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OBJECTIVE: The lack of objective documentation of pre-neoadjuvant chemotherapy (NAC) tumour margins is a major constraint in performing safe breast conserving surgery (BCS) in patients with breast cancer. Using a novel method of marking pre-NACT tumour margins with indigenous silver wire markers, this retrospective observational study attempted to assess the feasibility of safe BCS in breast cancer patients by performing excision wide of the marked pre-NACT margins. MATERIALS AND METHODS: This retrospective observational study was conducted on breast cancer patients who were attending our oncology centre between May, 2015 and April, 2022. All patients had received NAC followed by surgery as recommended by our multidisciplinary team. All the patients had a primary operable solitary breast cancer. We used radiopaque metallic rods made from silver to localize tumour margins prior to NAC. RESULTS: Sixty-four breast cancer patients were included; none had marker-related complications. Following NAC, BCS could be easily performed in 60 patients guided by the silver markers, which were used as temporary implants and removed during surgery. Only 2 patients were seen with positive margins and were converted to mastectomy. CONCLUSION: Breast cancer localization using sterile silver markers before the initiation of NAC is safe, easy, inexpensive, and effective, causing no morbidity or significant pain to the patients.

Data on the association between coronavirus disease 2019 (COVID-19) and the epidemiology and outcomes of hematological malignancies are limited. Hence, the present study aimed to assess the imaging findings using chest multidetector computed tomography (MDCT) in patients with hematologic malignancies who developed COVID-19 pneumonia.This retrospective study included two groups, the first group consisted of COVID-19 infected patients with hematologic malignancies (100 patients), while the second group consisted of COVID-19 infected patients without hematologic malignancies or other comorbidities (100 patients). The hematological malignancies included in this study were non-Hodgkin's lymphoma (40 patients), acute myeloid leukemia (25 patients), chronic lymphocytic leukemia (15 patients), multiple myeloma (10 patients), Hodgkin's lymphoma (8 patients), and myelodysplastic syndrome (2 patients). Chest multidetector CT imaging was performed in all patients to assess for ground-glass opacity, consolidation, pleural effusion, and airway abnormalities.More than one CT finding was reported in each patient. No significant difference was observed in the ground-glass opacities (Early and reliable diagnosis of lung disease in COVID-19-infected patients may be achieved through multidetector CT imaging. Patients with hematological malignancies are more likely to have severe COVID-19 pneumonia, and radiologists should recognize the CT characteristics of this infection.

Entry of coronavirus (SARS-CoV-2) into a host cell is pH dependent. Intracellular alkalinization by sodium bicarbonate (SB) could elevate endosomal pH and block viral entry into the host cells. So, we assessed the role of inhalable SB as an adjuvant treatment for COVID-19 in the study groups of this randomized, controlled trial. Here we show a significantly shorter duration to clinical improvement and hospital stay in the study group, while the number of deaths is significantly less only in severe grade of the study group. But the time to death is not significantly different in both groups. CRP and d-dimer levels are significantly lower in the severe cases of the study group. The overall median CT score is significantly better in the study group at one & 2 months. Our data thus suggest that inhaled SB (8.4%) could be a possible adjuvant therapy for patients with moderate and severe COVID‑19 pneumonia.

Knowledge about anatomical variants of the external carotid artery is crucial in head and neck surgery and interventional technique. This work aimed to present the frequency of regular and another variant of the external carotid artery using 128 multidetector computed tomography (MDCT) angiography.This retrospective study included 120 patients in our university hospital between April 2017 and October 2021. They were 65 men and 55 women (mean age, 45.6 years; range, 18-65 years). They were angiofibroma (10 patients), cerebral stroke (28 patients), partial glossectomy (13 patients), submandibular gland excision (12 patients), parotidectomy (17 patients), mandibulectomy (5 patients), and a thyroidectomy (35 patients). We retrospectively analyzed the level and branches of external carotid arteries on both sides of 120 patients.According to the level of bifurcation; the external carotid artery originated at the level of the upper border of the thyroid cartilage in 164/240 cases (68.3%), and a higher level was detected in 76/ 240 cases (31.7%). The lower level of origin of the external carotid artery was not detected. The superior thyroid, facial, and lingual arteries originated from separate branches of external carotid arteries in 173/240 cases (72.1%). At the same time, the facial arteries originated with lingual arteries in a common trunk in 67/240 cases (27.9%).MDCT angiography is a valuable noninvasive diagnostic tool for evaluating the external carotid artery and its branches.

