BACKGROUND & AIM. The mechanisms by which type 2 diabetes mellitus (T2DM) worsen liver function are not yet established. Tissue factor (TF) is a protein that participates in hemostatic, immune and inflammatory processes. To test the hypothesis that T2DM contributes to clinical outcome through changes of TF expression on monocytes and to investigate the association between antidiabetic therapies and monocytic TF expression in HCV-related cirrhotic patients with T2DM. MATERIAL AND METHODS. In HCV-related cirrhotic patients (139 diabetics and 130 non diabetics) compared with 100 matched diabetic patients and 100 Controls; the flowcytometric analysis of CD14, TF (CD142), costimulatory molecules; CD86 and HLA-DR on monocytes were determined. RESULTS. Cirrhotic patients with T2DM have increase in the expression of monocytic TF and CD86 in comparison with cirrhotic non-diabetic, diabetic and healthy control; which increase significantly with increase of the stage of the Child-Pugh score. The expression of HLA-DR is significantly lower in cirrhotic patients than controls. Albeit, there were no significant differences in the HbA1c levels between the three groups, the use of exogenous insulin were associated with significantly higher monocytic TF expression than those in sulphonylurea and insulin sensitizer group (P 0.03 for both). CONCLUSIONS. The monocytic TF as a significant link connecting inflammatory and immunological phenomena can partially explain a lot of events in HCV- related cirrhotic patients with T2DM. The use of exogenous insulin was associated with significantly higher TF expression than sulphonylurea and insulin sensitizer. Future target therapy against TF may be beneficial for T2DM cirrhotic patients.

BACKGROUND: Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. MATERIALS AND METHODS: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. RESULTS: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin 30g/dl, pre-operative hemoglobin 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival. CONCLUSIONS: PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

The authors examined the associations between farming and the risk for squamous cell (SCC) or urothelial cell (UC) carcinoma of the urinary bladder among Egyptians. The authors used data from a multicenter case-control study (1,525 male and 315 female cases, and 2,069 male and 547 female age- and residence-matched, population-based controls) to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Men in farming and who never smoked had increased risk for either SCC or UC (AOR [95% CI]: 4.65 [2.59-8.36] and 6.22 [3.82-10.15], respectively). If they ever smoked, their risks were 2.27 (1.75-2.95) and 1.93 (1.58-2.35), respectively. Women in farmer households were at increased risk for SCC (1.40 [0.93-2.09] and UC [1.25 (0.82-1.89]), although not statistically significant. Occupational and environmental exposures to farming increased the risk for bladder cancer among Egyptians.

Although reports suggest that Schistosoma mansoni increases hepatitis C virus (HCV) morbidity and chronicity, its impact on HCV spontaneous resolution is not clear. HCV genotype, viral load, abdominal ultrasonographic findings, and HCV-specific cell-mediated immunity (CMI) were examined among 141 healthcare workers infected with HCV (68 workers with and 73 workers without S. mansoni). HCV genotype 4 was dominate, and viral loads were 2.62 ± 0.69 × 10(6) and 4.24 ± 1.4 × 10(6) IU/mL among patients with and without coinfection, respectively (P = 0.309); 23.5% with and 32.9% without coinfection had spontaneously resolved HCV infection (P = 0.297). Interferon-γ spot-forming cells/10(6) peripheral blood mononuclear cells among responding viremic patients with and without coinfection were 716 ± 194 and 587 ± 162, whereas among aviremic patients, it was 794 ± 272 and 365 ± 36 (P > 0.05), respectively. In conclusion, there was no statistical difference in HCV spontaneous resolution, viral load, liver pathology, or CMI in patients with or without S. mansoni coinfection, suggesting that it did not impact the outcome of HCV infection.

