Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

Background@#For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. @*Methods@#Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 µg/kg dexmedetomidine (maximum volume 4 mL/side). @*Results@#The modified children’s hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. @*Conclusions@#Addition of dexmedetomidine 0.5 μg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

Response: Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults (Diabetes Metab J 2013;37:450-7)

No abstract available.

Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults

BACKGROUND: Recent evidence has suggested an association between subclinical hypothyroidism (SCH) and microalbuminuria in patients with type 2 diabetes. However, whether SCH is related to microalbuminuria among subjects with prediabetes has not been studied. Thus, we evaluated the association between SCH and microalbuminuria in a cohort of prediabetic Egyptian adults. METHODS: A total of 147 prediabetic subjects and 150 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR), thyroid stimulating hormone (TSH), free thyroxine, triiodothyronine levels, and urinary albumin-creatinine ratio (UACR) were assessed. RESULTS: The prevalence of SCH and microalbuminuria in the prediabetic subjects was higher than that in the healthy controls (16.3% vs. 4%, P<0.001; and 12.9% vs. 5.3%, P=0.02, respectively). Prediabetic subjects with SCH were characterized by significantly higher HOMA-IR, TSH levels, UACR, and prevalence of microalbuminuria than those with euthyroidism. TSH level was associated with total cholesterol (P=0.05), fasting insulin (P=0.01), HOMA-IR (P=0.01), and UACR (P=0.005). UACR was associated with waist circumference (P=0.01), fasting insulin (P=0.05), and HOMA-IR (P=0.02). With multiple logistic regression analysis, SCH was associated with microalbuminuria independent of confounding variables (beta=2.59; P=0.01). CONCLUSION: Our findings suggest that prediabetic subjects with SCH demonstrate higher prevalence of microalbuminuria than their non-SCH counterparts. SCH is also independently associated with microalbuminuria in prediabetic subjects. Screening and treatment for SCH may be warranted in those patients.

Cell proliferation of esophageal squamous epithelium in erosive and nonerosive gastroesophageal reflux disease

Gastroesophageal reflux disease [GERD] is a major public health problem that may cause erosive or nonerosive esophagitis in symptomatic patients. The severity of esophagitis in GERD seems to be correlated not only to the amount of reflux and altered motor activity but also to the ability of the mucosa to resist injury and repair the damage. This study aimed to evaluate the cell proliferation status of esophageal epithelium in both normal individuals and patients with GERD with or without erosions and its correlation with the degree of inflammation of the esophagus. This study was carried out on 33 individuals; their ages ranged between 17 and 74 years. All participants were subjected to a clinical assessment and an endoscopic evaluation. Four biopsies were taken using an endoscope at 5 cm from the Z-line; histological esophagitis was identified and graded. Cell proliferation was evaluated by Ki-67 immunostaining. The prevalence of GERD was the highest in the 15-29 years age group [46.43%] and decreased with age. Cell proliferation [estimated by the Ki-67-labeling index [Ki-67 LI]] was reduced in esophageal epithelium in erosive [13.44%] and nonerosive [36.83%] reflux disease in relation to normal individuals [68%]. There was a statistically significant positive correlation between cell proliferation [Ki-67 LI] and the endoscopic grade of esophagitis among patients with erosive disease. However, there was no significant correlation between cell proliferation [Ki-67 LI] and the histological grade of esophagitis in both erosive and nonerosive reflux disease. The ability of the mucosa to resist injury and to repair the damage should be considered a key factor in the development of GERD. Esophageal mucosa exposed to chronic acid insult show reduced cell replication, estimated by the Ki-67 LI. Erosive esophagitis in GERD seems to be related to a low cell proliferation rate of esophageal epithelium rather than the amount of reflux

Intravenous propacetamol as postoperative analgesia in cesarean section. Comparative study with intra-thecal morphine

