Summary and conclusionAdhesion molecules play an important role in cell-cell and cell –extracellular matrix interactions between hematopoietic cells and the stromal microenviroment. (Drillenburg et al., 2002).In lymphoma and ALL, the expression patterns of these molecules may alter the adhesive qualities of malignant cells influencing their proliferation, spreading, location and apoptosis of malignant cells.sCD44 sheds from the cell surface and release as soluble molecules (Angelopoulou et al., 2001).Serum sCD44 was a useful marker for reflection of disease status in leukemia and lymphoma patients and monitoring response to treatment and disease progression (Guo et al., 2001).This work was carried out to evaluate the serum level of CD44 for assessment of disease activity ,monitoring the response of treatment in lymphoma and acute Lymphoblastic Leukemic patients and also correlation of this marker with the other prognostic factors.This work was carried out on 50 subjects (35 of them were patients with leukemia and lymphoma and 15 healthy children as control). The patients were diagnosed, treated and followed up in the oncology unit of pediatric department, Zagazig University.Five groups were included in this study:Group (1): Twenty case of newly diagnosed patients of ALL.Group (2): Fifteen cases of newly diagnosed patients of Lymphoma composed of 10 case of Non Hodgkin lymphoma and 5 case of Hodgkin disease.Group (3): The same twenty patients of ALL after induction of remission.Group (4): The same fifteen patients of lymphoma after induction of remission.Group (5): fifteen healthy children were taken as control group.All patients and control groups were subject to the following:(1) Full history taking and full clinical examination.(2) Routine laboratory tests including:(a) Complete blood picture.(b) Liver and kidney function tests.(c) Serum lactate dehydrogenase enzyme(d) Erythrocyte sedimentation rate.(e) Bone marrow examination for patients.(f) Immunophenotyping for leukemic patients.(g) Histopathological examination for patients groups.(3) Special investigations including:Measurement of soluble CD44 in serum by ELISA technique*In this study, the results were statistically analyzed and revealed the following:• Median of CD44 is significant with hepatosplenomegaly in lymphoma patients.• Median of CD44 is non significant with hepatomegaly in ALL Patients.• Median of HB level was significantly lower in leukemia and lymphoma patients at diagnosis when compared to control. It is increased significantly at remission but still lower than control group.• Median of total leucocytes count was statistically higher in ALL and lymphoma patients at diagnosis than the value of control group, but there was no statistical significant between leukemia and lymphoma group at diagnosis. There was a highly significant decrease in T.L.C in lymphoma patients and a significant decrease in T.L.C of leukemia patients at remission when compared with those at presentation.• Median of the platelets count was statistically lower in lymphoma and leukemia patients at diagnosis than the value of control group. There was a significant increase in median of platelets count in lymphoma patients at remission compared to those at presentation but highly significant increase in median of platelets count in leukemic patients at remission compared with those at presentation.• Median of blast cells in the peripheral blood in leukemic patients at remission were a highly significant decrease compared to those at presentation.• Median of relative count of blast cells in bone marrow in leukemic patients at remission were a highly significant decrease compared to those at presentation.• Median of LDH levels were a highly significant increased in lymphoma and leukemic patients at diagnosis compared to control group and it was significantly decreased at remission compared to those at presentation.• Median of E.S.R levels were a highly significant increased in lymphoma and leukemic patients at diagnosis compared to control group, and it were significantly decreased after remission than those at presentation.• Median serum sCD44 levels were significantly higher in patients with lymphoma and acute lymphoblastic leukemia at presentation compared to the normal range of control group. There was a highly significant decreased in sCD44 level in patient at remission compared to those at presentation, but its level still higher than the control group.• There was a highly significant difference in serum level of sCD44 in relation to FAB classification i.e higher level of sCD44 in L3 than L2 and L2 than L1 either before or after induction.• There was no significant difference in serum level of sCD44 in relation to Lymphoma stages either before or after induction, although sCD44 is high in advanced stages than early stage, but within each stage there is a significant difference between each stage.• There was no significant difference between serum level of sCD44 and histopathology of Lymphoma in both NHL and HD.• There was a highly significant increase in sCD44 level in NHD patients compared to HD patients either before or after induction.