Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143122120160101THE SIGNIFICANCE OF CLAUDIN-1 AND S100A4 EXPRESSION IN PRIMARY COLORECTAL CARCINOMA114458710.21608/zumj.2016.4587ENRandaKafPathology Department, Faculty of Medicine, Zagazig University, EgyptEssamSabaPathology Department, Faculty of Medicine, Zagazig University, EgyptWafaaRefaatAmiraBahgatJournal Article20171212Background: Metastasis is a major cause of death in colorectal carcinoma (CRC). Epithelial to mesenchymal transition (EMT) plays a role in promoting carcinoma invasion and metastasis. Many molecules are crucial in EMT, including claudin-1 and S100A4.<br />Aim of work: The aim of this study is to assess the pattern of expression and the prognostic significance of claudin-1 and S100A4 in primary colorectal carcinoma.<br />Methods: Claudin-1 and S100A4 expressions were retrospectively analysed by immunohistochemistry in 55 paraffin-embedded specimens of patients with primary colorectal carcinoma. The expressions were correlated with clinicopathological variables, Dukes staging and lymph node metastasis.<br />Results: Normal colonic and rectal mucosa exhibited diffuse, strong circumferential linear membranous pattern of claudin-1 staining (score 0). Twenty six cases (65%) of primary colorectal carcinomas showed decreased claudin1 expression compared to normal mucosa and 14 cases (35%) showed similar claudin1 expression (score 0). None of the studied cases showed increased claudin1 expression. A highly statistically significant relationship was found between claudin1 expression and Lymphovascular invasion (p=0.003), degree of lymphocytic infiltration, peritumoral budding, lymph node ratio, lymph node metastasis and Dukes staging (p<0.001). Fourteen cases (35%) showed negative S100A4 expression (score 0-2), 10 cases (25%) showed mild positive S100A4 expression (score 3), 9 cases (22.5%) showed moderate positive S100A4 expression (score 4-5) and 7 cases (17.5%) showed marked positive S100A4 expression (score 6). A highly statistically significant relationship was found between S100A4 expression and grade of differentiation, lymphovascular invasion (p=0.002), lymphocytic infiltration, peritumoral budding, lymph node metastasis, lymph node ratio and Dukes staging (p<0.001). By Pearson's correlation coefficient (r) method, there is a strong inverse correlation between claudin1 and S100A4 expression.<br />Conclusions: Loss of tight junctions represented by decreased claudin1 expression and acquisition of mesenchymal properties represented by S100A4 overexpression are important in primary colorectal carcinoma progression and metastasis.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143122120160101ANTIOXIDANT AND ANTIAPOPTIC EFFECTS OF COMBINED SIDR HONEY AND NIGELLA SATIVA OIL AGAINST PARACETAMOL-INDUCED HEPATO-NEPHROTOXICITY IN RATS112458810.21608/zumj.2016.4588ENMohamedAbdallahPhysiology Department, Faculty of Medicine, Menoufeya University, EgyptMohamedAliPhysiology Department, Faculty of Medicine, Menoufeya University, EgyptMohamedKelanyClinical Pharmacology Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20171212Background: Acetaminophen (Paracetamol; PCM), commonly utilized as analgesic and antipyretic drug in many painful and febrile disorders, has been found to induce liver and renal disorders in both animals and humans. Its administration in a high dose causes hepatic and renal toxicities and results in hepato-renal cell deaths by activating multiple stress pathways. Objective: This study aimed to investigate and compare effects of Sidr honey (SH), Nigella sativa oil (NS) and their combination on the paracetamol (PCM)-induced hepato-renal toxicities in rats.<br />Methods: Forty male adult albino rats were divided into five groups and treated for 4 weeks (n= 8 each): (1) the control group; receiving distilled water orally, (2) PCM-treated; receiving single high dose PCM (SHDP) of 1 g/kg once orally, (3) NS- and PCM-treated (NS/P); receiving NS in the dose of 2 ml/kg/day orally, and at the end of NS-treatment, the same single PCM dose is given, (4) SH- and PCM-treated (H/P); receiving SH in the dose of 1 g/kg/day, and at the end of SH-treatment, the same PCM dose is given, (5) SH-, NS- & PCM-treated (H&NS/P) group; receiving SH and NS orally in the same doses, and at the end of treatments, the same PCM dose is given. Serum alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine, total antioxidative capacity (TAC) and Fas ligand (Fas L), and liver tissue TAC were measured after sacrificing the rats at the end of experiment.