BACKGROUND: Multiple primary malignancies are two or more malignancies in an individual without any relationship between the tumors. The development of improved diagnostic techniques, increased survival of cancer patients and the growing life expectancy have all contributed to the increased frequency of this phenomenon. OBJECTIVE: The aim of this study is to review the multidetector computed tomography (MDCT) findings of synchronous breast carcinoma and other solid malignancies. METHODS: This retrospective study included 65 patients confirmed with diagnosis of synchronous breast carcinoma and other solid malignancies. CT scanning was performed using 128 MDCT in all patients. All one hundred-thirty malignancies underwent pathological evaluation. RESULTS: Out of 4120 patients with breast carcinoma; 65 patients were diagnosed with other synchronous primary solid malignancy. All one hundred-thirty malignancies were confirmed pathologically. Breast carcinoma detected in all 65 patients; of them metastatic breast carcinoma detected in 8 patients. Hepatocellular carcinoma was detected in 18 patients, Non-Hodgkin lymphoma (NHL) in 12 patients, endometrial carcinoma in 8 patients, uterine sarcoma in 3 patients, malignant mixed Müllerian tumor in one patient, ovarian carcinoma in 5 patients, renal cell carcinoma in 4 patients, thyroid carcinoma in 4 patients, gastric carcinoma in 2 patients, colonic carcinoma in 2 patients, ano-rectal carcinoma in one patient, hilar cholangiocarcinoma in 2 patients, malignant melanoma in 2 patients and bronchogenic carcinoma in one patient. CONCLUSIONS: Patients with breast carcinoma have a risk of other synchronous primary malignancy. So, careful preoperative examination is recommended to improve the patients’ prognosis. MDCT scanning is accurately imaging modality for evaluation of synchronous breast carcinoma and other solid malignancies. The aim of treatment in cancer patients should always be curative even in the presence of multiple malignancies.

Sentinel lymph node biopsy (SLNB) has efficiently replaced axillary lymph node dissection (ALND) in axillary staging in node-negative breast cancer patients. Dual sentinel lymph node (SLN) localization using radioisotopes and blue dye is the standard technique for SLN mapping. Yet, nuclear medicine facilities are not widely available worldwide. In Japan, Computed tomography lymphography (CTLG) is presented as an SLN mapping technique which was first suggested in 2003 by Suga et al. Multiple subsequent studies confirmed the efficacy of CTLG in SLN mapping in breast cancer. Further applications of the technique followed; such as prediction of SLN metastasis using CTLG, the use of CTLG guided SLN biopsy after neoadjuvant therapy, video-assisted CTLG guided SLN biopsy, the use of real-time virtual sonography with 3-D CTLG, and preoperative localization of the CTLG mapped SLN using either real-time virtual sonography (RVS) guided Indocyanine green (ICG) injection or its marking using liquid charcoal and silver wire and the use of SPIO enhanced magnetic resonance imaging (MRI) for prediction of metastasis in SLNs detected by CTLG. This efficacy and variable applications open the door for conducting wide-scale randomized controlled trials to suggest using CTLG as an efficient alternative for the use of radioisotopes in SLN mapping in breast cancer patients, especially in low and middle-income countries.

Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. We aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating CO...

Objective: The aim of this work was to evaluate Multidetector Computed Tomography (MDCT) findings of hepatic manifestation in common malignant hematological disorders. Materials and Methods: This retrospective study included 300 patients with different types of malignant hematological disorders. They were 119 female and 181 male (mean age, 45.4 year; range, 5-70 years). The most common hematological disorder was Non-Hodgkin lymphoma (NHL) detected in 192/300 (64%) patients and then Hodgkin disease (HD) detected in 40/300 (13.3%) patients. All 300 patients had ultrasonography. Clinical evaluation and laboratory assessment were done for all patients. Whole body and triphasic abdominal CT scanning was performed on 64 MDCT systems. Results: MDCT scanning revealed hepatic affection in 82/192 of NHL. All these 82 cases revealed hepatomegaly and focal lesion detected in 36 cases. As regard Hodgkin disease (HD), hepatomegaly detected in 22/40 cases and focal lesion detected in 8/40 cases. Hepatomegaly detected in 8/14 cases of acute myeloid leukemia (AML) and focal lesion detected in 4/14 cases. In cases of chronic lymphocytic leukemia (CLL), hepatomegaly detected in 6/22 cases with no detection of focal lesion. Conclusion: Hepatic involvement is often observed in several malignant hematological disorders, resulting in abnormalities in liver imaging studies. Malignant hematological disorders must be considered in hepatomegaly and hepatic focal lesions either single or multiple. MDCT is the diagnostic modality of choice for diagnosis and follow up of liver affection in different malignant hematological disorders.

Sentinel lymphadenectomy has replaced axillary lymph node dissection as a staging tool in early breast cancer. To be accepted as a standard of care, it had to pass successfully through a long journey which started in the early 1990s. We carried out a comprehensive literature review focusing on the journey of the use of sentinel lymph node biopsy (SLNB) in breast cancer from its start until its current station, including the variable clinical applications, the current debates, and the future issues. Adoption of sentinel lymph node biopsy as a standard axillary staging procedure was a marvelous trend that helped to decrease the complications of axillary dissection and significantly improve the quality of life of patients with breast cancer. Various mapping techniques can be used for SLN localization, rendering oncology centers that have variable capabilities and preparations able to perform the procedure. This applies to specimen processing techniques as well. Many debates faced the researchers throughout the SLNB journey. They are all explained in the current article, in addition to the ongoing trials and the future aspects of SLNB in breast cancer. Further research should be conducted to help resolve the clinical issues which are still debatable and to provide bases for improving the future trends which are progressing towards limiting the role of axillary dissection and axillary surgery to the minimum required level.

