Advancement in liver laparoscopic resection - development of a new surgical device

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Assessment of thyroid functions in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is no longer considered to [COPE]; affect only the lungs and airways but also the rest of the body. The systemic manifestations of Thyroid hormones; COPD include a number of endocrine disorders, such as those involving the pituitary, the thyroid, the gonads, the adrenals and the pancreas. The severity of airway obstruction in chronic obstructive pulmonary diseases [COPD] is associated with the impairment of thyroid gland function. This study was carried out to evaluate thyroid abnormalities in patients with COPD and relationship between pulmonary function tests, arterial blood gases and thyroid functions. Serum free triiodothyronine [ft3], free thyroxin [ft4], and thyroid stimulating hormone [TSH] were measured in 50 patients with COPD and 50 healthy volunteers [control group] and its relation to some ventilatory function tests [FEV1/FVC, FEV1, FVC%, and FEF25-75] and ABG parameters [PH, Paco2, Pao2, Hco3 and O2 saturation] were studied. There was no significant difference in mean levels of TSH, FT3 and FT4 between COPD and control group. The mean values of free T3, free T4, and TSH were within normal limits in both groups however, free T3 values in the case group were toward upper normal limits and the mean values of free T3 were increased in the case group compared to their values in the control group. The mean values of free T3 of the cases were significantly increasing with increased severityof COPD. Significant negative correlations were present between free T3 levels and pulmonary function tests of the cases. Significant negative correlations were present between free T3 levels and both PaO2 and SO2 of the cases and also show a significant positive correlation between free T3 levels and PaCO2 of the cases. Thyroid function tests among COPD patients showed a significant increase of the mean free T3 values and a non significant decrease of the mean free T4 and TSH values compared to the control group. With increasing severity of COPD, the mean free T3 values showed a significant increase. Significant negative correlations were noticed between free T3 levels and both PaO2 and SO2 of the cases. A significant positive correlation was observed between free T3 levels and PaCO2 of the cases. Significant negative correlations were observed between free T3 levels and pulmonary function tests of the cases

Histopathological and immunohistochemical study of the wall of spermatic veins and its potential role in the development of varicocele testis

Varicocele is defined as a pathological alteration in the venous circulation of the testis which appears almost exclusively on the left side. The aim of current work was to compare the normal structure of the wall of the veins of the pampiniform plexus and also to highlight the occurrence of any structural alterations in these veins in cases of primary varicocele through a combined histopathologic and immunohistochemical study. Histopathological examination and immunohistochemical studies using monoclonal antibodies against CD31 [a marker for endothelial cells] and neurofilament-200 [NF-200] [nerve fiber marker] were performed on spermatic vein fragments of 30 varicocele patients and 30 normal spermatic veins obtained from patients undergoing inguinal herniectomy. Normal spermatic veins showed an inner circular smooth muscle [SM] layer in the tunica media, and an outer longitudinal SM layer in the tunica adventitia. Grade I varicocele cases, showed an increase in the connective tissue of the adventitia and of the tunica media, which increased proportional to the degree of varicocele. The outer longitudinal smooth muscle layer of the large spermatic veins was significantly degraded in the presence of varicocele grades I and II, and did not even exist in varicocele grade III. Immunostaining for CD31 and NF-200 revealed that vasa vasorum and nerve fibers were decreased in the wall of large spermatic veins in patients with grades I and II varicocele, and were minimal to absent in patients with grade III varicocele. The wall of pampiniform plexus veins is a complex structure of smooth muscle organization, inner circular and outer longitudinal fibers which is important for providing an effective blood transport through the pampiniform plexus. This mechanism is obviously damaged in varicocele patients

Teratogenic effects of ciprofloxacin and pefloxacin in pregnant rats

The adverse effects of ciprofloxacin and pefloxacin on rat fetuses following oral administration to the pregnant rats were studied. Ciprofloxacin and pefloxacin were given daily to pregnant rats at two [therapeutic and double therapeutic] dosage levels during the period of organogenesis [from the 6[th] to the 15[th] of gestation]. Oral administration of ciprofloxacin at 4.5 and 9 mg/100 g.b.wt. to pregnant rats induced fetal resorption, death and growth retardation. Visceral examination of live fetuses showed microcephaly, hypoplasia of the heart and lungs and dilatation of renal pelvis. Skeletal examination reveated incomplete ossification of skull bones and absence of some coccygeal vertebrae. Pefloxacin at 7.2 6 mg/100 g. b. wt. decrease the number of live fetuses and caused microcephaly, hypoplasia of the heart and lungs, dilatation of the renal pelvis. It also induced incomplete ossification of skull bones and absence of sternbrae and phalanges of forelimbs. A great attention should be considered during the clinical use of ciprofloxacin and pefloxacin in pregnant women and animals to avoid their teratogenic effects

