Role of CT and MRI in diagnosis of pericardial diseases

Background: pericardial diseases are important causes of morbidity and mortality in cardiovascular diseases. CT and MRI are more than adjuncts to echocardiography in pericardial diseases assessment, as they provide an excellent pericardial anatomy delineation and precise pericardial lesions evaluation including; effusion, constrictive pericarditis, thickening, masses and congenital anomalies. Ideal management needs the proper imaging modality choosing ability

Aim of the Study: this study aimed to evaluate the role of CT and MRI versus echocardiography in the diagnosis of pericardial diseases and to show the limitations of each modality

Conclusion: tissue characterization with CMR is superior to cardiac CT and echocardiography. CMR can differentiate tumor from thrombus and is often helpful to assess the perfusion of a pericardial mass with the use of gadolinium contrast. The final diagnosis depends on typical pathologic features

Multifocal electroretinogram changes after intravitreal injection of anti vegf for diabetic macular edema in correlation to visual acuity and optical coherence tomography

Back ground: compared to laser photocoagulation, intra vitreal injection of anti-vascular endothelial growth factors [Anti VEGFs] have more desirable results and less complication. Study of this issue by multifocal electroretinogram [mf-ERG] revealed significant improvement in macular function associated with decreased retinal thickness using optical coherence tomography [OCT] and improvement of best corrected visual acuity [BCVA]

Aim of the Work: to study the role of multifocal Electroretinogram in the follow up of diabetic macular edema after intravitreal injection of Anti vascular endothelial growth factors [Anti-VEGFs] and study its correlation to visual acuity and optical coherence tomography changes

Patients and Methods: a non-randomized prospective study was carried out from February 2018 to August 2018 on thirty eyes of patients with diffuse or focal DME without macular ischemia. The patients were selected from the outpatient ophthalmology clinic of Al-Hussein University hospital. The patients were injected intravitreally by anti VEGF Ranibizumab 0.5 mg / 0.05 mL at baseline, 1 and 2 months. In this study we assessed pre and post-injection BCVA, IOP measurement by applanation tonometer, OCT and multifocal ERG changes over 3 months

Results: log MAR BCVA improved from [0.88 +/- 0.12] preoperatively to [0.53 +/- 0.18] at the end of the 3rd month, with P-value <0.001. Central subfield thickness 1 mm improved from [408.73 +/- 79.40 Mm] preoperatively to [224.33 +/- 32.49 Mum] at the end of the 3rd month, while para and peri-foveal thickness improved from [402 +/- 46.52 Mum] preoperatively to [286.30 +/- 32.67 Mum] at the end of the 3rd month, with P-value <0.001. P1 amplitude in ring 1 using MF-ERG improved from [33.08 +/- 10.59 nv/deg2] preoperatively to [58.30 +/- 32.67 nv/deg2] at the end of the 3rd month, with P-value<0.001. P1 amplitude in ring 2 using MF-ERG improved from [18.82 +/- 5.01 nv/deg2] preoperatively to [26.36 +/- 3.006 nv/deg2] at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 1 using MF-ERG improved from [78.65 +/- 12.37 ms] preoperatively to [63.78 +/- 15.73 ms] at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 2 using MF-ERG improved from [48.81 +/- 6.44 ms] to [44.39 +/- 4.06 ms] at the end of the 3rd month, with P-value in the 1st and 3rd months <0.05. Complications during follow up of patients especially 1 week after injection were relatively uncommon, including mild subconjunctival haemorrhage in 1 eye [3.3%] and transient increase of IOP in 4 eyes [13.33%]

Conclusion: intravitreal injection of Anti-VEGFs especially Ranibizumab resulted in improvement of macular function in study patients with diabetic macular edema. Postoperative improvement in visual acuity was accompanied by decreased retinal thickness measured by OCT and improvement of P1 amplitude in the central ring measured by MF-ERG

Nonopioid versus opioid based general anesthesia technique for laparoscopic cholecystectomy

Background: The choices of premedication and anesthetic techniques are able to influence the neurohormonal stress response by modulating the pathophysiological pathways. Various pharmacological agents like nitroglycerine, beta blocker, and opioids were used to decrease surgical stress of laparoscopic procedures to improve outcome, with their own limitations

Objective: It was to compare the effect of opioid-free [using dexmedetomidine and propofol] and opioid-based [using fentanyl and propofol] TIVA techniques on hemodynamic stability, sedation postoperative pain intensity and the incidence of side effects in patients scheduled for LC

Patients and Methods: Eighty patients who were scheduled for elective laparoscopic cholecystectomy were included in this study. Before induction of anesthesia, patients were randomly divided into two equal groups: [40 each]. Dexmedetomidine group [Non-opioid group] received dexmedetomidine [1 Mug/kg] over 10 minutes before induction of anesthesia followed by continuous infusion of 0.5 Mug/kg/hr. till the end of surgery and Fentanyl group [Opioid group] received fentanyl [1.0 Mug/kg] over 10 minutes before induction of anesthesia followed by continuous infusion of 0.4 Mug/kg/hr. till the end of surgery

Results: The results of the present study showed that there were no significant differences between the two groups regarding HR and MAP except after loading dose of the studied drugs, after intubation, after pneumoperitoneum, 15 min, 30 min, 45 min, and 60 min after induction where it was lower in dexmedetomidine group than fentanyl group. There were no significant differences between two groups regarding intraoperative SPO2, postoperative SPO2 and blood glucose level [mg/dl]

Conclusion: This study concluded that dexmedetomidine is better than fentanyl for patients who undergo elective laparoscopic cholecystectomy due to perioperative maintaining of hemodynamic stability, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting

Role of medical imaging in cases of stress urinary incontinence

Background: traditional methods for evaluation of women with urinary incontinence include urodynamic studies with measuring the pressure in the abdomen, the bladder, and the urethra and urine flow analysis. In addition, cysto-urethroscopy, cysto-urethrography are used for visualization of the bladder and the urethra

Aim of the Study: urinary continence depends on a closed and empty urethra with high urethral pressure. High urethral pressure [Pura] depends on two factors; one is structural which is defined as damage and lacerations in the collagen chassis of the internal urethral sphincter [IUS], the second factor is acquired functional factor is having and maintaining high sympathetic tone at the IUS from toilet training

Patients and Methods: 40 women who from SUI are examined clinically and investigated with sonar scanning 3DUS. 20 cases control by 3DUS. Patients with primary infertility those who had no vaginal deliveries, did not suffer cognitive behavioral therapy. This study is done at Bab El-Sharia Maternity University Hospital during the period from January 2017 to June 2018

Result: the IUS, as it is a cylinder, the level and extent of the rupture along the cylinder will determine the type and the degree of urinary incontinence as well as the configurational shape seen on imaging [case with primary infertility two years ago]

Conclusion: we conclude that damage of the IUS leads low pura and stress urinary incontinence [SUI]. Childbirth trauma causes damage to the collagen layer [the frame] of the vagina that leads to redundancy of the vagina and vaginal prolapse

Therapeutic effects of olive leaf extract or bone marrow Mesenchymal stem cells against lung damage induced in male albino rats exposed to gamma radiation

Aim of the work- This study aimed to investigate the histological and histochemical changes in the lung tissue of male albino rats post exposure to gamma radiation and the possible therapeutic effect of both olive leaf extract and bone marrow mesenchymal stem cells

Matrerial and methods-The current study was carried out on 40 adult male albino rats [Sprague dawely strain]; they were divided equally into 5 groups [C group: control rats; O group: rats treated with olive leaves extract[15 mg /kg body weight/daily] ; R group: rats exposed to a single dose of gamma-radiation[3 Gy]; RO group: rats of this group treated with olive extract 15 mg /kg body weight/daily one week before and one week after irradiation; RS group: rats of this group irradiated with 3Gy then treated with bone marrow mesenchymal stem cells [BMSCs] 3×10[6] cells/ml suspension through caudal vein about 5h post radiation exposure. Histopathological and histochemical changes were studied

Results: Rats exposed to gamma radiation showed numerous histological and histochemical changes, these changes were ameliorated by using either olive leaf extract or bone marrow mesenchymal stem cells. BMSCs showed more obvious therapeutic effect than olive leaf extract

Conclusion: The present work showed that olive leaf extract or bone marrow mesenchymal stem cells [BMSCs] have lung tissue radiotherapeutic effects against whole body gamma radiation in male albino rats

Role guided intraperitoneal port-a-cath insertion in the managment of cancer ovary of fluoroscopic

The use of intraperitoneal [IP] chemotherapy as a treatment for ovarian cancer has been demonstrated to result in improved survival. The aim of this work is to evaluate the applicability and efficacy of fluoroscopic placed intraperitoneal port-A-cath and to assess the response rate to intraperitoneal chemotherapy in cases of ovarian carcinoma. The studied group included, 22 female patients with malignant ovarian cancer whom referred from gynecological surgery and gynecological oncology units to the Vascular and Interventional Radiology Unit, Ain Shams University Hospitals, for peritoneal port-A-cath application. All the patients were known cases of either primary or recurrent ovarian cancer, underwent cytoreductive surgery and referred to us. Intraperitoneal port-A-cath with the aid of fluoroscopy showed highest technical success [91.9%] and lowest complication rate on the long run compared to other methods of peritoneal access. Patients with cancer ovary showed significant improvement of the disease process denoted by changes in the degree of ascites, peritoneal nodules and tumor marker level after receiving combined IV/ IP chemotherapy. Port catheters proved to be the most safe method of long term access to the peritoneal cavity with the lowest complication rate compared to other methods of access to the peritoneal cavity

MRI of the shoulder joint

The aim of this work was to study the superior level of MRI and MR arthrography for the evaluation of the shoulder joint diseases. Sixty-five patients of different ages, occupations and different complaints and clinical suspicions were included in this study, 42 were subjected to plain MRI and 38 to MR arthrography and 15 were subjected to the two examinations. It was concluded that MRI with or without arthrography was the most available imaging modality for shoulder joint disease

Role of ultrasonography in ocular blunt trauma

To evaluate the reliability of ultrasonography in detecting lesions following non-perforating blunt trauma of the eye. 70 patients presented to Tanta University Eye Hospital with ocular blunt trauma were included in this study. Detailed history taking of the trauma, complete ophthalmological examination, and ultrasound examination were done in all cases. Evaluation of both the anterior and the posterior segments of the eye was performed using Mentor-B scan [10 M.Hz]. Different lesions of both anterior and posterior segments of the eye were demonstrated by ultrasonography. Traumatic hyphema [46.6%], cataract [26.6%], and vitreous hemorrhage [23.3%] were the most common causes of opaque media that interfered with visualization of the posterior segment. Ultrasound played an important role in revealing lesions that could not be seen clinically, as posterior capsular tears, retinal tears and detachment, cilio-choroidal detachment, posterior vitreous detachment, and macular lesions. B-scan ultrasound is a simple, helpful and reliable diagnostic tool in ocular trauma. It allows early and correct management of lesions obscured by opaque media