Chronic perforation of the sigmoid colon by foreign body

Colorectal foreign bodies (FBs) may be ingested or introduced transanally and then migrate proximally. Without a reliable history, it may be impossible to determine which way a certain colorectal FB gained access. We present a case of a nonverbal mentally retarded boy with a flat piece of plastic impacted in the sigmoid colon, the colonoscopic extraction of which failed. He underwent laparotomy more than a year later to remove the FB, where chronic perforation of the sigmoid colon was discovered. The perforation was sealed with extensive adhesions to the pelvic wall, and histologically, the colon showed a chronic granulomatous reaction. We discuss the types, presentations, and diagnosis of intestinal perforation with FBs. Chronic perforation may present with radiologic and pathologic features that suggest inflammatory bowel disease.     

Aggressive primary thyroid non Hodgkin's lymphoma with pregnancy

We present here a multigravida patient who presented with a huge neck swelling, severe respiratory distress together with dysphagia and hoarseness of voice while she was pregnant +/- 30 weeks of gestation. She was diagnosed as an aggressive non-Hodgkin lymphoma of the thyroid gland. She was treated by 6 cycles of chemotherapy, with dramatic response after receiving the first cycle. She had 3 cycles of 4 chemotherapeutic agents before successful, elective and scheduled induction of labor at 36 weeks of gestation with favorable outcomes.     

湿润烧伤膏在慢性糖尿病足溃疡愈合中的作用:随机对照试验

目的评估湿润烧伤膏（MEBO）在促进慢性糖尿病足溃疡（DFUs）愈合中的疗效和安全性。方法2005年至2010年间就诊于科威特艾哈迈迪医院的慢性糖尿病足溃疡患者被随机分为MEBO组（66例患者,82处溃疡）和生理盐水湿润敷料组（62例患者,78处溃疡）。前瞻性收集患者的人口统计学特征以及溃疡创面特点等数据。试验12周期间每隔两周计算一次患者的溃疡表面积（SA）和愈合指数（HI）,24周时记录继发性截肢和新溃疡形成的情况。结果两组患者的人口学特征,临床症状及溃疡特点相似。MEBO组患者在第2周和第4周时分别有愈合指数的明显升高和溃疡表面积的明显下降（P〈0．01）;与生理盐水组在治疗12周时25．7％的完全愈合率相比,MEBO组一半以上的溃疡创面（53．7％）都实现了完全愈合（P=0．0006）;治疗12周时,生理盐水组28．2％的患者愈合指数〈0．5,而MEBO组无1例此状况（P=0．0001）;治疗24周时,13位患者（10．2％）行足前段截肢术,而其中只有2例患者（3％）来自MEBO组（P=0．035）;此外,每组各有2例患者在治疗24周后出现了新溃疡（P〉0．05）。实验过程中MEBO组未见任何副反应。结论1）除了具备安全性以外．MEBO可显著促进慢性糖尿病足溃疡的愈合,治疗12周时就可实现超过50％的完全愈合结果;2）MEBO组患者治疗24周后的截肢率也明显下降。     

Level of Education and Gender-specific Self-reported Oral Health Behavior Among Dental Students

Purpose: To identify the oral health attitudes/behaviour among dental students in Jordan, and analyse the variations in oral health attitudes based on gender and level of education. Materials and Methods: Out of the 653 registered dental students at the faculty of dentistry, 580 students (455 females and 125 males, mean age = 20.1 ± 1.6 years) participated in the study (response rate 89%). The Hiroshima University-Dental Behavioural Inventory (HU-DBI) was used to assess oral heath attitudes and behaviour of the participants. Data were analysed using the chi-square test, and statistical significance was set at P < 0.05. Results: Females had better oral health attitudes and behaviour, especially towards visiting the dentist, toothbrushing habits and oral hygiene practice (P < 0.05). Also, students from the higher years had better oral health attitudes, behaviour and knowledge, especially towards gingival health, oral hygiene practice, toothbrushing and visiting the dentist (P < 0.05). Conclusion: Dental students in Jordan had poor oral health attitudes and behaviour. Females had better oral health knowledge, attitudes and behaviour than males. With increasing years of study, some aspects of dental students' oral health behaviour and attitudes improved. However, this improvement was limited and students should be encouraged to become an example of oral health for their society. Better comprehensive dental education with early exposure to dental health and prevention was suggested to improve dental students' oral health attitudes and behaviour.     

