Short term follow-up of prediabetics undergoing elective percutaneous coronary intervention

Epidemiologic evidence suggests that the complications of diabetes begin early in the progression from normal glucose tolerance to frank diabetes. Prediabetes is defined as people with impaired fasting glucose [IFG] or impaired glucose tolerance [IGT], some of whom in fact already have the characteristic microvascular changes resulting from diabetes itself. This study was conducted on 108 patients presenting to Ain Shams University Catheterization Laboratory for elective percutaneous coronary intervention using bare metal stents [48 diabetic patients, 30 pre-diabetic patients and 30 non-diabetic patients]. All patients underwent bare metal stent deployment either preceded by balloon dilatation or not. Follow-up was done at three and six months for major adverse cardiac and cerebral events [cardiovascular death, acute coronary syndrome, cerebrovascular stroke, target vessel revascularization]. Our findings demonstrate that there was no statistically significant difference between patients of the three different study groups regarding composite end point of death, stroke, acute coronary syndrome and target vessel revascularization at three months follow-up [diabetics = 18.8%, pre-diabetics = 13.3%, non diabetics = 3.3%, p-value = 0.1], but there was a highly statistical difference between them regarding acute coronary syndrome [diabetics = 43%, pre-diabetics = 26%, non diabetics = 10%, p-value = 0.006] at six months follow-up. Prediabetes, though not a disease entity by itself is associated with of risk for both macrovascular and increasingly, microvascular pathology. It is important to identify these conditions to prevent incident diabetes and to take measures to stop the vascular complications. Our study findings revealed that complications of diabetes may begin early as patients are suffering impaired glucose homeostasis, which warrants further evaluation in larger studies

Cortical excitability in amyotrophic; lateral sclerosis

The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis with a view to pointing out that these could contribute to symptoms, Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score [ALSSS] and transonic magnetic stimuli investigations including measurement of resting and active motor threshold [RMT, and AMT], motor evoked potential [MEP], input-output curve, contralateral silent period and transcallosal inhibition [CSP and TI] were measured for each participant. There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT, and AMT meaning that increased seventy was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group [P=0.03]. There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for there to be a significant negative correlation between left TI and ALSSS [P= 0.051]. Measurements of cortical motor excitatory and inhibitory changes in ALS confirm the presence of hypoexcitability and GABAb dysfunction, that was correlated with the severity of ALS

Effect of prion protein extract on the morphology of chick embryos with special reference to the cerebellum

Prion disease is transmitted under natural conditions and involves a variety of mechanism through multiple routes. Prion protein peptides were generated according to amino acid sequences. To study the effect of prion protein extract on the embryo using egg as a model. Thirty chickens, one-day old from Arbor acre strain were used in this study and divided into three groups. The 1[st] group was fed on basal diets and served as a control. The 2[nd] and 3[rd] groups were fed on hyperproteinized diets which contained 50% and 80% concentrates respectively. After four months of feeding, brain, spleen, heart and lung were obtained for the isolation and purification of prion protein [PrP]. The result of SDS-PAGE gel electrophoretic separation of the PrP showed that, all organs contained a major band around 29 - 30 kdt. But purification of the PrP indicated that, the only fraction contained one band in the lung, two bands in the spleen and heart and four bands in the brain. In addition, the normal sequence of isolated PrP was contained 209 amino acids. Chicken fertilized eggs from Arbor acre strain were used in this study and divided into five groups. Group A was a control group. Groups B, C, D, and E that injected with 50 micro L PrP extracted from brain, spleen, heart and lung, respectively of the adult chicken fed on diets containing 80% protein for four months. The eggs were incubated at 37.8°C for 22 days and the injection was performed in the albumin on the 1[st] day of incubation. The eggs were opened on days 3, 5, 7, 9, 11, 15 and 21. Embryos were collected for the morphological examination. On day 15 of incubation, the eggs were opened and the cerebellum was processed for light microscopic study. Indicated that, PrP caused delay in hatching, decreased body weight and reduced body length. The percentages of malformations in embryos were 31.5, 25, 23 and 37% post injection with PrP extracted from brain, spleen, heart and lung respectively. The congenital malformations were malformed eyes, twisting legs, syndactylia and unformed abdominal wall. Cerebellar sections of chick embryos from injected eggs with any source of tissue PrP extracts showed vacuolar degeneration of cerebellar layers. Purkinje cells lost their normal flask-shaped appearance with eccentric nuclei. It was concluded that, a single injection of PrP which was extracted from hyperproteinized fed chicken caused congenital anomalies as well as histopathological changes independent on the source of tissue PrP

Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with sufentanyl for epidural analgesia during labour

Recent clinical studies comparing bupivacaine 0.25% and ropivacaine 0.25% reported comparable analgesia and motor block during labaur. An opioid is combined with the local anesthetic to reduce the incidence of side effect and to improve analgesia for the relief of labour pain. Aim of our study was to evaluate the effects of epidural bupivacaine 0.25% compared with ropivacaine 0.25% both combined with sufentanyl for the initiation and maintenance of analgesia during delivery and labour

Repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants

The surgical repair of aortic coarctation with hypoplastic distal aortic arch has evolved over time. Some changes came from technique refinements and anatomical variations while other changes came from high rate of residual, recurrence or other complications. We report our experience with performing repair of aortic coarctation with hypoplastic distal aortic arch without prosthetic material to enlarge all areas of distal aortic arch in neonates and infanty. From March 2003 to March 2005, 17 patients ranging in age from 10 days to 8 months with aortic coarctation and hypoplastic distal aortic arch underwent repair.8 paticnts underwent extended end-to-end anastomosis with reversed subclairan flap.5 patients underwent extended end-to-end anastumosis.2 patients underwent extended end-to-end anastomosis with subclavian augmentation.2 patients underwent extended end to-end anastomosis with combined carotid- subclavian arch augmentation. There was no operative mortality. Residual gradients were as follows: 7 patients had no residual gradient, 8 patients had low residual gradient [< 20 mmHg] and 2 patients had gradients between 20 and 35 mmHg. There was no paraplegia, recurrent laryngeal nerve injury, Horner's syndrome, phrenic nerve injury or stroke. There was no left arm ischemia, hemorrhage, aneurysm, chylothorax, recoarctation or paradoxical hypertension. Performing repair of aortic coarctation with hypoplastic distal aortic arch in neonates and infants is safe, effective, and reproducible and avoids use of prosthetic materials. It has low residual gradient and complication rate

Acute ischemic cerebrovascular accident and new onset voiding dysfunction: a prospective correlation of CT findings with urodynamic findings

New onset voiding dysfunction after a stroke is a difficult problem for all persons involved in the care of those patients. We evaluated the effects of an acute cerebrovascular accident on the lower urinary tract and correlated the site, size and side of cerebrovascular accident with the urodynamic findings. This study included 103 patients [56 males and 47 females] with acute cerebrovascular accident from September 2001 to August 2003. All patients with disturbance of conscious level or mental changes or previous history of stroke were excluded from the study, The included patients were assessed neurologically and urologically. Computerized Tomography [CT] was done for all patients. A total of 56 patients underwent urodynamic study with electromyography within one week of cerebrovascular accident. Patients were divided into 5 different groups based on urodynamic findings. 59.2% of the patients had urinary.symptoms and the most common symptom was incontinence [42.6%], followed by retention [41%]. We found a correlation between voiding disturbance with hemiparesis [P<0.01], not with hemianopia. Urodynamic studies of 56 patients revealed that 31 patients [55.4%] had detrusor hyperreflexia and 17 patients [39.1] had detrusor areflexia. The majority of the lesions responsible for detrusor hyperreflexia were from frontoparietal region and internal capsule whereas thalamic, pontine and cerebelluar lesions were associated more with detrusor hyporeflexia. There was no effect of laterality or dominance on the urinary symptoms or urodynamic findings

correlative role of contrast-enhanced MR in evaluation of myelopathic changes in patients with progressive and clinically-active multiple sclerosis

During a period of time extending from January 2003 to May 2004, 16 patients [12 females and 4 Males] of ages ranging from 17-40 years and suffering from multiple sclerosis of the CNS with superadded myelopathic changes were involved in this study. All patients were initially evaluated on neurologic basis to asses the extent of disability according to a variety of functional assessment scores [EDSS and ambulation test of Kertzke] that was followed by an initial pre/ post contrast MR examination of the brain and cervical/dorsal spinal cord using a 1.5 T MR Units where analysis of the obtained images to get a basis datae as regard the morphologic criteria of any detected focal lesions including their site, shape, sizes in mm [to get the total lesion load of the brain and cord at this basis sitting], counts and postcontrast pattern of enhancement, follow-up clinical and MR exarninations were performed for all patients twice [at 3 and 6 months interval] so that a total of 32 follow-up examinations were done in addition to the initial ones to estimate the changes involving the initially detected lesions [according to the same morphologic basis], to detect any newly developing lesions and to asses the diagnostic value of contrast injection in monitoring of the clinically active lesions. In our study a moderate correlation between lesion load and sensory function and EDSS was noted. A majority [70%] of patients with new clinical manifestations had one or two enhancing lesions. Agreement of MR-findings and clinical examination was noted in almost 60% of the follow up examinations MR showed lesion progression in 44% of patients with clinical deterioration and 35% of those with clinical improvement or stability. We have finally concluded that MR imaging is the most accurate diagnostic procedure in monitoring multiple sclerosis lesions of the brain and/or spinal cord even in submanifest stage and in providing an undoubted evidence of lesions activity on both initial and serial scans. So, the procedure is an essential one that should be done documentarily and complementarily hand by hand with clinical assessments

