Background Glaucoma is a nonreversible optic neuropathy that may occur primarily or secondary to ocular pathology. Uveitis is a major etiological factor for secondary glaucoma, arising either owing to the inflammation itself or resulting from therapeutic steroid use. Many patients with uveitic glaucoma ultimately require a surgical intervention to maintain optimal intraocular pressures (IOP), often after treatment failure with multiple ocular antihypertensive agents. A leading surgical option for such patients is trabeculectomy augmented by intraoperative administration of mitomycin C (MMC). However, in the context of uveitic glaucoma, the relative merit of trabeculectomy with MMC compared with alternative surgical techniques, such as valve implantation, remains a subject of debate among ophthalmic surgeons. Study design This is a review of the literature to evaluate the efficacy and safety of trabeculectomy with MMC in uveitic glaucoma. Materials and methods A literature review of the use of trabeculectomy with MMC administration as an initial surgical management for uveitic glaucoma in adults was performed. Articles were identified by searches of PubMed and the Cochrane Library, using a strategy that defined the target condition (uveitis OR uveitic glaucoma OR inflammatory glaucoma) AND the intervention (trabeculectomy); limitation to MMC-augmented trabeculectomy was undertaken at the abstract and full-text stage. Data extracted included age of the patients, nature of the uveitis, preoperative status in terms of IOP and number of ocular hypotensive medications used, outcomes at annual time-points including IOP, number of ocular hypotensive medications, and surgical success (defined in terms of IOP) up to 5 years postoperatively. Adverse events were also recorded. Results The search strategy identified 498 papers, of which 32 were duplicates, 431 were excluded at abstract stage, and 28 were excluded at full-text stage; five of the 28 satisfied the inclusion criteria but were found to contain data that were entirely or largely contained within one of the other included papers. A total of seven studies were included, comprising 300 patients, with a weighted mean age of 45.8 years (range=30.0–56.9 years), and a range of uveitis syndromes including idiopathic (30%), Behcet’s disease (24.3%), Fuchs’ heterochromic uveitis (13.7%), and Vogt-Koyanagi-Harada syndrome (12.3%). Preoperative IOP and number of medications were reported in all studies. The mean (weighted) preoperative IOP was 34.2 mmHg (range=26.8–39.5 mmHg) and the mean (weighted) number of medications was 3.4 (range=2.3–4.5). Postoperative data were variably reported across the studies; the mean IOP at 1 year was reported in five studies (range=13.8–18.5 mmHg), the mean number of medications at 1 year was reported in four studies (range=0.3–2.6), and surgical success was variably defined preventing direct comparison or aggregation. Conclusion There is limited evidence to evaluate trabeculectomy with MMC as an initial surgical intervention for uveitic glaucoma, with the available evidence being derived entirely from retrospective studies, most of which do not have a parallel comparator group. Variation in reporting limits direct comparison and aggregation of these studies. Comparison between before and after intervention provides some limited evidence of effectiveness and safety. So, there is a need for well-designed prospective randomized controlled trials with long-term follow-up to compare interventions in this vulnerable group of patients.

Introduction

Acute myeloid leukemia (AML) is an aggressive disorder characterized by accumulation of blast cells in bone marrow. The heterogeneous phenotype of AML is based on cytogenetic mutations and molecular aberrations. Immunophenotyping is a convenient method for quick and reproducible diagnosis of most hematological malignancies. The higher frequency of aberrant expression of lymphoid markers in AML may be related to environmental changes and accumulation of biological defects. The CD7, a T‑cell antigen, is expressed in a minority of patients with AML, and it is the most common aberrant marker found in AML in most studies.

Aim

We aimed to determine the frequency of CD7 expression in AML and to verify if this aberrant expression is true or false.

Patients and methods

The study included 32 newly diagnosed patients with AML. Detection of CD7 in AML was done by using an independent method to check the gene expression, namely, reverse transcriptase‑PCR, besides the usually used monoclonal antibody‑based flow cytometric measurements.

Results

The study revealed the frequency of CD7 expression in newly diagnosed AML cases to be 18.1% by flow cytometry. The AML cases with positive CD7 expression by flow cytometry were subjected to reverse transcriptase‑PCR to determine gene expression. All cases with positive CD7 expression by flow cytometry were found to be negative for CD7 gene expression by PCR.

Conclusion

This study raises a reasonable possibility of a false‑positive detection of aberrant CD7 expression in AML using immunophenotyping by flow cytometry.

