Physiological Studies On The Efficacy Of Silymarin As Antioxidant Against The Disorders In Some Blood Constituents Induced By The Egyptian Journal of Hospital Medicine Vol., 11 : 1 ­ 14 June 2003
I.S.S.N:

12084
1687-2002

Physiological Studies On The Efficacy Of Silymarin As Antioxidant
Against The Disorders In Some Blood Constituents Induced By
Irradiation In Female Rats.

Mohamed S. El-Gabry*, Hekmat M. Abou-Safi **, Nabil A. El-Yamany*
and Gehan R. Abdel-Hamid**.
* Zoology Dept., Faculty of Science, Helwan University.
** Radiation Biology Dept., National Center for Radiation Research and
Technology (NCRRT), P.O. Box 29 Nasr City, Cairo.

This work was directed to evaluate the possible role of silymarin (a flavonoid used
as antihepatoxic agent) as a prophylactic agent confronting radiation hazard. Eighty
female albino rats were selected at the estrous stage and divided into four groups (G1 -
G4): 1- Control. 2- Whole body -irradiated group with two doses 1 Gy and 6 Gy.
3- Silymarin orally administered group (10 mg / 100 g b. wt., twice daily for one week
with the last dose 2 hours before blood sampling). 4- Silymarin administered as G3 then
rats were irradiated after 2 hours. Blood samples were taken at 2 hours, 2 days and 2
weeks after the last silymarin dose (G3) or irradiation (G2 and G4).
Irradiation induced significant declines in RBCs and WBCs count, Hg content and
Hct % denoting a deleterious effect in a dose and time dependent manner. Yet, it
produced high levels of plasma malondialdehyde, as the end product of lipid
peroxidation, concomitant with reduced levels of blood glutathione indicating a
depression in the antioxidant system. Dramatic increments in the plasma indices of liver
(ALT, AST and alkaline phosphatase) and kidney (urea, uric acid and creatinine)
functions were also recorded depicting a liver and kidney impairment state. Silymarin
manifested good amelioration in the radiation-induced changes in the studied
parameters. Hence, it could be concluded that silymarin plays a beneficial
radioprotective role against radiation hazard in female rats which serves a great sector
of women working in radiation application fields or those undergoing radiotherapy.

I n t r o d u c t i o n

Exposure to ionizing radiation could
therapies by patients to manifest the
induce direct and /or indirect effect in
oxidative stress. Although many such
the biological system. The depth of
modalities are available, herbal thera -
penetration of an ionizing radiation
pies are the most popular, and one of
depends on the nature of the radiation
these remedies is Silymarin (Bass,
on one hand and on the composition and
1999). Silymarin (milk thistle) is a
density of irradiated substance on the
mixture of flavonolignans, comprised
other (Yarmonenko, 1988).
mainly of three isomers: silybin,
Ionizing radiation injury to living
silydianin and silychristin extracted
cells is to a large extent, due to
from the seeds and fruits of silybum
induction of free radicals and oxidative
marianum (Quaglia et al., 1999). It has
stress (Karbownik and Reiter, 2000).
been clinically used largely as an
There has been a substantial
antihepatoxic agent, due to its strong
increase in the use of complementary
antioxidant activity (Lahiri - Chatterjee
Refree by : Prof. Dr : Eman G.E. Helal
1

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Histological and Histochemical Vascular Changes in Experimentally Induced Diabetic Rats The Egyptian Journal of Hospital Medicine Vol., 11 : 15 ­29 June 2003
I.S.S.N: 12084
1687-2002


Histological and Histochemical Vascular Changes in Experimentally
Induced Diabetic Rats

Ahmed El-kassaby; El-Sayed G. Khedr; Abdelmawgood A. ;
Mamdooh Ghaly; Atef I. and Moustafa El-Sawy

