Abstract:Background: Necrotizing enterocolitis is the most common sever gastrointestinal emergency that affects premature newborns. It is often has a rapid onset with few signs that can be used to predict its occurrence. Its rapid onset and progression to morbidity and mortality initiates the researchers for seeking early diagnostic tools helping in detection infants at risk for development of the disease, for whom early preventive measures could be targeted. Previous studies have shown that high resistance patterns of mesenteric arterial Doppler flow velocimetry are associated with a significantly reduced tolerance to enteral feeding. Moreover, groups of infants deemed to be at increased risk of necrotizing enterocolitis tended to have high resistance patterns of flow in the superior mesenteric artery. AIM: To evaluate the Doppler blood flow indices of the superior mesenteric artery (SMA) in pre-term neonates at risk for developing necrotizing enterocolitis (NEC). Materials and Methods: This prospective study included 52 preterm neonates, whose gestational age was less than 34 weeks. All of the neonates were subjected to clinical assessments, laboratory investigations and color Doppler flow evaluation of the SMA (including PSV, EDV, RI and PI) on the first day of life. Necrotizing enterocolitis was diagnosed and classified based on Bell's staging criteria with Walsh and Kliegman's modifications. Clinical management and diagnosis of NEC were performed blind to the Doppler results. Statistical analysis was performed using the Mann-Whitney U test, and P-values less than or equal to 0.05 were statistically significant. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold values of PSV, EDV, RI and PI, using MedCalc software, version 12.7.8.0. Results: The study included 52 preterm neonates, whose gestational age was less than 34 weeks. Twelve neonates (23%) developed NEC and were designated as group I, and the remaining 40 neonates (77%) were designated as group II. The median birth weights in groups I and II were 1000 and 1870 g, respectively, with a statistically significant difference of P < 0.05. Doppler indices of the SMA, peak systolic velocity (88.9 ±17 and 53 ±8.5 cm/s), end diastolic velocity (18.75±11.3 and 14.9±5.6 cm/s), resistive index (0.78±0.09 and 0.67±0.1) and pulsatility index (1.53±0.73 and 0.67 ± 0.15) were higher in group I than in group II, with statistically significant differences. Conclusion: Preterm infants with high resistance patterns of blood flow velocity in the SMA on the first day of life were at increased risk for developing necrotizing enterocolitis.

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Background: Cutaneous malignant melanoma (CMM) is a highly aggressive tumor with high tendency of return despite complete surgical removal. It has a high risk of dissemination to regional lymph nodes and visceral organs. The prognosis is highly dependent on lymph node involvement and distant metastases. Positron Emission Tomography with Computed Tomography (PET/CT) is a valuable non-invasive tool for the diagnosis and staging of patients with MM. The purpose of the present study was to evaluate the role of integrated (PET/CT) in staging, restaging, prognosis, and prediction of recurrence in patients with malignant melanoma. Results: Fifty malignant melanoma patients with age ranged from 28 to74 years (mean age 55.94 + 13.40 years) were 28 males (mean age 56.71 + 12.82) and 22 females (mean age 54.95 + 14.34). All our patients were histopathologically proven to have malignant melanoma. Twenty-one patients came for initial staging by 18F-FDG PET/CT. Their findings were compared with the reference standards and showed the sensitivity of 93.33%, specificity of 60%, and accuracy of 85.71% for primary staging. 18F-FDG PET/CT scan in 11 clinical suspicion patients of relapse after treatment showed the sensitivity of 100%, specificity of 66.66%, positive predictive value of 88.88%; negative predictive value of 100%; and accuracy of 90.90%. FDG-PET/CT of whole body scan in 18 cases of stage IV melanoma showed sensitivity of 100%, specificity of 66.66%, and overall accuracy of 94.44% for detection of distant metastases. SUVmean and SUVmax in all studied groups were significantly higher in true positive more than true negative or false-positive patients diagnosed by PET/CT with high sensitivity (82.88-100%). Conclusion: PET/CT imaging enhanced diagnostic performance in detection of the primary malignancy, in followup of high-risk patients and patients with suspected or known local or distant recurrence, and in restaging of patients with known distant metastatic disease to assess tumor response.

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