Functional outcome after swenson's operation for hirshsprung's disease

Hirschsprung's disease [HD] is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry. Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males [63.46%] and 19 females [36.54%] with a mean age of 3.29 +/- 1.6, [range 2-17 years]. Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly. All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients [67.31%] with 11 patients [21.15%] showing minor incontinence and six [11.54%] with major incontinence. On the other side, there were five patients [9.62%] with persistent constipation after operation [three due to anal stricture and two due to residual aganglionosis]. Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients [11.54%] four years after operation. Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation

Evaluation of wedge factor measurements for high energy photon treatment field using physical wedge

To evaluate the parameters that affect the wedge factor for physical wedge using 6 and 18 MV photon beams. Measurements were performed for manual wedges 15°, 30°, 45°, and 60° using Varian Linac 6 and 18 MV photon beams at different depths dmax, 5, 10, and 20 cm for square fields 4x4 cm2 to 20x20 cm[2]. Also the measurements were performed for rectangular fields start from 2x4 cm[2] to 20x35 cm[2]. Measurements were taken at two different set up, first of all the source surface distance [SSD] was 100 cm and the second, source axis distance [SAD] was 100 cm. The wedge factors [WFs] were calculated to describe its dependence on the field size, detector type and depth, and wedge position for 6 and 18 MV photon beams. The dependence of wedge factors on field size were less than 1% at 6 MV and 1% at 18 MV x-ray beams for all wedges. For 6 MV using field size 20x20 cm[2] and 45° wedge the wedge factors increased by 2.6% while at 18 MV the dependence of wedge factors on field size reach to 3%. For 6 MV, as the depth increases the wedge factor increases reach to 1.5%, 3.1%, 5.7 and 8.9% for wedge angles 150, 300, 450, and 600 respectively. The detector type and setup were slightly affecting the wedge factor by less than 1.4% for different type of detector with SSD and SAD setup. The difference between wedge factor using In and Out position for wedge angle 60° was 3% and 3.5% for 6 and 18 MV respectively. This study has demonstrated the parameters that affect wedge factor measurements using photon beam. The results show variation in the wedge factor with field size, up to 2.6% and 3% for the 6 and 18 MV respectively. The wedge factor using 6 MV is highly affected by the depth reach to 8.9%. On the other hand the wedge factor for wedge angle 60 was dependent on depth for both energies 6 and 18 MV. The detector type and setup were slightly affecting the wedge factor by less than 1.4%. The difference between wedge factor using In and Out position for wedge angle 60 was 3% and 3.5% for 6 and 18 MV respectively. According to these measurements it seems that the measurement using fixed position of wedge angle and detector at field size 10x10 cm[2] at depth between 5 to 10 cm would represent a good choice for measuring the wedge factor

Effect of reconstruction methods of HDR brachytherapy gynecological applicator on the prescription and reference points

This Paper demonstrate the effect of reconstruction methods on the prescription and reference points for HDR brachytherapy using Fletcher-Suit-Delclos applicator. To evaluate the effect of reconstruction methods on the prescription points for HDR brachytherapy, the gynecological applicator [Fletcher-Suit-Delclos] is used ovoid and different angles in uterine tube. Three different methods of applicator reconstruction were investigated, first reconstruction method was used electronic simulator image as 2 orthogonal pairs of A-P and lateral films. Second reconstruction method was used 150 slice image of CT as manual and automated reconstruction. All applications are used 22 dwell positions as 7 cm tandem contained 14 dwell positions and the ovoids each 4 dwell positions. All dwell positions are separated by 5 mm. The definition of prescription and reference point was related to Manchester technique. From 150 slices image of CT the applicator was reconstructed manually in TPS using 2cm ovoid and different angles in uterine tube. The dose to the prescription points A Rt and Lt were 500 cGy for all angles in uterine tube. While the dose to the reference points B Rt and Lt were slightly changed 137.1, 132.2 cGy, 144.3, 132.1 cGy and 136.2, 135.2 cGy for angles in uterine tube 15°, 30° and 45° respectively. By comparing CT automated and simulator reconstruction data in relation to the CT manual reconstruction the data illustrate that the difference in dose fore point A between manual and automated reconstruction was approximately 0.2, 2.1 and 6% for angles in uterine tubs 15°, 30° and 45° respectively. On the other hand the difference in dose tore point A between manual and simulator reconstruction was approximately 1.3, 4.3 and 8.6% for angles in uterine tube 15°, 30° and 45° respectively. This study has highlighted the effect of reconstruction methods on the prescription and reference points for HDR brachytherapy. While the differences were minimal on the reference point B it becomes highly considerable prescription point A. As the angle of tandem increases the dose to point A is highly dependent in the reconstruction. The difference in dose fore reference point B between manual and automated reconstruction was minimal approximately less than 1% for all angles in uterine tube. Our recomendation is the CT manual reconstruction is the best reconstruction method to reconstruct the applicator and to determine the accurate position of prescription point A and reference point B as will as bladder and rectum for patients