Major liver resection for giant hepatic tumors in adults and children

With the evolution in surgical technique, anaesthetic care and postoperative management, major hepatic resections for giant liver tumors are now considered reasonably safe procedures with a low surgical death rate. The aim of this study is to evaluate the results of major hepatic resection for giant hepatic tumors in the National Liver Institute during the period between September 1991 and September 2001 and to compare these results with reports from other centers. From September 1991 to September 2001 twenty-six giant liver tumors undenvent major hepatic resection out of a total number of one hundred and thirty seven liver tumors that were resected in the National Liver Institute. The tumor diameter was ranging from 8 cm to 27 cm. There were 6 children: their ages ranged from 8 months to 13 years. Four of them had hepatoblastoma, one malignant mesenchymoma [undifferentiated embryonal sarcoma] and one case of liver cell adenoma. The adult group included 20 cases with a mean age of 52.5 years [range 26-65 years]. There were six cases of hepatocellular carcinoma [HCC]; two of them were done as an emergency due to bleeding after tumor rupture. The remaining 14 cases were: 2 cases of HCC fibrolammellar type, one gallbladder carcinoma, 2 cases of colorectal liver metastasis, 5 cases of haemangioma, one case of haemangioendothelioma, one case of secondary leomyosarcoma from the stomach, one case of cholngiocarcinoma and one case adenocarcinoma. Right or extended right hepatectomy was done in 14 patients and left or extended left hepatectomy was done in 12 cases. Ultrasonic dissector and bipolar coagulation was used in 21 cases. Hospital mortality was three cases; two of them were emergency cases on top of chronic liver disease. Postoperative complications included: temporary ascites, chest infection, minor biliary leak and wound infection. major liver resection is a reasonably safe procedure especially, when performed on normal liver under elective conditions

Impact of stress on cognitive functions

This work was designed to study the effect of mental [exam] stress on the memory performance and on other cognitive functions. This was carried out through the evaluation of the cognitive aspects of 61 volunteer students [28 males and 33 females] during basal state by cognitive ability screening instrument [CASI] and Wechsler memory scale [WMS] together with an assessment of their anxiety levels by Hamilton anxiety scale and an estimation of the serum levels of catecholamines and cortisol. These estimates were reevaluated two months later immediately after exposure to mental [exam] stress. It was found that immediately after exposure to mental stress, there was a significant decline in all memory functions and total cognitive scales together with a significant increase in the perceived levels of anxiety symptoms and a significant rise in the serum levels of stress hormones. Stress hormones levels were found to have differential effects on memory and other cognitive functions with an end result of total impairment of these functions

study of placental distribution and transfer of lead and cadmium in urban and rural inhabitants

Distribution of lead and cadmium was studied in 10 placentas. Samples were taken from 3 different lobules [central, paracentral and peripheral] and lead and cadmium concentrations were determined. Our results revealed that both metals were distributed uniformly in the placenta as there were no significant differences between the tested samples [P > 0.05].Lead and cadmium concentrations were also determined in homogenized placental samples, maternal blood and umbilical cord blood from urban areas [n = 25] and rural areas [n = 25] in Cairo and Giza. Our results showed that the levels of lead and cadmium in the maternal and umbilical cord blood were significantly higher in urban population than in rural ones. Moreover, the mean lead concentration in the placenta was 1.5 and 2.3 times higher than that in the maternal and cord blood, while placental cadmium concentration was 1.6 and 1.3 times higher than that in the maternal and cord blood respectively. Therefore, it is concluded that the placenta is a suitable material for monitoring environmental lead and cadmium exposure and its placating effect is unable to totally prevent the foetus from exposure to these metals, thus we suggest that the pregnant women should avoid occupations where exposure to these elements is possible especially for urban population which is considered to be high risk group especially for lead exposure

