relation between Serum Hepcidin, Ferritin, Hepcidin: Ferritin Ratio, Hydroxyurea and Splenectomy in Children with ß-Thalassemia.

BACKGROUND: Hepcidin, a small peptide hormone, is established as the main regulator of iron homeostasis. AIM: To estimate serum hepcidin, ferritin, and hepcidin: ferritin ratio in ß-thalassemia patients and to determine the effect of splenectomy and hydroxyurea on serum hepcidin. METHODS: A study was conducted on 30 thalassemia major (ßTM), 29 thalassemia intermedia (ßTI) and 29 healthy children's controls. Data were collected by patient interviewing where detailed history-taking and thorough clinical examinations were carried out. Serum ferritin and hepcidin were measured by ELISA assay (Bioneovan Co. Ltd Beijing, China). RESULTS: Βeta-thalassemia patients had higher serum ferritin, serum hepcidin and lower Hb and hepcidin: ferritin ratio compared to the controls (p < 0.001, 0.010, 0.001, 0.001) respectively. Β-TM patients had higher mean serum hepcidin and serum ferritin compared to ß-TI, with statistically significant difference (P = 0.042, P < 0.001, respectively). Twenty-one patients out of 29 ßTI was on hydroxyurea therapy; these patients had significantly lower levels of serum ferritin (P < 0.004) and significantly higher levels of Hb (P < 0.004). Serum ferritin was statistically significantly higher in splenectomized patients P < 0.009. Serum hepcidin level was insignificantly higher in splenectomized patients than non-splenectomized patients (21.6 ± 14.75, 17.76 ± 10.01 ng/mL). Hepcidin showed a significantly positive correlation with hepcidin: ferritin ratio in all studied groups. CONCLUSION: Serum hepcidin was elevated in ß-thalassemia children with more evident elevation in ßTM patients. Splenectomy played no major role in hepcidin regulation. Knowing that hepcidin in serum has a dynamic and multi-factorial regulation, individual evaluation of serum hepcidin and follow up, e.g. every 6 months could be valuable, and future therapeutic hepcidin agonists could be helpful in management of iron burden in such patient.

Impact of Stress Annealing on the Magnetization Process of Amorphous and Nanocrystalline Co-Based Microwires.

The domain wall (DW) dynamics of amorphous and nanocrystalline Co-based glass-coated microwires are explored under the influence of stress annealing. Different annealing profiles have enabled remarkable changes in coercivity and magnetostriction values of Co-based amorphous microwires with initially negative magnitude, allowing induced magnetic bistability in stress-annealed samples and, consequently, high DW velocity has been observed. Similarly, Co-based nanocrystalline microwires with positive magnetostriction and spontaneous bistability have featured high DW velocity. Different values of tensile stresses applied during annealing have resulted in a redistribution of magnetoelastic anisotropy showing a decreasing trend in both DW velocities and coercivity of nanocrystalline samples. Observed results are discussed in terms of the stress dependence on magnetostriction and microstructural relaxation.

Removal of an endometrioid stromal sarcoma from the inferior vena cava and right atrium.

Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma. The patient gave a history of endometriosis followed by the appearance of a low-grade ovarian endometrioid stromal sarcoma 4 years before the development of the mass in the IVC and right atrium.

Copeptin as a Biomarker of Atherosclerosis in Type 1 Diabetic Patients.

AIM: To evaluate copeptin as an early marker of atherosclerosis in adolescent type 1 diabetics. METHODS: Sixty-two type 1 diabetic patients and 50 healthy volunteers were enrolled in the study. Serum copeptin, glycosylated haemoglobin (HbA1c), lipid profile, oxidised low-density lipoprotein (OxLDL), urinary albumin/creatinine ratio, carotid intimal medial thickness (cIMT), aortic intimal medial thickness (aIMT) and resistivity index were assessed for all participants in the study. RESULTS: HbA1c, albumin/creatinine ratio, lipid profile, OxlDL, copeptin, cIMT and aIMT were significantly higher in diabetic patients. Copeptin was higher in patients with positive cIMT and aIMT. Copeptin correlated with cIMT and aIMT. Stepwise multiple regression analysis found that copeptin correlated with aIMT. ROC curve showed that copeptin had 100 % specificity with aIMT and cIMT and 95.2 and 60,7 sensitivity with aIMT and cIMT respectively. CONCLUSION: Copeptin can be used as a marker for early detection of atherosclerosis of type 1 diabetic patients.