Department of Histology; Faculty of Medicine; Al-Azhar University; Cairo


Abstract

In this study, induction of diabetes in adult male albino rats by subcutaneous
injection of alloxan was done, to evaluate its effects on some blood vessels
(Aorta,Femoral and Renal arteries). Thirty adult male albino rats were divided into two
groups, diabetic group, and control group, fifteen animals each. After 6 weeks rats were
operated and paraffin as well as frozen sections of samples from the Aorta, Femoral and
Renal arteries were prepared and stained with different histological and histochemical
stains. Histological examination and statistical evaluation of the aorta of diabetic group
has showed marked intimal thickening caused by infiltration of smooth muscles, which
appear vacuolated. Moreover, the subintimal layer of the media has showed marked
proliferation of smooth muscles, with thickened, fragmented elastic fibers, and
increased collagen content. The mean ratio of the total areas occupied by collagen fibers
was 18.5±1.6, and that of the smooth muscles was 19.8±1.0 in the media. That in turn
was significantly increased (P<0.01) when compared to the control group (8.1±1.0) and
(12.9±0.9) respectively. Also, the mean thickness of the adventitia was 258.8±4.0, and
the mean number of fibroblasts was 41.5±1.7, was significantly higher than those in the
control group(P<0.01), which were 185.4±3.4 and 13.1±1.3 respectively. Histochemical
results have showed presence of fatty material in the intima and media. Also, the mean
optical density (O.D.) values of PAS positive materials was (0.36±0.01), which was
significantly increased (P<0.01) than that of the control group (0.32±0.01). Similar
results have been also detected in the femoral artery. Furthermore, the renal artery has
showed thickening and fragmentation of the external elastic lamina. In
conclusion,diabetes has a damaging effect on blood vessels leading to impairment of
their functions .

Introduction

Diabetes mellitus is a common
estimated that in 2000 there were
metabolic disease characterized a
approximately 150 million individuals
variety of microvascular, macrovascular
with the disease and that this number is
and neurologic complications. It is not a
likely to double by 2025 (King, et al.,
single disease but it is a heterogeneous
2002). Diabetes mellitus is a major risk
group of disorders related to each other
factor seem to contribute to the
(Silvio, 2003). The prevalence of the
development of atherosclerosis (Ross,
disease is increasing globally. It is
1999)and patients die more commonly
15
Refree by : Prof. Dr : Hassan S. El-Dawi

Full Paper (vol.11 paper# 2)


Antioxidative and antiapoptotic effects of vitamin A and vitamin C against carbon tetrachloride induced hepatotoxicity in mice The Egyptian Journal of Hospital Medicine Vol., 11 : 30 ­ 40 June 2003
I.S.S.N: 1208
1687-2002

Antioxidative and antiapoptotic effects of vitamin A and vitamin C
against carbon tetrachloride induced hepatotoxicity in mice

Sohair A Hassan* ,Mahmoud M Salem** And olfat hamam***
*Medicinal Chemistry Department, National Research Center, Cairo, Egypt.
**Zoology department, College of Science, Al-Azhar University, Cairo, Egypt
***Pathology DepartementTheodore Bilhars Institute Cairo, Egypt*

Abstract
Reactive oxygen radicals play an important role in various forms of liver injury.
The present study was a trial to evaluate the efficacy of each of vitamin A&C in its
clinical dose (80 mg / Kg ip) on experimental model of chronic liver injury in mice
using carbon tetrachloride (CCl4). Animals were subdivided into four groups (control,
CCl4 treated, CCl4+Vit.A and CCl4+Vit.C). Vitamin A&C were administrated 2 hours
prior interaperitoneal administration of 0.2 ml / Kg CCl4 in mice. A significant decrease
in serum Glutathione (GSH) and Superoxide dismutase (SOD) activity along with
marked elevation of serum malondialdehyde (MDA), aspartate aminotransferase (AST)
and alanine aminotransferase (ALT) was recorded in response to CCl4 hepatotoxicity.
An notable normalizing to this measured parameters was observed in the groups treated
by vitamin A & C. On Histopathological basis, hydropic degeneration, steatotic changes
and apoptosis was seen obviously in CCl4 treated group but partial improvement in the
previous parameters was noted in vitamin A & C treated groups in spite of vitamin C
seemed to be less effective as far as vitamin A. These results theorized that vitamin A &
C may have a potency to increase the antioxidant and antiapoptotic defense system
activity in the CCl4 treated mice.

