Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys

Tracheobronchial straight metallic pin aspiration in young Jordanian females

To define the clinical spectrum of tracheobronchial straight metallic pin aspiration in adults, assess predisposing conditions, evaluate the efficacy of bronchoscopy, and determine the outcome and complications at the largest 2 hospitals in Jordan. Retrospective analysis of 60 consecutive clinical cases from 2 referrAl based medical centers [32 patients at King Hussein Medical Center [KHMC] and 28 patients at Al Basheer Hospital]. Medical records of adult patients [>13 years of age] who presented with history of straight metallic pin aspiration over 6-year period [July 2000 and July 2006] were analyzed. Clinico-radiological features and location of the pins were studied. The flexible fiberoptic bronchoscopy [FFB] was used for foreign body [FB] identification and removal in all KHMC patients; video assisted rigid bronchoscope under general anesthesia was used at Al Basheer Hospital. All patients were females<28 years of age. Fifty-six patients [93%] presented within the first 24 hours after aspiration. Medical history was suggestive of FB aspiration in all patients. Chest x-rays demonstrated the radio opaque pins in all patients. At bronchoscopy, the intermediate bronchus was the most common site of FB lodgment [62%]. Ninety-two percent of patients were discharged on the same day of the procedure. Tracheobronchial straight metallic pins are relatively frequent FB in Jordanian young females and can occur in a very specific clinical setting. Removal of these FBs can usually be accomplished successfully by FFB

Different T-lymphocyte subset responses dictate organ involvement in schistosomiasis

In this study, 2 color flow cytometric immunophenotyping analysis of lymphocytes and their subsets estimated in fresh peripheral venous blood sample of 15 patients with bilharzial hepatic fibrosis as a result of Schistosoma mansoni infection. 15 patients with active intestinal bilharziasis only without hepatic fibrosis or splenomegaly as well as 15 healthy volunteers. Bilharzial hepatic fibrosis was confirmed by histopathological examination of liver biopsy specimens. HBsAg and HCV Ab positive patients were excluded from the study. Results showed that CD4+% in the group of patients with bilharzial hepatic fibrosis was significantly higher than that of the group with active intestinal bilharziasis. While no significant difference was observed between the two groups of patients with bilharziasis when compared with the control group. CD8+% decreased significantly in patients with bilharzial hepatic fibrosis compared with both control and patients with active intestinal bilharziasis. While CD8+% increased significantly in the group of active intestinal bilharziasis compared with control. CD4/CD8 ratio increased significantly in patients with bilharzial hepatic fibrosis compared with the group of active intestinal bilharziasis and control group. NK% decreased significantly in patients with bilharziasis while NK% increased significantly in the group of active intestinal bilharziasis compared to control. No significant difference was present among the studied groups as regards total leucocytic count, absolute lymphocytic count, CD3%, CD19% and activated T-lymphocyte percentages

Cervical mucous and serum IgA in diabetics using intrauterine contraceptive devices [IUDs]

IgA levels were measured in cervical mucous and serum of 24 fertile women using I.U.D'S [12 diabetics and 12 non-diabetics] and 24 fertile women not using any contraceptives [12 diabeties and 12 non-diabetics] between the 7[th] and 10[th] day of the menstrual cycle using the agar gel radial immunodiffusion. IgA levels in the cervical mucous and serum of I.U.D's users were significantly higher than in I.U.D's nonusers [4.83 +/- 1.9vs. 2.055 +/- 1.065] and [2.9 +/- 1.01vs. 1.58 +/- 0.66] respectively. The increased levels of IgA with the use of I.U.D's occurred in diabeties and non diabeties. However both cervical mucous and serum IgA levels were significantly lower in the diabetic group compared to the non diabeties whether using I.U.D's [3.91 +/- 1.25vs 5.75 +/- 2.42] respectively. A significant negative correlation was found between cervical mucous IgA levels and days of the cycle in the group not using I.U.D's whether diabetics or not. No significant correlation was found between the duration of use of I.U.D's and IgA levels in both cervical mucous and serum. While a significant negative correlation was found between the duration of diabetes and IgA levels in cervical mucous but not in serum. It is concluded that using I.U.D's resulted in higher levels of IgA in cervical mucous and serum. This elevation in IgA levels was less marked in the cervical mucous of diabetic females which may implicate a lower efficacy of I.U.D's as a method of contraception in diabetics

Some polymorph nuclear leukocytic functions in patients with transfusional iron overload

Phagocytosis and peroxidase activity of PMNLs were evaluated in eleven polytransfused patients [mean age 6.5 +/- 2.5 years] with high serum ferritin [mean 1390 ng/ml S.D. 219.3 ng/ml] and high serum iron [mean 196.9 ug/100ml, S.D. 20.5 ug/100 ml] and in 10 normal controls of matched age and sex. The patients were, 6 cases of B. thalassemia major, 2 cases with diamond-Blackfan anaemia, one case of sickle cell thalassemia, one case of sidroblastic anaemia and one case of chronic renal failure. Phagocytic index [P.I.], phagocytic percentage [P.P] and peroxidase activity were highly significantly reduced in patients than controls. Also patient's serum exerted highly significant inhibitory effect on phagocytic functions of patient's and control's PMNLs. After 10 - 12 weeks of desferrioxamin treatment, the studied PMNL function parameters were returned to normal in all patient's and the inhibitory effect of patient's serum was lost. These data suggest that patients receiving multiple blood transfusions have a reversible impairment of their neutrophil functions which is most probably due to iron overload