• The decrease in serum level of sCD44 is parallel to the attatinement of complete response to chemotherapy in patients with Lymphoma and ALL.• High sCD44 level at the time of diagnosis and at remission was associated with poor response, and several other adverse prognostic factors.Group B: with TIAs from 16 minutes to 30 minutes.Group C: with TIAs form 30 minutes to 60 minutes .All patients were subjected to the following:1- Detailed history taking.2- Complete general and neurological examination.3- Laboratory investigations:4- ECG (electrocardiography)5- Brain computed tomograhpy6- Transcranial Doppler7- Extracranial carotid DopplerThe results showed that:- Ther was male predomenence over females in both groups.- The prevalence of stroke risk factors were more common in group I than that of groupII.- The Canadian neurological scale was slightly higher in-group II with a higher scores among group A.- Among the patients of group II the outcome was favorable more than that of the first group according to Barthel index, the most favorable outcome was seen in subgroup A.- Favorable outcome was the best in patients with one week elapse time between the previous TIA and the onset of stroke.- Favorable outcome was better in patients who had 2 or 3 TIAs before their stroke.- Group II patients had smaller sized infarcts in CT than in group I patients.- -The mean cerebral blood flow velocities was lower on the affected side than the non affected side.In conclusion we do not state that TIA prevents ischemic stroke but if TIA occurs in the same vascular territory within a time window (4-14 days) and for short periods (less than 30 minutes) the clinical picture may become less severe and the outcome better after an ischemic stroke.RecommendationThis study like some other studies lead us to pay more attention to all risk factors of ischemic stroke and those with history of TIA to be fully investigated to identify the cause of TIA and to manage them and to be followed up to avoid evolving of cerebral infarction and these results may lead in the future to preventive medicine that target certain genes, drugs and/or combination therapy of ischemic stroke to create a neuroprotective effect against ischemic strokeSUMMARY AND CONCLUSIONOur study was done to show the effect of previous TIA in patients after their ischemic stroke in the anterior circulation and to clarify the neuroprotective effect of TIA through comparing the severity of clinical picture on admission and the outcome of stroke in patients with and without previous TIA.50 stroke patients was studied during the period from December 2003 to November 2004. There age range from 43 to 75 with mean age of (m ± SD = 60.8 ± 4.80).According to the presence or absence of previous TIA, our patients were divided into two groups:(Group I): (25 patients) with no past history of TIA (25 patients)(Group II): (25 patients) with previous one or more TIAs in the anterior circulation. We subdivided this group into:Group A: with TIAs of less than 15 minutes.Group B: with TIAs from 16 minutes to 30 minutes.Group C: with TIAs form 30 minutes to 60 minutes .All patients were subjected to the following:1- Detailed history taking.2- Complete general and neurological examination.3- Laboratory investigations:4- ECG (electrocardiography)5- Brain computed tomograhpy6- Transcranial Doppler7- Extracranial carotid DopplerThe results showed that:- Ther was male predomenence over females in both groups.- The prevalence of stroke risk factors were more common in group I than that of groupII.- The Canadian neurological scale was slightly higher in-group II with a higher scores among group A.- Among the patients of group II the outcome was favorable more than that of the first group according to Barthel index, the most favorable outcome was seen in subgroup A.- Favorable outcome was the best in patients with one week elapse time between the previous TIA and the onset of stroke.- Favorable outcome was better in patients who had 2 or 3 TIAs before their stroke.- Group II patients had smaller sized infarcts in CT than in group I patients.- -The mean cerebral blood flow velocities was lower on the affected side than the non affected side.In conclusion we do not state that TIA prevents ischemic stroke but if TIA occurs in the same vascular territory within a time window (4-14 days) and for short periods (less than 30 minutes) the clinical picture may become less severe and the outcome better after an ischemic stroke.RecommendationThis study like some other studies lead us to pay more attention to all risk factors of ischemic stroke and those with history of TIA to be fully investigated to identify the cause of TIA and to manage them and to be followed up to avoid evolving of cerebral infarction and these results may lead in the future to preventive medicine that target certain genes, drugs and/or combination therapy of ischemic stroke to create a neuroprotective effect against ischemic strokeSUMMARY AND CONCLUSIONOur study was done to show the effect of previous TIA in patients after their ischemic stroke in the anterior circulation and to clarify the neuroprotective effect of TIA through comparing the severity of clinical picture on admission and the outcome of stroke