Introduction
Hepatotoxins namely carbon tetra-
dered evidences for CCl4 hepatotoxicity
chloride (CCl4) induces acute hepatic
in mice (Mansour, 2000).
necrosis, fatty degeneration, advanced
CCl4 hepatotoxicity is mainly
fibrosis and many other significant
caused by increase the production of
alteration in liver enzymes activities
oxygen free radicals that causes lipid
(Turkdo et al., 2001& Nakamoto et al.,
peroxidation. Kamataki et al (1977)
2003).
found that oral administration of CCl4
A significant elevation in the
to rats inhibited microsomal NADPH-
activities of ALT, AST, alkaline phos-
dependent lipid peroxidation.
phatase (AP) and serum bilirubin was
Weber et al. (2003) suggested that
recorded by Datta et al. (1998)
CCL4 is activated by cytochrome (cyp)
following CCl4 hepatotoxicity.
2E1 or cyp2B2 and possibly cyp3A to
In addition to the above variables,
form the trichloromethyl radical, CCL3.
lactate dehydrogenase (LDH) elevation,
This radical can bind to cellular
significant decrease in total sulphydryl
molecules (nucleic acid, protein, lipid)
(-SH) content and catalase activity in
impairing crucial cellular processes
hepatic tissues and also a significant
such as lipid metabolism, with the
increase in lipid peroxidation measured
potential outcome of fatty degeneration
as malondialdhyde (MDA) were consi-
(steatosis).
Refree by : Prof. Dr. Yehya shaker

30

Full Paper (vol.11 paper# 3)


ž’ The Egyptian Journal of Hospital Medicine Vol., 11 : 41 ­ 49 June 2003
I.S.S.N: 12084
1687-2002

Interleukin ­1 Receptor Antagonist Gene Polymorphism and
Malignant lymphomas

Mona Hilmy Alrayes
Department of Clinical Pathology, Girls` Faculty of Medicine, Alazhar
University.


Abstract:
Background and objectives:
The functional polymorphisms regulating
immunologic responses may influence the proliferation or suppression of malignant
lymphoma. Polymorphism of a specific gene can have an important effect on gene
transcription, the stability of the mRNA, or the quantity and activity of the resulting
protein. Interleukin ­1 (IL-1) gene cluster polymorphisms have been shown to be
important mediators of inflammation. This study aimed to determine whether
polymorphisms at IL-1 receptor antagonist (IL-1ra) locus modulate the risk of
developing malignant lymphoma. Methods: the hospital-based case-control study was
conducted in Epidemiology and Genetics Unit, Algernon Firth Building, University of
Leeds, LS2 9JT. Genotypes were determined for a variable length polymorphism in
intron 2 of the IL-1ra gene (IL-1RN) using PCR based technique. Genotypes were
examined in a total of 279 lymphoma cases, 60 Hodgkin's disease (HD) cases and 464
non-cancer control subjects. Results: The overall allele distribution of these
polymorphisms did not differ substantially between patients and controls; the odds ratio
(OR) was 0.72 and 95% confidence interval (CI) was 0.5-1.03 for the allele 2 carriers of
IL-1RN. Subgroup analysis according to histology [diffuse large B-cell lymphoma
(DLBC) and follicular cell lymphoma (FCC)] failed to illustrate differences except for
DLBC which showed a significant deficit of the 2/2 genotype in the older DLBC cases,
i.e. that the IL-1RN*2/*2 genotype is protective for cases in the 60-65 years group
compared to the 1/1 genotype (OR = 0.25 & 95% CI=0.09 ­ 0.67). On the other hand
the IL-1RN*2/*2 genotype was a risk for HD cases (OR=2.27 & 95% CI=1.22-4.24).
Conclusion: The data of this study show a limited association between IL-1 RN gene
polymorphisms and malignant lymphoma risk in total. IL-1RN*2/*2 is associated with
increased risk to HD. The possible protection role/risk association of the IL-1RN*2/*2
genotype and DLBC/HD respectively needs further clarification.

