Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

Rotational tendencies and their influence on surveying and designing of removable partial denture: theoretical considerations with literature review

Rotational tendency is an important factor that determines the way in which all kinds of removable partial dentures [RPDs] behave during function. However, a literature review revealed lack of comprehensive quantitative presentation about the problem. The purpose of this article was to investigate this assumption and explain the importance of rotational tendency using diagrammatic as well as mathematical evidence. The presented diagrams and mathematical equations were used to explore different aspects related to the function of RPDs such as the way in which the guiding planes behave and interact with the tilt of the cast [decided path of insertion] to govern their retentive and stress breaking potential as well as other aspects related to RPD service. New evidence that supports considering zero tilt during RPD designing is also presented in the contest of this article. Rotational tendency is an important factor that influences the way in which RPDs function. The study approached the topic in a quantitative way and prescribed simple mathematical formulas that can be used in assessing different treatment plans. Accounting for this during RPD, surveying and designing steps should contribute to the quality improvement of this still applicable dental service. In addition, the quantitative approach carries the potential of increasing the predictability of the outcome when different factors related to RPD designing are manipulated. It is extremely important to consider the interactions that take place between the inclination of the desired path of insertion and the retention, stabilizing and stress breaking potential of the different RPD components

Functional results of surgical treatment of congenital superior radio-ulnar synostosis in children by muscle transfer and derotational osteotomy

This study was performed to evaluate the functional results of surgical treatment of congenital superior radio-ulnar synostosis [SRUS] in children by Anconeus muscle transfer and derotational osteotomy. Patients diagnosed as having SRUS presented to the outpatient clinic of the Suez Canal University Hospitals between august 2003 to October 2006. 6 patients were included in the study as 4 males and 2 females, and two male patients had bilateral deformity with the total number of deformed SRU joint of 8. The average age was 4.8 [3-8] years. History taking about the functional deficit caused by this deformity and local examination of the affected elbow joint for evaluation and measurement of the range of motion of flexion and extension, supination and pronation movement. The position of the forearm and if it is a bilateral deformity was also evaluated and measured. Pre-operative plain x-ray was done for every patient for evaluation of the degree of the synostosis and if there is any other consequent deformities such as bowing of the radius. Anconeus muscle transfer and derotational osteotomy of the distal radius was done for all patients and post-operative evaluation through x-rays and clinical evaluation for the range of supination and pronation was done and at one year of follow-up. All patients had fixed pronation deformity of the forearm pre-operatively at 70 degrees [ranged from 60 to 80 degrees] and this position causes functional disability. Post-operatively, they had a range of motion with the degree of supination as 30 degrees [range from 20 to 40 degrees], and the degree of pronation is 60 degrees [range from 40 to 70 degrees] and the range of motion was assessed after one year and all patients had decrease of the range of supination and pronation in different degrees as the supination was 25 degrees [ranged from 10 to 40 degrees] and the pronation was 40 degrees [ranged from 35 to 55 degrees]. Surgical treatment of congenital superior radio-ulnar synostosis in children using the Anconeous muscle as an interpositional material prevented recurrence of the ankylosis and improving rotation of the forearm. Also, derotational osteotomy of the radius will prevent dislocation of the radial head and this will improve rotation of the forearm as well. In addition this technique is more easy than other procedures and has less complications

Evaluation of the functional results of management of traumatic anterior glenohumeral instability by arthroscopic capsular shift using suture anchors

This study aimed to evaluate the functional results of management of traumatic anterior gleno-humeral instability by arthroscopic capsular shift using suture anchors. This prospective study was carried out on 20 patients who attended to the outpatient clinic of Suez Canal University hospital, during the period from 2004 to the end of 2006. Patients [19 male patients and 1 female with range of age from 20-50 years] included in the study had the criteria of chronic traumatic anterior glenohumeral instability. Every patient had complete history taking, complete physical examination of shoulders and cervical spine and range of motion of the shoulder joint, evaluation of the strength of the deltoid and rotators and screening neurological examination and investiagations of the shoulder joint by radiographs as plain x-ray and sometimes MRI. All patients had Bankart lesion managed by capsular shift using Mitek suture anchors. Average follow- up period was 16.5 months. Assessment of the improvement of motion ranges were registered, and satisfaction of each patient as well as in the criteria of the UCLA scale. The UCLA score revealed significant improvement in the status of the shoulder. Preoperatively: none of the patients rated their satisfaction as good or excellent. Postoperatively 16 [80%] rated their satisfaction as good or excellent and 4 [20%] rated it as fair or poor. For range of motion, most of the patients show improvement in range of elevation from 158.25 to 172.25 degrees. The mean external rotation measured 48.75 degrees preoperative and 45.20 postoperative with loss less than 5%. The mean abduction was 173.25 degrees preoperative and 172.25 postoperative with loss less than 5%. Most of the patients show improvement in range of all movements within three months of operations. For the degree of instability, the final mean UCLA score was found to be 34.11 points for the patients with recurrent dislocation, 35 points for the patient with recurrent subluxation after an initial dislocation, and 33 points for the patient with Apprehension [p = 0.519]. After one year of follow up no patient suffered from recurrence of dislocation or apprehension and only one patient [5%] suffered from subluxation. Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of degenerated labrum using capsular shift. Open repair does not offer a significantly better result in terms of stability, and what is more, can negatively affect the recovery of full ROM of the shoulder. Because the arthroscopic procedure has some advantages regarding duration of surgery, morbidity, postoperative pain, time of hospitalization, and risk of complications, also it is more cost-effective