The Provision of optimal analgesia after cesarean section remains a challenge, as satisfactory pain relief must be balanced with the ability of the mother to care for her newborn. [Cohen et al., 1992] Paracetamol is a non NSAID commonly used in multimodal post-operative pain management [Flouvat et al, 2004]. The recent availability of propacetamol an injectable pro-drug of paracetamol has prompted the use of this well known and safe analgesic in many clinical settings when the par enter al route is required [Van Aken et al., 2004]. of this study was to evaluate the safety and efficacy of intravenous propacetamol in comparison with intrathecal morphine for postoperative analgesia following cesarean section. The present study was carried out in Assiut University Hospital Eighty parturients undergoing elective cesarean section under spinal anesthesia were included. The parturients were allocated randomly into four equal groups: Group I is the control group and received intrathecal bupivacaine 0.5%, 10-12.5 mg alone. Group II received intrathecal bupivacaine 0.5% 10-12.5 mg combined with morphine 0.4 mg. Group III received intrathecal bupivacaine 0.5% 10-12.5 mg followed by i.v. propacetamol 2g /l00mL saline after delivery of the baby and after 6 hours. Group IV received intrathecal bupivacaine 0.5% 10-12.5 mg combined with morphine 0.2 mg followed by i.v. propacetamol 2g /l00mL saline after delivery of the baby and after 6 hours. All patients in the four groups received I. M. 75 mg diclofenac at the end of surgery and after 8 hours. When the Visual Analogue Scale [VAS] was 4cm or more, an additional postoperative I.M. meperidine 50 mg as rescue medication was given. Hemodynamic data were recorded immediately after induction and every 10 min till the end of the operation. Neonatal outcome was assessed by Apgar score at one and 5 minutes. Pain intensity score was assessed by VAS every hour and for 12 hours. There were no significant differences between the four groups as regard demographic data, hemodynamics and the neonatal outcome. The pain intensity was more in the control group, the 1. V. propacetamol group was better than the control group but less than the intrathecal morphine group and the pain intensity was the least in the combined group. The combined group was the best one, regarding the quality of pain relief and less side effects due to reduction in morphine dose. The control group required more supplemental analgesia than the propacetamol group and no supplemental analgesia was required in groups II and IV. Complications and side effects were minor. Conclusion: This study may be too small to detect the analgesic effect of propacetamol. The study is also too small to detect a reduction in side effects using multimodal therapy, if there is such a reduction. Therefore, the role of propacetamol is still unknown and a further investigations, with sample sizes large enough to quantify side effects and patient safety, still need to be performed

Determination of the efficacy of chemical disinfectants against some gram positive and gram negative bacteria in dairies under standardized conditions [DVG-guidelines]

In this study the bactericidal efficacy of four reference disinfectants used as standards in the recently published DVG-guidelines was assessed against Gram-positive and Gram-negative bacteria in dairies in the presence of organic matter [milk] by using two test methods according to the DVG-guidelines [2007] and European Standards which specify a test methods and minimum requirements for bactericidal activity of chemical disinfectants and antiseptics that are used in the dairies. This test methods are based on European standards [EN] which were prepared by the Technical Committee CEN/TC 216 [Chemical Disinfectant and Antiseptic]. The results showed that when we used suspension test which was the limiting test method for the listing of disinfectants for the food industries in the former DVG-guideline [2000] for determining the bactericidal efficacy of the tested reference disinfectants against tested organisms, Staphylococcus aureus [ATCC 6538] and Pseudomonas aeruginosa [ATCC 15442] were highly sensitive to formic acid while, Escherichia coli [ATCC 10536] and Enterococcus hirae [ATCC 10541] were more resistant. With application of peracetic acid the most resistant microorganisms were Staphylococcus aureus and Escherichia coli. While, the other two bacterial strains were highly susceptible. With glutaraldehyde the highly sensitive microorganisms were Enterococcus hirae and Escherichia coli. Benzyl-alkyl-dimethyl ammonium chloride showed higher bactericidal effect against Enterococcus hirae and Pseudomonas aeruginosa than against Staphylococcus aureus and Escherichia coli which needed longer exposure times at the same concentration. So, the limiting test organism when using formic acid as reference substance was Enterococcus hirae. While, with peracetic acid application was Staphylococcus aureus. Both Staphylococcus aureus and Pseudomonas aeruginosa appear to be the limiting test organisms with glutaraldehyde. When using benzyl-alkyl-dimethyl ammonium chloride were Staphylococcus aureus and Escherichia coll. Higher concentration and prolonged exposure times where necessary when test organisms were dried onto the surface of steel disks [carrier tests] as they were when the organisms were placed in suspension [suspension test] mainly with Gram negative organisms. This appears when using formic acid as reference substance against Gram negative test organisms we need higher concentrations in the same contact time. Also, with peracetic acid and benzyl-alkyl-dimethyl ammonium chloride applications higher concentrations respectively prolonged exposure time were required. This also was observed with Gram positive test organisms when using peracetic acid as reference substance. Differences in the disinfectant susceptibility were noticed between the four strains of microorganisms where, Escherichia coli was highly resistant to formic acid, while Pseudomonas aeruginosa was the most resistant strain to peracetic acid. Glutaraldehyde gave the same bactericidal effect against all tested strains. With benzyl-alkyl-dimethyl ammonium chloride the highly sensitive microorganism was Enterococcus hirae. These findings emphasize the need for caution in selecting an appropriate disinfectant for use on contaminated surfaces in dairies and dairy industry particularly in the presence of organic material [milk] as well as the need to include reference substances in the disinfectant testing procedure to be able to compare the activity of different products and check the susceptibility of the test organisms used

