Microsoft Word - Document1 The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 1 21

Inhibitory Effect of Dietary Curcumin on 1, 2-Dimethylhydrazine-Induced
Colon Preneoplasia in Irradiated Rats

Manar Nabih Hafez
National Centre for Radiation Research and Technology, Atomic Energy Authority


Prevention of cancer remains a primary need and new chemopreventive
agents must be developed for this purpose. It is well known that the radiotherapy is associated
with severe side effects and offers no firm expectation for a cure. Thus, there is a constant need
for the investigation of other potentially useful options. One of the widely sought approaches is
cancer chemoprevention that uses natural agents. Curcumin, a natural plant product, has been
shown to have anti-inflammatory and antioxidant properties and which, thus, may be a potential
anticancer drug.
Material and Methods: The inhibitory effects of dietary curcumin (0.6 % in diet) on
colonic precancerous lesions in rats treated with 1,2-dimethylhydrazine, (DMH, 20 mg/kg, s.c.
once weekly for 6 weeks) or exposed to -radiation (6.5 Gy) alone or in combination were
evaluated histologically and histochemically.
Results: The results showed clear features of colonic dysplasia with DMH treatment. The
dysplastic crypts exhibited marked hyperchromatism, loss of polarity besides nuclear and
cellular stratification. Whereas, -irradiation revealed marked crypt dilatation accompanied by
disorganized crypt structure and alteration of surface epithelium. The results also demonstrate
an apparent synergy between the radiation and the chemical carcinogen in the induction of
augmentation of mucosal abnormalities accompanied with increased total DNA content and cell
proliferation. Consistent with these observations, changes in the type of mucous secretion with
predominance of sialomucins were observed in the areas of mild to moderate dysplasia whilst
the surrounding normal epithelium produced sulphated material. Mucus depletion was a
common feature in areas of severe dysplasia.
Addition of curcumin to the diet remarkably reduced the amount and severity of dysplastic
lesions with DMH-induced colon preneoplasia without appreciable toxicity. Moreover,
curcumin could prevent or improve the disruption of colonic architecture caused by -
irradiation. Such improvement was also investigated but to a lesser extent with the combined
radiation and DMH.
Conclusion: These results indicated that curcumin is potent in inhibiting the preneoplastic
lesions and other cellular events relevant to colon and was, therefore, of value as a safe
chemotherapeutic agent.


Colon cancer is one of the most
Dimethylhydrazine (DMH) has been shown
common cancer in developed countries and
to induce colonic carcinomas in rats and
is considered to be one of the major causes
mice with marked organ specificity (Sitohy
of cancer-related death (Manju et al., 2005).
and El-Salhy, 2001). Also, Maskens (1976)
Virtually every major form of human
reported that DMH treatment enhances
cancer can be reproduced in experimental
epithelial cell proliferation in the rat colon .
animals by exposure to specific chemical
Deschner and Long (1977) found that
carcinogens (Yuspa and Poirier, 1988).1, 2-
whatever alterations are induced by DMH

Full Paper (vol.26 paper# 1)

The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 22 30

Effect of increase in Antioxidants Supplementation on Kidney Tissue
of Mice Subjected to Fractionated Dose of -Irradiation.

*Hanafi N., **Abel Baset El Aaser,***Mohamed S. Gabry,***Amany A
Tohamy and ***Manal El Saied Ebrahim
*Radiation Biology Department, National Centre for Radiation Research and Technology,
Atomic Energy Authority, Cairo, Egypt**Cancer Biology Depart. Cancer Institute, Cairo
University ***Zoology Dept. Faculty of Science, Helwan University.