Background: Breast cancer is more frequently being detected as radiographic non-palpable lesions with the increased utilization of national screening programs. Moreover, the sizes of tumors detected have decreased in recent years, increasing the need for the accurate image-directed localization for surgical excision in a significant portion of cases. Although Wire guided localization has been the most commonly used method for many years, but inherent problems remain and limited its practice. Radio-guided occult lesion localization (ROLL) is currently the standard method of localization, however it is unavailable in most of low resources communities. This encourages us to use charcoal localization which is simple and cheap method of surgical localization of non-palpable suspicious breast lesions. Methods: This prospective study included 34 patients presented with non-palpable suspicious breast lesion (BIRADS 4 or 5). All patients were injected with 1-3 ml of sterilized 3% aqueous suspension of charcoal granules under guidance of ultrasound at the superficial border of the suspicious lesion and the track between the lesion and the needle entry point in the skin which occur at the future incision. This method was carried out in most patients one day before operation, however two patients underwent surgical excision after 6 days of localization without any interruption.Results: Thirty four patients had 36 Lesions. The median age was 43 years. The mean diameter of lesions 10.9 mm. Out of 36 lesions; the BIRADS as follow10 (4a), 12 (4b), 8 (4c), and 6 (5). Postoperative revealed 16 malignant lesions and 20 benign lesions. All 20 benign lesions were managed by wide local excision; All 14 BIRADS 4a lesions were proved to be benign. Sixteen malignant lesions were managed as the following; nine patients had breast conserving surgery, five patients had modified radical mastectomy (three patients had past history of modified radical mastectomy, one patient had Multicentric ILC and one patient had infiltrated safety margins on conservation), and one patient had Nipple Sparing Mastectomy with immediate breast reconstruction by Latissimus Dorsi Flap . There was no reaction nor infection reported in our study.Conclusion: Charcoal localization has many advantages and help surgical localization.

Limited experimental and clinical evidence suggests a potential role for sofosbuvir/daclatasvir in treating COVID19. We aim to evaluate the efficacy of generic sofosbuvir/daclatasvir in treating COVID-19 patients with pneumonia.This multicenter prospective study involved 174 patients with COVID-19. Patients were randomized into two groups. Group A (96 patients) received sofosbuvir (400 mg)/daclatasvir (60 mg) for 14 days in combination with conventional therapy. Group B (78 patients) received conventional therapy alone. Clinical, laboratory, and radiological data were collected at baseline, after 7, 14, and 28 days of therapy. Primary endpoint was rate of clinical/virological cure.A lower mortality rate was observed in group (A) (14% vs 21%, P = 0.07). After 1 month of therapy, no differences were found in rates of ICU admission, oxygen therapy, or ventilation. Additionally, a statistically significant shorter duration of hospital stay (9% vs 12%, P 0.01) and a faster achievement of PCR negativity at day 14 (84% versus 47%, P 0.01) were noticed in group (A).Adding sofosbuvir/daclatasvir to conventional therapy of COVID-19 is promising. Their use is associated with shorter hospital stay, faster PCR negativity and may be reduced mortality.

Background Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB. Patients and methods One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically. Results There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (P

Dual localization of SLN in breast cancer patients using isotope & dye is the best-approved modality with limitations such as high cost of radioactive materials, complex logistic preparations & scheduling issues, especially in developing countries. We investigated the feasibility & accuracy of a novel technique for SLN localization using silver wire insertion or liquid charcoal injection guided by CT lymphography. 120 patients with clinically node-negative breast cancer were enrolled. In the test group, SLN was localized using preoperative CTLG guided injection of liquid charcoal or by placing a 3 cm silver wire. In addition, intraoperative SLN mapping was performed using methylene blue dye followed by searching for the SLN localized by both methods. In the control group, SLN was localized by the blue dye only. Feasibility, accuracy, detection rates, and number of SLNs retrieved were reported as well as matching between the LN detected with the CTLG and that detected with the dye technique. SLN could be detected in 59 out of 60 patients (98.3%) in the test group and in 54 out of 60 patients (90%) in the control group (P = .057). In self-controlled analysis of the test group comparing CTLG only to dye only was significant (P = .050). Comparing charcoal to silver wire in detection was statistically insignificant (P = .5). This novel method can offer advantages which are as follows: being more accurate than the dye alone, saving operative time, abandoning complex logistic preparations for the radioisotope, and solving the problem of timing.

