Hypoxia is a prevalent hallmark of many malignant neoplasms. The aim was to assess the serum hypoxia biomarkers HIF-1α, VEGF, osteopontin, erythropoietin, caveolin-1, GLUT-1, and LDH pre- and post-radiotherapy in patients with brain tumors. The study was conducted on 120 subjects were divided into two groups: group I: 40 healthy volunteers as control group. Group II: 80 brain tumor patients were subdivided into glioblastoma subgroup: 40 glioblastoma patients, meningioma subgroup: 40 malignant meningioma patients. Two venous blood samples were collected from every patient prior to and following RT and one sample from controls. Biomarkers were assayed by ELISA. In glioblastoma subgroup, HIF-1α, VEGF, and LDH were significantly increased after RT. On the contrary, these biomarkers were significantly decreased after RT in malignant meningioma subgroup. Osteopontin was significantly increased after RT in both subgroups. Regarding erythropoietin, it was significantly decreased in both subgroups when compared to before RT. Caveolin-1 showed a significant increase in glioblastoma subgroup after RT comparing to before RT. GLUT-1 was significantly increased after RT in both subgroups comparing to before RT. Association of significant elevation of hypoxia biomarkers either pre- or post-RT with aggressive tumor such as glioblastoma indicates that, they are markers of malignancy and may have a role in tumor development and progression.
Background: ''Selective peripheral neurotomies" (SPNs) are indicated for the treatment of refractory focal and multifocal spasticity of lower limbs in adults. Objective: To evaluate the surgical results of selective peripheral neurotomies in 20 adult patients who had refractory focal & multifocal spasticity of the lower limbs, follow up period of one year. Patients and Methods: Prospective study included 20 adult patients who had refractory spasticity of the lower limbs. Preoperative evaluation for muscle tone using Modified Ashworth Score (MAS), muscle power using Medical Research Council Scale (MRCS), functional assessment using Oswestry Functional Scale (OFS) and Range Of Motion (ROM) using manual goniometry were done for all patients. All cases underwent surgery in the form of SPN of tibial, obturator, sciatic and/or femoral nerves. Follow up of the patients was done at 10th day, 3, 6 months and one year postoperatively. Results: The mean age of patients was 31.35 ± 12.42 years. There were statistically significant improvement of muscle tone, muscle power, functional assessment and range of motion between preoperative and one year postoperative values. Improvement of the muscle tone was from a preoperative Mean ± SD of 3.60 ± 0.68 on MAS to a postoperative 2.30 ± 0.86 at one year, improvement of muscle power on MRCS was from preoperative Mean ± SD 3.75 ± 1.08 to postoperative 4.08 ± 0.69 at one year, There was a functional improvement from a preoperative Mean ± SD of 3.0 ± 0.73 on OFS to 3.60 ± 0.60 at one year postoperatively. Also, there was a significant improvement between preoperative ROM Mean ± SD 61.25 ± 15.29 and one year postoperatively 72.25 ± 12.19. Conclusions: Selective peripheral neurotomies could effectively improve muscle tone, muscle power, functional performance & range of motion in patients with refractory focal and multifocal spasticity in the lower limbs.
Background: Subclavian artery aneurysms (SAAs) are uncommon aneurysms.SAA is potentially serious disease due to complications. Objective: to evaluate the surgical treatment of SAAs and its complications. Methods: Fifteen patients with SAAs: 13 patients (86.67%) had extrathoracic (ET) aneurysms and two patients (13.33%) had intrathoracic (IT) aneurysms. Thoracic outlet syndrome (TOS) was presented in 8 patients (53.33%), while, atherosclerosis was presented in 7patients (46.67%). Laboratory & radiological studies were done. All patients were treated surgically. Results: In 13 patients with extrathoracic aneurysms, a supraclavicular approach to the subclavian artery was used in (6/13, 46.15%), supraclavicular and infraclavicular approach was used in (7/13, 53.85%) cases. After excision of the aneurysm, graft interposition using (PTFE) and saphenous vein graft bypass were done in (6/13, 46.15% & 5/13 , 38.46 %) patients respectively. In two patients (2/13, 15.38 %), aneurysmal excision and end to end anastomosis were done. While in two patients with intrathoracic aneurysms, a combined left thoracotomy and supraclavicular approach was used. Common carotid-subclavian bypass using Dacron graft was done. In (6/8, 75 %) of patients with TOS, decompression was performed before arterial reconstruction. In three (37.50 %) patients with cervical rib, the cervical rib was resected. In three patients (37.50 % ) with scalene syndrome, scalenectomy of the scalenus anterior muscle was done. In two patients (2/8, 25 %) with brachial artery embolism, embolectomy was done. Conclusions: Early intervention was needed, especially in distal SAAs, because of the risk of thrombo-embolic complications. Open repair is sill the gold standard intervention for SAA.
Twelve patients with" subclavian steal syndrome" were studied in 36 months period from June 2013 to June 2016. Their age ranged between 21-55 years with a mean age of 32 years. Female sex represented (7/12, 58.33%). All cases were subjected to complete history taking and clinical examination. They presented with drowsiness and, or fainting after left upper limb exercise. This was associated with manifestations of chronic left upper limb ischemia. Investigations were done for all cases including laboratory investigations, Duplex US, Angiography and CT Angiography. Surgical treatment was done for all cases (7 cases were treated by transcervical subclavian -subclavian bypass graft, 4 cases were treated by left common carotid to left subclavian artery bypass graft and one case by right subclavian to left axillary artery bypass graft). Ringed Gortex graft 8mm was used in all cases. The results of all surgical operations were successful and the symptoms of the brain and left upper limb ischemia disappeared. The graft in one case was occluded after 2½ years due to intimal hyperplasia (the case of right subclavian to left axillary artery bypass graft). Clearance of the graft was done by using Fogarty catheter. All grafts were functioning well and the results were excellent.
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