<br />Results: Compared to control group, the SHDP-treated rats developed significant increases in serum ALT, AST, BUN, Creatinine and Fas l, and decreases in serum and liver tissue TAC. SH, NS or more effectively the combined H/NS/P treatments produced significant decreases in serum ALT, AST, BUN, Creatinine and Fas l, and increases in serum and liver tissue TAC when compared with SHDP-treated rats. Conclusion: These findings suggested that oral combined SH and NS administration is more protective against PCM-induced hepato-renal toxicity in rats than using each of them alone. The collective data demonstrated that SH and NS have considerable ability to protect against oxidation, apoptosis, and other harmful effects of PCM in rats.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143122120160101EVALUATION OF METHOTREXATE IN THE MANAGEMENT OF UNDISTURBED TUBAL ECTOPIC PREGNANCY111458910.21608/zumj.2016.4589ENMostafaZaitounObstetrics and Gynecology Department, Faculty of Medicine, Zagazig UniversityHossamIbrahimObstetrics and Gynecology Department, Faculty of Medicine, Zagazig UniversityHalaEl SayedObstetrics and Gynecology Department, Faculty of Medicine, Zagazig UniversitySamahAliObstetrics and Gynecology Department, Faculty of Medicine, Zagazig UniversityJournal Article20171212Background: Ectopic pregnancy is a pregnancy with the zygot implanted out side the endometrium of the uterine cavity. 95% of ectopics are in the tube, 1.5% abdominal, 0.5% ovarian and 0.03% are in the cervix. EP can be diagnosed by serial quantitive beta subunite of human chorionic gonadotrophin hormone and transvaginal ultrasound. Methotrexate injtion give high success rates (86 to 94%) that are not skill-dependent and has become a standard medical treatment in appropriate patients. The best suitable cases for MTX therapy for undisturbed ectopic pregnancy are those who are not suffering symptoms, have a blood level of Q B-hCG of less than 5000 mIU/ml, tubal size less than 3.5 cm, no fetal cardiac activity on US, and will come in to be followed closely. MTX is typically given by injection and this method increases absorption of all of the medicine. Common side effects of MTX treatment for undisturbed EP include: abdominal pain, vaginal bleeding, nausea and vomiting and dizziness. Women diagnosed with an EP were considered candidates for treatment with MTX injection if they were hemodynamically stable, did not have free fluid outside the pelvic cavity on US examination, did not desire surgery and agreed to weekly follow-up visits until the level of serum Q B- hCG was fifty mIU per ml or lower. Aim of the work: To evaluate the fate of undisturbed tubal EP after injection of MTX. Patients and methods: This prospective study was carried out at the Department of Obstetrics and Gynecology, Zagazig University Hospitals on 54 women with undisturbed EP. The women were informed regarding the treatment and were consented. We gave single dose of MTX (50 mg/m2 of body surface area) to the patients. Q B-hCG were followed on day one (injection day), day four and on day seven. We administered 2nd dose of MTX if the level of quantitive of beta subunite on seventh day had not decreased by at least twenty five percent from the first day level and the protocol was repeated. If decrease in quantitive beta subunite between days four and seven was less than fifty percent, asecond dose of MTX (50 mg/m2) was given. Weekly measurements were continued until the quantitive beta subunite is undetectable. If quantitive beta subunite falls < fifty percent between weekly measurements after third dose, we perform laparoscopic salpingostomy or salpingectomy. Results: In current study the level of Q B-hCG in the studied cases pre-injection ranged from 397 to 7102 mIU/ml, its mean was 4231.9 ± 2210.3.4th day level ranged from 107 to 7400 and its mean was 3881.7 ±2317.6 mIU/ml. 7th day level ranged from 30 to 7900 mIU/ml and its mean was 2566.9 ±2145.6 mIU/ml.The success rate in the current study was 83.3% classified as follow:44 patients (81.48%) recived single dose of MTX. 10 patients (18.52%) recived multiple doses one week a part ( need prolonged follow up that exceeded 30 days). 6 patients (11.1%) had laparoscopic management and 3 patients (5.6%) had urgent laparotomy. Conclusion: There is no pathognomonic pain or findings on examination that are diagnostic for tubal pregnancy.Also the diagnosis of tubal pregnancy ,as early as 6-7 weeks postmenstrual by screening of all suspected pregnancies may be the key for optimal use of medical treatment. Transvaginal ultrasound and serial quantitive beta subunite are highly successful in early detection of EP.Medical management by methotrexate injection is safe and cost effective for the reolution of ectopic pregnancy proplem.