Background: Incidence of breast cancer in patients 40 years old accounts for 20% of the total breast cancer patients in Egypt which is quite higher than the incidence reported worldwide. This study was conducted to evaluate the differences in survival between age groups below and above the age of 40. Method: 170 patients 40 years and 500 patients ≥40 years were evaluated retrospectively to assess the differences in disease free survival (DFS) and overall survival (OS) between age groups after adjustment of other risk factors like stage, lymph node status, tumor size, and hormonal positivity. Results: After median follow up of 49 months, there was no significant difference between the 2 age groups with regards to DFS p= 0.6 and OS P=0.7 and there was no significant difference between the 2 groups when we stratified the patients according to stages, hormonal status and number of metastatic lymph nodes. However, we found significant increase in local recurrence after breast conserving surgery in patients 40 years compared to patients ≥40 years. Conclusion: Patients 40 years exhibited more often at advanced stage and large tumors size compared to patients ≥ 40 years; However, there was no significant difference in DFS and OS when we adjusted other risk factors. Furthermore, our analysis revealed that age 40 years can be considered as an adverse prognostic factor for the locoregional failure after breast conserving surgery. Keywords: breast cancer, young age, 40 years old, locoregional failure, DFS.

Cyclin D1 is involved in normal regulation of the cell cycle and in neoplasia. Inhibition of cyclin D1 function markedly attenuates the proliferation of fibroblasts of colon, esophageal, lung, and pancreatic cancer. However, the prognostic value of overexpression of cyclin D1 in multiple myeloma is still a point of debate. This study aimed at evaluating the effect of cyclin D1 gene amplification in multiple myeloma on overall survival and response to therapy. PATIENTS AND METHODS: Fifty patients with multiple myeloma were retrospectively studied. Cyclin D1 gene amplification was studied in bone marrow biopsies of these patients using FISH. An immunohistochemical study of the bone marrow biopsies was done to detect MDR1 protein expression. The correlations between the cyclin D1 gene amplification and overall survival and MDR1 expression were studied and analyzed statistically. RESULTS: Cyclin D1 gene amplification was found in 20% of myeloma patients and was associated with higher percentage of plasma cell infiltration of the bone marrow and increased liability for multiple osteolytic lesions. Cyclin D1-positive patients had a significantly lower progression-free and overall survival and higher levels of MDR1 compared with cyclin D1-negative patients. Cyclin D1 levels showed a highly statistically significant positive correlation with MDR1 levels (R, 0.8 and P .0001). CONCLUSION: We suggest that there is an association between cyclin D1 gene amplification and disease severity, unfavorable prognosis, and increased expression of MDR1 in multiple myeloma patients.

BACKGROUND: Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of ITM 0.2 mg, 0.5 mg, and 1 mg in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive morphine intrathecally either 0.2 mg (Group I, ITM 0.2 mg, n = 30), 0.5 mg (Group II, ITM 0.5 mg, n = 30), or 1 mg (Group III, ITM 1 mg, n = 30) dissolved in 5 mL physiological saline before general anesthesia. Assessment parameters included hemodynamics, respiratory rate, peripheral arterial oxygenation, sedation score, pain severity, time of first analgesic request, total analgesic consumption, and side effects in the first 72 hours. RESULTS: The mean time to first request for rescue analgesia was significantly prolonged in Group II (22.13 ± 5.21 hours, P 0.001) and Group III (30.83 ± 4.89 h, P 0.001), compared with Group I (0.50 ± 0.66 hours). The mean tramadol consumption dose was significantly reduced in Group II (383.33 ± 91.28 mg, P 0.001) and Group III (300 ± 69.48 mg, P 0.001) compared with Group I (770 ± 114.92 mg). Patients received 1 mg ITM showed lower VAS scores in the first 48 h postoperative (P 0.04) compared with Group I and Group II. No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate, and peripheral arterial oxygen saturation between groups. Lower mean heart rate values were observed in Group III patients at 6 hours (P 0.01) and 12 hours (P 0.03) postoperative compared with Group I and Group II patients. Six patients (20%) in Group II and 8 (26.7%) in Group III exhibited pruritus compared with 2 patients (6.66%) in Group I (P 0.01). No intergroup statistical differences were observed for other studied side effects. LIMITATIONS: This study is limited by its small sample size. CONCLUSION: One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings.