Resumo Introducao A neurolise do plexo celiaco guiada por tomografia computadorizada tornou‐se uma tecnica quase segura para aliviar a dor abdominal maligna. Comparamos a tecnica de agulha unica mudando o posicionamento do paciente e a tecnica de agulha dupla usando a abordagem anterocrural posterior. Metodos No grupo designado para neurolise celiaca com agulha dupla (n = 17), a tecnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decubito ventral. No grupo designado para neurolise celiaca com agulha unica (n = 17), a abordagem anterocrural posterior foi utilizada com uma unica agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decubito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorizacao foram a taxa de falha dos bloqueios e a duracao do posicionamento dos pacientes, o tempo da tecnica, os escores da escala visual analogica, as complicacoes (hipotensao, diarreia, vomitos, hemorragia, dano neurologico e infeccao) e a analgesia de resgate. Resultados A taxa de falha dos bloqueios e a duracao do posicionamento dos pacientes aumentaram significativamente na neurolise celiaca com o uso de agulha dupla vs. agulha unica (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Alem disso, o tempo da tecnica foi significativamente maior na neurolise celiaca com agulha dupla que na neurolise celiaca com agulha unica (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Nao houve diferenca significativa em relacao aos escores da escala visual analogica: neurolise celiaca com agulha dupla = 2 (0‐5), 2 (0‐4), 3 (0‐6), 3 (2‐6) e neurolise celiaca com agulha unica = 3 (0‐5), 2 (0‐5), 2 (0‐4), 4 (2‐6) apos um dia,uma semana, um e tres meses, respectivamente. No entanto, os escores da escala visual analogica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Nao houve diferenca estatisticamente significativa quanto a analgesia de resgate e complicacoes (p > 0,05). Conclusao A neurolise celiaca com o uso de agulha unica e a alteracao do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duracao do posicionamento do paciente que o uso de duas agulhas para neurolise celiaca em malignidade abdominal.

Osteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) are reported in children but rarely seen in adults. Herein, we described two patients with B-ALL presenting with hypercalcemia and symptomatic osteolytic bone lesions. They were treated by standard induction chemotherapy after correction of hypercalcemia with supportive measures. With this two case reports we would like to emphasize the importance of clinical awareness of hypercalcemia and osteolytic bone lesions as rare presentations of ALL. The prognostic implication of bone lesions and hypercalcemia in ALL is unclear and needs to be verified in large prospective studies. However, immediate recognition and treatment of hypercalcemia and the underlying B-ALL are vital since a delay of diagnosis poses a possible life-threatening risk. J Hematol. 2018;7(4):154-157 doi: https://doi.org/10.14740/jh455w

BACKGROUND: Transforming growth factor–β (TGFβ) has a dual function in breast cancer, having a tumor suppressor activity in early carcinomas while enhancing tumor metastasis in advanced breast carcinoma. Consequently, the prognostic role of TGFβ and its signaling cascade in breast cancer remain unclear. OBJECTIVE: To investigate the relationship between TβRII expression, clinic-pathological characteristics, and prognostic significance of TβRII expression in clinical stage III breast cancer. METHODS: Biopsy from the primary tumor was obtained from 30 newly diagnosed clinical stage III breast cancer patients before receiving any therapy. Expression of TβRII, ER, PR, Her2 and Ki-67 was assessed by immunohistochemistry. RESULTS: TβRII expression was positive in 66.7% of cases and was significantly associated with advanced nodal stage and distant metastases. After a median follow up of 42.3 months, TβRII was associated with poor disease-free survival and it was an independent factor for predicting the poor outcome for breast cancer patients, especially in node positive tumors, ER/PR positive and Her2-negative tumors. CONCLUSIONS: These findings suggest the usage of therapeutic drugs that target TGFβ in advanced breast cancer patients may be effective. Nevertheless, blockage of the tumor promoting and sparing of the tumor suppressor effect of TGFβ pathway should be taken into consideration. We suggest that these therapies might have more benefit in ER and PR positive tumors.

Objective: The objective of this study is to review the multidetector computed tomography (MDCT) findings of synchronous lymphoma and other solid malignancies. Patients and Methods: This retrospective study included 18 patients confirmed with diagnosis of lymphoma and other solid malignancies. They were 8 women and 10 men (mean age, 62.5 year; range, 44–73 years). CT scanning was performed on one of the two systems: 64 MDCT in 11 patients and 6 MDCT in 7 patients. All 36 malignancies were underwent pathological evaluation. Results: All cases were confirmed pathologically. Lymphomas were Hodgkin disease ( n = 5 patients) and non-Hodgkin lymphoma ( n = 13 patients). Hepatocellular carcinoma was detected in five patients. Bronchogenic carcinoma was detected in two patients. Renal cell carcinoma was detected in two patients. Breast carcinoma was detected in two patients. Prostatic carcinoma was detected in two patients. Gastric carcinoma was detected in two patients. Endometrial carcinoma was detected in one patient. Colonic carcinoma was detected in one patient. Thyroid carcinoma was detected in one patient. Conclusions: MDCT scanning is accurately imaging modality for the evaluation of synchronous lymphoma and other solid malignancies. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon, and may lead to a new treatment strategy for synchronous lymphoma and other solid malignancies.

