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Purpose: To review Multi-detector CT findings of seven cases with spontaneous regression of hepatocellular carcinomas (HCC). Materials and methods: This retrospective study included 7 patients confirmed with diagnosis of HCC. Triphasic CT... more
Purpose: To review Multi-detector CT findings of seven cases with spontaneous regression of hepatocellular carcinomas (HCC). Materials and methods: This retrospective study included 7 patients confirmed with diagnosis of HCC. Triphasic CT scan using multi-detector CT scanner was done for all patients. They were 2 women and 5 men. 1st patient presented with metastatic HCC underwent fine needle aspiration cytology (FNAC) from vertebral metastasis. 2nd patient underwent only one session of trans-arterial chemo-lipidol. 3rd patient exposed to blunt trauma with rib fissure fracture. 4th patient presented with two HCCs underwent radio-frequency ablation of one lesion. 5th patient underwent FNAC from HCC and exposed to fracture acetabulum. 6th and 7th patients underwent FNAC from hepatic focal lesions. Results: Complete regression of primary HCC and metastases occurred in 1st patient. 2nd patient showed partial lipidol uptakes of HCC with complete regression of HCC on follow up. Incomplete regression of HCC detected in 3rd, 6th and 7th patients. Partial regression of nonablated lesion detected in the 4th patient. Complete regression of HCC occurred on 5th patient. Conclusion: Spontaneous regression of HCC is an interesting phenomenon. It has been hypothesized that invasive techniques and trauma may be linked. They may initiate immunologic mechanisms that may be involved in the regression. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon and may lead to a new treatment strategy for HCC.
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Background: This study aims to evaluate the value of adding elastography (strain elastography) to US in the evaluation of tendon abnormalities with comparison to conventional MRI. Methodology: After institutional review board approval and... more
Background: This study aims to evaluate the value of adding elastography (strain elastography) to US in the evaluation of tendon abnormalities with comparison to conventional MRI. Methodology: After institutional review board approval and informed consent taken from all the patients, supraspinatus and tendoachillis tendon sonoelastography performed on 46 patients with shoulder or ankle pain and limitation of movement. Statistical analysis of this research was assessed by Chi-square test, Fisher’s exact test and Independent-Samples t-test. Results: This study included 46 patients with shoulder or ankle pain and limitation of movement, 23 male and 23 female patients. Their mean age (years) ± SD was 51.30 ± 12.4 years. We found that US had perfect agreement with MRI for detection of complete tear (k=1), strong agreement in diagnosis of partial tendon tear (k=0.810), while moderate agreement in detection of tendinopathy (k=0.645). Also we found that elastography increased US sensitivity...
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Aim: This study was conducted to assess the dose-volumetric threshold of radiation induced hypothyroidism (RIHT) in patients receiving radiotherapy (RT) to the neck. Study Design: This is a prospective cohort observational study. Place... more
Aim: This study was conducted to assess the dose-volumetric threshold of radiation induced hypothyroidism (RIHT) in patients receiving radiotherapy (RT) to the neck. Study Design: This is a prospective cohort observational study. Place and Duration of the Study: The study was conducted at Mansoura University Hospital, Mansoura, Egypt, between April 2016 until March 2019. Methods: We have completed 2 years of follow up to 50 patients with different malignancies who were treated by radiotherapy to the neck. Baseline assessment of the thyroid clinically and radiologically was done prior to the start of radiotherapy. Periodic testing of the cohort through the follow up period was done by clinical examination, measurement of TSH, fT4 and thyroid ultrasonography. Results: the incidence of RIHT was 26%. No statistical significance for the clinical risk factors. The dose-volumetric risk factors were studied and showed positive results. A mean dose of 5185 cGy was found a significant risk fa...
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Research Interests: Immunology and Medicine
Background The presentation of synchronous multiple primary tumors is rare. The aim of this report was to report an uncommon series of cases diagnosed with synchronous gastrointestinal tract carcinoma and other solid malignancies by... more
Background The presentation of synchronous multiple primary tumors is rare. The aim of this report was to report an uncommon series of cases diagnosed with synchronous gastrointestinal tract carcinoma and other solid malignancies by multidetector computed tomography. Case presentation Our report included 34 patients with synchronous gastrointestinal tract carcinoma and other solid malignancies from November 2009 to September 2019. They were 14 men and 20 women (mean age, 65.5 year; range, 52–82 years). The highest number of GIT cases were colonic carcinomas detected in 70% (24/34) of the patients. The most frequent extra-gastrointestinal primary malignancy sites were renal cell and breast carcinomas, 17.6% (6/34) of each. Conclusions Careful preoperative evaluation is recommended to detect this pattern of synchronous extra-gastrointestinal tumors. More reports of such cases should help to clarify the pathogenesis of this phenomenon and may lead to a new treatment strategy for synchr...