Although there is little doubt that antioxidants are a necessary component
for good health, no one knows if supplements should be taken and, if so, how much.
Materials and methods: To investigate the increase in antioxidants supplementation, a
group of mice feeding on a diet containing 20% soybean was used as control group. The control
group treated with 5% Nigella sativa and Antox drug (3 mg/mouse/day) either alone or in
combination for 15 days. Another control group was treated with the same antioxidants and
subjected to 1 Gy of - irradiation x 5 times day after day. In kidney tissue the levels of
malonaldehyde (MDA) and reduced glutathione (GSH) were estimated. Also, the
histopathological changes were recorded.
Results: 5% Nigella sativa revealed a little decrease in MDA level and a highly
significant decrease in GSH in kidney tissue while the exposure to fractionated dose of -
irradiation predicted a highly significant decrease in MDA and a highly significant increase in
GSH level. Gastric intubations of Antox drug showed a highly significant increase in MDA and
GSH levels in kidney tissue either alone or in addition to fractionated radiation exposure.
Combined treatments of Nigella sativa and Antox drug showed a highly significant decrease in
MDA level and a highly significant increase in GSH level in kidney tissue in comparison to the
control group. Histopathological changes showed that treatment with 5% Nigella sativa and
Antox drug either alone or in combination revealed toxic effect on kidney tissue. However, their
treatments prior to radiation exposure showed ameliorating effect.
Conclusion: Our findings indicated that we must use the antioxidants under control or
under oxidative stress.


Antioxidant in a classification of
have suggested benefits for antioxidant
several organic substances, including
supplements in laboratory experiments,
vitamins C, E and vitamin A (which is
excess supplementation may be harmful. It
converted from beta-carotene), selenium (a
is logic to assume that one dimensional
mineral), and a group known as the
approach to dietary supplementation with
carotenoids. At the molecular and cellular
one specific antioxidant is not a panacea,
levels, antioxidants serve to deactivate
since a broad diet rich in phytonutrients will
certain particles called free radicals.
yield thousands of different polyphenol
Antioxidants are widely used as ingredients
antioxidants available for metabolism.
in dietary supplements that are used for
Also, clinicians should advise their patients
health purposes such as preventing cancer
against the use of antioxidant dietary
and heart disease. However, many studies
supplements during chemotherapy or

Full Paper (vol.26 paper# 2)

The protective effect of L-tryptophan versus alpha lipoic acid against L-arginine induced experimental acute pancreatitis in a The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 31 45

The protective effect of L-tryptophan versus alpha lipoic acid against
L-arginine-induced experimental acute pancreatitis in albino rats

Lamia M. Farghaly* , Nagwan A. Sabak ** and Naglaa A. El-sherbeny***
Departments of Histology*, Biochemistry**and Pharmacology.***
Faculty of Medicine, Suez Canal University.


Aim of the study:
This study was conducted to investigate the possible protective effects
of L- treptophan "a precursor of melatonin" and alpha lipoic acid against L- arginine-induced
experimental acute pancreatitis in albino rats.
Methods: Fourty adult male albino rats (200- 250g) were randomized into 4 groups (n=
10). Group I, the control group was given 0.9% saline intraperitoneally (i.p). Group II, was
given 500 mg/100g L-arginine (i.p) as a single dose to induce acute pancreatitis. Group III: was
given 250mg/kg L-tryptophan (i.p) 30 min prior to L- arginine injection. Group IV: was given
50mg/kg alpha lipioc acid(i.p) 30 min prior to L-arginine. Before scarifice, blood samples were
obtained from all groups to assay serum amylase and interleukin 6. Animals were sacrificed
after 6 hours. For the histopathological study, pancreatic tissue was prepared for histological
(H&E, PAS) histochemical ( Tween stain for lipases) and immunohistochemical ( Bax stain
for apoptosis) techniques. Both qualitative and quantitative analyses were done to assess the
degree of acinar cells affection
Results: It was revealed that serum amylase and interleukin 6 in group II rose rapidly.
Microscopically, severe acinar cells degeneration, interstitial edema, diffuse bleeding and
inflammatory infiltration were demonstrated. These changes were markedly improved with the
administration of both L- tryptophan and alpha lipoic acid.
Conclusion: It was concluded that both L- tryptophan & alpha lipoic acid reduced the
effects of L-arginine-induced acute pancreatitis with better protection achieved by L-tryptophan


