This study was carried out in the Medical Biochemistry department and Clinical Oncology and Internal Medicine outpatient clinics, Faculty of Medicine, Zagazig University. MAGE-1 m-RNA expression in blood and serum levels of VEGF and AFP were evaluated in a trial to assess their possible use as a diagnostic/or prognostic tool for HCV infection complications like cirrhosis and HCC.This study comprised seventy-five individuals classified into five groups; control group (group I) which comprised fifteen apparently healthy volunteers, group II which involved fifteen HCV infected patients without any complications (cirrhosis), group III involved fifteen HCV infected patients complicated with cirrhosis, group IV included fifteen HCV infected patients complicated with cirrhosis and localized HCC and group V included fifteen HCV patients complicated with cirrhosis and metastatic HCC.MAGE-1 m-RNA expression in blood and serum levels of VEGF and AFP were determined and the results were statistically analyzed revealing the following:MAGE-1 m-RNA determination in blood by RT-PCR assay revealed 36.7 % (11 out of 30 HCC patient) were found to be positive for MAGE-1 in the peripheral blood samples. Detection of MAGE-1 transcript in PBMCs is closely correlated to the pathological stages of HCC. The more advanced stages of HCC, the higher rate of micro-metastasis of cancer cells detectable in peripheral blood and the higher frequency of positivity of MAGE-1 transcript among the group V (metastatic HCC) (60 %, 9 out of 15), while in the group IV (localized HCC), the positivity was (13.3 %, 2 out of 15) (with significant increase in group V than group IV; P< 0.05). Whereas, all samples from healthy volunteers and patients with hepatitis and cirrhosis were negative. These results indicate that MAGE-1 m-RNA is cancer-specific and could be detected in samples from patients with HCC (specificity=100%).As regard the obtained results of serum VEGF, a significant increase was detected in localized HCC group as compared with cirrhosis group (P< 0.05). Also, a significant increase was detected in metastatic HCC group as compared with localized HCC, cirrhosis, hepatitis and healthy control groups (P< 0.001). No other significant differences were detected between the studied groups.Concerning the obtained results of serum AFP, when localized and metastatic HCC groups were compared with cirrhosis, hepatitis and healthy controls ones, a significant increase was observed (P< 0.001), whereas a non significant difference was observed when they were compared with each other (P> 0.05). Also, a non significant difference was detected between cirrhosis and hepatitis groups (P> 0.05) but when they were compared with healthy control one, a significant increase of serum AFP was detected (P< 0.001).Regarding the correlation matrix, a positive correlation between VEGF and AFP in all studied individuals (r=0.34, P< 0.01) and in hepatitis group (r=0.76, P< 0.01) were obtained, whereas non significant correlations were detected in healthy control and cirrhosis groups. In hepatoma groups, non significant correlations were detected between all studied parameters in localized or metastatic HCC groups.In conclusion, detection of MAGE-1 m-RNA in blood and serum VEGF and AFP has different significances; As regard MAGE-1 m-RNA, it seems to be a parameter to detect occult hematogenous dissemination of HCC cells much earlier than any other means, So detection of MAGE-1 transcript in blood, especially with follow up, may help to prefigure HCC metastasis and monitor the response to the therapy. Concerning serum VEGF, our results suggest a possible role for serum VEGF as an indicator of the development of HCC in patients with liver cirrhosis during follow-up and the possibility to use it as an indicator to reflect the disease’s potential activity of vascular invasion and metastasis. In case of AFP, this parameter may represent a liver cell-specific marker, not a tumor-specific marker and our results suggest to use it as a supplementary marker which may help diagnosis of HCC, but not to detect circulating HCC cells, as it was elevated in large portion of patients with localized HCC. Therefore, combination of multiple markers may be more valuable in the diagnosis and prognosis of HCC.Moreover, it was reported that, the expression of MAGE-1 gene, the tumor-specific marker, in HCC is more frequent than in various other cancers and several peptides of the MAGE-1 protein, which contain Major histocomptability (MHC) binding motifs and