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BACKGROUND: Transforming growth factor–β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role... more
BACKGROUND: Transforming growth factor–β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role of TGFβ and its signaling cascade in breast cancer remain unclear. OBJECTIVE: To investigate the relationship between TβRII expression, clinic-pathological characteristics, and prognostic significance of TβRII expression in clinical stage III breast cancer. METHODS: Biopsy from the primary tumor was obtained from 30 newly diagnosed clinical stage III breast cancer patients before receiving any therapy. Expression of TβRII, ER, PR, Her2 and Ki-67 was assessed by immunohistochemistry. RESULTS: TβRII expression was positive in 66.7% of cases and was significantly associated with advanced nodal stage and distant metastases. After a median follow up of 42.3 months, TβRII was associated with poor disease-free survival and it was an independent factor for predicting the poor outcome for breast cancer patients, especially in node positive tumors, ER/PR positive and Her2-negative tumors. CONCLUSIONS: These findings suggest the usage of therapeutic drugs that target TGFβ in advanced breast cancer patients may be effective. Nevertheless, blockage of the tumor promoting and sparing of the tumor suppressor effect of TGFβ pathway should be taken into consideration. We suggest that these therapies might have more benefit in ER and PR positive tumors.
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Objective: To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast- conserving surgery using oncoplastic techniques with con- comitant symmetrization of the contra lateral breast.... more
Objective: To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast- conserving surgery using oncoplastic techniques with con- comitant symmetrization of the contra lateral breast. Introduction: Although breast-conserving surgery is the standard form of treatment for invasive breast tumors up to 4 cm, cosmetic results may be poor and clear resection margins difficult to obtain in patients with large, ill-defined, or poorly situated tumors. The integration of oncoplastic techniques with or without a concomitant contralateral symmetrization procedure is a novel surgical approach that combines both oncologic and plastic surgical procedures and allows wide excisions and prevents breast deformities. Patients and Methods: This is a prospective study of 32 patients who were operated on for breast carcinoma between August 2004 and Mars 2006 by the author. The procedure was proposed for patients in whom conservative treatment was possible on o...
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A 58-year-old woman who had recently developed vague right-sided abdominal pain. Pre-contrast and triphasic CT scans were performed by using a 64 multi-detector CT scanner. Patient underwent hepatic resection. The preoperative findings of... more
A 58-year-old woman who had recently developed vague right-sided abdominal pain. Pre-contrast and triphasic CT scans were performed by using a 64 multi-detector CT scanner. Patient underwent hepatic resection. The preoperative findings of multi-detector row CT data sets were compared with intra-operative findings, which served as the standard of reference. There were 4 hepatic arterial supplies. 1st hepatic artery was small and originated from aorta. 2nd artery originated from aorta. 3rd artery originated from celiac trunk. 4th artery was left hepatic artery and originated from LGA. Segment and distal subsegmental branches were clearly delineated.
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Background Multiple primary malignant neoplasms (MPMNs) became more prevalent as the population aged and medical technology progressed. The purpose of this research was to review the findings of multidetector computed tomography (MDCT) in... more
Background Multiple primary malignant neoplasms (MPMNs) became more prevalent as the population aged and medical technology progressed. The purpose of this research was to review the findings of multidetector computed tomography (MDCT) in synchronous renal cell carcinoma and other solid tumors. Results 31 individuals with synchronous renal cell carcinoma and additional solid cancers were included in this retrospective analysis. CT scanning was carried out using 64 MDCT scanners. All sixty-two malignancies were undergoing pathological assessment. Out of 685 patients with renal cell carcinoma, 31 individuals were identified with another primary solid cancer that occurred concurrently. All of our instances were pathologically verified. In all 31 individuals, clear renal cell carcinoma was found. The most frequent extra-renal malignancies were hepatocellular carcinoma (10/31), followed by breast carcinoma (4/31), non-Hodgkin lymphoma (4/31), bronchogenic carcinoma (3/31), colonic carcin...