Acute pancreatitis ( AP ) is a clinical
amylase, lipase, immunoreactive trypsin or
entity that is believed to have intracellular
elastase) at animal models ( Smotkin and
activation of digestive enzymes and
Tenner, 2002).
autodigestion of the pancreas as its central
Therefore, it is advised to find good
patho-physiologic cause. This non-infec-
animal models to characterize the events of
tious destruction of pancreatic parenchyma
this severe disease. Mizinuma et al. (1984)
quickly induces an inflammatory reaction at
were the first who studied the type of
the site of injury ( Park et al ., 2005)
experimental necrotizing pancreatitis by
intraperitoneal administration of a high
lethality of severe acute pancreatitis is still
single dose (500mg/100g) of L-arginine in
high (20- 30%) ( Peter et al ., 2004) a l
bi n
o r a ts. They demonstrated that 70-80%
Histologically, acute pancreatitis is
of acinar cells were necrotized without any
characterized by interstitial edema, vacuo-
morphological change in the islets of
lization, inflammation and acinar cell
Langerhans ( Peter et al ., 2004).
necrosis ( Baron and Morgan, 1999).
It was shown in experimental models
The diagnosis of acute pancreatitis is
usually based on pancreatic edema index
antioxidant compounds, inspite of their
(pancreatic weight/ body weight), pancr-
diverse structure, were all capable of
reducing the severity of many substances

Full Paper (vol.26 paper# 3)

Cytogenetic study in couples with recurrent miscarriage The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 46 54

Cytogenetic Study in Couples with Recurrent Miscarriage

*Tarek A. Atia, **Salah E. Mourad*** Salem H.
*Histology Dept., **Anatomy Dept., ***Gyn.& Obst. Dept.
Al-Azhar Faculty of Medicine, Cairo, Egypt.


Recurrent miscarriage (RM) is a mysterious reproductive problem affecting
a proportion of couples trying to conceive. Although spontaneous abortion occurs in
approximately 15 to 20% of clinically diagnosed pregnancies of reproductive-aged women,
recurrent miscarriage occurs in approximately 1 to 2% of these women. Many syndromes are
involved in the aetiology of RM, where genetic factors appear to be highly associated. Indeed,
chromosomal anomaly constitutes the single most common cause. About 7% of couples with
RM have one partner with balanced chromosomal rearrangement.
Aim of the study: This study is a prospective study carried out to evaluate the incidence
of chromosomal abnormalities in couples suffering recurrent miscarriage.
Patient and methods: The present study included one hundred couples attending the
antenatal clinic. They have been divided into two groups; the first, is a study group, included 50
couples with recurrent miscarriage. And the second, is a control group, included 50 couples with
normal reproductive history. Conventional cytogenetic analysis was done for both groups.
Result: We have found four cases (8%) carrying chromosomal rearrangements (two
reciprocal translocations, one Robertsonian translocation, and one with duplicated chromosome
segment) among RM group, and no cases of chromosomal rearrangement among those with
normal reproductive history. Statistically, there was a significant association between recurrent
miscarriage and chromosomal rearrangement.
Conclusion: We have concluded that chromosome analysis is highly important to evaluate
such cases with RM.
Key Words: Recurrent miscarriage, cytogenetics, chromosome anomalies.


Human reproduction is an inefficient
but the incidence may be higher by adding
process, as ~50% of all pregnancies were
the chemical detectable pregnancies (Ansari
lost before the expected menses, and
and Kirkpatrick, 1998). The actual preva-
another 30% was lost after or around the
lence of RM in all fertile couples of
time of a missed menses, i.e. before a
reproductive age is 12% (Kutteh, 2006),
woman realizes she is pregnant (Choudhury
and it is increased dramatically with mate-
and Knapp. 2000). Miscarriages are
rnal age 40 years (Bulletti et al., 1996).
considered any pregnancy loss before 20th
Many studies showed a positive correlation
gestational weeks. Some authors further
between the number of previous miscarr-
divide these into embryonic losses, which
iages and the miscarriage rate in the next
occur before the 9th gestational week; and
pregnancy, as up to 40% of women with
fetal losses, which occur at or after the 9th
three abortions and 50% of women with
gestational week to 20th weeks (Kutteh,
four abortions will expect foetal loss in
2006). Recurrent miscarriage (RM) refers
their coming pregnancy (Quenby and
to three or more consecutive spontaneous
Farquharson, 1993).
abortions before the 20th week of gestation.
Many syndromes are known to be
Spontaneous abortion represents 15-20%
associated with RM such as anatomical
among all clinically detectable pregnancies,
anomalies, genetic disorders, hormonal