Role of drugs affecting potassium channels on morphine analgesia in mice

The modification of antinociceptive effect of morphine by either K[+] channel blockers such as glibenclamide or K[+] channel openers such as diazoxide and minoxidil was evaluated. Antinociceptive activity of morphine was measured by tail-immersion test and hot plate test in mice. The intraperitoneal administration of morphine [5 mg/kg] elicited a time-dependent antinociceptive effect [after 15, 30, 60 and 120 minutes post injection]. The selective blockers of ATP -senstive K[+] channels glibenclamide [15mg, IP] antagonized the spinal [tail-immersion test] and supraspinal [hot plate lest] antinociception induced by 5 mg/kg morphine IP. In contrast the antinociceptive effect of morphine was enhanced by intraperitoneal administration of either diazoxide [140 mg/kg] or minoxidil [14 mg/kg] [K[+] channels openers] in a time dependent manner [after 15, 30, 60 and 120 minutes post injection]. These results suggested that K[+] channels openers as diazoxide and minoxidil potentiated the spinal and supraspinal analgesia induced by morphine. In addition the selective blockers of ATP -senstive K[+] channels glibenclamide antagonized the spinal and supraspinal analgesia induced by morphine in time dependent manners

Evaluation of uterine arterial impedance in pregnant women with recurrent spontaneous first trimester abortions

Uterine receptivity is of great importance in achieving a normal pregnancy and is regulated by a number of factors including uterine perfusion. The predictive value of uterine arterial pulsed Doppler velocimetry in recurrent first trimester abortions is controversial. In this prospective study, we measured uterine artery pulsatility index [PI], as a marker of uterine arterial blood flow resistance in pregnant women with and without recurrent pregnancy loss in first trimester by transvaginal pulsed Doppler ultrasonography and evaluated the association of autoantibodies, including antiphospholipid antibodies [APAs]. This study was carried out at Mansoura University Hospitals, Obstetrics and Gynaecology, Diagnostic Radiology and Clinical Pathology departments from October 2004 to May 2006. One hundred women at 5 to 7 weeks' gestation were enrolled in the study after informed consent. The study population consisted of two groups: healthy women with one or no abortion [control group: n = 60] and women with three or more successive spontaneous first trimester abortions [recurrent abortions group: n = 40]. Uterine artery pulsatility index [PI], was evaluated by transvaginal pulsed Doppler ultrasonography. Blood tests for antinuclear antibodies [ANAs] and antiphospholipid antibodies [APAs] were also performed. The uterine artery PI was significantly higher in the recurrent spontaneous first trimester abortions group than that in the control group. Women with abnormal blood tests had a significantly higher PI in the uterine artery. A high PI in the uterine artery was observed in women with antinuclear antibodies and even higher in women with antiphospholipid antibodies. Among women without antinuclear antibodies or those without antiphospholipid antibodies, the uterine artery PI in the recurrent spontaneous first trimester abortions group was significantly higher than that in the control group. This observation suggests that the uterine artery PI may be an independent index for recurrent spontaneous first trimester abortion. The introduction of pulsed and color Doppler sonography has provided the means for direct non-invasive evaluation of uterine impedance. Analysis of uterine artery PI combined with other blood tests may help in evaluating the risk of pregnant women with recurrent early pregnancy failure

