Ahmed Mansour

Case Report: Conservative Treatment of Liver Injury during Percutaneous Nephrolithotomy

Liver injury during percutaneous nephrolithotomy (PCNL) is very rare and is usually overlooked. In this report, we present a case of inadvertent liver injury during right supracostal PCNL and describe diagnostic tools, conservative management measures, and outcome. A literature review of potential risk factors and suggested techniques to avoid injuring the liver during PCNL is also presented.

Assessment of Bcl-2 Expression as Modulator of Fas Mediated Apoptosis in Acute Leukemia

Abstract Apoptosis is the primary mechanism through which most chemotherapeutic agents induce tumor cell death. The balance in the expression of pro (Fas/CD95) and anti-apoptotic protein (Bcl-2) may control the response of leukemic cells to chemotherapy and subsequently affect the patients prognosis. The aim of this study was to determine the levels of Bcl-2 and Fas expression on blast cells from patients with acute leukemia and to correlate the degree of expression to the clinical and laboratory prognostic factors and the patients outcome. Forty newly diagnosed patients with acute leukemia (16 ALL, 24 AML) were included in the study. Ten normal subjects of matched age and sex were studied as a reference control group. The degree of Bcl-2 and Fas expression on acute leukemia blast cells were assessed before the start of therapy and on mononuclear cells after 1 year of follow up, using flow cytometry. The degree of Bcl-2 and Fas expression were significantly higher in AML (P<0.01,<0.05, respectively) and ALL (P<0.01, <0.05, respectively) as compared to controls. The expression of Fas and Bcl-2 was related to FAB type with the highest Bcl-2 and lowest Fas expression in M5 and T-ALL (P<0.01, for all). In ALL, patients responding to induction chemotherapy revealed lower Bcl-2 and higher Fas expression when compared to non-responders (P<0.05). In contrast, in AML the difference between responders and non-responders to induction chemotherapy regarding Bcl-2 and Fas expressions was not statistically significant (P>0.05). Bcl-2 and Fas expression were significantly elevated in the relapsed acute leukemia group (in both AML and ALL) when compared to those in remission (P<0.01, <0.05, respectively). Bcl-2 and Fas expression at diagnosis was not significantly different when those surviving were compared to the group who had died, either in the ALL or AML groups (P>0.05). Bcl-2 expression was significantly correlated to bone marrow blast cell counts (R=0.6, P<0.01), blast cell distribution ratio (R=0.4, P<0.05) and lymphadenopathy (R=0.33, P<0.05). Whereas Fas expression was significantly correlated to bone marrow blast cell counts (R=0.52, P<0.01). In conclusion, assessment of Bcl-2 and Fas expression at diagnosis in acute leukemia (1) could predict responsiveness to induction chemotherapy in ALL but not in AML group but (2) could not predict patients out come both in ALL and AML groups.

Markers of apoptosis and proliferation related gene products as predictors of treatment outcome in childhood acute lymphoblastic leukemia.

Abstract The aim of the study is to characterize markers of apoptosis in children with acute lymphoblastic leukemia (ALL) in relation to treatment outcome of the disease. The study was performed on 34 children with ALL and 39 healthy children as a control group. Apoptosis was assessed by cell morphology; DNA fragmentation; ELISA and RT-PCR for CD95, CD95L, BcL-2 and nuclear factor-kappa B (NF-κB); and flow cytometry for CD95, CD40, CD49d and CD11a. Apoptosis was significantly lower in patients than controls. Apoptosis detected by CD95 ligand was significantly lower in cases with no remission after treatment than those who achieved remission. Anti-apoptotic factors: CD40, BcL-2, and NF-κB were all found to be higher in cases than controls and in cases with no remission than those achieved remission. CD49d was significantly lower in cases than controls, and significantly lower in cases with who did not achieve remission. CD11a levels were similar in the various groups. Delayed apoptosis of ALL cells is genetically controlled either directly or indirectly by a network of oncogenes and tumor suppressor genes. CD40 appeared to stimulate both T and B lineage and is considered the most potent influencer and predictor of resistance to therapy. Inhibitors for the activity of CD40, Bcl-2 and NF-κB as well as stimulants to CD95 could have a potential therapeutic benefit.

Acute myeloid leukemia presenting with a large subgaleal hematoma.