Introduction
Maintaining
the
physiological
species and between individuals of the
balance or homeostasis is of vital
same species has a great variation. One
importance for any living organism.
of the most important population
Various forms of endogenous and
genetic mechanisms explaining this
exogenous stress constantly interfere
natural diversity is genetic polymo -
with this homeostasis. As a result of
rphism (Steven et al, 2002). Inflam -
genetically determined adaptive poten -
matory stress is the stress form, which is
tial, the effect of these stress factors is
constantly present. Cytokines are a
normally compensated, and a new level
group of small soluble or cell-
of homeostasis is usually rapidly achie -
membrane- bound protein or glycop
ved. The adaptive potential between the
rotein messenger molecules with high
41
Refree : Prof. Dr. Talaat Abdel Halim
.


Full Paper (vol.11 paper# 4)


SINGLE PROPHYLACTIC DOSE OF DEXAMETHASONE ANTIEMETIC VERSUS ONDANSTERON IN PATIENTS UNDERGOING MIDDLE EAR SURGERY: A COMPARATI The Egyptian Journal of Hospital Medicine Vol., 11 : 50 ­ 57 June 2003
I.S.S.N: 12084
1687-2002

Single Prophylactic Dose Of Dexamethasone Antiemetic Versus
Ondansteron In Patients Undergoing Middle Ear Surgery: A
Comparative Clinical And Experimental Animal Study

Khaled Taha


[MD Anesthesia, B.A. Psychology, M.Sc. Neuropsychiatry]
Assistant Professor, Anesthesia Department,
Faculty of Medicine, Ain Shams University


Abstract
This prospective, randomized, double-blinded, placebo-controlled study in which
150 ASA I-II patients scheduled for middle ear surgery were randomized into three
equal groups. The dexamethasone group (group D) received a single dose of
dexamethasone 10 mg IV at induction of anesthesia, ondansetron group (group O)
received 4 mg IV ondansetron and the control group (group C) received 5 ml saline IV
as placebo by the same technique. The study demonstrated that the incidence of early
postoperative nausea, retching and vomiting (PONV) was significantly greater in the
placebo group than the dexamethasone group (P<0.001) and the ondansetron group
(P<0.001), indeed the incidence was comparable in the dexamethasone and ondansetron
groups (P> 0.05). More over, the severity of late PONV (6-24h) was markedly less in
the dexamethasone group than the ondansetron group (P< 0.05) and still the incidence
of late PONV was markedly less in both dexamethasone and ondansetron groups than
the control group (P< 0.001). The study also reported that postoperative analgesic
requirement was notably lower in the dexamethasone group than the ondansetron and
control groups. An experimental animal study was also done to assess the
extrapyramidal reaction associated with the use of both dexamethasone and
ondansetron. Increasing doses of both drugs were given IV to the rats, up to 5 times the
therapeutic dose of each drug. The rats then stimulated for 24h after injection by light,
sound and 6 volt electric current in the Rat Conditioning Chamber. No one rat
developed akathisa or acute dystonic reaction. In conclusion, dexamethasone and
ondansetron were quite effective and have limited side-effects profile when given as
single prophylactic antiemetic doses in patients undergoing middle ear surgery. The
advantages of dexamethasone over ondansetron were its prolonged antiemetic effect, its
analgesic effect and the lower cost.