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143122120160101IMPACT OF MYOCARDIAL BLUSH ON LEFT VENTRICULAR REMODELING IN PATIENTS TREATED SUCCESSFULLY WITH PRIMARY OR RESCUE CORONARY INTERVENTION110459010.21608/zumj.2016.4590ENMohamedAboulEninCardiology Department, Faculty of Medicine, Zagazig University.;MahmoudAlmenshawyCardiology Department, Faculty of Medicine, Zagazig University.;ElsayedFaragCardiology Department, Faculty of Medicine, Zagazig University.AzzaNasifCardiology Department, Faculty of Medicine, Zagazig University.Journal Article20171212Background: Myocardial blush grade (MBG) in patients treated successful primary or rescue percutaneous coronary intervention (PCI) for anterior ST elevation myocardial infarction (STEMI) is a good indicator of microvascular reperfusion that may impact left ventricular (LV) remodeling.<br />Methods: this study included 60 consecutive patients suffered from anterior STEMI whom primary or rescue PCI were done , we evaluate MBG after primary or rescue PCI immediately . For each patient transthoracic echocardiography was done at 24 hours and repeat after 6 months after PCI for evaluation of LV function and volumes.<br />Results: patients with myocardial reperfusion MBG ( II-III) after primary or rescue PCI was associated with a highly significantly lower rate of remodeling than the absence of myocardial reperfusion MBG (0-1) (12.1% vs. 75 %, P <0.001). also, after 6 months, patients with MBG ( II-III) had significantly smaller LV end-diastolic volume (99 ± 23 vs. 113 ± 27 ml) compared with patients with MBG (0-1). LV remodeling was defined as an increase in end-diastolic volume (LVED) by more than 20%.<br />Conclusions: Microvascular reperfusion impairment , that assessed by MBG (0-1) in patients with STEMI treated successfully with primary or rescue PCI may be associated with LV dilatation and remodeling.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143122120160101TRANS-ABDOMINAL PREPERITONEAL AND TOTALLY EXTRAPERITONEAL LAPAROSCOPIC INGUINAL HERNIA REPAIR :A COMPARATIVE STUDY114463610.21608/zumj.2016.4636ENAbd Al-RahmanNawarDepartment of general surgery, Faculty of medicine, Zagazig university, EgyptTarekAbd El-LatifDepartment of general surgery, Faculty of medicine, Zagazig university, EgyptWaelLotfyDepartment of general surgery, Faculty of medicine, Zagazig university, EgyptJournal Article20171217Background: Laparoscopic repair of inguinal hernia repair has added to the ongoing debate over the ‘‘best groin hernia repair.’’ There are two basic laparoscopic techniques, trans-abdominal pre-peritoneal (TAPP) and total extraperitoneal (TEP). Our study was carried out to compare these two methods of laparoscopic inguinal hernioplasty. Methods: This prospective randomized study was carried out in Surgery Department of Zagazig university hospitals between October 2013 and October 2015 and included 30 patients presenting with primary uncomplicated inguinal hernia. Patients were serially numbered and randomly arranged into two groups; group (A) as TAPP included 15 patients with odd number and group (B) as TEP included 15 patients with even number. All patients were admitted through the outpatient clinic and subjected to detailed history , clinical examination and laboratory work up. Results: Both groups were comparable regarding their demographic profile and hernia characteristics. The majority of hernias were indirect and left sided in both groups. The mean operative time was significantly longer in TAPP group compared to TEP group ( p= 0.045). No major intraoperative complications were recorded apart from minor complications in the form of injury of the inferior epigastric artery ( p= 0.67), pneumoscrotum ( p= 0.62) and surgical emphysema ( p= 0.67) with no significant difference between both groups. Postoperative pain scores recorded the day of surgery were significantly higher in TAPP group patients (p= 0.043) when compared to those in TEP group. They did not however differ significantly between the TEP and TAPP repairs in the 1st postoperative day (p= 0.404). No persistent or serious postoperative complications were recorded apart from mild complications in the form of subcutaneous seroma in the early postoperative period ( p= 0.794) with no significant difference between both groups. The mean postoperative hospital stay was significantly longer in TAPP group compared to TEP group ( p= 0.033) . The mean time interval before return to full activities was significantly longer in TAPP group compared to TEP group ( p= 0.038) . Conclusion: Based on this study, laparoscopic TEP and TAPP repair of inguinal hernia is safe and efficacious. we can conclude that TEP was far better procedure compared to TAPP. According to mean operative time, post-operative pain, post-operative hospital stay and return to normal work, all were far better than TAPP.