in patients with and without previous TIA.50 stroke patients was studied during the period from December 2003 to November 2004. There age range from 43 to 75 with mean age of (m ± SD = 60.8 ± 4.80).According to the presence or absence of previous TIA, our patients were divided into two groups:(Group I): (25 patients) with no past history of TIA (25 patients)(Group II): (25 patients) with previous one or more TIAs in the anterior circulation. We subdivided this group into:Group A: with TIAs of less than 15 minutes.Group B: with TIAs from 16 minutes to 30 minutes.Group C: with TIAs form 30 minutes to 60 minutes .All patients were subjected to the following:1- Detailed history taking.2- Complete general and neurological examination.3- Laboratory investigations:4- ECG (electrocardiography)5- Brain computed tomograhpy6- Transcranial Doppler7- Extracranial carotid DopplerThe results showed that:- Ther was male predomenence over females in both groups.- The prevalence of stroke risk factors were more common in group I than that of groupII.- The Canadian neurological scale was slightly higher in-group II with a higher scores among group A.- Among the patients of group II the outcome was favorable more than that of the first group according to Barthel index, the most favorable outcome was seen in subgroup A.- Favorable outcome was the best in patients with one week elapse time between the previous TIA and the onset of stroke.- Favorable outcome was better in patients who had 2 or 3 TIAs before their stroke.- Group II patients had smaller sized infarcts in CT than in group I patients.- -The mean cerebral blood flow velocities was lower on the affected side than the non affected side.In conclusion we do not state that TIA prevents ischemic stroke but if TIA occurs in the same vascular territory within a time window (4-14 days) and for short periods (less than 30 minutes) the clinical picture may become less severe and the outcome better after an ischemic stroke.RecommendationThis study like some other studies lead us to pay more attention to all risk factors of ischemic stroke and those with history of TIA to be fully investigated to identify the cause of TIA and to manage them and to be followed up to avoid evolving of cerebral infarction and these results may lead in the future to preventive medicine that target certain genes, drugs and/or combination therapy of ischemic stroke to create a neuroprotective effect against ischemic strokeSUMMARY AND CONCLUSIONOur study was done to show the effect of previous TIA in patients after their ischemic stroke in the anterior circulation and to clarify the neuroprotective effect of TIA through comparing the severity of clinical picture on admission and the outcome of stroke in patients with and without previous TIA.50 stroke patients was studied during the period from December 2003 to November 2004. There age range from 43 to 75 with mean age of (m ± SD = 60.8 ± 4.80).According to the presence or absence of previous TIA, our patients were divided into two groups:(Group I): (25 patients) with no past history of TIA (25 patients)(Group II): (25 patients) with previous one or more TIAs in the anterior circulation. We subdivided this group into:Group A: with TIAs of less than 15 minutes.Group B: with TIAs from 16 minutes to 30 minutes.Group C: with TIAs form 30 minutes to 60 minutes .All patients were subjected to the following:1- Detailed history taking.2- Complete general and neurological examination.3- Laboratory investigations:4- ECG (electrocardiography)5- Brain computed tomograhpy6- Transcranial Doppler7- Extracranial carotid DopplerThe results showed that:- Ther was male predomenence over females in both groups.- The prevalence of stroke risk factors were more common in group I than that of groupII.- The Canadian neurological scale was slightly higher in-group II with a higher scores among group A.- Among the patients of group II the outcome was favorable more than that of the first group according to Barthel index, the most favorable outcome was seen in subgroup A.- Favorable outcome was the best in patients with one week elapse time between the previous TIA and the onset of stroke.- Favorable outcome was better in patients who had 2 or 3 TIAs before their stroke.- Group II patients had smaller sized infarcts in CT than in group I patients.- -The mean cerebral blood flow velocities was lower on the affected side than the non affected side.In conclusion we do not state that TIA prevents ischemic stroke but if TIA occurs in the same vascular territory within a time window (4-14 days) and for short periods (less than 30 minutes) the clinical picture may become less severe and the outcome better after an ischemic stroke.RecommendationThis study like some other studies lead us to pay more attention to all risk factors of ischemic stroke and those with history of TIA to be fully investigated to identify the cause of TIA and to manage them and to be followed up to avoid evolving of cerebral infarction and these results may lead in the future to preventive medicine that target certain genes, drugs and/or combination therapy of ischemic stroke to create a neuroprotective effect against ischemic stroke