Evaluation of endothelial dysfunction in postmenopausal women

Postmenopause was correlated with atherosclerosis. The aim of the study was to evaluate endothelial cell dysfunction by carotid intimal- medial thickness [IMT] and correlate it, using recently available plasma markers nitric oxide [NO], E-selectin, Nuclear factor kappa B [NF-kB]. Case control study. Mansoura university and private clinic. The work was conducted on 15 postmenopausal women with age mean 62.55 +/- 6.68 and 10 premenopausal women with age mean 43.2 +/- 2.53 as a control group. All cases were subjected to complete clinical examination, carotid artery intimal-medial thickness [IMT] measurement by ultrasonography scanning and study of selected plasma markers of endothelial dysfunction nitric oxide [colorimetric method], E selectin [ELISA] and [NF-kB] [immunocytochemistry]. In addition to plasma lipid [colorimetric method]. There was significant [p=0.003] increase in the IMT in post-menopausal women in comparison to the control group. The lipid profile showed significant increase in triglycerides [TG] [p=0.001] and total cholesterol [p=0.013] and significant decrease in HDL-C [p=0.02] in postmenopausal women in comparison to the control group. The nitric oxide [NO] level was significantly lower in post menopausal women compared with control group [p=0.015]. The plasma E-selectin level was elevated in postmenopausal versus with the control group [p=0.03]. NF-kB was significantly increased in post-menopausal women in comparison to control group [P<0.01]. IMT was positively correlated significantly with total cholesterol [p=0.009], LDL-C [p=0.02] and NF-kB [p=0.000] and negatively correlated with HDL-C [p=0.001]. NF-kB was correlated positively with age [p=0.016], total cholesterol [p=0.005], LDL-C [p=0.012] and negatively correlated with HDL-C [p=0.026] and NO [p=0.004]. The present data are in Keeping with the evidence for significant endothelial cell dysfunction, increased IMT, decreased NO in postmenopausal women

Elevated cerebrospinal fluid beta-2 microglobulin as a tumor marker in a patient with myeloma of the central nervous system

Myeloma involvement of the nervous system is rare. Extensive literature review revealed only a few cases reported from different parts of the world. The presence of CNS symptoms and detection of plasma cells in the CSF is the usual basis of diagnosis. In addition, immunoelectrophoresis and immunofixation for detection of monoclonal protein confirm the diagnosis in some cases, while some authors used flow cytometry and cytogenetic studies on CSF. Reports of multiple myeloma also include unfavorable cytogenetic abnormalities of chromosome 13. We report a case with relapsed CNS multiple myeloma with the detection of elevated b-2 microglobulin [b2M] as a tumor marker in the CSF

Elevated cerebrospinal fluid beta-2 microglobulin as a tumor marker in a patient with myeloma of the central nervous system

Myeloma involvement of the nervous system is rare. Extensive literature review revealed only a few cases reported from different parts of the world. The presence of CNS symptoms and detection of plasma cells in the CSF is the usual basis of diagnosis. In addition, immunoelectrophoresis and immunofixation for detection of monoclonal protein confirm the diagnosis in some cases, while some authors used flow cytometry and cytogenetic studies on CSF. Reports of multiple myeloma also include unfavorable cytogenetic abnormalities of chromosome 13. We report a case with relapsed CNS multiple myeloma with the detection of elevated beta-2 microglobulin [beta2M] as a tumor marker in the CSF