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Background: Langerhans cells histiocytosis (LCH) is a rare disease characterized by the uncontrolled proliferation of Langerhans cells (LCs). This study aimed to explore the clinicepidemiological and pathological data of that disease in... more
Background: Langerhans cells histiocytosis (LCH) is a rare disease characterized by the uncontrolled proliferation of Langerhans cells (LCs). This study aimed to explore the clinicepidemiological and pathological data of that disease in our population. Methods: Sixteen patients were referred to the Dermatology and the Clinical Oncology & Nuclear Medicine Departments of our university during the 6 years from 2007 to 2012. Records data were retrospectively analyzed. Pathologic specimens and radiologic films were reassessed by consultants. Case Study El-Gayyar et al.; AORJ, 3(1): 6-19, 2020; Article no.AORJ.54099 7 Results: Pediatric age and male sex predominated. The multifocal uni system (MUS) was the commonest presentation (50% of cases) while the multifocal multisystem (MMS) was found in 37.5% of cases including a case of Letterer-Siwe disease. Microscopic examination revealed dense infiltrate mainly of LCs with characteristic features and positive immunostaining for S100, CD1a and...
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Background: Breast cancer is more frequently being detected as radiographic non-palpable lesions with the increased utilization of national screening programs. Moreover, the sizes of tumors detected have decreased in recent years,... more
Background: Breast cancer is more frequently being detected as radiographic non-palpable lesions with the increased utilization of national screening programs. Moreover, the sizes of tumors detected have decreased in recent years, increasing the need for the accurate image-directed localization for surgical excision in a significant portion of cases. Although Wire guided localization has been the most commonly used method for many years, but inherent problems remain and limited its practice. Radio-guided occult lesion localization (ROLL) is currently the standard method of localization, however it is unavailable in most of low resources communities. This encourages us to use charcoal localization which is simple and cheap method of surgical localization of non-palpable suspicious breast lesions. Methods: This prospective study included 34 patients presented with non-palpable suspicious breast lesion (BIRADS 4 or 5). All patients were injected with 1-3 ml of sterilized 3% aqueous sus...
Objective The aim of this study was to evaluate the role of MRI and MR angiography in the assessment of vascular malformations as compared with the usefulness of duplex sonography and digital subtraction arteriography. Participants and... more
Objective The aim of this study was to evaluate the role of MRI and MR angiography in the assessment of vascular malformations as compared with the usefulness of duplex sonography and digital subtraction arteriography. Participants and methods A total of 40 patients (age range, 1-35 years; 21 male and 19 female) with diagnosed vascular malformations on the basis of color duplex imaging were examined on a 1.5 T whole-body MR scanner. Using parameters based on a fast localizer sequence, we acquired axial or coronal T1-, T2-, short-time inversion recovery (STIR) and contrast-enhanced T1-weighted images. Dynamic postcontrast three-dimensional (3D) gradient-echo MRIs were used for patients with high-flow arteriovenous malformation. MR data sets were evaluated for the detection of the lesion, determination of the malformation extent, involvement of surrounding structures, and vascular details with regard to the nidus, feeding arteries, and draining veins. Results were compared with findings from the digital subtraction angiography (DSA). Results All MRIs revealed 14 low-flow venous vascular malformations, 12 high-flow arteriovenous malformations, and 14 hemangiomas. The STIR sequence was helpful for determining the extent of vascular malformation, whereas dynamic postcontrast 3D MR angiography helped in the classification of the type of the vascular malformation. MR angiography was inferior to DSA in revealing the vascular details and for interventional procedure planning. Conclusion MRI and MR angiography appear to play a significant role in the assessment of vascular malformations. The protocol for imaging such vascular malformations should include dynamic postcontrast 3D gradient-echo MRI with STIR sequences. However, DSA is still required for more vascular detail delineation and definitive treatment decisions.