Introduction

Postoperative nausea, retching and
pneumonia (3) and dehydration (4). It may
vomiting (PONV) are among the most
delay discharge from the hospital with
common complications after anesthesia
obvious economic (5) consequence, and
and surgery, with a relatively high
at the very least is distressing to the
incidence after middle ear surgery
patient (6).
(tympanoplasty or mastoidectomy). (1-2)
The concept of using steroids for
PONV may lead to serious medical
the prevention of PONV is not a new
complications
such
as
aspiration
one (7-10). Even though the concept is not
Refree : Prof ; Dr. Ibrahin Abd El- Gany
50

Full Paper (vol.11 paper# 5)


Comparative Histopathological Evaluation of Permethrin, Pirimiphos Methyl and Bendiocarb Toxicities in Testes, Liver and kidne The Egyptian Journal of Hospital Medicine Vol., 11 : 58 ­73 June 2003
I.S.S.N: 12084
1687-2002

Comparative Histopathological Evaluation of Permethrin, Pirimiphos
Methyl and Bendiocarb Toxicities in Testes, Liver and kidney of rat.


Afaf L. Nessiem; Nahed S. bassily and Salwa A. Metwally
National Organization for Drug Control and Research NODCAR, Egypt

Abstract

The increasing use of insecticides in agriculture and in public health calls for
greater attention for studying their possible toxic effect (s) on man and animals. Acute
toxic effects have been relatively well known whereas chronic effects require further
studies. The aim of the present work was, therefore, to study the histopathological
changes in testes, liver and kidney of rats due to 30 days feeding on diet containing
permethrin, pirimiphos methyl and bendiocarb. The dose used for each insecticide
represented a concentration that equals ten times the acceptable human daily intake.
These doses are far below the LD50, but represent possible exposure doses. Forty male
Sprague- Dawley rats were divided into 4 equal groups. Animals of each group were fed
either by normal diet, or diet mixed with permethrin (21.739 ppm), pirimiphos methyl
(4.350 ppm) or bendiocarb (2ppm) for 30 days. Histological sections of testes, liver and
kidneys were examined and histopathological changes and quantitative estimates were
recorded. Incidence of spermatogenic suppression, Leydig cell atrophy and vacuolation
of Sertoli cells were most prominent in testicular sections from primiphos methyl
treated animal testis than in animals of the other groups. Peremethrin feeding resulted in
the least deteriorative changes. In sections of liver, dilatation and congestion of blood
sinusoids was most evident in the group treated with primiphos methyl and to less
extent in those treated with bendiocarb. Swollen hepatocytes with pyknotic nuclei and
incidence of apoptosis were also recorded. In kidney sections, vacuolar degeneration,
tubular and capsular dilatation, and glomerular congestion were observed especially in
primiphos methyl treated rats.
In conclusion, the obtained changes were of different severity as a response of
exposure to permethrin, pirimiphos methyl or bendiocarb at the same equivelant of
human acceptable daily intake.

Introduction

The use of pesticides has been
pesticidepoisoning and deaths occurred,
largely expanded during the last fifty
the reasons behind this include inadeq -
years. More than 3 million tons of
uate occupational safety standards and
approximately 600 different chemicals
insufficient knowledge of pesticide
are applied annually throughout the
hazards. Some pesticides are carcinog -
world. The WHO (1992), reported that
enic, most are teratogenic, and others
3 million pesticide poisoning cases
are mutagenic. All are attributed to
occurred annually and resulted in 220
normal agriculture use (US Geological
000 deaths allover the world. In the
survey 1997). So, it is safe to assume
developing countries the situation is
that sooner or later higher percentages
worse, since higher proportions of
of our people (especially in developing
Refree : Prof ; Dr. Fathey Matter .
58

Full Paper (vol.11 paper# 6)


Preoperative assessment of different treatment Modlaities in Bronchial Asthma patients The Egyptian Journal of Hospital Medicine Vol., 11 : 74 ­ 89 June 2003
I.S.S.N: 12084
1687-2002
Preoperative Assessment of Different Treatment Modalities in
Bronchial Asthma Patients

*Kawther A. Azzam M.D. and **Sahar S. Khattab MD.