Quantitative Assessment of Tension Reduction at the Midline Closure During Abdominal Component Separation.

BACKGROUND: Abdominal component separation is used commonly for closure of midline abdominal wounds. The value of each step in reducing tension has not been studied. Our aim was to test whether component separation decreases tension in the midline closure and to quantify the value of each procedural step. STUDY DESIGN: Tension required to bring the rectus muscle to midline was measured using tensiometry after subcutaneous dissection (step 1), external oblique muscle release (step 2), separation of the internal and external oblique muscles (step 3), and internal oblique muscle release (step 4). Measurements were taken in the upper, middle, and lower thirds of the abdominal midline. Distance to midline was also measured after each surgical step. Tension (measured as percent change) and distance were analyzed using Student's t-test with significance set at p < 0.05. RESULTS: In 41 hemi-abdominal defects, tension decreased in middle, upper, and lower thirds of the abdomen by 22.5%, 24.3%, and 34.8% after step 1; 33.4%, 31.8%, and 39.8% after step 2; 26.5%, 22.2%, and 27.4% after step 3; and 33.2%, 28.2%, and 23.5% after step 4. Mean distance change was 0.97 cm, 1.97 cm, 2.22 cm, and 2.59 cm after steps 1 to 4, respectively. CONCLUSIONS: This study shows through a quantitative measure of tension that all steps of the component separation procedure decrease wound tension to variable degrees, with the release of the external and internal oblique muscles being the more effective steps. An internal oblique release is a useful and simple adjunct to the classical component separation procedure.

Apelin, Nitric Oxide and Vascular Affection in Adolescent Type 1 Diabetic Patients.

AIM: To evaluate the relationship of apelin and nitric oxide (NO) to endothelial dysfunction in type 1 diabetics. PATIENTS AND METHODS: Sixty two type 1 diabetics and 30 healthy age and sex matched controls were included. Blood samples for apelin, NO, glycosylated hemoglobin (HbA1c), and lipid profile were collected. Albumin/creatinine ratio was assessed in urine. Flow mediated dilatation (FMD) via ultrasound was done. RESULTS: The mean age of diabetics were 16.3 ± 1.5 yrs (14.0 - 19.0 yrs), and duration of disease, were 9.4 ± 2.9 yrs (5.0 - 16.5 yrs). FMD and FMD/nitrate mediated dilatation (NMD) ratio were lower in diabetics. NO was decreased, while apelin and albumin/creatinine ratio were increased significantly in diabetics. There was a positive correlation between apelin and HbA1c. On the contrary, NO had a negative correlation with HbA1c, albumin/creatinine ratio, LDL-c and OxLDL. CONCLUSION: Diabetic patients had endothelial dysfunction and high apelin level, with no related to each other. High level of apelin is associated with bad glycemic control. Obesity had no role to increase in apelin level. NO is related to diabetic nephropathy and atherosclerosis. We recommend a further large study to evaluate the relationship of apelin with endothelial dysfunction.

Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency.

OBJECTIVE: Several studies correlated between vitamin D deficiency and the development, and the recurrence of benign positional paroxysmal vertigo (BPPV), but none of them proved that treatment of vitamin D deficiency would reduce the recurrence rate of BPPV. This study aims to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV. METHODS: The inclusion criteria of the study group were: (1) Unilateral, idiopathic, posterior canal BPPV with no history suggestive of secondary BPPV and (2) 25-hydroxyvitamin D3 level ≤10 ng/ml. All subjects enrolled in the current study underwent detailed clinical history, audiovestibular evaluation consisting of pure-tone audiometry, Immittancemetry, Videonystugmography, serum 25-hydroxyvitamin D3 assessment, and Dual-energy X-ray absorptiometry (DXA). Vitamin D therapy was prescribed for the study group. Serum 25-hydroxyvitamin D3 level was evaluated twice, on recruitment into the study group and 3 months after commencing vitamin D therapy. According to the results of the second evaluation of serum 25-hydroxyvitamin D3, the study group was subdivided into two subgroups: Subgroup (I): including 28 subjects who disclosed elevation of serum 25-hydroxyvitamin D3 level; improvement ≥10 ng/ml. Subgroup (II): including 65 patients who disclosed elevation of serum 25-hydroxyvitamin D3 levels <10 ng/ml. The study group was followed up for 18 months in order to observe the recurrence of BPPV. RESULTS: The differences between both study subgroups (I) & (II) regarding age, sex distribution, and bone mineral density were insignificant. The number of subjects who had recurrence of BPPV in subgroup (I) was 4 (14%) versus 28 subjects (43%) in subgroup (II). The mean values for recurrent attacks/subject in subgroups (I) & (II) were 0.18, and 0.66 attack/subject respectively; these differences between both subgroups were of high statistical significance (p<0.01). The Odds Ratio for development of recurrence of BPPV in subjects with severe vitamin D deficiency was 4.54 (95% CI: 1.41-14.58, p<0.01). The relapse attacks of BPPV affected both ears irrespective of the ear showing the original BPPV attack. CONCLUSION: The present study indicates that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.