Full Paper (vol.26 paper# 4)

Epistaxis Management The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 55 62

Epistaxis Management

Hesham A. Abdesallam, Ali K. Mahrous, & Abdelsalam H. Hashim

Otolaryngology/ Head and Neck Surgery Department,


Introduction: Epistaxis is common and has been reported to occur in up to 60 percent of
the general population. The affected person usually does not seek medical attention, particularly
if the bleeding is minor or self-limited. In rare cases, however, massive nasal bleeding can lead
to death. The nose has an abundant blood supply. The arterial supply to the nose comes from
carotid arteries. Nasal bleeding usually responds to first-aid measures. When epistaxis does not
respond to simple measures, the source of the bleeding should be located and treated
There is no unanimity amongst Otorhinolaryngologists in terms of the sequence of
different treatment methods in Epistaxis patients. We aimed in this study to examine our
existing practice in terms of management of epistaxis, and to try to come up with suggestions of
sequential treatment steps.
This is a retrospective study conducted from November 2004 to January 2005 in the
Otolaryngology Department in Midway Maritime Hospital.
Subjects and Methods: The study group consisted of 100 case notes requested. The
demographic data of the patients were collected and the history of epistaxis in each patient.
Results: The study showed the peak of incidence of epistaxis (66%) was in adults (51 91
years old). No sex predilection. It was mostly spontaneous. 60% of the patients presented for the
first time. 63% of the patients have co-morbid conditions. 60% of the patients needed hospital
admission. The patients were treated with different measures.
Conclusion: We concluded that the cases of epistaxis caused by trauma in our series is far
less than expected. Co-morbidity plays a major role in the causation of epistaxis according to
this study.
We recommend the use of chemical cautery, merocele or both as the first line of local
treatment of epistaxis. If it does not work, Rapid Rhino with or without anterior packing should
be considered. If this does not work, then sphenopalatine artery ligation is the next step.


Epistaxis is defined as bleeding from
carotid, namely the branches of the anterior
the nostril, nasal cavity, or nasopharynx. It
and posterior ethmoid arteries from the
is a frequent Emergency Department (ED)
ophthalmic artery, and (2) branches from
complaint and often causes significant
anxiety in patients and clinicians.
sphenopalatine, greater palatine, superior
(Choudhury et al, 2004).
labial, and angular artery.
Epistaxis is common, particularly if
Internally, the lateral nasal wall is
the bleeding is minor or self-limited. In rare
supplied by the sphenopalatine artery
cases, however, massive nasal bleeding can
posteroinferiorly and by the anterior and
lead to death. (Tan and Calhoun,. 1999).
posterior ethmoid arteries superiorly. The

nasal septum also derives its blood supply
Arterial supply of the nose, (Fig. 1)
from the sphenopalatine and the anterior
The nose, like the rest of the face, has
and posterior ethmoid arteries with the
an abundant blood supply. The arterial
added contribution of the superior labial
supply to the nose may be principally
artery (anteriorly) and the greater palatine
divided into (1) branches from the internal
artery (posteriorly). The Kiesselbach

Full Paper (vol.26 paper# 5)

Screenning for Hypertension The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 63 72

Assessing Knowledge, Attitude and Practices of Primary Health Care
Physicians Towards Screening Patients for Hypertension in Cairo.

Ayman S. Abdelhady
Community Medicine Department , Faculty of Medicine , Al-Azhar University.


