Clinical application of mangled extremity severity score [MESS] among injured patiens attending emergency department at the main Alexandria University Hospital

Management of mangled lower extremity is one of the most challenging problems for a trauma surgeon. The decision of whether to amputate or not and when to amputate is a critical decision. It has surgical, medicolegal, social and psychological importance. Many scoring systems have been devised to facilitate the decision of amputation of an injured extremity. Mangled Extremity Severity Score [MESS] is one of the used scores and it is needed to be evaluated in our country. Of this study was to evaluate the validity of clinical application of MESS for mangled lower limbs and its predictive value in the decision making for injured cases. Fifty patients admitted to the emergency department of the Main Alexandria University Hospital were studied. They were assessed by MESS to have a provisional decision for amputation or conservative treatment. The final decision of conservative treatment or amputation was decided after complete investigations and proper evaluation. In five patients, trials of conservative treatment were done first. The utility of MESS for decision of amputation was assessed. The studied patients were 38 males and 12 females. Their ages ranged between 2.5 and 42 years with a median of 23. 7 +/- 18.]. MESS had a score 7or more than 7for 3lpatients with probability of amputation; and score less than 7 for 19 patients with probability of saving the limb. After complete investigations, trials of revascularization and proper evaluation; amputation was performed for 18 patients. Secondary amputation was done for five of them. The sensitivity of MESS on decision making for amputation was 58% and specificity of the scoring was 63%. Positive predictive value of MESS for amputation was 72% and negative predictive value was 68%. This study showed that MESS has limits for its usefulness and cannot be used as the sole criterion by which amputation decision can be made. With a cooperative multidisciplinary effort with close communication between the trauma, orthopaedic and plastic surgeons, the outcome of mangled lower extremity injuries can be optimized. More limbs could be salvaged by complete evaluation after necessary investigations, continuous surveillance and even operative exploration

Electrophysiological evaluation of nerve affection after trauma to the extremities

Evidence of peripheral nerve injury should be sought in all wounds of extremities. Nerve conduction studies [NCSs] and electromyography [EMG] are used to evaluate the nature of pathophysiology, and quantification of severity of involvement, detection of the level of neurological deficit and determining prognosis. The study was conducted to correlate between clinical examination and electrophysiological studies in diagnosis and prognosis of nerve affection. The study was conducted on 36 cases with trauma to the extremities referred to the Department of Physical Medicine. They were clinically examined and electrophysiological study was performed to every case including motor conduction of the relevant and contralateral nerves in addition to EMG of the relevant muscle. The mean age of patients was 30.11 +/- 13.23 years. 44.44% of cases were manual workers. 58.33% of the injuries were accidental, of these 33.33% were occupational accidents. The number of nerves affected in all cases was 49 nerves. The clinical evaluation revealed that 33.33% of cases had partial injury, while 55.56% had complete injury A percent of 11.11% of cases were considered to be clinically free, however the nerves were proved to be affected by electrophysiologic study. Electrophysiologically 80% of cases showed same nerve affection as showed clinically. 10% of cases showed multiple nerve affection electrophysiologically, while clinically they were diagnosed as single nerve affection. Ulnar nerve was the most frequent nerve affected in the studied sample. Evidence of reinnervation was detected in 35% of cases by electrophysiological studies, while clinically they were considered completely paralyzed. It was concluded that in every case of extremity injury requiring medicolegal evaluation, electrophysiological studies should be done beside the clinical examination to discover mild, subclinical or even unnoticed deficits of nerve affection to determine the prognosis

Evaluation of the severity of organophosphous insecticide intoxication using poisoning severity scoring, laboratory and therapeutic parameters