Phrenic nerve palsy after open heart surgery

In a retrospective study of 1130 patients underwent open cardiac surgery in Kasr El-Aini hospital, 29 [2.6%] patients developed phrenic nerve palsy. The highest incidence [9%] was in the infants below two years of age. In children 2-12 years of age, the incidence was 3.2%. In older age group, the incidence was 1.2%, left sided phrenic nerve palsy was present in 66%, and right sided palsy in 27% and 7% of patients had bilateral palsy. Ten patients needed diaphragmatic plication. All were below the age of twelve. Twelve patients were followed for a period of 3 m. Out of the nineteen nonsurgical treated patients, seven of them showed spontaneous recovery

Evaluation of different techniques in management of second degree hemorrhoids

This work included 66 males and 14 females, their ages ranged from 22-55 years. They were divided into 4 groups; the 1st group included 20 patients subjected to rubber band ligation, the 2nd group included 20 patients subjected to cryotherapy, the 3rd group included 20 patients subjected to combined procedures [rubber band ligation + cryotherapy for the ligated pedicle], while the last group included 20 patients subjected to open surgery. Excellent results were obtained by using the combined procedures as regard the least amount of pain postoperatively, less postoperative discharge in comparison with cryotherapy, no recurrence of rectal bleeding or prolapse in the period of follow up. In addition, it is more simple, less time consuming and less liable to be followed by complications, and the average bed occupancy and time off work are less

Comparative study between one stage and two stages procedures in penile hypospadias reconstruction

This study included 18 patients with penile hypospadias, their age ranged from 3-5.8 years with a mean of 4.4 years. They were divided into 2 equal groups. The 1st was repaired by using Mustardes method as a one stage procedure. While the 2nd group was repaired by using Bayers method as two stages procedures. The postoperative complications [devascularization of flaps, fistula, uretheral stricture, meatal stenosis, stream irrigularities, persistent chordee and uretheral diverticula] were common in the 1st group but hospital stay was more in the 2nd group. It is concluded that in cases of penile hypospadias, it is better to use two stages type of repair which gives good results with less complications

Ultrastructure changes of the pituitary gland of rat after garamicin treatment

An antibiotic drug of the aminoglycoside group gentamicin [commercial name garamycin] was used in the present study. The ultrastructural changes induced in pituitary gland of female albino rat by intraperitoneal injection of daily 5 doses double therapeutic dose [1O mg/kg body weight] of garamycin were studied and examined on the 5th day post treatment. Garamycin, affected the releasing and synthesising activity of prolactin, leutinizing hormone [LH], follicular stimulating hormone [FSH], growth hormone [GH] and adrenocorticotrophic hormone [ACTH]. Prolactin and leutinizing hormones stimulate estrogen and progesterone, follicular stimulating hormone, stimulus ovary follicles production, while growth hormone for development and ACTH stimulates the functions of the adrenal cortex. Post-treatment pathological changes appeared in most secretory cells of the pituitary glands. Generally, cells appeared degranulated with dilatation of RER and Golgi apparatus, swollen and aggregation of mitochondria and irregularity of cell membrane. Nuclear changes were also prominent

Cytological study on the effect of the food preservative sodium nitrite and pyrethoid insecticide polytrin on some mammalian organs

The purpose of the present work was to study the synergestic effect of food preservative sodium nitrite and pyrethroid group of insecticide "polytrin" on the Golgi apparatus of the liver, kidney and spleen cells of male albino rat, and to study the effect of each of those chemicals separately. Polytrin was injected intraperitoneally with a single sublethal dose [1/50 LD50] for two days and sodium nitrite was given at a dose of [2 g/L of water] daily for 90 days by the oral route. The Golgi apparatus has proved to be highly sensitive to polytrin and sodium nitrite treatment. Fragmentation, atrophy and coarse of Golgi apparatus appeared to be a consequence of the destruction of the membrane systems or the suppression of the lipoprotein synthesis necessary for membrane formations

Curative role of isologous bone marrow transplantation on radiation induced histochemical changes in bone marrow of rat

This work is a comparative study of radiation injury on bone marrow enzymes; namely, alkaline phosphatase and peroxidase, and possible control by the isologous bone marrow transplantation. The present study showed increased levels of alkaline phosphatase and peroxidase enzymes in bone marrow cells after radiation exposure. The level of enzymatic activity under investigation could be significantly restored over 3 weeks post-exposure of 6 Gy of gamma irradiation. The results obtained demonstrated the efficacy of bone marrow transplantation for replacement or proliferation of injured hematopoietic tissue component and, consequently, more rapid restoration of the normal levels of enzymatic activities in the irradiated bone marrow