Differential expression of interferon gamma by mitogen-stimulated peripheral blood mononuclear cells among Kuwaiti psoriasis patients

Most diseases exhibit characteristic profiles of cytokine expression, broadly subdivided into Th1, involving primarily cell-mediated responses, of which Interferon-gamma (INF-gamma), Interleukin-2 (IL-2) and Tumor Necrosis Factor-alpha (TNF-alpha) are hallmarks, and Th2 processes, which often involve activation of the humoral arm of the immune system, resulting in elevated levels of IL-4, IL-5 and IL-10. Psoriasis, a disorder characterized by disfiguring skin lesions and elevated levels of activated CD4+ T helper lymphocytes in both peripheral blood and lesional tissue, exhibits a profile of cytokine expression that includes high levels of TNF-alpha and IFN-gamma, with low IL-5 and IL-10, indicating that immunologically, the pathogenesis of the disease is Th1. In this study, we report the results of an investigation of peripheral blood mononuclear cell cytokine expression among Kuwaiti psoriasis patients; we demonstrated two patterns of IFN-gamma production which may suggest differing pathogeneses. Whole, haparinized blood was donated by 17 patients with active psoriasis and 11 healthy control subject. Mononuclear cells were isolated by density centrifugation and cultured for 3 days in the presence or absence of a mitogen (PHA). Supernatants were assayed for IFN-gamma (a Th1 marker) and IL-10 (a Th2 marker) by enzyme-linked immunoabsorption assay (ELISA). IFN-gamma expression by both PHA-stimulated and unstimulated cultures from psoriatics significantly exceeded that of controls (p < 0.001), whereas no significant differences in IL-10 expression were noted between psoriatic and control subjects. Stimulation indices (cytokine concentration in PHA-stimulated/unstimulated cultures, SI) for psoriatic subjects were significantly higher than those of controls for IFN-gamma (p = 0.000), but not for IL-10. Ratios of SI (SI IFN-gamma/SL IL-10) for the psoriatic subjects also were significantly greater for the psoriatic subjects than for the controls (p = 0.003). However, within the psoriatic group, eight patients failed to show the expected elevation of IFN-gamma/IL-10 ratio as a result of high unstimulated levels of IFN-gamma production. The divergence of IFN-gamma expression within the psoriatic group may indicate two different modes of T lymphocyte activation contributing to the pathogenesis of psoriasis in this study.     

Experimental induction of rough dermatitic skin in humans

The response after application of various concentrations of sodium lauryl sulfate (SLS) on human skin is reported. The induced changes associated variable degrees of roughness and erythema characterizing rough dermatitic skin (RDS). These clinical changes were almost invariably (less than 5% experimental error) associated with increased values of transepidermal water loss (TEWL) and increased cutaneous blood flow values (CBFV). A significant positive correlation was found between TEWL and CBFV at all concentrations of SLS. However, values of TEWL higher than those found in 84% of the controls (mean + SD: 8.127 + 2.89 gr/m2/h) were usually significantly correlated with clearcut clinical changes (total clinical score greater than 2 or erythema greater than 1) at all concentrations of SLS, while CBFV (mean + SD of controls: 2.717 + 2.165) which had a wider dispersion, were significantly associated only with erythema after 10% and 1% SLS. This reflects the distinction that is being made between a primary chemical insult, which we identify clinically as roughness and functionally as increased TEWL associated with alterations of barrier function of the skin, and a secondary, delayed inflammatory response, which is clinically recognized as erythema and functionally objectivated by increased CBFV. These results provide a rational basis supporting the use of this experimental model of RDS for testing of preventive and therapeutic efficacy as well as refining the evaluation of tolerance of cosmetics especially designed for use on sensitive skin.     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

1. Download : Download high-res image (331KB)
2. Download : Download full-size image

     

Significance of matrix metalloproteinase 9 and CD34 expressions in esophageal carcinoma: correlation with DNA content

BACKGROUND: Esophageal carcinoma is common in many countries, and it is characterized by poor prognosis and rapid clinical progression with a high frequency of lymph node metastasis and recurrence. The present study was carried out to evaluate the correlation between vascular endothelial cell marker (CD34), matrix metalloproteinase type 9 (MMP9), and DNA content in esophageal carcinoma. METHODS: A total of 38 patients were classified with histopathologic examination as 8 cases with adenocarcinoma, 24 cases with squamous cell carcinoma, and the last 6 cases with undifferentiated carcinoma. The obtained results of the patient group were compared with the results of 6 cases with proven normal esophageal mucosa as a control group. The samples of patients and controls were subjected to immunohistochemical evaluation of CD34 and MMP9 expression along with DNA index determination using flow cytometry. RESULTS: There was a significant difference between patients and normal cases in DNA index, CD34, and MMP9 pattern (P = 0.003, <0.001, and 0.002, respectively). DNA index was positively correlated with MMP9 (r = 0.574, P < 0.001) and with CD34 (r = 0.562, P < 0.001). MMP9 was correlated with CD34 (r = 0.55, P < 0.001). A significant difference was found in both microvessel density and MMP9 expression with respect to tumor grade and stage. The microvessel density in patients with highly positive staining for MMP9 was higher than in those with negative and weak staining for MMP9 (P = 0.002). CONCLUSION: The analysis of DNA content along with detection of CD34 and MMP9 in esophageal cancer can successfully differentiate the different pathologic lesions and hence can be used powerfully in disease prognosis reflecting valuable information about the aggressiveness and activity of those lesions.