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Research Interests: Hematology and Medicine
Aim To find out the characteristics of extranodal classical Hodgkin lymphoma (cHL). Patients and methods A retrospective analysis was done on 175 patients with cHL who attended the Oncology Center of Mansoura University from January 1,... more
Aim To find out the characteristics of extranodal classical Hodgkin lymphoma (cHL). Patients and methods A retrospective analysis was done on 175 patients with cHL who attended the Oncology Center of Mansoura University from January 1, 2008 to May 31, 2016, with a median follow-up of 2.93 years (range, 0.05–10.2 years). Results One (0.6%) patient was diagnosed with primary extranodal cHL and 48 (27.4%) patients had secondary extranodal cHL. Liver (25.3%), lung (24.1%), and the bone (20.3%) were the most frequent extranodal sites. A total of 27 (55.1%) patients had one extranodal site, 16 (32.7%) patients had two extranodal sites, and six (12.2%) patients had more than or equal to three sites. Overall, 42 (85.71%) patients with extranodal sites were less than 45 years old (P=0.019), 15 (30.6%) had splenic involvement (P=0.003), 39 (79.6%) patients had absolute monocyte count /absolute lymphocyte count (monocyte-lymphocytes ratio) more than or equal to 0.305 (P<0.001), 36 (73.47%) ...
OBJECTIVE The aim of this study was to describe the triphasic multidetector CT (MDCT) finding of primary hepatic lymphoma (PHL). MATERIALS AND METHODS This retrospective study included eighteen patients. Each patient presented with... more
OBJECTIVE The aim of this study was to describe the triphasic multidetector CT (MDCT) finding of primary hepatic lymphoma (PHL). MATERIALS AND METHODS This retrospective study included eighteen patients. Each patient presented with primary hepatobiliary lymphoma without associated lymphadenopathy or other visceral involvement. Triphasic CT scanning was performed on one of two systems (64 MD CT) in 12 patients and (6 MDCT) in 6 patients. All eighteen patients underwent ultrasound percutaneous trucut liver biopsy using 18-gauge biopsy needle. Pathology was confirmed on all cases. RESULTS Four of eighteen patients presented with a single focal lesion. Thirteen of eighteen patients presented with multiple well defined focal lesions. One patient presented with a diffuse hepatic involvement. On triphasic CT, three patients showed gradual progressive contrast enhancement. Lesions remained isodense to the liver on the arterial phase with mild enhancement in the portal phase and showed washo...
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BACKGROUND Transforming growth factor-β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role... more
BACKGROUND Transforming growth factor-β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role of TGFβ and its signaling cascade in breast cancer remain unclear. OBJECTIVE To investigate the relationship between TβRII expression, clinic-pathological characteristics, and prognostic significance of TβRII expression in clinical stage III breast cancer. METHODS Biopsy from the primary tumor was obtained from 30 newly diagnosed clinical stage III breast cancer patients before receiving any therapy. Expression of TβRII, ER, PR, Her2 and Ki-67 was assessed by immunohistochemistry. RESULTS TβRII expression was positive in 66.7% of cases and was significantly associated with advanced nodal stage and distant metastases. After a median follow up of 42.3 months, TβRII was associated with poor disease-free survival and it was an independent factor for pred...
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The diagnosis of different types of cancer in a single patient has been appeared in the field in some case reports involving different categories of cancer types either appeared at the same time (synchronous) or subsequently... more
The diagnosis of different types of cancer in a single patient has been appeared in the field in some case reports involving different categories of cancer types either appeared at the same time (synchronous) or subsequently (meta-synchronous). The aim of this report is to present this interesting case of male patient who was under treatment of CML then T-lymphoblastic lymphoma and HCC discovered subsequently. CML, Lymphoma and HCC are arising from different lines of cells with different biology and cytogenetic criteria. CML and acute lymphoblastic leukemia may occur together in cases of blastic crisis of CML. But, they rarely occur together as separate multiple malignancies especially without any history of exposure to ionizing radiation, chemotherapy or transplantation.
Endobronchial metastasis from hepatocellular carcinoma are very rare. A 63-years-old woman was admitted to the hospital with a 4-week history of cough, shortness of breath, and abdominal pain. The patient had a history of radio-frequency... more
Endobronchial metastasis from hepatocellular carcinoma are very rare. A 63-years-old woman was admitted to the hospital with a 4-week history of cough, shortness of breath, and abdominal pain. The patient had a history of radio-frequency ablation of hepatocellular carcinoma 1 year previously. Radiological findings were solitary lung mass and multiple hepatic focal lesions. Tru-cut biopsies were taken from the hepatic focal lesions. Bronchoscopic evaluation and biopsy were taken from lung mass. Final diagnosis was hepatocellular carcinomas with endobronchial metastasis.