Leptin, osteocalcin, and bone mineral density in post-hepatitic liver cirrhosis

The pathophysiology of osteoporosis complicating chronic liver disease is unknown. Some studies have found leptin to be a potent inhibitor of bone formation. The aim of this study is to investigate the relationship between leptin, osteocalcin and bone mineral density [BMD] in liver cirrhosis. Sixty patients with post-hepatitic liver cirrhosis were classified into three groups: group I, 20 pre-menopausal females; group II, 20 post-menopausal females; and group III, 20 males. In addition, 21 age- and sex-matched healthy subjects [seven for each group] were included as control subjects. Patients were classified according to Child-Pugh classification into grade A [n = 0], grade B [n = 38] and grade C [n = 22]. Serum osteocalcin, leptin and parathyroid hormone [PTH], in addition to liver functions test, hepatitis B surface antigen [HBsAg], anti-hepatitis C virus [HCV], serum phosphorus and calcium were measured. Bone mineral density [BMD] was measured by calcaneal ultrasound. Leptin was elevated in all groups [I, II and III] when compared with their control groups [p < 0.01, p < 0.001 and p < 0.01, respectively]. Further, it was high in female groups [I and II] compared to males [group III], [p < 0.01 each]. BMD and serum osteocalcin decreased in each group compared with the respective control [p < 0.001; p < 0.01 in group I, p < 0.05; p < 0.001 in group II and p < 0.001; p < 0.001 in group III, respectively]. In the Child-Pugh grade C group, BMD and osteocalcin were low [p < 0.001, p < 0.05, respectively], while serum leptin was elevated [p < 0.05], when compared with grade B group. Leptin correlated negatively with serum osteocalcin [r = -0.553; p < 0.001], BMD [r = -0.229; p < 0.05], albumin [r = -0.449; p < 0.001] and albumin/globulin [A/G] ratio [r = -0.661; p < 0.001], while positively correlated with both aspartate transaminase [AST] [r = 0.462; p < 0.001], and alanine transaminase [ALT] [r = 0.483; p < 0.001]. Osteocalcin negatively correlated with intact iPTH [r = -0.370, p < 0.001], while positively correlated with BMD [r = 0.418; p < 0.001], albumin [r = 0.659; p < 0.001] and A/G ratio [r = 0.444; p < 0.001]. Serum leptin was elevated in cirrhotic patients and may have a role in the pathogenesis of osteoporosis in liver cirrhosis

Value of the terminal QRS distortion in the admission electrocardiogram compared to several clinical and electrocardiographs parameters in predicting myocardial infarction size, and final scar size

The major determinants of short and long-term prognosis after myocardial infarction [MI] are MI size as well as the final scar size. Clinical and electrocardiographic [ECG], admission variables were studied in 60 consecutive patients admitted with their first acute anterior ST-segment elevation MI of <6 hours duration. Predischarge low-dose dobutamine stress echo was done to the patients unless contraindicated to measure MI size [Resting wall motion score index; WMSI] and final scar size [low-dose WMSI]. Out of the 19 variables studied only 4 variables were significant univariate predictors of both MI size and scar size; QRS distortion, higher Killip class, number of leads with ST segment elevation and Selvester score. Other 3 variables predicted only MI size; history of chronic stable angina, sum of ST elevation, and maximum creatinine kinase level. Of the admission variables, the multivariate predictors of larger MI size were QRS distortion and higher baseline Killip class. For scar size the only multivariate predictor was Killip class. The pre-discharge multivariate model added Selvester score to the above admission variables as a significant multivariable predictor to both MI and scar sizes. The presence of QRS distortion in the admission ECG can independently predict large MI ALT but not essentially a large final scar size. Both can be independently predicted by the admission Killip class as well as by Selvester score in the predischarge ECG