The aim of this study was to evaluate the effects of bacterial pneumonia and malnutrition on the frequency of micronuclei (MN) in peripheral blood of pediatric patients through flow cytometric analysis. The study was an analytical case-control study carried out on 35 malnourished children with bacterial pneumonia and 20 well-nourished children with bacterial pneumonia, in addition to 20 healthy children as controls. Complete physical examination including; anthropometric measurement, Chest roentgenograms were done for all cases. Assessment of MN was done by FACSCalibur flow cytometry. The frequency of micronucleated reticulocytes (MN-RETs) was higher both in the malnourished children with pneumonia and well-nourished children with pneumonia than the controls. Within the malnourished children with pneumonia, patients with kwashiorkor had more micronucleated mature erythrocytes (MN-RBCs) and MN-RETs than patients with marasmus. In conclusion: Pneumonia is associated with an increased frequency of MN and this increment is more pronounced in children with severe malnutrition especially kwashiorkor group.

Background: We conducted a retrospective analysis to investigate the clinical outcome of combined modality therapy using multiagent chemotherapy, nephrectomy, and radiotherapy in treatment of children with Wilms' tumor. Methods: This study was conducted on 91 cases of newly diagnosed Wilms' tumor from January 2001 until February 2012. Patients were categorized into two groups according to treatment approach: i) preoperative chemotherapy with delayed surgery (group A; n=66) and ii) immediate surgery (group B; n=25). Results: Preoperative chemotherapy showed a 54.5% partial response rate in group A patients. A final stage distribution indicated that the majority of patients (64%) from both groups were considered to be in the early disease stages (I and II). The median follow up was 49 months (range 3-124). The five-year overall survival rate was 66.5%, whereas the event-free survival rate was 62.5%. In univariate analysis, factors associated with statistically significant reduction in overall (P0.0001) and event-free survival (P=0.0001) rates included advanced disease stages (P0.0001 for both) and blastimal subtype (P=0.0067 for overall survival; P=0.012 for event-free survival). Age of >24 months was associated with a significant reduction in the overall survival rate (P=0.038, HR: 0.438, 95% CI: 0.192-0.953), but was not significant in terms of eventfree survival (P=0.104, HR: 0.539, 95% CI: 0.256-1.136). Age >24 months (P=0.0095), disease stage (P=0.0014), and blastimal subtype (P=0.006) were associated with significant increases in relapse rate. Conclusion: Preoperative chemotherapy resulted in a final stage redistribution that placed the majority of patients in the early stages of the disease. Age at diagnosis, disease stage, and histological subtype significantly affected survival and relapse rates.

Background: We conducted a retrospective analysis to investigate the clinical outcome of combined modality therapy using multiagent chemotherapy, nephrectomy, and radiotherapy in treatment of children with Wilms' tumor. Methods: This study was conducted on 91 cases of newly diagnosed Wilms' tumor from January 2001 until February 2012. Patients were categorized into two groups according to treatment approach: i) preoperative chemotherapy with delayed surgery (group A; n=66) and ii) immediate surgery (group B; n=25). Results: Preoperative chemotherapy showed a 54.5% partial response rate in group A patients. A final stage distribution indicated that the majority of patients (64%) from both groups were considered to be in the early disease stages (I and II). The median follow up was 49 months (range 3-124). The five-year overall survival rate was 66.5%, whereas the event-free survival rate was 62.5%. In univariate analysis, factors associated with statistically significant reduction in overall (P0.0001) and event-free survival (P=0.0001) rates included advanced disease stages (P0.0001 for both) and blastimal subtype (P=0.0067 for overall survival; P=0.012 for event-free survival). Age of >24 months was associated with a significant reduction in the overall survival rate (P=0.038, HR: 0.438, 95% CI: 0.192-0.953), but was not significant in terms of eventfree survival (P=0.104, HR: 0.539, 95% CI: 0.256-1.136). Age >24 months (P=0.0095), disease stage (P=0.0014), and blastimal subtype (P=0.006) were associated with significant increases in relapse rate. Conclusion: Preoperative chemotherapy resulted in a final stage redistribution that placed the majority of patients in the early stages of the disease. Age at diagnosis, disease stage, and histological subtype significantly affected survival and relapse rates.