Technology insight: Enteral stenting and new technology

Self-expandable metal stents (SEMS) have gained acceptance for use in the gastrointestinal tract in order to relieve malignant luminal obstruction. In the upper gastrointestinal tract SEMS are used as an alternative to surgical bypass for palliation of malignant gastric-outlet obstruction. In the colon, SEMS are used to avoid colostomy during palliation and as a bridge to surgery for left-sided colonic obstruction. Enteral SEMS appear to be cost effective. This article reviews the latest in stent technology as well as the outcomes following their placement.     

Subacute sclerosing panencephalitis. Study of 32 cases observed in Conakry, Guinea

Thirty two cases of subacute sclerosing panencephalitis were reported. Diagnosis was based on epidemiological, clinical and electroencephalographic data; myoclonies and alterations of intellectual functions were the most frequent symptoms.     

Comparative analysis ofp53 protein immunoreactivity in prostatic,lung and breast carcinomas

Summary In this study we analysed the expression ofp53 protein in a total of 143 carcinomas immunohistochemically. These consisted of 34 prostatic adenocarcinomas, 59 lung and 50 breast carcinomas. In 28 cases, an average of 2–3 additional sections from different tumour areas were analysed. Forty-nine of the 143 carcinomas (34%) showed typical nuclear immunoreactivity by immunohistochemical staining with thep53 antibody CM-1. Two of the 34 prostatic carcinomas (6%) werep53 positive while 25 of the 59 lung carcinomas (43%) and 22 of the 50 breast carcinomas (44%) showed positivity forp53. By grade: 49% of grade III tumours, 36% of grade II and 5% of grade I tumours werep53 positive. There were significantly morep53-positive cases in grade II–III tumours than in grade I tumours (P= 0.001) when all tumours were taken into account. Further, there were significantly morep53-positive cases in grade III than in grade I–II tumours (P=0.001). In lung tumours there were significantly morep53-positive cases in grade II–III tumours than in grade I tumours (P=0.018). Similarly, there were significantly morep53-positive tumours in grade III breast tumours than in grade I–II tumours (P=0.003). The low incidence ofp53 positivity in prostate carcinomas suggests that mutations of thep53 gene are not as frequent in the neoplastic transformation of these tumours as in lung or breast carcinomas. The association ofp53 positivity with tumours of higher grade suggests thatp53 mutations lead to tumours of a more aggressive type. The analysis of tumours by multiple sections indicates thatp53 positivity is not evenly distributed in tumour tissue. Therefore, analysis of additional tumour areas may reveal positivity some cases, which is not evident if only one section is studied.     

Sciatic nerve in gluteal portion: application of sciatic nerve post injection lesion

In our regions malaria is endemic and intraguteal injection is a common procedure. One unfortunate complication of that procedure appeared to be a sciatic nerve injury. The purpose of our study was to set up the anatomical feature and basis of this post injection lesion. We performed sciatic nerve gluteal dissection on 10 adults black African fresh cadavers on both side. The pathway of the nerve was 19 times in the subpiriformis canal. Only in one cadaver, the outlet of the nerve was above the piriformis muscle. In each case the pathway is identical with an oblique and vertical portion running down through the ischio-trochanteric channel. The nerve was crossed between its two portions by an arteriole coming from the inferior gluteal artery. The cutaneous projection of the sciatic nerve is distant from the upper lateral quadrant of the buttock. Intra-gluteal injections in this area doesn't damage the nerve. The anatomical variations of this nerve pathway are almost nonexistent. So, other hypothesis of sciatic nerve post injection lesion should be considered. We think that the local toxicity of quinine and its diffusion in the neurovascular gluteal area might explain the nerve lesion. Thus, the intramuscular injections should be replaced by the intravenous or rectal administration in children.     

