UNUSUAL PRESENTATION OF A COMMON DISEASEMazin A Abdullah*, Noori H Jasim#, Furat Shani@*CABS, Lecturer, Dept of Surgery, College of Medicine, University of Basrah. #FICMS, Lecturer, Dept of Surgery, College of Medicine, University of Basrah, @CABS, Lecturer, Dept of Surgery, College of Medicine, University of BasrahAbstractThis study aimed to describe the clinical features of acute rupture of hydatid cyst in the peritoneum. We retrospectively studied 7 patients who underwent explorative laparotomy between January 2002 and October 2005, and in whom exploration confirmed the rupture of hydatid cyst in the peritoneum. Rupture was secondary to trauma in 2 patients, and occurred spontaneously in 5 patients.All patients presented with acute peritonitis, and anaphylactic shock developed in 4 patients. One patient died postoperatively. Ultrasonogrophic diagnosis was made in 3 patients. Surgical treatment consisted of the treatment of peritonitis, the ruptured hydatid cyst and evacuation of the free intraperitoneal hydatid fluid. All patients kept on albendazole. Acute rupture of hydatid cyst in the peritoneum should be considered when evaluating acute abdomen in endemic areas.

Fournier’s gangrene is uncommon acute fulminating cellulitis of scrotum, perineum and groin which develops suddenly and often without any apparent causes. The aim of this study is to elucidate the effectiveness of early and extensive surgical excision with primarily performed complete diverting colostomy in outcome of patients. Fourteen patients with Fournier’s gangrene were included from January 2000 to October 2005 at Basrah General Hospital. History and examination has been taken. Treatment was in form of giving triple antibiotics. Early wide extensive excision of necrotic skin with complete diverting colostomy at the same occasion has been done in all patients. There were all male patients, their ages ranged between 4-75 years old, the average is 50 years. Determining the possible underlying cause finding that five patients has no obvious cause , three had perianal abscesses , determining the extent of disease , finding that in ten patients sloughing of tissue involved perineum , scrotum plus groin and or penis mortality were two out of fourteen patients ( 14%). Fournier’s gangrene is a rapidly progressive, fulminate infection. With institution of aggressive treatment, including early Surgical intervention, formation of completely diverting colostomy in first operation, haemo- dynamic support if needed, intensive care monitoring and broad spectrum antibiotic coverage, the disease has a greatly reduced mortality.

DIVERTING COLOSTOMY --- FOURNIER’S GANGRENE.

Abstract It is previously reported that cancer prognosis is affected by mutations of P53 gene. However, the prognostic significance of P53 mutated gene detection in breast cancer is a subject demanding numerous investigations in a view of numerous facts such as presence of different tumor subtypes, P53 positivity in early breast cancer, different overall survival and disease free period as well as variability of tumor response to chemotherapeutic agents and presence of primary resistance of tumor among patients whether same or different grade and stage. Hence, it is of interest to detect this mutated gene in our area and evaluate its relation to other prognostic factors in terms of age, stage, histological grade and lymph node status. This study aimed to evaluate the relation of P53 mutated gene expression in female with breast cancer in respect to the other prognostic factors such as age, grade, stage and lymph node status. Fifty female patients diagnosed as a breast cancer, underwent clinical and pathological staging (I,IIA,IIB,IIIA,IIIB,IIIC, and IV), histopathological grading (I,II,III). All patients underwent same surgical operation which was modified radical mastectomy and axillary dissection. All specimens were sent to histopathological study and P53 mutated gene detection study by using immunohistochemistry (IHC). P53 mutated gene was detected by immunohistochemistry in 72% of patients with breast cancer. P53 positivity showed a statistically significant direct proportion to histological grade, stage and lymph node status. In addition, more P53 mutated gene expression was detected in younger patients (age group ≤49 years old) and this probably explaining more advance stage observed in this group in this study. All these data leads to a conclusion that the presence of mutated p53 gene is associated with worse prognosis. This study detected P53 mutated gene by IHC for the first time in our region and showed a statically significant association between status of P53 gene mutations and the other prognostic factors such as age, histological grade, stage and lymph node status and consequently to tumor aggressiveness and thereafter to prognosis.

P53 GENE --- BREAST CANCER LYMPH NODES