potential CTL (Cytotoxic T lymphocyte) epitopes were reported, so many HCC patients might be candidates for the specific immunotherapy. Furthermore, understanding of tumoral angiogenesis has dramatically increased and it is hopeful that numerous drugs are currently tested and becoming available in clinic as Bevacizumab (rhuMAb-VEGF) which is a humanized murine monoclonal antibody directed against VEGF, therefore inhibiting the key factor for angiogenesis in tumors and controlling tumor growth, so it may turn it from a deadly into a chronic disease. والعيادة الخارجية للأمراض المتوطنة - كلية الطب البشرى - جامعة الزقازيق. وقد تم تقييم تعبير الحامض النووى الريبوسى حامل الشفرة للجين (ماج-١) فى الدم و قياس مستويات عامل النمو البطانى الوعائى و الألفا فيتوبروتين فى مصل الدم كمحاولة لتقييم إمكانية إستخدامهم كدلالات كيميائية حيوية كامنة لتشخيص ومتابعة مضاعفات الإلتهاب الكبدى الفيروسى سى مثل تشمع الكبد و سرطان الكبد الخلوى.وقد شملت هذه الدراسة خمسة وسبعين شخصاََََ و اعتمادا على الفحص المعملى والإشعاعى و الإكلينيكى تم تقسيمهم إلى خمس مجموعات كالآتى:Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.? US are modalities of choice for the initial imaging of the abdomen and pelvis in children, the technique is non-invasive and? most children can be examined without sedation. The lack of exposure to radiation is important and examination can be repeated at frequent interval if required.? Sensitivity in the detection of different groups of lymph node enlargement is definitely higher using CT (100%) than US (70%).? Regarding accuracy in the evaluation of extranodal lymphoma CT was better than US with a sensitivity of (95%) and specificity of (90.9%). CT in addition to visualizing lymph node enlargement, offer more information about the extent of the lesion with involvement of the intra-abdominal nodes and extranodal organs.? On gastrointestinal lymphoma US can be used as an initial approach whenever there is a clinical suspicion of the intestinal lymphoma. However, the US demonstration of the small bowel loops may be obscured by over lying air in the adjacent loops, there fore, negative US findings cannot excluded the diagnosis of intestinal lymphoma, with a sensitivity of (55.6%) and specificity of (71.4%).? Regarding gastrointestinal lymphoma CT has been proven to be more sensitive than US in revealing bowel wall thickening with sensitivity of (100%), so CT must be performed for staging of the disease and assessment of the extension of the mass.Summary and ConclusionThis study included 30 patients, they were 20 males and 10 females and their age ranged from 1 year to 15 years old.Detailed personal history was taken, full clinical examination and laboratory investigation were performed prior imaging.Abdominal distention was the most common presentation seen in 53.3% of cases.Ultrasonography and abdominal computed tomograhpy were performed in all cases.NHL accounts for about 63.3% of cases and HD for about 36.7% of cases.The results of these diagnostic modalities were recorded, analyzed and compared to the final diagnosis. Which was based on clinical follow up and histopathological findings.From the study we can conclude the following points:? HD and NHL may involve any organ or organ system where lymphoid tissue is found.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.Fig (6): The suggested algorithm of diagnosis of exudative pleural effusionsSummaryThirty patients with exudative pleural effusions were 17 males and 13 females. Their age ranged from 18-77 years, according to Light’s criteria, were fit for pleural biopsy and didn’t have any of the following; bleeding disorders, positive culture of pleural fluid, frank pus, chylothorax, recent history of chest trauma, recent abdominal operation or recent coronary artery bypass, were selected from Patients with pleural effusions, who were admitted at Chest and Internal Medicine Departments, Zagazig University Hospitals, in the period from July 2004 to August 2005, and subjected to the following:1) Thorough medical history2) Full clinical examination.3) Plain Chest X- ray (postero-anterior and lateral views).4) Hematological investigations including:a) Complete blood picture.b) Liver function tests (total proteins, albumin, SGOT, SGPT, and total and direct bilirubin).c) Kidney function tests (blood urea and serum creatinine).d) Prothrombin time and partial thromboplastin time.e) Erythrocyte sedimentation rate (ESR).f) Fasting blood sugar; simultaneous with measurement of pleural fluid glucose level.g) Serum LDH simultaneous with measurement of pleural fluid value of LDH.h) Bone marrow biopsy from the sternum, under local anesthesia, was done in one case which diagnosed as chronic lymphocytic leukemia.5) Sputum analysis: was done for 5 patients with expectoration• Z.N. staining.