Departments of *Anaesthesiology and **Clinical Pathology
Faculty of Medicine for Girls, Al-Azhar University

Abstract:

This study was performed to assess the effectiveness of acupuncture and medical
therapies of bronchial asthma preoperatively. Sixty patients suffered from mild to
moderate bronchial asthma and coming for elective operations were chozen from the
outpatient clinic of Al-Zahraa University Hospital. Patients were randomly divided into
three equal groups (n=20 each). Group I patients (drug group) received oral
theophylline and Salbutamol (ventolin) inhaler according to the needs. Group II patients
(drug +ear acupuncture group) received same medical treatment as in group I and added
ear acupuncture. Group III patients (drug + ear and body acupuncture group) received
same medical treatment as in group I and II and added ear and body acupuncture.
Ventilatory function tests through spirometer and interleukin-13 estimation were
performed before treatment and after two weeks of treatment. Improvement of
subjective and objective parameters had occurred with significant decrease in the mean
serum level of interleukin-13 and decrease in the mean number of using b-agonist puffs
after two weeks of treatment in the three groups, with the best results being in group III
than in group II and then in group I.
Conclusion: Interleukin-13 estimation togheter with ventilatory function tests is a
useful parameter for pre-operative assessment and evaluation of asthmatic patients. Also
medication was significantly reduced when combined with acupuncture.

Introduction

The American Thoracic Society
neuropeptide substance P with the mast
(1987) defined bronchial asthma as a
cell membrane Each result in mast cell
clinical syndrome characterized by
degeneration and release of its
increased responsiveness of tracheo-
mediators, these mediators are either
bronchial tree to a variety of stimuli and
performed molecule, found within the
manifested by widespread narrowing of
mast cell granules (histamine, neutral
the airways that changes in severity
protease and proteoglycans_ or newly
either spontaneously or as result of
generated molecules (prostaglandins,
therapy.
leukotrienes and cytokines)(1) These
Many cells and cellular elements
released inflammatory mediators from
play a role in asthma in particular mast
mast cells contribute to bronchocons -
cells, eosinophils, T lymphocytes,
triction, inflammatory oedema, mucous
macrophges, neutrophils and epithelial
secretion and activation of secondary
cells. Mast cell activation can occur
effector cells(2)
through the crosslinking of high affinity

Cytokines play an integral role
IgE receptors on the cell surface or the
in the coordination and persistence of
interaction of other stimuli such as
the inflammatory process in the chronic
Refree : Prof ; Dr. Talaat Mohammed Abdel Halim .
74

Full Paper (vol.11 paper# 7)


infections in cases of miscarriage The Egyptian Journal of Hospital Medicine Vol., 11 : 90 ­ 100 June 2003
I.S.S.N: 12084
1687-2002

Enteroviral infections in cases of miscarriage

Eman A. Mohamed ­ Daad F.I. El Fouhil ­ Soad E. Abdel Rehim
Jaylan A. Ali ­ Salwa E. Abdel Hamid

Microbiology Department, Faculty of Medicine for Girls, Al­Azhar University

Abstract
To investigate enteroviral infections as possible causes of miscarriage in pregnant
women, 100 women with miscarriage were studied, 75 of whom had miscarriage before
the 13th week of gestation (group A) and 25 had miscarriage after the 13th week of
gestation (group B). Placental tissue samples were taken from all women and were
investigated for the presence of enteroviruses by cell culture in Vero cell line. The viral
isolates of cell culture positive samples were subjected to neutralization test for typing,
and to reverse transcription ­ polymerase chain reaction (RT­PCR) for detection of
enteroviral RNA. It was found that 36 out of 100 placental tissue samples (36%) were
cell culture positive as they showed enterovirus ­ like cytopathic effect (CPE) in Vero cel
culture, including 29/75 samples (38.7%) from group A and 7/25 samples (28%) from
group B, with statistical y insignificant difference in results between both groups (P>0.05).
Al the 36 viral isolates of the cell culture positive samples were untypable by
neutralization test with the available enteroviral antisera, while 26 of these isolates
(72.2%) were positive for enteroviral RNA by RT­PCR, comprising 21/29 isolates
(72.4%) from group A and 5/7 isolates (71.4%) from group B, with no statistically
significant difference in results between both groups (P>0.05). The remaining 10 viral
isolates were negative for enteroviral RNA by RT­PCR and were attributed to other
CPE producing viruses which may induce miscarriage. As 26 out of 100 samples (26%)
were positive in both cell culture and RT­PCR, thus the obtained incidence of
enteroviral infections among cases of miscarriage was 26%. This incidence is
considered to be a quite high one, needing further attention and studies. No relation was
found between age or parity and enteroviral infections in the studied groups.
Enteroviruses may be considered as important causative agents of miscarriage, and
enteroviral infections should be investigated in all cases of miscarriage. Further studies
including typing of enteroviral isolates from cases of miscarriage by sequencing are
recommended.