Background: Nephritis is one of the most common complication of systemic lupus erythematosus (SLE). Studies are going on to find a non-invasive alternate to renal biopsy. Renal Doppler US derived resistive index (RRI) has been... more
Background: Nephritis is one of the most common complication of systemic lupus erythematosus (SLE). Studies are going on to find a non-invasive alternate to renal biopsy. Renal Doppler US derived resistive index (RRI) has been studied before in patients with lupus nephritis, but its role isstill a matter of controversies. Objectives: To study the role of RRI in the diagnosis of lupus nephritis and correlate it to the biopsy findings, laboratory, and serology markers of the disease. Methods: We evaluated 46 lupus nephritis patients in comparison to 24 SLE patients with no nephritis and 18 healthy control subjects. The study protocol included ultrasonographic assessment to measure the RRI and comparing it to renal biopsy (International Society of Nephrology/Renal Pathology Society classification), clinical, laboratory and serology markers of the disease. Results: RRI was significantly higher in LN group than LNN and healthy groups (p= 0.007, and 0.026) respectively. No difference of R...
1 Pak M, Lindseth G. Risk factors for cholelithiasis. Gastroenterol Nurs 2016; 39:297–309. 2 Yoo EH, Lee SY. The prevalence and risk factors for gallstone disease. Clin Chem Lab Med 2009; 47:795–807. 3 Acalovschi M. Gallstones in patients... more
1 Pak M, Lindseth G. Risk factors for cholelithiasis. Gastroenterol Nurs 2016; 39:297–309. 2 Yoo EH, Lee SY. The prevalence and risk factors for gallstone disease. Clin Chem Lab Med 2009; 47:795–807. 3 Acalovschi M. Gallstones in patients with liver cirrhosis: incidence, etiology, clinical and therapeutical aspects. World J Gastroenterol 2014; 20:7277–7285. 4 Montomoli J, Erichsen R, Christiansen CF, Ulrichsen SP, Pedersen L, Nilsson T, Sørensen HT. Liver disease and 30-day mortality after colorectal cancer surgery: a Danish population-based cohort study. BMC Gastroenterol 2013; 13:66. 5 Vanhuyse F, Maureira P, Portocarrero E, Laurent N, Lekehal M, Carteaux JP, Villemot JP. Cardiac surgery in cirrhotic patients: results and evaluation of risk factors. Eur J Cardiothorac Surg 2012; 42:293–299.
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BACKGROUND: Multiple primary malignancies are two or more malignancies in an individual without any relationship between the tumors. The development of improved diagnostic techniques, increased survival of cancer patients and the growing... more
BACKGROUND: Multiple primary malignancies are two or more malignancies in an individual without any relationship between the tumors. The development of improved diagnostic techniques, increased survival of cancer patients and the growing life expectancy have all contributed to the increased frequency of this phenomenon. OBJECTIVE: The aim of this study is to review the multidetector computed tomography (MDCT) findings of synchronous breast carcinoma and other solid malignancies. METHODS: This retrospective study included 65 patients confirmed with diagnosis of synchronous breast carcinoma and other solid malignancies. CT scanning was performed using 128 MDCT in all patients. All one hundred-thirty malignancies underwent pathological evaluation. RESULTS: Out of 4120 patients with breast carcinoma; 65 patients were diagnosed with other synchronous primary solid malignancy. All one hundred-thirty malignancies were confirmed pathologically. Breast carcinoma detected in all 65 patients; ...
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Sentinel lymphadenectomy has replaced axillary lymph node dissection as a staging tool in early breast cancer. To be accepted as a standard of care, it had to pass successfully through a long journey which started in the early 1990s. We... more
Sentinel lymphadenectomy has replaced axillary lymph node dissection as a staging tool in early breast cancer. To be accepted as a standard of care, it had to pass successfully through a long journey which started in the early 1990s. We carried out a comprehensive literature review focusing on the journey of the use of sentinel lymph node biopsy (SLNB) in breast cancer from its start until its current station, including the variable clinical applications, the current debates, and the future issues. Adoption of sentinel lymph node biopsy as a standard axillary staging procedure was a marvelous trend that helped to decrease the complications of axillary dissection and significantly improve the quality of life of patients with breast cancer. Various mapping techniques can be used for SLN localization, rendering oncology centers that have variable capabilities and preparations able to perform the procedure. This applies to specimen processing techniques as well. Many debates faced the researchers throughout the SLNB journey. They are all explained in the current article, in addition to the ongoing trials and the future aspects of SLNB in breast cancer. Further research should be conducted to help resolve the clinical issues which are still debatable and to provide bases for improving the future trends which are progressing towards limiting the role of axillary dissection and axillary surgery to the minimum required level.