Background and Objectives: The incidence of synchronous primary malignant tumors is increasing due to the ageing of the population and advances in medical technology. In this retrospective study; we review the multidetector computed tomography (MDCT) findings of synchronous breast carcinoma and other solid malignancies. Methods and Materials: This retrospective study included 65 patients confirmed with diagnosis of synchronous breast carcinoma and other solid malignancies. The patients aged ranged from 35 – 78 years. CT scanning was performed using 128 MDCT in all patients. All one hundred-thirty malignancies were underwent pathological evaluation. Results: Out of 4120 patients with breast carcinoma; 65 patients were diagnosed with other synchronous primary solid malignancy. All one hundred-thirty malignancies were confirmed pathologically. Breast carcinoma detected in all 65 patients; of them metastatic breast carcinoma detected in 8 patients. Hepatocellular carcinoma detected in 18 patients. Non-Hodgkin lymphoma (NHL) detected in 12 patients. Endometrial carcinoma detected in 8 patients. Uterine sarcoma detected in 3 patients. Malignant mixed Mullerian tumor detected in one patient. Ovarian carcinoma detected in 5 patients. Renal cell carcinoma detected in 4 patients. Thyroid carcinoma detected in 4 patients. Gastric carcinoma detected in 2 patients. Colonic carcinoma detected in 2 patients. Ano-rectal carcinoma detected in one patient. Hilar cholangiocarcinoma detected in 2 patients. Malignant melanoma detected in 2 patients. Bronchogenic carcinoma detected in one patient. Conclusions: Patients with breast carcinoma have a risk of other synchronous primary malignancy. So, careful preoperative examination is recommended to improve the patients’ prognosis. MDCT scanning is accurately imaging modality for evaluation of synchronous breast carcinoma and other solid malignancies. The aim of treatment in cancer patients should always be curative even in the presence of multiple malignancies. Funding Statement: There was no financial support for this research and publication. Declaration of Interests: The author declares that there is no conflict of interest. Ethics Approval Statement: The study was approved by the institutional research ethics review committee (Mansoura University/Faculty of Medicine/ Egypt). IRB reference number is “R.20.02.753 "

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.

Pulmonary agenesis is a very rare congenital anomaly characterized by the absence of pulmonary parenchyma and its vasculature. The diagnosis is usually during childhood. Herein, we report a case of incidental discover right pulmonary agenesis in adulthood male. A 30-year-old male presented with pre-operative medical evaluation for varicocele. There was no complaining from respiratory symptoms. He underwent plain chest X-ray and post-contrast CT scanning was performed using 64 multi-detector CT scanner. Chest Plain X-ray revealed cardiac and mediastinal shift to right side with hyper-inflated left lung crosses to right side. Multi-detector computed tomography examination revealed total absence of right lung with compensatory hyperinflation and increase volume of left lung. Hyper-inflated left lung extended to right hemithorax. Mediastinal structures including heart and great vessels were displaced to middle and lower parts of right hemithorax. Descending aorta located to anterior to thoracic vertebrae. Right pulmonary artery was absent. Right main bronchus was rudimentary. No detected other organ anomalies. No detected bony thoracic cage abnormalities.

Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients’ position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0–5), 2 (0–4), 3 (0–6), 3 (2–6) and single needle celiac neurolysis = 3 (0–5), 2 (0–5), 2 (0–4), 4 (2–6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients’ position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy. Resumo: Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica relativamente segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12.5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30.8% vs. 0%; 13,8 ± 1.2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia, uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal. Keywords: Celiac neurolysis, Computerized tomography, Patient position, Single needle, Double needle, Palavras-chave: Neurólise celíaca, Tomografia computadorizada, Posição do paciente, Agulha única, Agulha dupla

Purpose To evaluate the role of multi-detector computed tomography (MDCT) in detection and characterization of chemotherapy induced hepatic changes. Materials and methods This retrospective study included 400 patients with confirmed 14 malignancies and treated by standard chemotherapy regimens. The most common malignancy was non-Hodgkin lymphoma and mostly chemotherapy regimen was Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisolone (CHOP). All patients underwent CT scan using 64 MDCT scanner (Brilliance 64, Philips) before chemotherapy and follow-up after 6 months from last session of chemotherapy. Precontrast series and post-contrast triphasic study were done for all patients. All the patients underwent radiological evaluation for hepatic changes after chemotherapy treatment. All CT scans were evaluated for fatty liver, capsular retraction, venoocclusive disease and biliary sclerosis. Four patients with capsular retraction underwent liver biopsy. Results Forty patients (32 females and 8 males) had hepatic changes due to effect of chemotherapy. The most common CT finding was fatty liver. Hepatic fatty changes were detected in 36/40 patients. These fatty changes were diffuse, focal fatty and diffuse with fatty spare area. Four patients had capsular retraction: 1 patient with HD and 3 patients with metastatic cancer breast. Veno-occlusive disease and biliary sclerosis were not detected.