Organophosphorus [OP] compounds are the most widely used insecticides that cause poisoning after accidental, occupational or suicidal exposure. Poisoning is particularly common in the developing countries where more potent agents are widely available for agricultural and household purposes. The aim of the study was to evaluate the role of poisoning severity score [PSS], different laboratory and therapeutic measures in assessment of severity of OP poisoning, and to determine the need for intensive care management in cases of OP intoxication. One hundred patients suffering from acute OP poisoning were interviewed and categorized clinically according to PSS into three grades. Routine laboratory tests were done including arterial blood gases, random blood sugar and serum potassium on admission. Specific tests were estimation of pseudo choline sterase activity on admission and serum amylase on admission and after six hours. The studied patients received different lines of treatment in the form of general measures plus atropine or atropine and pralidoxime with or without assisted mechanical ventilation.55% of patients had the mildest degree of OP intoxication [PSS1], 31% had PSS2 and 14% were graded as PSS3. Significant correlation was detected between the degree of poisoning assessed by PSS and different laboratory investigations as well as the lines of treatment used. Cases having the highest score of severity [PSS3] had the lowest psudocholinesterase activity with more pronounced hyperglycemia, hypoxia, metabolic acidosis and hypokalemia. Acute pancreatitis occurred specifically in them. They needed atropine and pralidoxime in addition to assisted mechanical ventilation with longer stay in hospital than other cases. Accordingly, all these parameters including clinical scoring[PSS], laboratory findings and lines of treatment needed can be used for determination of the severity of OP poisoning. They are recommended to be applied in all OP-intoxicated patients

Assessment of the severity of acute poisoning using poison severity score [PSS] and acute physiology and chronic health evaluation II score [APACHEII]

Drug intoxication is a major medical and health problem in developed as well as in developing countries. In the course of time, the rate incidence of drug intoxication has increased. Subjective evaluation of clinical status by individual clinicians may differ in terminology, and even in management of the severity of illness. Hence, various descriptive and prognostic evaluation scales [scoring systems] have been developed during the last three decades. The objective of the present study was the assessment of the severity of acute poisoning using Poison Severity Score [PSS] and Acute Physiology and Chronic Health Evaluation II Score [APACHEII]. The study was carried out on 435 patients suffering from acute intoxication and admitted to the Poison Unit at the Main University Hospital. The results showed that most of the patients were in the age group of 15-30 years and that organophosphorus pesticides were the most common type of poison encountered. Accidental poisoning represented the largest mode of poisoning where most of the patients [80.5%] suffered from typical symptoms and signs. Patients follow-up revealed complete recovery in 30.1% of cases, clinical improvement in 64.4% of cases and two deaths. PSS was applied to all cases where a remarkable improvement was seen in most cases of the three PSS categories [mild. moderate, and severe] with no significant relation between PSS and patients outcome. On the other hand, applying APACHEII score to all cases showed a significant relationship between APACHEII score and both duration of stay in hospital and patients outcome. In addition, the present study showed that APACHEII was a good indicator for mortality

Intelligence quotient IQ in congenital heart disease in Alexandria

The study comprised 2 groups of patients with congenital heart diseases [CHD]; the first included 12 patients with cyanotic CHD and the second included 32 patients with acyanotic CHD. Their ages ranged between 2 and 27 years. Intelligence quotient [IQ] was measured for all patients as regards verbal, performance and full scales. In the cyanotic group, the mean IQ for verbal, performance and full scales were lower than those in acyanotic group, but without significant statistical differences. The IQ in the lower age groups were much lower in the cyanotic group. The greater number of patients in both groups were on the borderline. Patients with Fallot's tetralogy showed lower IQ scales than the other types of cyanotic CHD. Patients with pulmonary stenosis had higher IQ scales than the other types of acyanotic CHD

Cytomorphologic and immunocytochemical study of touch imprints of malignant Non-Hodgkin's Lymphomas [NHL]

The present study reports on experience with the application of lymphocyte markers [4KB5, UCHL1 and MAC 387] to lymph node imprints in NHL. The cytologic and immunophenotypic classification of the imprints were compared with those of the corresponding tissue sections. Among the 50 cases studied 43 had a B-cell phenotype, 3 had a T-cell phenotype, while 4 cases defied any staining. Using immunohistochemistry, it was not only possible to identify the phenotype of the cells but to decide whether the lymphoid population was polyclonal or monoclonal as well. Demonstration of monoclonal light chain restriction in B-cell lymphoma made it possible to confirm the neoplastic nature of the imprint. The present work emphasized the value of imprint material as good source of tissue for immunologic study, where immunoreactivity to MoAbs was retained by storage of the imprints at -70C. The advantages of this technique include enhanced cellular detail, clear staining reaction with reduced artefactual distortion in addition to a more rapid methodology

use of some genetic markers in paternity problems

The study was carried out on 10 biological families. Each family was composed of a father, a mother and one of their children [5 sons and 5 daughters]. Blood grouping was done for each one. This included 22 red cell antigens of 10 blood group systems in addition to HLA typing class 1 [HLA-A-A, B]. As regards the frequency of the different blood groups and the different HLA-A, -B types, no two similar HLA-A and -B were found in the sample studied. On comparing these results with those of the different blood groups, a significant statistical relation was found, denoting that HLA typing is extremely individual. The relation between blood groups of parents and children in different systems were correlated. This study is needed to be repeated on a wider scale involving a large number of the Egyptian population, to find out the gene frequencies of the different blood groups. This enables a correct interpretation of the probability of paternity results

comparative study between intra-uterine insemination [IUI-husband] and direct intraperitoneal insemination [DIPI-husband] in the treatment of male infertility