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Sentinel lymph node biopsy (SLNB) has efficiently replaced axillary lymph node dissection (ALND) in axillary staging in node-negative breast cancer patients. Dual sentinel lymph node (SLN) localization using radioisotopes and blue dye is... more
Sentinel lymph node biopsy (SLNB) has efficiently replaced axillary lymph node dissection (ALND) in axillary staging in node-negative breast cancer patients. Dual sentinel lymph node (SLN) localization using radioisotopes and blue dye is the standard technique for SLN mapping. Yet, nuclear medicine facilities are not widely available worldwide. In Japan, Computed tomography lymphography (CTLG) is presented as an SLN mapping technique which was first suggested in 2003 by Suga et al. Multiple subsequent studies confirmed the efficacy of CTLG in SLN mapping in breast cancer. Further applications of the technique followed; such as prediction of SLN metastasis using CTLG, the use of CTLG guided SLN biopsy after neoadjuvant therapy, video-assisted CTLG guided SLN biopsy, the use of real-time virtual sonography with 3-D CTLG, and preoperative localization of the CTLG mapped SLN using either real-time virtual sonography (RVS) guided Indocyanine green (ICG) injection or its marking using liq...
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BACKGROUND Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. we aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with... more
BACKGROUND Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. we aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with pneumonia. RESEARCH DESIGN AND METHODS This multicenter prospective study involved 174 patients with COVID-19. Patients were randomized into two groups. Group A (96 patients) received sofosbuvir (400 mg)/ daclatasvir (60 mg) for 14 days in combination with conventional therapy. Group B (78 patients) received conventional therapy alone. Clinical, laboratory and radiological data were collected at baseline, after 7, 14 and 28 days of therapy. Primary endpoint was rate of clinical/virological cure. RESULTS A lower mortality rate was observed in group (A) (14% vs 21%, P = 0.07). After one month of therapy, no differences were found in rates of ICU admission, oxygen therapy or ventilation. Additionally, a statistically significant shorter duration of hospital stay (9% vs 12%, P <0.01) and a faster achievement of PCR negativity at day 14 (84% versus 47%, P <0.01) were noticed in group (A). CONCLUSION Adding sofosbuvir/daclatasvir to conventional therapy of COVID-19 is promising. Their use is associated with shorter hospital stay, faster PCR negativity and may be reduced mortality.
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Background and Objectives: Chest CT evaluation is often key to the evaluation of patients suspected of COVID-19 infection Multi-detector CT findings of COVID-1
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Background Patients who undergo abdominoperineal resection with colostomy may experience phantom rectum pain syndrome. Aim To evaluate combined ganglion impar block and pregabaline for treatment of phantom rectum pain syndrome and... more
Background Patients who undergo abdominoperineal resection with colostomy may experience phantom rectum pain syndrome. Aim To evaluate combined ganglion impar block and pregabaline for treatment of phantom rectum pain syndrome and improvement of quality of life. Settings and design We conducted a randomized prospective open-label blinded end-point level IV trial in a university-affiliated oncology center in Mansoura, Egypt during the period from June 2018 to May 2019. Patients and methods A total of 40 patients were randomly allocated into two groups: group A (n=20) received pregabaline 150 mg twice daily, and group B (n=20) received pregabaline 150 mg twice daily and ganglion impar block using 5 ml bupivacaine 5% with 14 mg/2 ml betamethasone. We monitored numerical rating scale (NRS), participant satisfaction reporting scale, pain anxiety symptoms scale, postblock complication, and success rate of block. Statistical analysis We used χ2, t-test, and Mann–Whitney tests for statistical analysis. Results NRS improved in each group at 1 week, 1, and 2 months in comparison with basal values (within-group P<0.001). NRS decreased in group B in comparison with group A at 1 week (P<0.001) and 1 month (P=0.01). Participant satisfaction reporting scale Q2 and Q5 were better in group B than group A (P=0.02 and 0.049; respectively). Cognition items, anxiety items, and total pain anxiety symptom scale were better in group B than group A (P=0.003, <0.001, and <0.001; respectively). No complications were detected during or after the procedure, and the success rate of the block was 95%. Conclusion Ganglion impar block with pregabaline improved pain and quality of life in patients with phantom rectum pain syndrome.