Intestinal capillariasis is a parasitic zoonosis caused by the tiny nematode parasite Capillaria philippinensis. It is a major health problem that may lead to death if not diagnosed and treated appropriately. The difficulties in the diagnosis of C. philippinensis highlight the importance of developing accurate, sensitive, and specific methods for early diagnosis. This study aimed to detect the presence of C. philippinensis infection among 42 clinically suspected patients with certain criteria that are highly suggestive of capillariasis and to compare the diagnostic yield of microscopy, copro-ELISA, and PCR for the detection of copro-DNA. Sociodemographic characteristics and clinical data were also described for the infected group. Out of 42 patients, 10 were microscopically positive, 40 samples were positive by copro-ELISA, nested PCR detected 35 positive cases, with total detection rates of 23.8%, 95.2%, and 83.3% using direct microscopic examination, copro-ELISA, and PCR, respectively. The majority of positive cases were females, middle-aged people, and people from rural areas. The real number of cases infected with C. philippinensis may far exceed those estimated using microscopy. The diagnosis by copro-ELISA for the detection of C. philippinensis coproantigen and by nested PCR to identify parasite DNA revealed a higher number of positive cases. Using ELISA for the detection of coproantigen is a sensitive test that identifies the infection, yet it is not specific. Copro-DNA offers a satisfactory sensitive and specific method for the detection of infection in clinically suspected patients. The most susceptible individuals to C. philippinensis infection are females, middle-aged people, and people of low social standards. Intestinal capillariasis needs to be considered in patients who present with symptoms of chronic diarrhea and hypoalbuminemia because if these cases are left undiagnosed and untreated, they may suffer from lethal complications.

Introduction

Chronic lymph ocytic leukemia (CLL) is a clonal expansion of small mature lymphocytes accumulating in the blood, bone marrow, and lymphoid organs. The interactions of the CLL microenvironment are known to promote CLL cell survival and proliferation. CD49d, an adhesion molecule belonging to the integrin family mediates cell‑to‑extracellular matrix and cell‑to‑cell interactions. CD44 is a glycoprotein and also a major hyaluronan receptor that mediates the response of cells to their cellular microenvironment.

Aim

We aimed to evaluate the value of CD49d and CD44 in CLL patients, and their effect on response to fludarabine, cyclophosphamide, and rituximab therapy, to study the relation of each to the other and its relation to the poor prognostic marker CD38.

Patients and methods

The study included 30 newly diagnosed CLL patients with measurement of the expression of CD49d and CD44 by flow cytometry before and after therapy.

Results

CD49d expression was increased in advanced risk stages according to modified Rai staging, but CD44 had no different expression in the different stages. There is a positive correlation between CD44 with CD49d, CD38 (documented poor prognostic marker) with CD49d, and CD38 with CD44. Lymphadenopathy showed a significant relation with CD49d only. Patients without complete response had a significant higher expression of CD49d, CD38, and CD44 before and after therapy.

Conclusion

The study has shown that the expression of CD49d and CD44 in newly diagnosed CLL patients is related to resistance to the fludarabine, cyclophosphamide, and rituximab therapy and their expression is related to each other and to CD38.

The SALL gene family is involved in normal development as well as tumor genesis. SALL4 is essential for the maintenance of the pluripotent and the self-renewal properties of embryonic stem cells.

Patients and methods It was conducted from the period of April 2008 to June 2012 on 40 patients with acute leukemia (group I), 20 patients who had nonmalignant hematologic disease (group II), and 20 healthy individuals (group III). They were subjected to laboratory investigations including a complete blood picture, RT-PCR for the detection of the SALL4 gene, for group I bone marrow aspiration biopsy, cytochemical studies, and immunophenotyping of either peripheral blood or bone marrow samples to diagnose and classify the hematologic malignancy.

Results SALL4 mRNA was expressed in 50% of the acute myeloid leukemia (AML) cases and was undetectable in 50% of the cases. Whereas it was expressed in only 20% of acute lymphoblastic leukemia (ALL), it was undetectable in 80% of ALL. SALL4 mRNA was undetectable in all cases of immune thrombocytopenic purpura (group II) (0%). SALL4 mRNA was undetectable in all samples of the control group (group III) (0%). There was no significant difference between the expression level of CD markers and SALL4 in AML cases, whereas there was a significant elevation of the CD10 expression level in SALL4-positive ALL cases (P < 0.05). There was a significant reduction in the RBC count and the hematocrite (Hct) and platelet level in SALL4-positive ALL cases (P < 0.05), and there was a statistically significant reduction in the platelet count in SALL4-positive AML cases.

Conclusion SALL4 mRNA expression was higher in cases of AML (50%), compared with ALL cases (20%). There was no SALL4 mRNA expression detected in all cases of immune thrombocytopenic purpura patients and in normal control individuals.

Background:

Breast cancer is a major health problem resulting in high morbidity and mortality. Early diagnosis of primary and secondary lesions is crucial to optimize treatment options. Our study aimed to investigate the role of PET-CT and CT alone in detecting metastatic lesions in breast cancer patients.

Result:

This retrospective study showed better PET diagnostic performance in the detection of lymph nodal and lytic bony metastatic deposits with more accurate detection of the malignant nature of hepatic focal lesions and detection of activity in sclerotic bony lesions, compared with CT alone, while CT had a higher value in the localization of lesions. Hybrid PET/CT showed optimal diagnostic performance than each modality separately.

Conclusion:

The combination of CT and PET was a powerful diagnostic tool that is more accurate than CT alone in the detection of distant metastases.  

Keywords: PET, Hybrid PET/CT, Recurrent breast cancer, Staging of breast cancer.