Body mass index, physical activity and quality of life of ovarian cancer survivors: time to get moving?

OBJECTIVE: To evaluate the association between body mass index (BMI), physical activity (PA) and the quality of life (QoL) of ovarian cancer survivors. METHODS: We performed a two-centre cross-sectional study of women who had been treated for ovarian cancer between January 2007 and December 2014 at the Royal Cornwall Hospital Trust and the Plymouth Hospitals NHS Trust. QoL was assessed using the EORTC QLQ-C30 and QLQ-OV28 questionnaires, and PA using the Godin Leisure Time Exercise questionnaire. RESULTS: In total, 293 ovarian cancer survivors were invited to participate, of which 209 women (71.3%) responded. Thirty-five percent of women were overweight and 18% were obese, whilst only 21% met recommendations for PA. Obesity was associated with significantly poorer global QoL, physical, cognitive and social functioning, a poorer body image and more symptomatology. Sedentary behaviour was associated with poorer QoL scores including global QoL, physical, role, social and sexual functioning. After adjustment, BMI and PA both remained independently associated with QoL scores. CONCLUSION: Obesity and inactivity are associated with poorer QoL among ovarian cancer survivors. Future interventions promoting PA and weight loss should be evaluated as possible means to improve the QoL of this population.

Urinary monocyte chemoattractant protein-1 as a biomarker of lupus nephritis activity in children.

Systemic lupus erythematosus (SLE) is a life-long, life-limiting and multi-systemic autoimmune disease. Glomerulonephritis is one of the most serious manifestations of SLE. Younger children have an increased incidence, severity and morbidity of lupus nephritis (LN) compared with adult-onset disease. Monocyte chemoattractant protein-1 (MCP-1) enhances leukocyte adhesiveness and endothelial permeability in the kidneys of murine and human LN models. Our study aimed to assess the role of urinary MCP-1 in the early diagnosis of LN activity. Sixty children, of whom 45 children aged from six to 12 years old and of both sexes (15 SLE patients without nephritis, 15 active LN and 15 inactive LN) fulfilling the American College of Rheumatology Classification Criteria for SLE were studied in comparison with 15 healthy subjects. We investigated the serum and urinary MCP-1 in all groups using the enzyme-linked immunosorbent assay test. Urinary MCP-1 was significantly higher in active LN in comparison with inactive LN and controls, and also significantly higher in inactive LN in comparison with SLE without nephritis and controls. There was also a significant difference between SLE without nephritis and controls. Serum MCP-1 was significantly higher in the group with active LN in comparison with the inactive group and SLE without nephritis and controls, but there was no significant difference between SLE and controls. The urinary MCP-1 level correlated well with SLE disease activity as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Urinary MCP-1 correlates positively with proteinuria, blood urea nitrogen level and creatinine and negatively with hemoglobin and creatinine clearance. We concluded that measurement of MCP-1 in urine may be useful for monitoring the severity of renal involvement in SLE. We recommend measuring urinary MCP-1 in pediatric SLE for the early diagnosis of LN and for the evaluation of the severity of renal involvement.

Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo.

Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31-71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > -1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.

Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening.