Introduction : Hypertension (HTN) is a common serious health problem associated with
high morbidity and mortality rates .At the same time ,HTN is widely prevalent all over the
world including Egypt. For many people, the primary care physician is their first point of
contact with the health care system, as well as their main source of preventive and essential
Objective: Assessing knowledge, attitude and practices of primary health care
physicians towards screening patients for hypertension in Cairo.
Methodology:A cross-sectional study , conducted in the primary health care centres
(PHCC) in Nasr city, which was chosen randomly to represent Cairo city , where all doctors
working in these centres were asked to complete a self administered structured and open ended
questionnaire contained the relevant variables :
Results: About 90% of the studied physicians were convinced with the importance of
routine measuring blood pressure for risky patients and 79% stated that role of the PHC
physician should be the early detection of HTN. As regards knowledge towards HTN items,
only 23.5% knew the prevalence and 18.5% knew the most recent definition and grading. The
practices of the doctors towards screening patients for HTN ,showed that only 63.9% of the
doctors usually perform accurate and enough procedures to diagnose HTN patients and 46.2%
routinely screen patients around forty years old while only 43.7% were regularly checking up
the accuracy of the used sphygmomanometers .
Conclusion: The participating physicians had poor knowledge towards some important
items especially the prevalence and new classification of HTN. Their practices were not optimal
as regards the accurate diagnosis of HTN and routine checkup and measuring blood pressure for
people attending the PHC clinics. Recommendations to manage these defects were suggested.


Hypertension (HTN) is a common
patient may have. This classification cons-
serious health problem associated with high
idered blood pressure of the person to be
morbidity and mortality rates (El-Khashab,
normal below 120 /80 mmHg , prehyp-
ertensive at BP:120-139/80-89 mm Hg,
One old and most prevailing defin-
hypertensive (stage 1) at BP: 140-159/90-
ition and classification of HTN recom-
99 and hypertensive (stage 2) with BP
mended a systolic blood pressure (SBP)
160/100. Treatment should be started to
>140 mmHg or diastolic blood pressure
BP<140/90 or BP <130/80 in patients with
(DBP) of 90 or more for the starting point
diabetes or chronic kidney disease
of HTN of mild degree, ( DBP) of 105-114
(National Heart, Lung & Blood Institute
mmHg for moderate HTN and (DBP) of
US, 2004).
115 mmHg for severe HTN (National
Heart , Lung & Blood Institute US, 1993).
Hypertension National Project on a random
The most recent definition and
sample of 6733 subjects in six Egyptian
classification of HTN emphasized the
governorates, revealed that the overall
importance of assessing the risk factors, the
prevalence of hypertension is unusually

Full Paper (vol.26 paper# 6)


Effect Of Some Slimming Drugs On Haematological And Some Vital Signs
Of Albino Rats

Eman G.E. Helal* and Shadia, A. Radwan**
* Zoology Dept., Faculty of Science, Al-Azhar University **Biology & Geology Dept.,
Faculty of Education, Ain Shams University