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.

Background: Non cyclic-mastalgia is a challenge among women. We aimed to study the effects of adding pulsed radiofrequency to tamoxifen 10mg daily in treatment of non-cyclic mastalgia. Methods: We conducted a randomized prospective open blinded end-point, level IV trial in outpatient pain clinic of a university-affiliated oncology center during the period from 2018 till 2019. Patients were randomly allocated into two groups. Group A (n=13) received tamoxifen 10mg tablet once daily and group B (n=13) received tamoxifen 10mg tablet once daily and pulsed radiofrequency of the 2nd, 3rd and 4th thoracic dorsal root ganglia. We monitored numerical rating scale (NRS) and quality of life (QOL) before and at intervals of 2 weeks, 1, 2 and 3 months after treatment; complications; side effects of tamoxifen; and number of patients who needed analgesia. Results: Numerical rating scale significantly decreased in group B compared to group A at 2 weeks (P = 0.002) and 1, 2 and 3 months (P Conclusions : Combined usage of pulsed radiofrequency and tamoxifen 10mg daily is a safe line of treatment of non-cyclic mastalgia and markedly improves QOL.

Spontaneous regression (SR) of lymphoma is a rare phenomenon. While the precise mechanism of SR remains unknown, apoptosis may be associated with its process. Here, we present a case of a 52-year-old woman was admitted to our hospital with cough and orthopnea for 2 weeks. Multi-detector computed tomography of whole body showed anterior and middle mediastinal soft tissue mass with multiple adjacent malignant lymphadenopathy. The mediastinal mass invaded right atrium and pericardium. Another left subphrenic retro-pancreatic mass was detected. This mass surrounded upper pole of left kidney. Fine needle aspiration cytology was done and revealed lymphocytic smear with advised tru-cut biopsy. CT guided tru-cut was taken after 8 days. During CT guided technique; marked regression of left subphrenic mass was detected. Post-contrast MDCT scan was done and revealed partial response of the masses after 8 days. The partial regressive course of this disease suggests the effectiveness of fine needle aspiration cytology in initiating spontaneous regression. Tru-cut biopsy revealed non-Hodgkin lymphoma (diffuse large B-cell type). We report a case of NHL with abnormal location and spontaneous regression.

The determination of gender of unknown persons is of vital importance in forensic investigations. The present study aimed to evaluate the accuracy and reliability of frontal sinus (FS) dimensions measurement in gender identification. One hundred people (50 males and 50 females) with age range from 20 to 70 years were selected in this study. FS dimensions for both right and left sinuses (transverse, height & anteroposterior lengths) were measured from axial and coronal sections (4-mm slice thickness) using multi-detector computed tomography (MDCT) scanner. Statistically significant lower values for the maximum transverse length of both right and left FS in female group were detected in comparison to the male group ( p =0.002). In addition, the maximum height of right and left FS in females showed statistically highly significant lower values for in comparison to males ( p =0.001). Also, the maximum anteroposterior length of the frontal sinus for right and left sides in female group had statistically significant lower values ( p =0.001and 0.01 respectively) in comparison to the male group. Multiple regression equations revealed that among all FS measurements, the right FS anteroposterior length was the best discriminate variable between genders with overall accuracy 67.0% (70.0% for women and 64.0% for men). It can be concluded that FS dimensions measurement especially the right anteroposterior length are valuable in studying sexual dimorphism using MDCT image.

Aim To determine if focal liver masses could be differentiated as benign or malignant by DWI and ADC maps. Methods and materials Sixty focal liver lesions were scanned using 1.5 T MRI. DWI was performed with b 0, b 500 and b 1000 gradients with ADC measurements. Comparison of mean ADC values between each benign and malignant lesion was done. Reference standard of diagnosis was obtained by correlating DWI with histopathologic findings and imaging follow-up. The accuracies of DWI and ADC values were assessed with the Student’s t test, and cut-off values were determined with receiver operating characteristic curve analysis. Results When ADC value of 1.0 × 10−3 mm2/s was used as a threshold value for differentiation of malignant tumors from benign lesions, sensitivity was 90.3%, specificity 78.57% and accuracy 86.7%. The best result was obtained with the use of ADC cut off value (at b 500) of 1.5 × 10−3 mm2/s and ADC cut off value (at b 1000) of 1.0 × 10−3 mm2/s, with 90.3% sensitivity, 92.86% specificity, 91.1% accuracy, 96.6% positive predictive value and 81.3% negative predictive value. Conclusion DWI and ADC map is a useful tool in differential diagnosis of malignant from benign liver lesions.