Validity and reliability of mini nutritional assessment in elderly

Malnutrition is common among elderly population and underdiagnosed, and the current study aimed at evaluation the validity and reliability of the Arabic version of Mini Nutritional Assessment [MNA] to be used as a tool for assessment of malnutrition state of elderly people. The original form of MNA questionnaire was translated to the Arabic and applied on 30 geriatrics patients on two occasions with average 7 days between. Measurement of weight, height, calf muscle circumference, mid arm circuthference and serum albumen was done with calculation of BMI and Nutrition Risk Index as well as assessment of mood and cognition. Reliability was measured by Test-retest, split-half and Cronbach's alpha resulting in good level of reliability of the Arabic version. Validity was measured by item analysis which resulting that each item in the Arabic version in relation to the total score of MNA was significant at 0.01 and 0.001, and the accuracy of the MNA has good level of validity. The Arabic version of Mini Nutritional Assessment has good level of validity and reliability and can be used in assessment of nutritional status of elderly people in Comprehensive Geriatric Assessment

Comparison between Nalbuphine and propofol for Treatment of intrathecal morphine-induced pruritus after cesarean section

Intrathecal opioids are frequently used in management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use. Our study was done to compare between nalbuphine [a mixed opioid agonist antagonist] and propofol [2-6 di-isopropylphenol] in treating intrathecal morphine-induced pruritus after cesarean delivery. It included one hundred forty one parturients undergoing elective cesarean section with spinal anesthesia and post-operative analgesia by intrathecal morphine [0.3 mg]. Ninty four parturients were reported to have moderate to severe pruritus. Without pre-medications, all women were hydrated with 500 to 1000 ml of normal saline before intrathecal injection of 7.5-10 mg of bupivacaine for spinal anesthesia and morphine 0.3 mg for postoperative pain control. Heart rate, mean blood pressure, respiratory rate and oxygen saturation were monitored. The degree and onset of pruritus were also recorded. Those parturients whose pruritus scores was >/= 3 or those who requested antipruritic treatment were assigned to receive either 3mg nalbuphine IV, 20mg propofol IV or placebo. The degree of success was reported when pruritus score decreased to 1 or 2 after treatment and then women were evaluated every 15 minutes for up to 4 hours to determine the duration of antipruritic response. The patients who continued to have pruritus scores >/= 3 were considered treatment failure after only a single dose of the study medicine. Any side effects from spinal anesthesia or from the drugs used were recorded. we were able to demonstrate that the success rate after treatment with 3 mg of nalbuphine was significantly greater than with 20 mg of propofol. Among the successfully treated patients, [8%] in the Nalbuphine group and [5.3%] in the Propofol group reported the recurrence of moderate to severe pruritus [pruritus score >/= 3] within 4 hours after administration of the study drug. Among all the treated patients, [21.9%] in the Nalbuphine group and [40.6%] in the Propofol group reported failure of success [moderate to severe pruritus [pruritus score >/= 3]] within 15 minutes after administration of the study drug. our study showed that nalbuphine [3 mg] was superior to propofol [20 mg] in the treatment of intrathecal morphine induced pruritus after cesarean delivery