Some of slimming drugs had been withdrawn from markets so, the present study was
conducted to follow the effect of three different anorexic drugs; on the haematological and
physical parameters of adults albino rats. The used drugs differ in their nature, where the first
one i.e., apple-lite is a fully natural substance, the 2nd one i.e., mirapront-N. is a chemical
substance and the 3rd one i.e., tenuate is a synthetic foamy filler substance.
Fourty adult male albino rats (130 20g) were randomly divided into four groups, ten
on each treated group and ten for the first group which conserved as control group. The 2nd
group was treated daily with apple-lite (3.5mg/ 100g.b.wt), the 3rd group was treated daily with
mirapro-N (0.14mg/100g.b.wt) and the 4th group was treated daily with tenuate (0.1
mg/100g.b.wt). Haematological parameters (RBCs, WBCs count, haemoglobin content (Hb),
hematocrit value (Hct%), mean cell volume (MCV), mean cell heamoglobin (MCH) and mean
cell heamoglobin concentration (MCHC) were detected after 30 days of treatment and also after
15 days of the last treatment as a recovery period. Also, body weight, percent of organs
weight/body weight, skin-fold thickness and some vital measurements i.e. heart beats,
respiratory rate and rectal temperature were recorded after the same periods of treatment and
Haematological studies revealed that RBCs count, total WBCs count, Hb and Hct values
were significantly decreased in the three groups treated daily with anorexic drugs for 30 days.
These changes aere also recorded after the recovery period except in apple-lite treated group
which showed insignificant change in RBCs and Hb after the recovery period. The calculated
mean cell haemoglobin concentration (MCHC) recorded significant increase in apple-lite after
treated and recovery periods, while non significant changes in MCHC were observed after
mirapro-N and tenuate groups after treatment 30 daysfor 30 days but significant increase of
MCHC was recorded after the recovery period of tenuate treated group. Skin-fold thickness of
the three regions tested (gluteal, back and belly) revealed significant decrease in all the treated
groups except the belly region in apple-lite treated group which showed insignificant decrease
after treatment for 30 days. Significant decrease of skin-fold thickness of different regions still
present after the recovery period of 15 days in the three treated groups except the back region of
mirapro-N and the belly region of apple-lite- treated rats which showed insignificant decrease.
Percent of organs weight/body weight were affected according the type of tested drug, while
apple-lite- caused non significant changes, mirapro-N caused significant increase in
hepatosomatic ratio and cardiosomatic ratio, and significant decrease in gonadosomatic ratio.
On the other hand, tenuate resulted in a significant increase in percentage weight of kidneys and
hepatosomatic ratio and significant decrease of gonadosomatic ratio after treatment for 30 days.
After the recovery period, apple-lite revealed significant decrease in brain/b.wt. ratio, while
mirapro-N still affected kidneys, gonadosomatic ratio and brain and tenuate still affected
gonadosomatic ratio and brain; they recorded significant decrease. The physical measurement of
vital signs, i.e. heart rate, respiratory rate and rectal temperature recorded insignificant change
after treatment with apple-lite, mirapro-N and tenuate for 30 days, but significant increase of
rectal temperature was recorded in the tenuate group of the treated rats. After recovery period
insignificant changes in heart rate, respiratory rate and rectal temperature of the treated rats
were observed in the three treated groups.
Key words : Slimming drugs, Haematology, Vital signs, Albino rats.

Full Paper (vol.26 paper# 7)


Platelet Derived Growth Factor And The Extent Of Skin Thickening
As Potential Indicators Of Pulmonary Affection In Systemic Sclerosis

Manal Mahmoud, Mona El Fangary*, Aya M Abdel Dayem**,
Nesriene El Margoushy***, Mohamed Said****
Internal Medicine Ain Shams University, *Dermatology Department Misr University for
Science and Technology,**Chest Department Ain Shams University, ***Medical and
Radiation Research Department, Nuclear Material Authority, ****Biochemistry
Respiratory Intensive Care Unit Ain Shams University.