Introduction :
Several viral diseases with a
adverse outcome for the fetus and
confirmed effect on the fetus and neon-
neonate (Carrington, 1990).
ate have attracted particular attention.
Enterovirus
infections
during
Maternal infection with rubella virus,
pregnancy have been associated with a
cytomegalovirus, human immunodefic-
variety
of
fetal
complications.
iency virus, parvovirus B19, hepatitis B
Gestational poliovirus infection caused
virus, herpes simplex virus type 1 and 2,
spontaneous abortion and stillbirths,
varicella zoster virus and influenza
especially with severe maternal disease
virus have all shown to be linked to an
(Palmer et al., 1997). Infection with
Referee : Prof ; Dr. Ragaa Abdallah Awad .
90

Full Paper (vol.11 paper# 8)


IMMUNOHISTOCHEMICAL EXPRESSION OF ESTROGEN AND PROGESTERONE RECEPTORS IN NEUROENDOCRINE BREAST CARCINOMAS The Egyptian Journal of Hospital Medicine Vol., 11 : 101 ­ 111 June 2003
I.S.S.N: 1208
1687-2002

Immunohistochemical Expression of Estrogen And Progesterone
Receptors in Neuroendocrine Breast Carcinomas

Naser M.anwer, M.d.*- Ahmed H. Abdel-Rahman, M.D.** Ahmed S. Salem,
M.d**- Abdel- Ghany Awad Essa, M.D.***

Departments of Pathology*' ** and General Surgery*** Al-Azhar University
(Cairo) and (Assuit)

Abstract:
Neuroendocrine (NE) breast carcinomas are defined by the diffuse expression of NE-
markers. They may coexpress NE and non-NE substances such as glycoproteins and apocrine
protein "divergent differentiation". In the present study, twenty NE-breast carcinomas,
expressing chromogranin A (CgA) and neurone specific enolase (NSE) were selected from a
series of two hundreds retrospective breast carcinomas, in addition to ten normal breast tissue
biopsies taken as control. The NE-tumors were graded into G1, G2 & G3 and were divided
according to the mucin expression into group 1 (Mucinous NE-tumors) and group 2 (other
variants that did not express mucin). Each group included 10 cases.
Immunohistochemistry was applied to paraffin sections for investigating CgA & NSE
expression as well as estrogen and progesterone receptors (ER & PR) status. Group 1 tumors
fell within lower grades than those of group 2. Moreover, ER & PR positivity rates were 75%
& 65% respectively. Also, ER expression was not significantly correlated with NE phenotype
(P = 0.14) or with grade (P = 0.24) while PR expression was significantly higher in group 1
than in group 2 (P = 0.02) and in G1, G2 than G3 (P = 0.04) Both steroid receptors co-
expression was significantly higher in group 1 than in group 2 tumors (P = 0.05) and found in
G1 and G2 but not in G3 tumors. Finally, ER and PR were coexpressed, although fewer &
sporadic, in all control biopsies (100%) compared to its presence only in 45% of the studied
NE tumors.
The study concluded that NE-breast tumors, producing high level of NE markers were
specific entity and those coexpressing ER & PR might possess a multidirectional
differentiation. Moreover, it may appear quite necessary to define estrogen & progesterone
receptors status in NE breast carcinomas so as to decide, whether or not to try hormone
therapy as adjuvant treatment modality in these tumors.

