Abdelrahman

Evaluation of simian virus-40 as a biological prognostic factor in Egyptian patients with malignant pleural mesothelioma

The association between simian virus (SV40) and malignant pleural mesothelioma (MPM) suggests an etiological role for SV40. However, exact pathogenetic mechanisms and possible prognostic value are not clear. The purpose of the present paper was to investigate 40 Egyptian MPM patients for the presence of SV40 DNA, altered Rb expression and p53 gene status using immunohistochemistry and molecular techniques. The relation between SV40, asbestos exposure, Rb, p53 and their contribution to the overall survival (OS) were also assessed. SV40 DNA was detected in 20/40 patients and asbestos exposure in 31 patients; 18 of them were SV40 positive. Altered p53 and Rb expression were detected in 57.5% and 52.5%, respectively, with no p53 mutation. Univariate analysis showed a significant correlation between OS and stage (P = 0.03), performance status (P = 0.04), p53 overexpression (P = 0.05), asbestos exposure (P = 0.002) and SV40 (P = 0.001). Multivariate analysis showed that when SV40 and asbestos exposure were considered together, only combined positivity of both was an independent prognostic factor affecting the OS (P = 0.001). SV40 and asbestos exposure are common in Egyptian MPM, denoting a possible etiological role and a synergistic effect for both agents. Combined positivity for SV40 and asbestos exposure is an independent prognostic factor in MPM, having a detrimental effect on OS.

Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon's view.

BACKGROUND AND PURPOSE The incidence of retrosternal goiter (RSG) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria. There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach. PATIENTS AND METHODS Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed. RESULTS The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p<0.0001. CONCLUSION Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

Comparative study on the analgesic effect of acute ipsilateral shoulder pain after open thoracotomy between preoperative ultrasound guided suprascapular nerve block (SNB) and intraoperative phrenic nerve infiltration (PNI) in cancer lung patients

INTRODUCTION Acute ipsilateral shoulder pain (ISP) is a common complaint in patients after thoracotomy. The incidence ranges from 21% to 97%. Unfortunately, clinical studies did not put enough focus on ISP post thoracic surgery. AIM OF THE WORK This study was designed to compare the effectiveness of suprascapular nerve block (SNB) and phrenic nerve infiltration (PNI) for controlling ISP. PATIENTS AND METHODS One hundred and thirty-five lung cancer patients (135) scheduled for open-lung surgery were randomly allocated into three equal groups; control group: received thoracic epidural with general anesthesia, suprascapular group: (SNB) one hour before the operation with 10 ml bupivacaine plus thoracic epidural with general anesthesia and phrenic nerve group: (PNI) was performed by the operating surgeon with 10 ml bupivacaine plus thoracic epidural with general anesthesia. The visual analogue score (VAS) of ISP, rescue of ketorolac for break through shoulder pain, peak expiratory flow rate (PEFR) and arterial blood gases were measured every 6 h postoperatively for 48 h. RESULTS The VAS, rescue doses of ketorolc and PEFR were significantly lower in the phrenic nerve group (P-value <0.05). There was no statistically significant difference between the three groups postoperatively as regards arterial blood gases (P-value >0.05). CONCLUSION PNI is more effective than SNB for ISP.

Abstract 687: Enhanced expression of multidrug resistance (MDR) protein in malignant pleural mesothelioma (MPM) patients is possibly achieved viaOsteoponin, CD44variants andp-AKTexpression

Malignant pleural mesothelioma (MPM) is an aggressive disease, which is discovered late. It is resistant to chemotherapy and thus shows a dismal prognosis. Recently, in vitro studies demonstrated that osteoponin (is involved in the development of MPM via induction of multidrug resistance through unidentified mechanism(s). Tissue and serum samples from 55 Egyptian cases of MPM were assessed for OPN, MDR, p-AKT and CD44 proteins and RNA by ELISA, immunohistochemistry (IHC) and RT-PCR. Normal pleural samples (20) were used as a control. Results were correlated with standard prognostic factors and survival. In tissues, OPN, CD44, MDR and p-AKT protein overexpression was detected in 39, 26, 37 and 25 cases; respectively whereas RNA expression was reported in 31, 24, 30, 24 cases; respectively. In sera, OPN, CD44, MDR and p-AKT proteins were found in 36, 20, 40, 28 cases; respectively. There was a significant correlation between OPN expression and other markers, at the protein and RNA levels (p In conclusion, OPN, CD44, and p-AKT could be used as poor prognostic markers in MPM being associated with reduced OS rates and poor response to treatment. This could be achieved via enhanced MDR expression with subsequent resistance to chemotherapy. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 687. doi:10.1158/1538-7445.AM2011-687

Carcinoma of the superior pulmonary sulcus: Results of multidisciplinary treatment

Background:  Superior sulcus tumors are a complex subset of tumors accounting for less than 5% of lung tumors.