Background and objective:
Systemic sclerosis is a multisystem disease that has
considerable variability in its presentation, course, and prognosis. The aim of this study
was to determine serum levels of platelet-derived growth factor (PDGF A/B) in patients
with systemic sclerosis (SSc) and to correlate these levels with the extent of skin sclerosis
and presence of pulmonary affection. Moreover, the efficiency of PDGF and skin score in
early detection of pulmonary affection were assessed.
Patients and methods:The study included 22 female patients with SSc (according
to the American College of Rheumatology) (Masi et al., 1980) and 15 age-matched
healthy control females. According to the classification by LeRoy et al. (1988), we
divided our patients into limited SSc (10 patients-45.5%) and diffuse SSc (12 patients-
54.5%). The extent of skin sclerosis was assessed by the modified Rodnan total skin
thickness scoring (TSS) system (Clements et al.,1995). In our study, patients with limited
SSc had a skin score <25, while those with diffuse SSc had skin score >25. Five diffuse
SSc patients had associated pulmonary affection, diagnosed by history taking, clinical
examination, chest x-ray, arterial blood gases, spirometry and diffusing capacity of the
lung for carbon monoxide (DLCO). Serum levels of PDGF were determined in SSc
patients and healthy controls using quantitative sandwich ELISA technique.
Results: Serum PDGF mean and standard deviation in healthy subjects was
5.2+2.466 ug/l. PDGF values showed continuous significant increment with progression
of the disease. Mean PDGF serum levels in limited SSc, diffuse SSc without pulmonary
affection and with pulmonary affection were 15.8+2.3, 20.86+2.41 and 32+3.08 ug/l,
respectively. Furthermore, the results revealed that PDGF value <10 ug/l, tend to exclude
the diagnosis of SSc with 100% sensitivity and specificity, respectively. Moreover, all
patients with diffuse SSc and having pulmonary affection had PDGF values >25 ug/l.
This value provided a diagnostic sensitivity and specificity of 100 %.
As regards the total skin score, a statistical significance was found between limited
and diffuse SSc but did not show a statistically significant difference between SSc
patients with (32.2+4.49) and without (29.71+3.25) pulmonary affection (p>0.05).
However, in patients with diffuse SSc, PDGF levels tended to correlate positively with
the skin score (p=0.05). ROC plot showed that skin score at a value of 29 was the best
cut-off level to diagnose pulmonary affection in patients with diffuse SSc with a
diagnostic sensitivity of 80% and specificity of 71.4%.
Conclusion: PDGF is a simple and easy laboratory test that tends to exclude the
presence of SSc at a cut-off value of 10ng/ml with 100% sensitivity and specificity,
respectively. PDGF correlates positively with extent of skin involvement and
significantly with pulmonary affection. PDGF and skin scoring system are simple
laboratory and physical measures for evaluating patients with systemic sclerosis with cut-
off levels of 25 ug/l, and 29 respectively in detecting pulmonary affection. However,

Full Paper (vol.26 paper# 8)

Role of complement and superantigens in the pathogenecity of psoriasis The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 96 105
Role of Complements C5, C6 in the Pathogenecity of Psoriasis

Fayez Muhammad Shaldoum
Lecturer of Immunology and Parasitology, Department of Zoology, Faculty of Science,
University of El-Azhar, Cairo, Egypt


Background: Psoriasis lesion/scale contains C5a des Arg and C5b-9 (Takematsu et al.,
1992; Terui et al., 2000 and Uyemura et al., 1993). These activation products may have arisen
from C5-C9 produced supposedly by keratinocytes (KC). In this work we have started with C5
and C6 to prove our hypothesis. Since psoriatic lesions contain several pro-inflammatory
cytokines, it is important to find out which pro-inflammatory cytokines can differentially
regulate the expected synthesis of C5 and C6 by keratinocytes.
Methods: Human KC have been cultured in the absence and the presence of varying
concentrations of pro-inflammatory cytokines and the synthesis of C components C5 and C6
have been measured by ELISA at the protein level and RT-PCR at the mRNA level. To test
whether KC also secrete these C components, the same measurements have been performed to
find out if these late components are present in the supernatant of the medium where these KC
were cultured. The keratinocytes cell-line A431 was also used and the monocytes cultures were
considered as the positive control.
Results: The results showed that resting KC synthesize C5 mRNAs in detectable amounts.
C5 mRNA which is synthesized by resting KC is not translated into detectable amount of
protein. Although resting KC did not produce C6 mRNA in detectable amounts the levels of C6
protein were detectable. However, These C6 protein levels were minimally secreted by resting
KC, into the culture medium. TCGF induced the secretion of C5 and C6 while TGF- induced
only the secretion of C6.
Conclusion : Normal KC synthesize their own C5 and C6. The synthesis of them is
activated by TCGF. While TGF- activated the synthesis of C6 other factors might be
responsible for activating the synthesis of C5. These factors could be secreted from other cell
types than KC in human skin