Key words: Immunohistochemistry, Estrogen Receptors, Progesterone Receptors,
Neuroendocrine, Breast Carcinoma

Introduction:
Breast carcinomas are a multifaceted
carcinomas while in other non-endocrine
entity that may show various types of
organs, such as lung(5) and prostate(6), this
differentiation. In breast carcinomas of
term defined tumors uniformly and
usual type, focal neuroendocrine and
homogenously positive for NE markers
apocrine differentiations are occasionally
and correlated to a specific clinical
detected in scattered cells by the immun-
evolution(7). As a consequence, the NE-
ocytochemical expression of NE and
differentiated breast carcinomas were
apocrine markers(1-3). In addition, scattered
confined to those with a relevant percent-
hormone-producing
cells
have
been
age (> 50%) of cells expressing NE-
descrybed in two cases of apocrine breast
markers(8). Moreover, all the existing
carcinoma(4).
studies on the clinical evolution of NE-
The term "neuroendocrine" was
breast carcinomas regarded them as a
applied to a heterogenous series of breast
single entity(1,3,7,8). Small cell carcinomas
101
Refree : Prof ; Dr. Bahaa EL- Ghaam

Full Paper (vol.11 paper# 9)


Serum Iron, Serum Ferritin and Hepatic Iron The Egyptian Journal of Hospital Medicine Vol., 11 : 112 ­ 125 June 2003
I.S.S.N: 12084
1687-2002

Serum Iron, Serum Ferritin and Hepatic Iron
Content as a Predictive Values for Combined Therapy of Chronic
Hepatitis C Patients

El-Kholy NM*, Saleh BM**, Ragab SH***, Khalil AM****,
El-Shazly SH*, El-Hosary YA*

*Tropical Medicine, Faculty of Medicine for Girls Al Azhar University,
**Medicine Liver Institute, Menofeya University, ***Clinical Pathology National
Research Center,****Pathology Department Cairo University.

Abstract
This Study was carried out on 40 patients with chronic hepatitis C virus who were
selected with special inclusion criteria. All cases were subjected to evaluation by liver
function tests (especially transaminases), HCV RNA (by PCR quantitative method),
serum iron and serum ferritin. Liver biopsy was taken for histopathological study and
detection of iron content. According to hepatic iron staining in liver biopsies of the 40
patients, the patients were classified into 4 groups (0, I, II, III hepatic iron grade) (20,
10, 8, 2 cases) respectively. All the patients were subjected to combined therapy
(ribavirin and interferon alpha 2b) for 6 ms. then the patients were evaluated for the
biochemical response (AST, ALT) virological response (HCV RNA viraemia) and
histopathological response. Also serum iron, Serum ferritin and hepatic changes were
estimated.
This study revealed that there was a statistical significant difference in hepatic iron
grade 0, I and II with no statistical significant difference in grade III hepatic iron as
regards AST and ALT before and after the therapy. Also there was statistical significant
difference in serum ferritin before and after therapy only in grade 0 and I hepatic iron
although there was no significant difference found as regard serum iron level changes in
all grades of hepatic iron before and after therapy.
For the virological response there was a statistical significant difference as regards
undetectable viraemia after therapy in total patients (30%) and in patients with hepatic
iron grade 0 (45%) while no significant difference found in patients with grade I hepatic
iron (30%), although no patients were found to have undetectable viraemia after therapy
in grade II and III hepatic iron.
For the histopathological response there was a statistical significant improvement
of necroinflammatory activity score in hepatic iron grades 0, I and II while no
significant improvement found in hepatic iron grade III after the course of the treatment
compared to baseline biopsies (before the treatment)
Also for the changes of fibrosis stages after therapy, there was no significant
improvement in total cases and in patients with different hepatic iron grades.
Out of 20 patients with hepatic iron staining (grades I, II, III) before therapy, only
in 4 cases improved the hepatic iron staining after therapy with no statistical significant
change.



Refree : Prof . Dr: Mostafa A.M.
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