Maternal serum IgA as a predictor of congenital toxoplasmosis

Maternal seroconversion for Toxoplasma gondii during pregnancy is said to have a good role for diagnosis of congenital infection. To determine whether maternal serum levels of antibodies against Toxoplasma gondii parasite are associated with definite fetal parasitic infection and consequent pathology or not. Maternal serum IgA levels against toxoplasma gondii were measured in 29 patients with strongly suspected congenital toxoplasmosis [maternal IgM seroconversion with fetal pathology] out of 200 patients with suspected pathology. Their pregnancies were complicated by hydrocephalus [Group I, n=17], hydropes fetalis and other congenital anomalies [Group II, n=6], and fetal loss [Group III, n=6]. They were compared with 17 women with negative IgM and normal pregnancies as a control group [Group IV]. All cases were examined by ultrasonography for obtaining amniotic fluid samples during pregnancy. After termination; if possible; fetal cord serum samples were drawn for measuring the same antibodies. Also, placental imprints, placental samples and umbilical cord samples were prepared for microscopic detection of the parasite. Hydrocephalic cases with or without meningornyelocele were treated by neonatal shunt operations with or without repair. Cases presented by maternal IgM seroconversion against toxoplasma gondii during pregnancy with suspected pathology [hydrocephalus, other anomalies, and abortions] showed significantly higher maternal specific toxoplasma IgA levels than the control group [166.7 +/- 27.2, 165.7 +/- 21.1, and 149.7 +/- 9.1 respectively vs. 127.2 +/- 15.3, p<0.001]. Microscopic parasitic detection was positive in 3/11 [27.3%] in the amniotic fluid and in 1/11 [9.1%] in placental imprints of these cases. Conventional serological neonatal testing for specific toxoplasma IgA revealed sensitivity and specificity of 77.8% and 100% respectively. The combination of the results of conventional serological neonatal testing for specific toxoplasma IgA with the results of parasitic detection [amniotic fluid and placenta] resulted in sensitivity and specificity of 94.4 and 100 respectively. Detection of specific toxoplasma gondii IgA antibody response by ELISA is more reliable than IgM level for diagnosis of congenital toxoplasmosis

Early post-treatment immunoglobulin profile in human schistosomiasis

In a trial at determining the most relevant immunoglobulin isotype that could reflect success of praziquantel treatment, an ELISA using soluble egg antigen [SEA] was applied on sera of Egyptian patients suffering from active intestinal schistosomiasis without hepatic complications determining the levels of IgE, IgA, IgM, IgGl, IgG2, IgG3 and IgG4 raised against the SEA, bot0h pre- and early post-treatment. The positive results obtained to all anti-SEA immunoglobulin isotypes before treatment support the usefulness of this technique in the diagnosis of schistosomiasis. Except for IgG3 subclass, a statistically significant correlation was found between egg output-reflecting intensity of infection-and the different immunoglobulin levels, especially anti-SEA IgG4. When repeating the assay 5-6 months after treatment, the immunoglobulin levels showed either a rise [in case of IgE] or a drop [in case of IgA, IgM and IgG1-4], all of statistical significance; yet IgG1-4 were still positive. So, ELISA could not give a definite indication of cure after anti-bilharzial treatment. IgE, IgG2 and IgG4 were revealed to be the most significant immunoglobulin isotypes at the post-treatment level, both statistically and due to their implications on resistance/susceptibility to re-infection and also due to the correlation of IgG4 with the tendency to develop periportal fibrosis. Conclusively, although not having defined a particular Ig isotype as marker for cure, it exposed the urge for early post-treatment determination of IgE and IgG4 isotypes which could serve as markers for picking up high risk patients susceptible to re-infection or liable to develop bilharzial periportal fibrosis and who might benefit from a second course of specific treatment

Effect of interferon: a on experimental schistosoma mansoni infection in mice

To investigate the immunomodulatory effect of the Th1 mediated cytokine IFN-alpha on schistosomiasis, this cytokine was weekly injected into mice experimentally infected with S. mansoni, beginning from day 0 [group II], week 3 [group III], week 6 [group IV] and week 10 [group V] post-infection. TGF beta 1 serum levels were estimated on a weekly basis and beginning one week after initiation of IFN-alpha therapy, while all animals were sacrified on week 14 to be used for egg counts in liver and small intestine, oogram study for determination of the maturity of deposited eggs, and histopathological examination of stained liver sections. IFN-alpha treated groups were characterized by a more intense oviposition in the intestine [liver/intestine ratio less than 1], with higher egg numbers the earlier IFN-alpha was administered. Oograms of the intestine indicated the level of immature eggs to be statistically significantly higher in group II, III and IV than in the control group I [p < 0.05]. In IFN-alpha medicated mice, the mean numbers and diameters of hepatic granulomas were less than in GI, in addition to a lower representation of fibrocellular and fibrous granulomas among them [all parameters p < 0.05], especially in Gs IV and V. The inflammatory cell population in the form of eosinophils, histiocytes and giant cells was more pronounced in Gs III, IV and V. TGF-beta 1 serum levels showed a progressive rise, however more pronounced in the untreated control. A statistically positive significant was established between TGF-beta 1 levels and number, size and percentage of fibrotic hepatic granulomas in all groups