Psoriasis is a T-cell immune-mediated
Timar et al., 2006). It has also been
dermatitis (Tagami et al., 1997). Deposition
demonstrated that IFN- and tumour
of complement (C), has been seen in very
necrosis factor TNF- can augment the
early of psoriasis (Terui et al., 1987). This
production of C3 by human cultured
C system was found in an active state in
epidermal KC (Kaneko et al., 1980; Purwar
psoriasis skin since C fragments (C3a, C4a,
et al., 2006 and Terui et al., 1997).
C5a and C4d), factors (Bb) and late
Therefore, it is postulated that an abnormal
complex (C5b-9) were present in high
production of C components in lesional
levels in the lesions (Takematsu et al.,
skin is involved in the acute inflammation
1992; Terui et al., 2000 and Uyemura et
occurring in the epidermis in psoriasis,
al., 1993). It has been shown that C3, factor
under the influence of various cytokines
B and factor H are produced by interferon
including IFN- and TNF- (Kaneko et al.,
1980; Miura et al., 1985; Purwar et al.,
epidermal keratinocytes (KC) (Basset-
2006 and Takematsu et al., 1986).
Seguin et al., 1990; Ozawa et al., 2005 and
However, while KC are known to produce

Full Paper (vol.26 paper# 9)

Circle of Willis, Variation sex linked The Egyptian Journal of Hospital Medicine (2007) Vol., 26: 106 121
Anatomical Variations of the Circle of Willis in Males and Females on
3D MR Angiograms

Kawther A. Hafez, Nahla M. Afifi, Fardous Z. Saudi
Anatomy department, Faculty of Medicine, Ain Shams University


Objective: The objective of the present work was to study the anatomical variations of
the circle of Willis as regard its component vessels and their average diameters in a sample of
adult Egyptians and to detect any sex-related differences in these variations.
Material and Methods: One hundred and twenty adult patients were observed (60 males
and 60 females). They all had problems unrelated to any ischemic or vascular diseases, so they
were considered as healthy control, concerning the morphology of the circle of Willis. In
addition, ten cadavers' brains were obtained from the Anatomy department, Faculty of Medicine
Ain Shams University for examination of the circle of Willis and for detection of any variations.
Results: The anatomical variations of the anterior part, posterior part and completeness of
the circle were inspected. Also, the diameters of all component vessels were assessed.
The results indicated that, the anterior part of the circle was completed in 70% males and
75% females of the study sample. No statistically significant difference was detected between
sexes. The most common variant of the anterior part was the single anterior communicating
artery followed by the hypoplastic or absent anterior communicating artery.
The posterior part of the circle was completed in 44% males and 58% females. The most
common variant was the bilateral posterior communicating arteries, followed by the unilateral
posterior communicating artery. An entirely complete circle was found only in 45% of the entire
population; and it was higher in the females than the in males. The vessels diameters were
smaller in the females than in the males, except for the diameter of the posterior communicating
artery. Cadavers' examination revealed six cases with complete circle, 3 cases of unilateral fetal
posterior communicating and one case of absent posterior communicating artery.
Conclusion: The present study showed the amazing great variability of the anatomy of the
circle of Willis in asymptomatic persons. Nevertheless, there were no marked differences
between both sexes in most of the components and the mean diameters of the circle. Therefore,
these anatomical variations have to be considered during radiological interpretation and would
be reported in the current anatomy text to be aware of all these normal variations.


Circle of Willis is located in the
proximal segment of the posterior cerebral
interpeduncular fossa and joins the two
artery with reversal flow through the
internal carotid arteries with the basilar
posterior communicating artery (Schomer
artery to ensure continued blood supply to
et al., 1994). Ability of the circle of Willis
vital nervous tissues in cases of occluded
to redistribute blood flow depends on its
cerebral arteries (William et al., 1995; Ray
component vessels (Miralles et al., 1995).
et al., 2007 ), (Fig.1). The proximal
Patients who suffered from occluded
segment of the anterior cerebral artery can
internal carotid artery (ICA) but their circle
provide hemispheric cerebral blood flow
of Willis with efficient collateral circulation
from the contralateral internal carotid if the
have a risk of strokes than those without
anterior communicating artery is patent and
such collaterals (Hoksbergen et al., 2003,
the basilar artery can supply collateral flow
Eftekhar et al., 2006). Vessels of the circle
to the anterior circulation through the
of Willis vary in caliber, being often

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