Internal fixation of aseptic non-united fractures of tibia after implant failure by interlocking nail and bone grafting

This study was performed to evaluate the results of internal fixation of non-united fractures of the tibia by interlocking nailing after implant failure. Fourteen patients were included in the study, 10 males and 4 females who were admitted to the Suez Canal university hospital. The average age was 36 years [21-68]. Patients who had non-united fracture tibia after implant failure were the material of this work. Eleven patients had been treated with plate and screws and three by locked intra-medullary nailing. Twelve patients had closed fractures and two had open fractures Gastilo I. The diagnosis of nonunion was made on the absence of progression of the radiological signs of union and the persistence of pain at the fracture site. The mean interval between fracture and secondary surgery was 13 months [6 to 21]. Open technique was used in all patients for removal of tibial plating and Locked intra-medullary nailing and also laying down an iliac bone graft at the non-united fracture Site. Clinical union was proved in all patients with pain-free weight-bearing and this precede radiological union which occurs in all patients after 3 to 9 months with an average of 4 months. Angular and rotational deformities were corrected in all patients and 4 patients had shortening of 1 to 2.5 cm. One patient developed infection but debridement and frequent dressing and antibiotics resulted in relieve of infection after one month and union occurred radiologically after 9 months. Locked nailing, providing stable fixation, with iliac bone graft in patients with aseptic nonunion of the tibia allows physiologic early weight bearing stresses at the fracture site, together with the osteogenic potential of the bone graft, stimulate healing of the nonunion

Assessment of serum magnesium level in congestive heart failure patients treated with frusemide

Electrolyte balance has been regarded as an important factor to cardiovascular stability, particularly in congestive heart failure. However, electrolyte disturbances are common in patients with congestive heart failure especially during long term treatments. Unlike potassium, little is known of how magnesium is affected in these patients. To assess the serum magnesium level in congestive heart failure [CHF] patients treated with frusemide and to describe the electrocardiographic [ECG] changes with different serum magnesium patterns. The study was carried out by means of data collection and analysis of clinical, biochemical. and ECU variables with respect to serum magnesium changes. The data were taken from patients fulfilling the inclusion criteria. This was a descriptive cross-sectional study, that was conducted in the outpatient, inpatient and cardiology care units of cardiology department in Suez Canal University Teaching Hospital, in the period from 1/4/2004 to 1/2/2005, In our study, [58] patients with CHF were included representing the designed sample size and fulfilling the inclusion and exclusion criteria mentioned in the methodology. Hypermagnesemia was more prevalent in CHF patients treated with frusemide, According to our study, we found that hypermagnesemic patients had the following characteristics: Old age, female, increasing severity of CHF [functional class III-IV], nonsmokers, high frusemide maintenance dose, hypernatremia and hyperkalemia, high dose of spironolactone and high dose of digoxin

Evaluation of terazosin action on experimentally-induced hypertension and insulin resistance in rats

Terazosin is an alpha 1 blocker indicated in therapy of mild to moderate hypertension, in peripheral vascular disease and in cases of refractory congestive heart failure. It is also used in benign prostatic hypertrophy. The present study was designed to investigate the effects of terazosin on blood pressure, renal blood flow parameters, insulin resistance, blood glucose, cholesterol and triglycerides in rats. Insulin resistance was induced experimentally by feeding rats l0% fructose in drinking water for 4 weeks. In vitro studies done to investigate terazosin site of action. In-vivo studies, terazosin significantly decreased systolic and mean arterial blood pressure and serum cholesterol but triglycerides showed insignificant change. Terazosin significantly improved insulin sensitivity. Doppler technique showed that Terazosin significantly decreased renal artery systolic pressure and blood flow velocity while it produced insignificant effect on heart rate. In-vitro studies on isolated rat aorta and isolated rat heart, terazosin had a significant cholinomimetic effect beside it's alpha 1 blocking action

Physiological assessment of cardiac autonomic reflexes in diabetics

The cardioautonomic reflexes of 77 diabetic subjects and 23 age and sex matched healthy controls were studied using heart rate variation in response to deep breathing, Valsalva maneuver, standing-up and lying down. Also, the decrease in systolic blood pressure in response to standing-up and the increase in diastolic blood pressure during sustained handgrip were assessed. The study concluded that the autonomic nervous system integrity appeared to be greatly affected by diabetes mellitus in comparison with non-diabetic subjects. The degree of impairment was dependent on the progression of age, increase in body weight, duration of the disease and hyperglycemia

contribution to variations of the terminal part of the radial artery in man

The course and branches of the terminal part of the radial artery were studied both hands of 25 cadavers. An abnormal course for the radial artery and four different patterns of branching were found. The artery crossed deep to the tendon of extensor carpi radialis longus on the dorsum of the hand before passing to the palm. The arteria radialis indicis may arise directly from the radial artery, or may arise with the arteria princeps pollicis by a common stem or by an arterial dilatation. The arteria princeps pollicis may arise as two branches. These variations must be observed in surgery of the thumb and index fingers