Pulmonary hyalinizing granuloma. Bilateral pulmonary nodules associated with chronic idiopathic thrombocytopenic purpura

We report a case of a 30-year-old female who had been treated periodically with steroids for idiopathic thrombocytopenic purpura ITP over the last 10 years. Recently, during the course of investigation, she was found to have incidental asymptomatic multiple pulmonary nodules on chest CT. Following a needle biopsy to exclude malignancy, 2 nodules were excised and were histologically confirmed as pulmonary hyalinizing granuloma PHG. The remaining 2 nodules regressed on increasing her dose of steroids. The case is discussed with emphasis on the histological and radiological differential diagnosis, in addition to including ITP among the spectrum of immunologic conditions associated with PHG

Efficacy of prostatic massage in treatment of chronic prostatitis patients

To evaluate the efficacy of prostatic massage in treatment of chronic bacterial prostatitis [CBP = Category II] and chronic non-bacterial prostatitis [CNBP = Category IIIa] Category II patients were divided into two groups; group A [n=17] was treated with antibiotics and prostatic massage, and group B [n=20] with antibiotics alone. The same was done in Category IlIa [group C, n=25 and group D, n=19] The eighty-one patients were evaluated before and after treatment. Evaluation at baseline and after treatment consisted of complete history and previously validated questionnaires including the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and the O'Leary Sexual Function Inventory [SFI]. TRUS was also done for all patients before and after treatment. Treatment consisted of triweekly prostatic massage combined with specific culture directed and /or empirical antimicrobial therapy for at least one month. According to this study, we found that patients with chronic prostatitis [category II and IlIa] treated with antibiotics and prostatic massage showed a significant improvement, compared to baseline, in all types of pain related to the prostate, frequency, dysuria, and dribbling. There was also a significant improvement regarding painful ejaculation and erectile dysfunction. Although the incidence of improvement in symptoms was more towards prostatic massage; however, this improvement was not significant when compared with patients treated with antibiotics alone. Premature ejaculation was significantly improved in cases of chronic pelvic pain syndrome, inflammatory type [category IlIa] treated with prostatic massage more than category IlIa treated with antibiotics alone. Frequency was significantly improved incases of chronic pelvic pain syndrome, inflammatory type [category IlIa], treated with prostatic massage more than chronic bacterial prostatitis [category II] treated also by prostatic massage. On the other h and, the ejaculation quality [ejaculation volume and difficulty] worsened significantly in cases treated with prostatic massage

Pulmonary effects of thoracic epidural analgesia for cardiac valve replacement surgery