Objective: To evaluate the efficacy, feasibility and safety of contrast-enhanced CT-guided core biopsy of retroperitoneal masses. Materials and Methods: Contrast-enhanced CT-guided biopsy of retroperitoneal masses was performed in 26 patients. Histopathological diagnosis was obtained and accuracy was calculated. Two blinded radiologists determined feasibility of biopsy procedures on routine CT-guidance, and compared accessibility of target lesions using contrast-enhanced and non-contrast-enhanced CT. Results: Satisfactory samples were obtained in all 26 patients and pathological diagnosis was made in 24. Accuracy was 95.5%. Routine CT-guided biopsy punctures were not satisfaction in 4/26 patients, and contrast-enhanced CT scans rendered the target lesions more accessible in 16 patients. Conclusion: Contrast-enhanced CT-guided biopsy increases the feasibility of biopsy of retroperitoneal masses.

Purpose: To determine the role of diffusion weighted MR imaging and apparent diffusion coefficient (ADC) in benign hepatic focal lesions. Method and Materials: This study included 47 patients (29 M, 18 F with mean age of 43 years) with benign hepatic focal lesions. They were cyst (n = 8), hemangioma (n = 23), abscess (n = 5), adenoma (n = 5), focal nodular hyperplasia (n = 4) and nodular regenerative hyperplasia (n = 2). They underwent routine MR imaging and diffusion MR weighted imaging using 1.5 tesla MR unit (Symphony-Siemens). Diffusion MR imaging was done using spin echo type of single shot echo planar imaging (EPI) with b value of 0, 500 & 1000 sec/mm2. The apparent diffusion coefficient (ADC) map was reconstructed and ADC value was measured. The mean ADC values correlated with histo-pathological results as well as follow-up imaging results. Results: Adequate ADC maps were obtained in 47 patients. The mean ADC values were 3.4 ± 0.12 × 10-3 mm2/sec in cystic lesion, 2.23 ± 0.08 × 10-3 mm2/sec in hemangioma, 1.94 ± 0.05 × 10-3 mm2/sec in abscess, 1.72 ± 0.07 × 10-3 in focal nodular hyperplasia, 1.65 ± 0.06 × 10-3 mm2/sec in adenoma, 1.62 ± 0.07 × 10-3 mm2/sec in nodular regenerative hyperplasia. The mean ADC values were significantly different within benign hepatic focal lesions (P < 0.001). The differences between the mean ADC values of FNH, adenoma and NRH were not statistically significant (P < 0.23). Conclusion: Diffusion weighted MR imaging is a new imaging modality for diagnosis and characterization of different benign hepatic focal lesions, particularly in patient with renal dysfunction.

Background and aim of the work: Chronic hepatitis C virus (HCV) infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. Subjects and methods: After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests (spirometry), arterial blood gas (ABG) parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients. Results: The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea (51.7%), followed by cough (43.3%). Oxygen saturation (Spo2 and Sao2%), and FEV1 and FVC levels, were significantly decreased in the cryoglobulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV1 level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. Conclusions: The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection.

AIM To investigate ductus arteriosus (DA) location in relation to viscero-atrial situs and branching pattern of the right aortic arch (RAA). MATERIALS AND METHODS Computed tomography (CT) images of paediatric patients (May 2015 to July 2017, n=352) referred for evaluation of cardiovascular malformations were reviewed retrospectively. Patients with RAA were identified and images were analysed for documentation of the viscero-atrial situs, the branching pattern, DA location, and associated malformations. RESULTS The study included 64 RAA patients, 45 situs solitus, 11 situs ambiguous, and eight situs inversus. Mirror-image branching was observed in 34 situs solitus, 11 situs ambiguous, and seven situs inversus patients. Aberrant left subclavian artery (ALSCA) was present in 10 situs solitus and one situs inversus patient. One patient with situs solitus had isolated left subclavian artery. The location of the DA was identifiable in 32 patients (19 left and 13 right). In situs solitus with mirror-image branching, the DA was left in 10, right in four patients. In situs inversus and ambiguous with mirror-image branching, the DA was right in eight and left in two patients. In patients with ALSCA, the DA was left in seven and right in one patient. The location of the DA was identifiable in 85 patients with left aortic arch (left-sided in 84, right-sided in only one patient). CONCLUSION The location of DA in RAA varies according to viscero-atrial situs and branching pattern. In mirror-image branching, the DA is more commonly left-sided with situs solitus and more right-sided with abnormal viscero-atrial situs.

