To compare three fractionation schedules in post-mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. One hundred and seven breast cancer patients treated with modified radical mastectomy and adjuvant radiotherapy±adjuvant systemic treatments between November 2001 and July 2004 were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50 Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45 Gy over 17 fractions. Group C (30 patients) received 40 Gy over 15 fractions. The median follow-up period was 23 months. There has been no statistical significant difference in local control (P=0.88), pain (P=0.98), telangectasis (P=0.23), fibrosis (P=0.13), arm oedema (P=0.96) or pigmentation (P=0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (P=0.001). Although acute skin reactions were higher in the hypofractionated arms, there was no significant difference in the local recurrence rates or late radiation effects. A national randomized multicentre study is recommended to explore this further.

No abstract

SummaryCreutzfeldt-Jakob disease (CJD) is typically described as a pre-senile dementia. However, cases do occur in the elderly and a case of sporadic CJD in an 86-year-old patient is described. The database of the UK national surveillance unit has been studied, and the age-specific incidences for various age groups over the period 1980-93 calculated. Cases of CJD in those over 80 years old have been identified and their clinical characteristics examined. There is no evidence that CJD presents atypically in the elderly, or that large numbers of cases are being missed in the elderly due to poor ascertainment.

Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children's Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.

No abstract

Warfarin is the most commonly prescribed anticoagulant drug; however, a narrow therapeutic range and a high risk of bleeding or stroke complicate its clinical use. Warfarin resistance was defined as prolonged warfarin requirements of more than 15 mg/day to achieve therapeutic anticoagulation or failure to achieve therapeutic anticoagulation with more than 20 mg/day. The resistance is associated with polymorphisms of the vitamin K epoxide reductase-oxidase complex (VKORC1) and cytochrome P450-2C9 (CYP2C9) genes, which affect warfarin pharmacodynamics and pharmacokinetics, respectively. Identification of the VKORC1 -1639 (A/G) and CYP2C9 (*1/*2/*3) allelic variants was performed using the PGX-Thrombo Strip in 41 patients with warfarin resistance compared with 30 patients with normal warfarin response out of 352 diagnosed cases of deep vein thrombosis. In warfarin-resistant patients, the VKORC1-1639 genotype frequencies were GG 0.756, GA 0.244 and AA 0.0, whereas in warfarin responder patients, they were: GG 0.333, GA 0.400 and AA 0.276 with P ≤ 0.001. The CYP2C9 genotype frequencies showed nonsignificant difference in both group of patients (P = 0.31). Our results suggest that the VKORC1-1639 GG and the wild type CYP2C9*1*1genotypes are associated with the high-dose requirement for warfarin therapy, and that VKORC1-1639 GG is responsible for warfarin resistance and failure in Egyptian patients.

We report usefulness of ultrasound used as an adjunct diagnostic tool to mammogram in routine annual checkup for women breasts of certain ages and breast mass. The purpose of breast imaging is to detect areas of tissue distortion and breast cancers. A mammogram is the common diagnostic imaging modality used to find breast diseases but sometimes the mammogram might not give the doctor enough information especially in women with dense breasts. As a result, the patient may be asked to undergo ultrasound or magnetic resonance imaging as a better mean of judgment to the case. Because ultrasound is widely used, simple and safe to patients we were encouraged to emphasis on exploring its role adjunct to mammogram. A retrospective observation study was done at the diagnostic radiology department at King Abdulaziz University Hospital (KAUH) in the period from January 2012 to June 2012; we covered all women with dense breasts in mammography and ultrasound units. The study group was 40 patients. All patients were imaged with both mammography and ultrasound. The statistical measures of accuracy, sensitivity and specificity were calculated using the SPSS program. The results we obtained suggest that age and the physical density of breast potentially affect mammogram images of women with 41 years or smaller with sensitivity 66% and specificity 68%. Therefore, we recommend using ultrasound alongside the mammogram in women with dense breast for better diagnosis of small cancers that were not identified on mammography or clinical breast examination alone.

Type 2 diabetes mellitus (type 2 DM) is one of the common epidemics worldwide. The prevalence of type 2 DM is high among Saudi population. Renal affection by DM is in the form of nephropathy that may end in the end stage of renal disease (ESRD) and renal failure warrants chronic dialysis or renal transplantation. Renal Ultrasonography (US) is a simple, accurate, affordable and non-invasive test that can help in management of type 2 DM patients who have renal affection. Four hundred patients, aged from 13-93 years with type 2 DM were recruited from the outpatient internal and family medicine clinics at KAUH. Renal US was requested for 202 patients, and was done at the diagnostic radiology department using digital iU22 Philips machine with 3.5-5 MHz convex array transducer. The renal size, parenchymal echogenicity and associated renal pathologies e.g. stones, cysts or masses were evaluated. Statistical analysis was performed using SPSS program version 16. Most cases showed normal renal size and echogenicity. Grade one nephropathy was more than grade two or three. Nephropathy was non-significantly correlated to the patients' gender, but to their age. Increased patients' age was associated with increased renal echogenicity. Non-diabetes-related renal abnormalities were detected in 39% of patients. The most common of non-diabetes-related renal abnormalities was simple renal cyst followed by renal stones (25% and 23%) respectively. Renal US for patients with type 2 DM has a great role in diagnosing and grading diabetic nephropathy, selecting cases with non-diabetic nephropathy for renal biopsy, and detecting associated renal abnormalities. Due to the high prevalence of DM in Saudi Arabia, we recommend future expanding study of the underlying possible genetic relation between DM and renal cysts and also the relation between renal stones and type 2 DM.