OBJECTIVE: To assess the performance of ultrasonography in a multimodal ovarian cancer screening strategy. DESIGN: Prospective ovarian cancer screening trial between December 1986 and June 1993. SETTING: General practice, occupational health departments and an ovarian cancer screening clinic at a London teaching hospital. POPULATION: Postmenopausal women, ≥ 45 years with a raised CA125. METHODS: Volunteers with a CA125 ≥ 30 U/mL underwent a pelvic ultrasound. Scans were classified as normal, abnormal (ovarian volume ≥ 8.8 mL) or equivocal (normal volume with abnormal morphology). Abnormal ovarian morphology was subclassified as simple cyst (single, thin walled cyst with no septa or papillary projections) or complex (all other abnormalities). Volunteers with abnormal scans were referred for a gynaecological opinion. Follow up was via the cancer registry and postal questionnaires. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of the ovary and fallopian tube). RESULTS: Seven hundred and forty-one women underwent 1219 scans and 20 index cancers occurred during a median follow up of 6.8 years. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal morphology, 89.5% for abnormal volume and 84% for complex morphology. The highest specificity (97%) and positive predictive value (37.2%) was achieved using complex morphology. CONCLUSION: A variety of ultrasound criteria can achieve high sensitivity, specificity and positive predictive value for index cancers in postmenopausal women with an elevated CA125. Use of ovarian morphology to interpret ultrasound may increase sensitivity and use of complex ovarian morphology may increase the positive predictive value.

Eosinophilic granuloma of the temporal bone in children.

Eosinophilic granuloma (EG) is a bony destructive disease that frequently occurs in children; it is a subtype of Langerhans cell histiocytosis. The aims of this study were to detect the presenting features of temporal bone lesions in children and to evaluate the efficacy of surgery combined with radiotherapy in treatment of the disease. A retrospective study on 12 children with EG of the temporal bone was done. Computed tomography and hearing assessment were performed for all patients. All patients were treated with cortical mastoidectomy followed by postoperative radiotherapy. Follow-up was carried out for at least 2 years. The patients' presenting symptoms were external ear canal mass in 10 patients (83.3%), postauricular swelling in 8 patients (66.7%), and persistent otorrhea in 4 patients (33.3%). Ten patients (83.3%) showed conductive hearing loss, whereas 2 patients (16.7%) showed mixed hearing loss on the affected side. Computed tomography showed osteolytic defects without sclerotic margins filled with soft tissue masses involving the mastoid bone. Histopathologic examination showed eosinophils and Langerhans cells that were immune reactive for CD1 antigen and S-100 protein. Postoperative follow-up showed complete cure of the disease in 10 children (83.3%), with recurrence detected in 2 patients (16.7%) who needed second surgical intervention. We concluded that temporal bone EG in children may present with features that mimic the features of chronic suppurative otitis media. However, computed tomography and histopathologic examination are diagnostic. Cortical mastoidectomy together with postoperative radiotherapy is an achievable treatment in most cases.

Otolaryngologic manifestations of diffuse idiopathic skeletal hyperostosis.

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by formation of large cervical osteophytes that may compress the posterior wall of the aerodigestive tract. It is a rare cause of dysphagia in the elderly. The aim of this study was to investigate the various otolaryngologic manifestations of DISH. Eleven elderly patients with DISH were included in the study. All patients presented with dysphagia that was graded on the swallowing screening tool (EAT-10), and the diagnosis of DISH was based on computed tomographic criteria. The patients were subjected to otolaryngologic examination and flexible laryngoscopy. Polysomnography was used for patients with excessive daytime sleepiness for detection of obstructive sleep apnea (OSA). In addition to dysphagia of varying severity, OSA was found in nine patients, change of voice in six, globus sensation in seven, aspiration in three, and cervical pain in seven. Flexible laryngoscopy showed bulging of the posterior pharyngeal wall in all patients. DISH may be an unrecognized contributory factor to both dysphagia and OSA in the elderly. Change of voice, aspiration, globus sensation, and cervical pain are other otolaryngologic manifestations that may be encountered symptoms of the disease. An otolaryngologist should be aware of the disease that may be overlooked, and computed tomography is a confirmatory diagnostic method.

Propranolol treatment of infantile hemangioma: clinical and radiologic evaluations.