Spontaneous regression (SR) of lymphoma is a rare phenomenon. While the precise mechanism of SR remains unknown, apoptosis may be associated with its process. Here, we present a case of a 52-year-old woman was admitted to our hospital... more
Spontaneous regression (SR) of lymphoma is a rare phenomenon. While the precise mechanism of SR remains unknown, apoptosis may be associated with its process. Here, we present a case of a 52-year-old woman was admitted to our hospital with cough and orthopnea for 2 weeks. Multi-detector computed tomography of whole body showed anterior and middle mediastinal soft tissue mass with multiple adjacent malignant lymphadenopathy. The mediastinal mass invaded right atrium and pericardium. Another left subphrenic retro-pancreatic mass was detected. This mass surrounded upper pole of left kidney. Fine needle aspiration cytology was done and revealed lymphocytic smear with advised tru-cut biopsy. CT guided tru-cut was taken after 8 days. During CT guided technique; marked regression of left subphrenic mass was detected. Post-contrast MDCT scan was done and revealed partial response of the masses after 8 days. The partial regressive course of this disease suggests the effectiveness of fine nee...
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Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a... more
Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a case of metastatic breast cancer to the deep cervical lymph nodes that caused stridor due to compression of the recurrent laryngeal nerve which was diagnosed by indirect laryngoscopy. After full investigations, urgent chemotherapy was started and it showed a dramatic response with disappearance of the lymph node after two cycles with resolution of the stridor. This report also highlights the association of other metastatic sites with this higher level of neck nodal metastases of breast cancer.
Pulmonary agenesis is a very rare congenital anomaly characterized by the absence of pulmonary parenchyma and its vasculature. The diagnosis is usually during childhood. Herein, we report a case of incidental discover right pulmonary... more
Pulmonary agenesis is a very rare congenital anomaly characterized by the absence of pulmonary parenchyma and its vasculature. The diagnosis is usually during childhood. Herein, we report a case of incidental discover right pulmonary agenesis in adulthood male. A 30-year-old male presented with pre-operative medical evaluation for varicocele. There was no complaining from respiratory symptoms. He underwent plain chest X-ray and post-contrast CT scanning was performed using 64 multi-detector CT scanner. Chest Plain X-ray revealed cardiac and mediastinal shift to right side with hyper-inflated left lung crosses to right side. Multi-detector computed tomography examination revealed total absence of right lung with compensatory hyperinflation and increase volume of left lung. Hyper-inflated left lung extended to right hemithorax. Mediastinal structures including heart and great vessels were displaced to middle and lower parts of right hemithorax. Descending aorta located to anterior to thoracic vertebrae. Right pulmonary artery was absent. Right main bronchus was rudimentary. No detected other organ anomalies. No detected bony thoracic cage abnormalities.
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Objective: The aim of this work was to evaluate Multidetector Computed Tomography (MDCT) findings of hepatic manifestation in common malignant hematological disorders. Materials and Methods: This retrospective study included 300 patients... more
Objective: The aim of this work was to evaluate Multidetector Computed Tomography (MDCT) findings of hepatic manifestation in common malignant hematological disorders. Materials and Methods: This retrospective study included 300 patients with different types of malignant hematological disorders. They were 119 female and 181 male (mean age, 45.4 year; range, 5-70 years). The most common hematological disorder was Non-Hodgkin lymphoma (NHL) detected in 192/300 (64%) patients and then Hodgkin disease (HD) detected in 40/300 (13.3%) patients. All 300 patients had ultrasonography. Clinical evaluation and laboratory assessment were done for all patients. Whole body and triphasic abdominal CT scanning was performed on 64 MDCT systems. Results: MDCT scanning revealed hepatic affection in 82/192 of NHL. All these 82 cases revealed hepatomegaly and focal lesion detected in 36 cases. As regard Hodgkin disease (HD), hepatomegaly detected in 22/40 cases and focal lesion detected in 8/40 cases. H...
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Abstract Background Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients’ position and the double... more
Abstract Background Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients’ position and the double needle technique using posterior anterocrural approach. Methods In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0–5), 2 (0–4), 3 (0–6), 3 (2–6) and single needle celiac neurolysis = 3 (0–5), 2 (0–5), 2 (0–4), 4 (2–6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion Single needle celiac neurolysis with changing patients’ position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.