• Cytological examination for malignant cells.6) Tuberculin skin test. (Mantoux method)7) Serological studies including some selected tests:a) Serum rheumatoid factor (RF).b) Serum antinuclear antibody (ANA)8) Pelvi-abdominal ultrasound.9) Ultrasound guided thoracocentesis.10) Pleural fluid analysis:(pH, protein, glucose, LDH, total and differential leukocytic count, gram stain, culture and sensitivity for aerobic, anaerobic organisms and AFB, ZN staining and cytological examination for malignant cells)11) Blind pleural biopsy by Abrams’ needle: biopsy taken was sent for culture for AFB and histopathological examination.12) Contrast enhanced CT chest.13) CT guided pleural biopsy: from the maximum area of parietal pleural thickening detected in CT chest and sent for histopathological examination.14) Fiberoptic bronchoscope: was done for 8 patients with parenchymal lesions detected in radiological examination and one patient with hemoptysis. The biopsy was sent for histopathological examination and BAL was sent for both ZN staining and cytological examination.15) Medical thoracoscope: with biopsy taken using the ”Storz” rigid thoracoscope 9 mm diameter was performed. The procedure of thoracoscopy was done under local anaesthesia and through a single puncture, that was made before for Abrams’ needle, at the posterior axillary line in the 6th-8th intercostal space while the patient lying in the lateral decubitus position with affected hemithorax up.The results of current study were as follow:1) The final diagnosis as established by different diagnostic tools was reached in 30 cases (100%) and distributed as follow; 8 patients (26.7%) with tuberculosis, one patient (3.3%) with rheumatoid arthritis, 4 patients (13.3%) with primary lung cancer (3 adenocarcinoma and 1 small cell carcinoma), 10 patients (33.3%) with metastatic carcinoma, 2 patients (6.7%) with hematological malignancies (one lymphoma and the other leukemia), and 5 patients (16.7%) with mesothelioma.2) Pleural fluid cytology achieved the diagnosis in 8 /21cases with sensitivity (38 %) of malignant pleural effusion, among them 2 cases (50%) with primary lung cancer, 5 cases (50%) with metastatic carcinoma and one case (20%) with mesothelioma.3) Abrams’ pleural biopsy yielded an overall sensitinity in 21 patients (70%) was obtained. It was positive (pathology and culture for AFB) in 7 patients of tuberculous pleural effusion (87.5%), while the corresponding result for malignancy was 14 patients (66.7%) which distributed as follow; 3 patients (75%) with primary lung cancer, 8 patients (80%) with metastatic carcinoma and 3 patients (60%) with malignant pleural mesothelioma.4) The magnitude of the maximum site of the parietal pleural thickening, detected by CT chest, ranged from 2-28 mm (9.4 ± 6). CT guided cutting needle biopsy from the maximum site of the parietal pleural thickening was positive for the diagnosis in 15/30 patients with overall sensitivity (50%) and was distributed as follow; 3 patients (37.5%) with tuberculosis, and 12 patients (57.1%) with malignant group that distributed as follow; 2 cases (50%) with primary lung cancer, 5 patients (50%) with metastatic carcinoma, 4 cases (80%) with malignant pleural mesothelioma and 1 case (50%) with hematological malignancy (lymphoma). No complication was reported in the procedure of CT-guided cutting needle biopsy.5) Diagnosis was reached by thoracoscopic pleural biopsy in 27 patients with overall sensitivity (90%), amoung them 7/8 patients (87.5%) tuberculous pleural effusion, 19/21 patients (90.5%) malignant pleural effusion and one patient with rheumatoid arthritis. Thoacoscopy was negative in 3/30 patients (10%); one patient in tuberculous group was diagnosed by Abrams’needle, one patient with metastatic carcinoma was diagnosed by cytological examination of pleural fluid and the third patient with lymphoma was diagnosed by bronchoscopic biopsy and CT-guided. 