Adel El-Badrawy

Stridor as the First Presentation of Metastatic Breast Cancer that Was Managed with Chemotherapy: a Case Report

Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a case of metastatic breast cancer to the deep cervical lymph nodes that caused stridor due to compression of the recurrent laryngeal nerve which was diagnosed by indirect laryngoscopy. After full investigations, urgent chemotherapy was started and it showed a dramatic response with disappearance of the lymph node after two cycles with resolution of the stridor. This report also highlights the association of other metastatic sites with this higher level of neck nodal metastases of breast cancer.

Multi-detector Computed Tomography (MDCT) Findings of Chemotherapy-Induced Cardiopulmonary Changes

Purpose: To evaluate the role of multi-detector computed tomography (MDCT) in detection & characterization of chemotherapy-induced cardiopulmonary changes. Materials and Methods: This retrospective study included 400 patients with confirmed 14 extrapulmonary malignancies and treated by standard chemotherapy regimens. Of the 400 patients, 234 complained of Non Hodgkin lymphoma (NHL). Thirteen other types of malignant tumors were enrolled in our study. All patients underwent CT scan using 64 MDCT scanner (Brilliance 64, Philips) before chemotherapy and 6 months after the last session of chemotherapy. Chest CT scans were evaluated for ground-glass opacities (GGO), fibrosis, consolidation, nodules, pleural effusion, cardiac dilatation, pericardial effusion and pulmonary embolism. Results: Cardiopulmonary chemotherapy-induced changes detected in 36/400 patients. The most Original Research Article Helmy et al.; JCTI, 3(2): 1-10, 2016; Article no.JCTI.23439 2 common finding was pneumonic consolidation detected in 18/36. GGOs, fibrotic bands, pleural effusion and pericardial effusion were detected in 10/36, 6/36, 6/36 and 2/36 respectively. More than one finding detected in 6 patients. These changes completely resolved on follow-up without medication. Conclusion: MDCT can accurately detect and evaluate cardiopulmonary chemotherapy-induced changes, differentiate these changes from disease progression and /or superadded pathology. Pneumonic consolidation is the commonest finding. Awareness of chemotherapy-induced cardiopulmonary changes can help the radiologist to detect these at early stages, which helps in appropriate management.

Transvaginal Bilateral Uterine Artery Occlusion for Treatment of Symptomatic Uterine Myomas: An Effective Modality in Low Resource Settings

Objective: To study the effectiveness and safety of bilateral uterine artery occlusion through the vaginal approach as an alternative treatment modality for symptomatic uterine myomas. Methods: Sixty-nine premenopausal women with symptomatic uterine leiomyomata were studied. None of them desired further pregnancy underwent bilateral vaginal uterine arteries occlusion. The primary outcome measures were patient satisfaction as regards menstrual blood loss compared with pre treatment loss and operative duration. Secondary outcome measures included postoperative pain, complications, secondary interventions, and failures. Results: Sixty-three women were completed follow up till 24 months after the procedure. The primary outcomes were encouraging as regards patient satisfaction for post treatment blood loss (90.7 %) and mean operative duration ( 35 ±9.5 minutes). After 6 months of follow-up, 6 patients resumed heavy periods and interventions needs secondary. Conclusion: Trans-vaginal occlusion of uterine arteries improved clinical symptoms in the majority of patients.

Chronic hepatitis C genotype 4 infection and interstitial pulmonary fibrosis: is there any association?

Background Chronic hepatitis C (CHC) is associated with multiple extrahepatic manifestations, including the recently recognized effect on pulmonary function tests (PFTs) and lung parenchyma. Aim To evaluate changes in PFTs and lung parenchyma in asymptomatic Egyptian patients with a CHC infection. Patients and methods This cross-sectional study included 70 CHC patients. All patients were subjected to a liver biopsy. Fibrosis stage and activity grade were assessed according to the METAVIR scoring system using scale ranges from 0 to 4. All patients were subjected to PFTs, measurement of arterial blood gases, and high-resolution computed tomography (HRCT) of the chest. All smokers, obese (BMI≥30) patients, and patients with known pulmonary disease were excluded. Results An alteration in PFTs was observed in 29 (41.42%) patients out of 70. A restrictive pattern was found in 27 patients (38.57%), in whom forced vital capacity and the total lung capacity values were reduced to less than 80% of the predicted values. Forced expiratory volume in 1 s/forced vital capacity value was more than 70%. Also, HRCT of the chest showed interstitial pulmonary fibrosis (IPF) with either an interstitial or an alveolar pattern with a total score not exceeding 2. These findings correlated significantly with the PFTs results. Also, there was no significant correlation between the presence of a restrictive pattern in PFTs or IPF in HRCT with other parameters in terms of age, BMI, sex, liver fibrosis, activity score, level of viremia, and duration of disease. Conclusion Hepatitis C virus could be a trigger factor for alterations in PFTs and lung parenchyma in the studied asymptomatic Egyptian patients with a CHC genotype 4 infection. HRCT could be a sensitive, noninvasive method for the early detection of IPF in these patients.