In this study, 109 infertile couples due to male factor were evaluated to compare the results of [IUI husband] and [DIPI- husband] in normal and stimulated cycles.The study revealed that IUI and DIPI are of minimal therapeutic effect in the treatment of male factor of infertility in normal cycles. However, when the cycle were stimulated the conception rate increased from 5.2% to 11.3% in IUI and increased from 3.6% to 10.3% in DIPI. There are in male infertility IUI and DIPI with stimulated cycles deserve trial before attempting the more invasive, costly and complicated assisted reproductive technology

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

Scanning electron microscopy of microincenerated metal salts

The progressive increase in number of toxic metal salts has increased the opportunity to hazardous exposures. In the present study, the light microscopic microinceneration technique has been modified and simplified to be suitable for scanning electron microscopy. The toxic metal salts used were mercuric chloride, arsenic oxide, zinc phosphide and antimony trichloride 20 rats were classified into five groups; four groups were orally given the toxic metal salts while the fifth group was used as a control. Each rat was given the minimal lethal dose of a particular metal salt and then sacrificed. Gastric contents and liver tissues were gradually incenerated in a muffle furnace till 650C and after cooling the samples were gold coated and examined by scanning electron microscopy. The technique succeeded in visualization of metallic salts under a wide range of magnification. Each metal has a characteristic diagnostic appearance. The technique is simple, rapid and economic. It is recommended for use in both forensic cases and research studies

Evaluation of the sensitivity of different methods for detection of seminal stains

identification of seminal stain by finding spermatozoa has long been regarded as the best and most certain means of detection. When the demonstration of complete spermatozoa was impossible, especially in persons having azoospermia as a result of disease or vasectomy, several methods have been sought for seminal fluid identification. The study showed that Florence test remained positive till five or six fold dilutions. On the other hand, Barberios and dithizone tests retained their positivity till 10-fold dilutions. As regards thin layer chromatography, the Rf value of fresh seminal stains was significantly higher than that of old seminal stains in undiluted specimen, but both could be identified till 1:64 dilution. A high creatine phosphokinase activity was reported with both fresh and old seminal stains, but it was significantly higher with fresh than with old stains till 1:16 dilutions. The activity of CK in fresh seminal stains remained high for less than a week [6 days]. This indicated that the presence of high CK activity might provide additional evidence for seminal fluid identification

immunohistochemical study on the histogenesis of granular cell tumor

The presence and distribution of S-100 protein, desmin and alpha-1- antichymotrypsin were investigated in ten cases of granular cell tumor using the peroxidase-antiperoxidase method. The granular cells of all cases were negatively stained with anti-desmin and anti-alpha-1-antichymotrypsin antisera. On the other hand, they were positively stained with anti-S-100 protein antiserum. These results supported the concept of the neurogenic origin of the granular cell tumor

Demonstration of alpha-1 antichymotrypsin in tumours of supposed bibroblastichistocytic origin using the immunoperoxidase technique

Using the immunoperoxidase [PAP] technique, 28 cases of fibrohistiocytic tumors were stained for alpha-1-antichymotrypsin [A1ACT], a histiocytic marker, and S-100 protein, a marker for Schwann cells. A1ACT was demonstrated in 12 of 13 cases of malignant fibrous histiocytomas [MFH], in 6 of 9 cases of dermatofibrosarcoma protuberans [DFP] and in 4 of 6 cases of dermatofibroma [DF]. None of these tumors stained positively for S-100 protein. A1ACT is found to be a useful and reliable marker for malignant fibrous histiocytoma. The presence of alpha-1 antichymotrypsin and the absence of S-100 protein in DFP and DF support the concept that these neoplasms are parts of the spectrum of fibroblastic-histiocytic tumors and excludes their neurogenic origin