Lowp53 protein expression in salivary gland tumours compared with lung carcinomas

Summary Fifty-one salivary gland tumours (23 pleomorphic adenomas, 5 Warthin's tumours, 12 mucoepidermoid carcinomas, 7 adenoid cystic carcinomas, 3 undifferentiated carcinomas and 1 acinic cell tumour) and 27 lung carcinomas (18 squamous cell carcinomas, 6 adenocarcinomas and 3 small cell carcinomas) were analysed immunohistochemically for the expression ofp53 nuclear phosphoprotein. Eight out of 51 (16%) salivary gland tumours werep53 positive. Three of these were benign and 5 malignant. All 3 benign salivary gland tumours were pleomorphic adenomas and expressed only occasional nuclear positivity with less than 1% of tumour cells positive. Of the 5p53-positive malignant tumours, 3 were mucoepidermoid carcinomas and 2 undifferentiated carcinomas. The malignant salivary gland tumours expressed more than 1% of positive nuclei in every case. Seventeen lung carcinomas werep53 positive (63%). Thirteen of these were squamous cell carcinomas, 3 were adenocarcinomas and 1 small cell lung carcinoma. The results show that mutations of thep53 gene may be infrequent in salivary gland tumours when compared with lung carcinomas. The relatively indolent course of some histological types of malignant salivary gland tumours could be associated with the preservation of the non-mutatedp53 gene in most of these tumours. The presence ofp53 positivity in some pleomorphic adenomas might, on one hand, suggest thatp53 gene alterations are also present in these tumours; on the other hand, the accumulation of thep53 protein in these tumours might also be due to some unknown mechanism, not necessarily related top53 gene mutation.     

Validation of the indirect TaSP enzyme-linked immunosorbent assay for diagnosis of Theileria annulata infection in cattle

An ELISA based on a recombinant Theileria annulata surface protein (TaSP) was evaluated for detection of antibodies in sera from cattle exposed to tropical theileriosis in Sudan. The reference positive samples, used in this study, were from Theileria-infected populations and consisted of 80 cattle from an endemic area in Khartoum State, with high antibody titers in the indirect fluorescent antibody test (IFAT). The reference negative samples were taken from non-exposed populations and consisted of 120 cattle maintained under strict tick control at a commercial farm in Sudan. The cut-off value determined by Two-Graph Receiver-Operating Characteristic (TG-ROC) curves was set at 31.6%, based on the positive reference samples. Further diagnostic validation was performed, which consisted of the measurement of the area under the ROC (AUC) and by valid range proportion (VRP), which was 0.97 and 0.98 for the cut-off, respectively. There were no cross-reactions with antibodies raised against Babesia spp. It is concluded that the TaSP ELISA is a useful test for the diagnosis of T. annulata infection in cattle under field conditions.Omer E. Shariff Deceased.     

Comparisons of human-landing catches and odor-baited entry traps for sampling malaria vectors in Senegal

A comparative study of human-landing catches (HLCs) and odor-baited entry traps (OBETs) for sampling malaria vectors was conducted in two different bioclimatic areas of Senegal, the Sahelian and Sudano-Guinean phytogeographic zones, from September to December 2002. Mosquitoes were collected by the two methods both indoors and outdoors. The reliability of OBET samples was tested by comparing the two methods. Overall, HLC was more effective indoors and for surveying the anopheline fauna. Both methods were effective in sampling the four known malaria vectors in Senegal [Anopheles gambiae s.s., An. arabiensis Patton, An. funestus Giles, and An. nili (Theobald) ], and mosquito age structures and infectivity rates did not differ between methods.     

Facteurs liés au diagnostic tardif des cancers du sein en Afrique-sub-saharienne : cas de la Côte d’Ivoire

ObjectiveTo identify in Ivorian environment, reasons involved in late diagnosis of breast cancer.Patients and methodsRetrospective study over 4 years (January 2008 to December 2011) including 350 patients with breast adenocarcinoma. A questionnaire was created and filled according to the medical files of the patients. Linear regression analysis applied to the data showed concordance between the factors and the delay before diagnosis.ResultsThus 78.9% of the patients sought for care above 10 months with inflammatory cancers (54%) and necrotic ulcerations (18%). Factors found during interview were the lack of financial means (36%), cultural habits with first intent traditional treatment (41.1%), misdiagnosis (7.1%) and lack of therapeutic care. Yet, when comparing each of these factors to the delay, no significant link was found. Chemotherapy was the first therapeutic method.ConclusionIn our context, the conjunction of ignorance, poverty and socio-cultural habits were the key factors in late diagnosis of breast cancers in Côte d’Ivoire.