Hematol Oncol Stem Cell Ther 3(1) First Quarter 2010 hemoncstem.edmgr.com 51 Acute myeloid leukemia (AML) represents about 20% of acute leukemias. CNS hemorrhage is a complication that occurs more frequently in patients with AML than in those with acute lymphoblastic leukemia. It is caused by leukostasis in cerebral blood vessels, leading to leukothrombi, infarcts and hemorrhage and/or thrombocytopenia and coagulopathy.1 A 2.5-year-old boy was admitted to our hospital with a progressive head enlargement three days after trivial head trauma due to falling on the ground while playing. He had no history of recent drug intake, fever or bleeding tendency. There was no family history of a bleeding disorder. On clinical examination, he was fully conscious and alert, but he appeared ill with severe pallor and a mild tinge of jaundice. There were no lymph node enlargements or other manifestations of bleeding tendency such as purpura or ecchymosis. The abdominal examination was normal. Head examination revealed a large soft swelling of the scalp demonstrated by pressure indentation with normal overlying skin (head circumference, 65 cm) (Figure 1). Neurological and fundus examinations were normal. Two days after admission, purpura and ecchymosis started to appear over the entire body. Peripheral blood examination showed leucocytosis (total leucocytic count, 78×109/L), severe normocytic normochromic anemia (hemoglobin, 4.5gm/dL) and thrombocytopenia (platelets, 12×109/L). A peripheral blood film revealed the presence of 36% monoblasts. The bleeding profile was normal (aPTT=25 second, PT=12.5 second and INR: 1.1). Other laboratory investigations were a serum bilirubin of 1.3 mg/dL, alanine aminotransferase of 124 U/L, aspartate aminotransferase of 32 U/L and serum creatinine of 0.6 mg/dL. Bone marrow aspiration demonstrated 79% monoblasts, which confirmed the diagnosis of AMLM5 according to the FAB classification. X-ray of the skull revealed a radiolucent shadow surrounding the Acute myeloid leukemia presenting with a large subgaleal hematoma

Abstract 904: EGFR expression predicts recurrence in patients undergoing adjuvant chemotherapy for advanced bladder cancer

Epidermal growth factor receptor (EGFR) overexpression has been associated with bladder cancer progression and poor clinical outcomes. In vivo studies have linked EGFR subcellular trafficking and chemo-resistance to cisplatin-based protocols in other tumor types. This has not been studied in the clinical adjuvant setting in bladder cancer. In this study, we aimed to investigate the prognostic significance of EGFR expression in patients receiving adjuvant chemotherapy following radical cystectomy for advanced bladder cancer. Mansoura Urology and Nephrology Center database was reviewed. Patients treated with radical cystectomy and thereafter completed adjuvant chemotherapy for adverse pathological features or node positive diseases were identified. Patients who underwent palliative cystectomy, those with histological diagnosis other than pure transitional cell carcinoma and patients who received adjuvant radiotherapy were excluded. Immunohistochemical analysis for EGFR expression was performed on archived bladder specimens. The relationship of EGFR expression and clinical outcomes was assessed. In vitro studies were performed to determine whether EGFR expression associates with resistance to chemotherapeutic reagents. The study included 58 patients. Mean age was 57 years. All patients had pathologic stage T2 or greater. Majority of patients had node positive disease (n=53, 91%). Mean follow up was 26.61 months. EGFR was overexpressed in 25 cystectomy specimens (43%). Kaplan Meyer analysis revealed that EGFR over-expression significantly correlated with disease recurrence (p=0.021). Cox proportional hazard modeling identified EGFR overexpression as an independent predictor for disease recurrence (p=0.04). In vitro functional analysis demonstrated that EGFR expression level altered response to cisplatin-induced apoptosis, and that inhibition of EGFR enhanced sensitization of bladder cancer cells to cisplatin-induced apoptosis. In summary, our findings suggest that EGFR overexpression is associated with disease recurrence following adjuvant chemotherapy for advanced bladder cancer. EGFR status may help predict prognosis and select patients for adjuvant chemotherapy. Citation Format: Ahmed Mansour, Mona Abdulreheem, Mamdouh Elsherbeeny, Mohammed Sultan, Ahmed Shokeir, Ahmed Mosbah, Hassan Abol-Enein, Taeeun Park, Hyung Kim, Jayoung Kim. EGFR expression predicts recurrence in patients undergoing adjuvant chemotherapy for advanced bladder cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 904. doi:10.1158/1538-7445.AM2014-904