Background Patients who undergo abdominoperineal resection with colostomy may experience phantom rectum pain syndrome. Aim To evaluate combined ganglion impar block and pregabaline for treatment of phantom rectum pain syndrome and improvement of quality of life. Settings and design We conducted a randomized prospective open-label blinded end-point level IV trial in a university-affiliated oncology center in Mansoura, Egypt during the period from June 2018 to May 2019. Patients and methods A total of 40 patients were randomly allocated into two groups: group A (n=20) received pregabaline 150 mg twice daily, and group B (n=20) received pregabaline 150 mg twice daily and ganglion impar block using 5 ml bupivacaine 5% with 14 mg/2 ml betamethasone. We monitored numerical rating scale (NRS), participant satisfaction reporting scale, pain anxiety symptoms scale, postblock complication, and success rate of block. Statistical analysis We used χ2, t-test, and Mann–Whitney tests for statistical analysis. Results NRS improved in each group at 1 week, 1, and 2 months in comparison with basal values (within-group P Conclusion Ganglion impar block with pregabaline improved pain and quality of life in patients with phantom rectum pain syndrome.

Purpose To evaluate the role of multi-detector dental CT in the evaluation of the impacted maxillary canine. Methods and patients This prospective study included 20 patients who were clinically suspected of having impacted permanent maxillary canines. They were 10 males and 10 females with mean age of 23.3 years. They were exposed to plain radiographs and referred for further evaluation using multi-detector dental CT scanner. The panoramic and paraxial images were obtained. Then reformatted images were done in different planes. Imaging data were analyzed for localization and complication of impacted maxillary canine. Distances and angles measurements were made. MDCT findings were compared with intra-operative data of 24 impacted canines. Results A total of 28 impacted maxillary canines were studied in 20 patients. Twelve patients presented with a unilateral impacted canines and 8 with bilateral impactions. The localization of the root apex was 3 (10.7%) labial, 6 (21.4%) palatal, and 19 (67.9%) mid alveolus. The average of the angulations of the impacted maxillary canines to the mid sagittal plane was 39.64. Root resorption was detected in 16 cases. Conclusion MD dental CT provides more reliable and accurate information for the intraosseous location, inclination, and morphology of impacted maxillary canine.

To review Multi-detector CT findings of seven cases with spontaneous regression of hepatocellular carcinomas (HCC).This retrospective study included 7 patients confirmed with diagnosis of HCC. Triphasic CT scan using multi-detector CT scanner was done for all patients. They were 2 women and 5 men. 1st patient presented with metastatic HCC underwent fine needle aspiration cytology (FNAC) from vertebral metastasis. 2nd patient underwent only one session of trans-arterial chemo-lipidol. 3rd patient exposed to blunt trauma with rib fissure fracture. 4th patient presented with two HCCs underwent radio-frequency ablation of one lesion. 5th patient underwent FNAC from HCC and exposed to fracture acetabulum. 6th and 7th patients underwent FNAC from hepatic focal lesions.Complete regression of primary HCC and metastases occurred in 1st patient. 2nd patient showed partial lipidol uptakes of HCC with complete regression of HCC on follow up. Incomplete regression of HCC detected in 3rd, 6th and 7th patients. Partial regression of nonablated lesion detected in the 4th patient. Complete regression of HCC occurred on 5th patient.Spontaneous regression of HCC is an interesting phenomenon. It has been hypothesized that invasive techniques and trauma may be linked. They may initiate immunologic mechanisms that may be involved in the regression. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon and may lead to a new treatment strategy for HCC.

Background: Bronchoscopic lung volume reduction using silver nitrate solution is minimally invasive technique when compared to surgical lung volume reduction,not associated with high morbidity nor mortality, with lower cost. Objective(s): To assess the efficacy and safety of use of Silver Nitrate in bronchoscopic lung volume reduction in patients with emphysema. Methods: Silver nitrate solution 0.5% was administered bronchoscopically to 12 patients with homogeneous and heterogenous emphysema in an open-labeled study. Each patient received 5 ml of silver nitrate solution 0.5% in each segment of the emphysematous lobe. Safety was assessed in terms of medical complications during 3-month follow-up. Efficacy was assessed in terms of change from baseline in gas trapping, spirometry, diffusing capacity, exercise capacity, dyspnea, and health related quality of life. Results: There were no deaths or serious medical complications during the study. A statistically significant reduction in gas trapping was observed at 3-month follow-up. At 3 months, changes from baseline in FEV1 (27.29±10.56% vs. 55.43±17.43%) in heterogenous group and (22.80±4.66 vs. 36.60±8.82) in homogenous group, FVC (44.29±15.52% vs. +68.86±6.77%) in heterogenous group and (50.40±10.29 vs. 60.80±16.05) in homogenous group, RV/TLC ratio (139.00±39.28 % vs. 67.43±21.35%) in heterogenous group and (120.60±29.59 vs. 63.00±9.67) in homogenous group, and St. George9s Respiratory Questionnaire total domain scores (5.8±8.3 U vs. 13.2±12.27 U). Conclusions: Bronchoscopic Lung Volume Reduction With Silver Nitrate solution 0.5% may be a safe and effective therapy in patients with advanced emphysema either homogenous or heterogenous.