The study was performed on forty patients [ASA physical status II: III] with symptomatic mitral valve disease underwent mitral valve replacement surgery. The patients where criteria were randomly allocated into two equal groups [20 patients each] 1- General anesthesia group [GA] ['control group]. 2- General anesthesia with thoracic epidural analgesia group [TEA group]. Anesthetic technique and management of cardiopulmonary bypass were standardized for all patients. Spirometric data: [FVC, FEV1, FEV1/FVC% and PEFR,], and respiratory rate were measured at the night before surgery, after extubation by 1h, 12h, 24h, 48h, 72h and [6th postoperative day Arterial Blood Gases: PaO2, PaCO2 and pH were measured after induction of GA by 15 min., after extubation by 48h, 72h and 6th postoperative day. Visual analogue scale [VAS] score for assessment of pain was measured after extubation by 1h, 6h, 12h, 18h, 24h, 48h, 72h and 6th postoperative day. Total dose of fentanyl analgesia was calculated in each group. There were some improvement in respiratory function [FVC, FEV 1 and PEFR.] started at the 3rd to the 6th post operative days.There were insignificant changes in FEV1/FVC all over the study period RR decreased significantly in the epidural group than control group in all readings. There was a significant decrease in VAS in TEA group than the control group throughout the study period. PaO 2 was significantly decreased in both groups at all readings. 1. Intensive Care Unit [ICU] stay: There was insignificant difference between the two groups. 2. Time to first awake /hour was significantly decreased in thoracic epidural group than general anesthesia group [1.3 +/- 0.3 vercus 2.5 +/- 0.6]. 3. Time to extubation /hour was significantly decreased in thoracic epidural group than general anesthesia group [3.5 + 0.2 versus 7.3 +/- 0.3]. 4. Total postoperative fentanyl consumption in 1st 24h was a significant decrease in TEA than GA group [p<0. 00] [677.9 +/- 26 in TEA group versus 1203.4 +/- 44 in general anesthesia group] perioperative epidural infusion of 0.125% bupivacaine and fentanyl, started before induction of anesthesia in valve replacement surgery reduces the total requirements of intraoperative narcotics, without cm appreciable delay in extubation. There was slight improvement in pulmonary function, but not to expected values and far less than control reading indicating multifactorial bases of pulmonary dysfunction in cardiac surgery using CBP

Does low dose of aprotinin influence haemostatic profile in-patients under going mitral valve replacement?

Aprotinin [Trasylol], a non-specific serine protease inhibitor, is successful used to reduce excessive postoperative bleeding during cardiopulmonary bypass. The aim of our study was to verify the hypothesis whether aprotinin used during cardiopulmonary bypass procedure affects hemostatic parameters, which might be crucial for the elevated risk of thromboembolic complications. Patients and methods: Thirty patients undergoing open heart surgery for valve replacement were divided into two equal groups. Group 1[Aprotinin group, AP] [N = 15] a loading dose of 1,000,000 u was given over 20 minutes before sternotomy followed by a constant infusion of 500,000 U/h and 1,000.000 U was added to the priming. Group 2 [Control group] [N = 15] no antifibrinolytic medications were given to this group of patients. Anesthesia and cardiopulmonary bypass protocol were standard for all patients. Plasma level of [Hemoglobin, Hematocrit, Platelet], and Coagulation profile were measured. All blood samples were withdrawn in all patients at 6 times, before induction of anesthesia [basal], post CPB, at ICU arrival, after 6, 12 and 24 hours from ICU arrival. Postoperative, blood loss from the mediastinal chest tubes was collected and reported at 6, 12, and 24 hours from the time of arrival to ICU The percentage of patients received transfusion and the number of transfused units of packed red blood cells [PRBC], platelet and fresh frozen plasma were estimated and recorded at the end of CPB and at the time of discharge from the hospital. At the end of CPB, the thrombin time decreased in group I but this decrease was with in normal range [38-54 seconds] and elevated to exceed the normal range in group [2], This change in thrombin time returned gradually to the baseline value at the end of the study [24hours from ICU arrival] in groups [1], but still exceeded the normal range in group [2] till the end of the study. The fibrinogen level was decreased at the end of CPB in all the studied groups. It began to return to the baseline value in groups [1] at 12 and 24 hours from ICU arrival but the level still lower in group [2] till the end of the study. The D-dimer level was elevated at the end of CPB in all the studied groups and began to return to the normal value in groups [1] at 12 and 24 hours from ICU arrival but the level was markedly elevated and exceeded the normal value in group [2] till the end of the study. The amount of blood loss was significantly reduced [P < groups [1] when compared with group [2] at all the time of study. The amount of transfused [PRBC] units, FFP and Platelet were significantly decreased [P < 0.05] in group [1] when compared to control group. Low dose aprotinin during mitral valve replacement surgery decreased perioperative blood loses and the need for allogenic transfusion together with improvement the haemostatic profile