Effect of vitamin - E on methotrexate hepatotoxicity in rats

The aim of this study was to elucidate the possible role of free radicals in methotrexate [MTX] hepatotoxicity and the protective effect of antioxidant [vitamin E] against MTX hepatotoxicity. Experimental MTX hepatotoxicity was induced by a daily oral administration of 15 mg/kg MTX for four days to Sprague-Dawley rats. The oral co-administration of vitamin E 450 mg/kg with MTX for the same period produced a significant improvement in both the functional parameters and the histopathological picture in the liver of the treated rats. Also, the concomitant administration produced a significant decrease in serum malondialdehyde [MDA] which was significantly increased by MTX alone

Toxicity of methotrexate on fertility and internal organs of male albino rats

Fifty male adult albino rats with average weight of 220 - 250 gm were used in this study. Animals were divided into four test groups and a control group each comprised of ten rats. Test animals received methotrexate [MTX] in a therapeutic constant low dose of 7.5 mg/kg/ week for eight weeks. The effects of the drug were assessed by histopathological, biochemical and spermatozoal examination immediately after its stoppage and within one month recovery period. Significant histopathological changes in internal organs of albino rats associated with marked functional biochemical abnormalities were observed. Also there was marked alteration in sperm count, motility and increased percentage of abnormal forms. Gradual improvement was observed during the recovery period

Influcence of low energy laser treatment on antigen induced experimental arthritis

This study was performed to evaluate the effect of low energy laser irradiation on arthritis induced by type II collagen in rats 10 rats were used as normal control and 50 were utilized for induction of arthritis, 10 of them were not irradiated [arthritic control group] 20 were subjected to local laser application [experimental group] and 20 were exposed to sham laser irradiation [sham laser irradiated group]. Animals of arthritic control group were sacrificed 2 weeks after induction of arthritis Animal of experimental and sham laser irradiation group were subjected to clinical and radiographic examination before and after irradiation. Then they were sacrificed to evaluated histopathological changes in ankle joints after laser application, compared to arthritic control group. Our data reveal improvement of clinical radiographic and histopathological changes after laser therapy

Evaluation of endometrial cytology in diagnosis of endometrial hyperplasia and carcinoma

The present study was carried out on 150 women with perimenopausal bleeding and attending the gyneocologic outpatient clinic of Mansoura University Hospital.Endometria 1 brush biopsy was obtained from each women using an endometrial brush. Smears were stained by Papanicolaou stain, thoroughly examined and results were compared to the standard histopathology of function curettage obtained from the same patient. Endometrial hyperplasia was easily identified by cytopathology in 127 cases, out of which 16 cases were histopathologically negative for hyperplastic changes. Eleven suspicious smears were obtained, of which 8 cases were histologically proved to be atypical hyperplasia, or hyperplasia associated with atypical foci. The 3 malignant cases were identically diagnosed by both cytodiagnosis and tissue diagnosis. Collectively, 123 out of the 150 studied cases had a similar diagnosis by cytopathology and histopathology in only 27 cases the cytodiagnosis compared to histodiagnosis was incorrect. On these bases, the authers could recommend the endometrial cytobrush as a safe reliable and efficient out-patient procedure to be initially used for women with perimenopausal bleeding and restrict the invasive fractional curettage to the cytopathologically suspicious cases