BACKGROUND: There is no way to predict the size that proliferative infantile hemangiomas (IHs) can reach and to expect the occurrence of complications. Moreover, there are no well-known characteristics that can affect the rate of involution of IHs and to predict its completion. Accordingly, intervention is frequently indicated. Different modalities have been reported for treatment of IHs. The possible mechanisms of action of propranolol on IHs are complex. METHODS: Fifty infants presented with 80 IHs treated by oral propranolol at a dose of 2 mg/kg body weight per day. Treatment outcomes were clinically and radiologically evaluated. RESULTS: The first noticeable effects on propranolol treatment were the changes in color and softening of IHs, followed by regression of their sizes. The clinically elicited color changes of superficial IHs and superficial components of compound IHs have been objectively proven by statistically significant color clearance (P ≤ .001) and resisting index (P ≤ .01) (∼50% increase) as a good indicator of lower vascular activity within IHs. Moreover, the softening of lesions followed by the clinically elicited regression of sizes of deep IHs and deep components of compound IHs has been objectively proven by statistically significant changes at lesions' thickness (P ≤ .01) (∼50% regression) and resisting index (P ≤ .01) (∼50% increase). CONCLUSIONS: Collectively, high efficacy and tolerance of propranolol treatment have been elicited. However, propranolol treatment of IHs is still an issue suitable for more studies to confirm the safety and efficacy of the drug and to investigate whether there are some hemangiomas that are, perhaps, nonresponsive to propranolol treatment.

Association of tumor necrosis factor-alpha gene polymorphisms with juvenile systemic lupus erythematosus nephritis in a cohort of egyptian patients.

INTRODUCTION: The production of tumor necrosis factor (TNF)-alpha has been deeply deregulated in systemic lupus erythematosus. We evaluated the association of -863C>A and -1031T>C polymorphisms of the TNF gene with susceptibility to and clinical manifestations of juvenile systemic lupus erythematosus. MATERIALS AND METHODS: This study was performed on 70 juvenile patients with systemic lupus erythematosus (mean age, 13.0 ± 4.2 years). Ninety age- and sex-matched children served as a controls. All participants were genotyped for the TNF -863C>A and -1031T>C polymorphisms by polymerase chain reaction-restriction fragment length polymorphism method. Analysis of serum TNF-alpha was done by solid-phase sandwich enzyme immunoassay. RESULTS: The mean serum TNF-alpha was significantly higher in the SLE patients compared to controls (P < .001). Regarding all participants, the mean serum TNF-alpha was significantly higher in children with -863AA genotype compared to carriers of -863C allele (P < .001). The TNF -863AA genotype frequencies were significantly higher in the patients group compared with the controls (P = .005) and were associated with increased risk for SLE development (odds ratio, 4.05; 95% confidence interval, 1.38 to 13.13; P = .005). The -863AA variant was associated with nephritis (P < .001) and Raynaud phenomenon (P = .001). CONCLUSIONS: The -863A allele of the TNF gene can be used as a genetic marker for SLE susceptibility and was associated with high TNF-alpha production, Raynaud phenomenon, and nephritis in juvenile SLE Egyptian patients.

Experience in the management of patients older than 80 years with vulval cancer.

INTRODUCTION: Vulval cancer is a disease of an increasing elderly population and consequently comorbidities are common. These conditions may preclude the application of standard therapy. OBJECTIVE: To review the outcome of women with vulval cancer older than 80 years comparing those who received recommended treatment (protocol-adherent) with those who did not (protocol-violated). METHODS: A retrospective chart review of a consecutive series of patients discussed over a 6-year period at our Multidisciplinary Team meeting. Treatment was deemed protocol-adherent if the Royal College of Obstetricians and Gynaecologists guidelines were followed and protocol-violated if not. Outcome data were retrieved from case notes, primary care input, cancer registry database, and reviewed in terms of survival and recurrence. RESULTS: Twenty-three cases of squamous cell carcinoma of the vulva were identified between 1999 and 2005 at Portsmouth Oncology Centre. Eight women were protocol-adherent and 15 women were not. Treatment decisions were made after individual discussion in conjunction with performance status. Protocol adherence was associated with a 25% recurrence rate and violation with a 53% recurrence rate. Median survival was shorter in the protocol-violated group compared with the adherent group (18 months vs 43.5 months respectively). CONCLUSION: These data imply that this issue arises not infrequently, perhaps every 3 to 4 months at each gynecological oncology Multidisciplinary Team meeting in the UK. The higher recurrence rate and shorter median survival among the protocol-violated group supports the validity of the current Royal College of Obstetricians and Gynaecologists treatment guidelines in this elderly age group. A prospective scoring system should be evolved to ensure a more objective approach to such patients with considerable co-morbidities.