2/30 cases were persistent pneumothorax post thoracoscopy, these two cases were shown to have metastatic carcinoma to the pleura.Comparison of the diagnostic yield of different diagnostic tool versus the diagnostic yield of medical thoracoscopy in the studied patients:1) Pleural fluid cytology was positive in 8/21 patients (38%) with malignancy while thoracoscopic biopsy was positive in 19/21 patients (90.5%) with the same group (p<0.001).2) Abrams’ needle biopsy and thoracoscopy were positive in 7/8 patients (87.5%) with tuberculosis with non significant difference, while Abrams was positive in 14/21 patients (66.7%) of malignant group when compared to thoracoscopy which revealed positive in 19/21 patients (90.5%) of the same group with statistically significant improved yield with thoracoscopy (p0.05).3) CT guided biopsy was inferior with significant statistical difference to thoracoscopy in the diagnosis of tuberculous effusions, as it diagnosed 3 patients (37.5%) while thoracoscopy was positive in 7 patients (87.5%) of the same group (p0.05).4) As regard the total sensitivity of both Abrams’ biopsy and CT guided biopsy; it was 87.5% in TB, 75% in primary lung cancer, 80% in metastatic carcinoma, 50% in hematological malignancy, 100% in mesothelioma and 80.95% in total malignancy.5) Thoracoscopy was the only positive tool in the case of rheumatoid arthritis.Comparison of the diagnostic yield of Abrams’ needle biopsy versus CT guided biopsy in different groups:Abrams’ needle biopsy is superior significantly to CT guided biopsy in the diagnosis of tuberculous effusions (pConclusion1. The available Abrams’ needle biopsy is still an excellent and relatively safe procedure in the diagnosis of exudative pleural effusion especially tuberculous one.2. Percutaneous CT-guided cutting needle biopsy is safe and less invasive and diagnostic tool in patients with exudative pleural effusion.3. CT-guided biopsy is the diagnostic modality of choice in patients with mesothelioma and should precede thoracoscopy in those patients.4. CT-guided biopsy and Abrams’ needle biopsy are complementary to each others in the diagnosis of malignant pleural effusion especially mesothelioma.Recommendation1. Abrams’ needle biopsy should never be neglected as an invaluable diagnostic tool in the diagnosis of exudative pleural effusion that never to be abandoned.2. Based on routine investigations and clinical suspicions, the priority of CT-guided or blind Abrams’ pleural biopsies should be individualized as shown in the following algorithm (fig-11).3. Multiple CT-guided cutting needle pleural biopsies are advisable to be tried in patients with exudative pleural effusion as this guided technique may improve the total sensitivity of this procedure.4. The conclusion of the current study should be challenged widely on larger groups of patients for each of the items included.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.Summary and conclusionFor management of neglected epiphyseal injuries fundamental points must be clarified:1- The nature of the initial physeal injury.2- If the physeal injury is open or closed.3- The location of the cleavage plane through the zones of the epiphyseal pate.4- The anatomical location of the epiphyseal fracture.5- The adequeacy of the treatment of recent epiphyseal injury.6- The patient age at the time of injury e.g. partial or complete epiphyseal arrest in the young child provides a far greater problem than that in the adolescent.The methods of treatment of sequele of epiphyseal injuries are very important includes:1-Treatment of partial growth arrest by osseous bridge resection and implant but failure of the technique may occur, producing erbridging.2- Correction of the angular deformity by osteotomy or epiphyseal stapling.3- Epiphyseal distraction either asymmetrical distraction in angular deformity or symmetrical distraction in complete epiphyseal arrest.4- Epiphyseal transplantation either with or without blood supply the results are only experimental and have no specific indications for use except when a growth center is completely lost with the injury.• There was no significant correlation between Hcy and CRP.It was concluded that CRF patients with hyperhomocysteinemia are more risky to have CVD than patients with normal Hcy level. In addition, other risk factors for CVD such as hypertension, diabetes mellitus, dyslipidemia and inflammation are also common in CRF patients. The effect of pharmacologic doses of vitamin supplementation on reduction of Hcy level and risk of CVD in CRF is limited.For the treatment of hyperhomocysteinemia and reducing the risk of CVD in CRF patients, it’s recommended to increase the doses of vitamin supplementation (folic acid and vitamin B12). At the end, renal transplantation with vitamin supplementation is the suitable treatment for ESRD patients in order to decrease the hazards of CVD.