Immunohistochemical study of epithelial cell markers in carcinoma of urinary bladder

Immunohistochemical expression of keratin proteins and epithelial membrane antigen [EMA] were studied in 23 specimens of bilharzial associated human bladder cancer, using an indirect immunoperoxidase method on formalin fixed paraffin embedded sections.Expression of both tumour markers was detected in vast majority of differentiated carcinomas with relative superiority of keratin proteins to EMA immunoreactive staining for keratin proteins was diffuse intracytoplasmic and more uniform allover tumour tissue, compared to the prominent cell membrane localized, but less consistent reaction for EMA.The associated bilharzial reaction induced no detectable influence on distribution, intensity nor consistency of immunoreactivity for either tumour markers.Great variability in expression of both tumour markers was noticed in poorly differentiated carcinoma [2 adenocarcinomas were negative for keratin and positive for EMA and 2 squamous cell carcinomas were negative for EMA and positive for keratin proteins] which issues an advice to evaluate both tamour markers in poorly differentiated tumours in order to optimize detection of these neoplasms

Role of vitamin E in dietary iron overload in rats

The effect of chronic dietary iron overload on various organs of adult male and female rats was studied and compared with concomitant administration of vitamin E, 2 hours before iron. 60 mature rats of both sexes were used and divided into equal 5 groups. The first group received control diet.The second group received corn oil. Ferrous iron [100 mg/kg/day] was given orally to group III. Vitamin E [10 gm/kg/day] was given orally either separate [group IV] or 2 hours before iron supplementation. After 6 weeks serum and organs iron were estimated together with serum GOT, GPT, acid and alkaline phosphates and total lipids. Furthermore histopathological and histochemical study of iron storage were carried out in liver, spleen, lymph nodes, bone marrow, stomach and intestine. Iron overload induced marked rise of iron in serum with histochemical demonstration of its granules in liver, spleen, abdominal lymph nodes, bone marrow, stomach and intestine, associated by elevation in serum GOT, GPT, acid and alkaline phosphatases with reduction in total serum lipids.These pathological and biochemical changes were more evident in male rats than females. They were on the other hand, markedly improved by presupplementation with vitamin E. However, the resulting improvement was still significantly higher than the controls which issues our recommendation for further study using larger doses of vitamin E

Hepatotoxic effect of concomitant administration of acetaminophen [paracetamol] and ethanol in rats

Five groups of albino rats, 10 animals each, were used in this work. Animals of group I were given ethanol, those of group II were given acetaminophen, while in group III and IV animals were given both ethanol and acetaminophen concomitantly. The dose of acetaminophen was doubled to animals of group IV. The fifth group was served as a control. Histopathological and histochemical studies of the liver showed that the hepatotoxic effect of acetaminophen or ethanol when each was given alone is more than when both substances were given concomitantly

Histopathological study of rectal mucosa in acute diarrhoea

Acute diarrhea is a major public health problem, however the related aetiology is controversial. This study was done upon 25 patients complaining of acute diarrhea, their age ranges from 20-55 years, all were males. All patients were subjected to clinical microbiological and sigmoidoscopic study Rectal biopsy was taken from every patient and subjected to histopathological examination. The most important change was the vascular lesion which occur in all patient with +ve and -ve stool culture

Exposure to formaldehyde vapour: a medical occupational hazard

Fourty male and female albino rats were housed in dissecting room of Pathology Department for 10 weeks to determine histopathological alterations in their internal organs resulting from exposure to occupational concentration of formaldehyde vapour [4.5 ppm]. Definite changes were induced in the liver [up to focal necrosis], kidney [focal periglomerular fibrosis], lungs [generalized congestion with epithelial hyperplasia and pseudostratification of bronchioles] and the testis showed focal hypospermatogenic tubules. These toxic changes nescessitate fulfillment of strict measures for reducing concentration of formaldehyde vapour in medical laboratories to protect medical and paramedical personnel, particularly those with hepatic, renal or pulmonary troubles