Value of serum and synovial fluid activin A and inhibin A in some rheumatic diseases

Activin is a growth and differentiation factor of many cell types and has recently been implanted in inflammatory processes. Clinical data demonstrating roles of activin and its antagonist inhibin in inflammatory arthropathies, are lacking. The Study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis [RA] systemic lupus erythematosus [SLE] and osteoarthritis [OA] and correlate them with disease activity parameters. This study included 60 patients with three rheumatic diseases [20 with RA, 20 with SLE and 20 with OA], as well as ten healthy subjects as a control group. All of them were subjected to complete history, physical and musculoskeletal examination and estimation of disease activity index [DAS- 28] for RA and [SLEDAI] for SLE. The following investigations were done for all subjects; serum and synovial activin A and inhibin A; in addition to complete blood picture, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP],rheumatoid factor [RF], antinuclear antibodies [ANA],anti-dsDNA, serum complement [C 3, 4] and Xrays on affected joints. The mean values of serum activin A were significantly higher in RA, SLE and OA than controls [P<0.001] also in RA and SLE versus OA [P<0.05 for both]. The mean values of serum inhibin A were significantly higher in all studied groups than controls [P<0.05 for RA and OA and P<0.001 for SLE]. Also serum inhibin levels were significantly higher in SLE versus OA P<0.001, but there was no significant differences between RA and SLE. Synovial fluid activin and inhibin A were significantly higher in RA than OA [P<0.05 for both]. Positive correlations were found between serum activin A and disease activity parameters of RA morning stiffness [MS], Ritchie index [RI], ESR, CRP and DAS 28] P<0.05, for all. Also positive correlation was found between serum inhibin A and RI in RA patient [P<0.05]. In SLE, positive correlations were found between serum activin A and inhibin A with ESR [P<0.001 for activin and P<0.05 for inhibin A and SLEDAI [P<0.001 for both activin and inhibin]. No correlation were found between synovial activin and disease activity and negative correlation between synovial inhibin and ESR. The significant increase of serum and synovial activin A and inhibin A in RA and SLE and their positive correlations with disease activity parameters of RA and SLE suggest pro-inflammatory action. However the lack of correlations or negative correlation of their synovial levels with disease activity may indicate their anti inflammatory action, We recommended further studies to detect the exact role of activin A and inhibin A

Evaluation of transforming growth factor alpha [TGFn] and tumor necrosis factor alpha [TGFn] in children with acute hepatitis

The present study included 60 children who were recruited from Pediatric Department of National Liver Institute [NLI], Menoufiya University and 20 apparently healthy children from the relatives of patients as a control group. Their ages ranged from 2 to 15 years, they were 49 males and 31 females. The studied children were divided according to their diagnosis into groups each of 20; Group [I] acute hepatitis, Group [II] acute fulminant hepatitis [F. H], Group [III] chronic hepatitis and Group [IV] control group. The mean level of both transforming growth factor alpha [TGF I] and tumor necrosis factor alpha [TNF I] were higher in group II [32.74 +/- 9.98 pg/mL and 116.41 +/- 49.70 pg/ml, respectively] more than the other groups and the difference was statistically highly significant [[P<0.001] and [<0.05], respectively]. The mean of level of [TGFD in FH survivors was [29.23 +/- 5.51pg/mL] compared to deceased ones [20.93 +/- 4.60 pg/mL] but the difference was statistically insignificant [p>0.05]. On the other hand the mean of [TNFI] in the deceased cases was 132.76 +/- 48.81pg/mL compared to 117.93 +/- 19.15pg/mL in survivors but the difference was statistically insignificant [P > 0.05]. Case fatality rate for all FH cases was 80%. In conclusion, the levels of both TGFI and TNFI are significantly higher in fulminant hepatitis more than acute hepatitis cases but with no significance in the progress of the disease. Further studies is recommended to uncover predictors that can differentiate between acute hepatitis and fulminant hepatitis and the progress of the disease

Different doses of sublingual Misoprostol versus Methylergometrine for the prevention of atonic Postpartum Haemorrhage

Objective: In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage [PPH] is the most common cause of death. Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and1000Mug in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag [APPH]

Study Design: Double blind randomized controlled study

Methods: One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 Mug tablets were given to women in control and the three study groups respectively, immediately after delivery. Outcome Measures: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration

Results: Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 Mug and 1000 Mug. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related

Conclusion: Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects

Different doses of sublingual misoprostol versus methylergometrine for the prevention of atonic postpartum haemorrhage

In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage [PPH] is the most common cause of death Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and 1000 micro g in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag [APPH]. Double blind randomized controlled study. One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 micro g tablets were given to women in control and the three study groups respectively, immediately after delivery. Outcome Measures: Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non-anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration. Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 M9 and 1000 micro g. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related. Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects

value of lipoprotein [a], homocysteine and doppler of carotid and femoral arteries in assessment of atherosclerosis in asymptomatic cardiovascular risk patients

Atherosclerosis is a major health problem and a common cause of death in our locality. Traditional cardiovascular risk factors do not predict most future cardiovascular events. The aim of this study is to evaluate role of non traditional biochemical markers, carotid and femoral doppler in early detection of atherosclerosis in asymptomatic cardiovascular risk patients. This study was conducted on seventy two patients with various cardiovascular risk factors [22 diabetic. 15 hypertensive, 20 smokers and 15 obese], in addition to eighteen apparently healthy subjects as a control group. All patients and controls were subjected to complete history, physical examination anthropometric measurements, calculation of Framingham risk score [FS]. Measurement of serum levels of lipoproteln [a] [Lp[a]], homocysteine, insulin and C-reactive protein [CRP] as well as microalbumin in urine [UAER], in addition to lipid profile, serum glucose and calculation of insulin sensitivity [QUICKI] were done for all subjects. Also intinia-media thickness [IMT] and plaque formation were assessed in both carotid and femoral arteries using high resolution ultrasound [B mode]. According to FS patients were classified into 3 groups: group [A] 40 patients FS< 10, group [B] 25 patients FS 10-<20% and group [C] 7 patients FS >/= 20%. Also according to presence of atheroma patients were classified into two groups, group I patients without atheroma [62 patients] and group II patients with atheroma [10 patients]. Mean values of serum insulin, homocysteine, CRP, UAER and left common carotid IMT revealed significant elevation in diabetic, hypertensive, obese and smoker groups compared to controls [P<0.01 for all and P <0.05 for CRP in smoker group]. Insulin sensitivity [QUICKI] showed significant reduction in all studied groups compared to controls [P<0.01 for all]. Mean value of Lp[a] showed significant elevation in smoker group compared to controls [P<0.01], but in other groups the mean values of Lp[a] were higher but statistically insignificant. In group C [FS >/= 20%] the mean values of triglycerides, Lp[a] and IMT of both right femoral and right carotid showed significant elevation compared to group [A] FS < 10% [P<0.01 for all]. In group II [patients with atheroma] mean values of systolic blood pressure, serum insulin, triglycerides and CRP revealed significant elevation compared to patients group I [without atheroma] [P< 0.05 for all], while insulin sensitivity showed significant reduction [P<0.05]. Univariate analysis showed significant positive correlations between IMT of left carotid artery and BMI, systolic and diastolic blood pressure, cholesterol, LDL-c., triglycerides, CRP, homocysteine and FS and negative correlation with HDL-c, Also there were positive correlations between triglycerides with CRP and between Lp [a] with homocysteine. Age, waist circumference, waist/hip ratio, homocysteine, triglycerides and CRP were predictors of IMT of carotid artery: while age, CRP and triglycerides were predictors of atheroma. Non traditional biochemical markers were elevated in all cardiovascular risk groups. IMT of carotid artery correlated positively with traditional risk factors [systolic and diastolic blood pressure, BMI lipogram and FS] and negatively with HDL-c. Also it correlated positively with non traditional risk factors [CRP and homocysteine]

Effect of phoxim and amitraz insecticides on fetal development and newborns in rats

The present work was carried out to study the effect of phoxim and amitraz insecticides on fetal development and newborns in rats. Oral administration of phoxim in doses of 110 and 220 mg kg[-1] b.wt. to pregnant rats during the period of organogenesis significantly increased the number of resorbed fetuses and decreased the number, body weight and length of viable ones. Dilatation of cerebral ventricles, pulmonary hypoplasia and dilatation of renal pelvis were reported as visceral malformations. Skeletal examination of fetuses revealed incomplete ossification of skull bones and aplasia of pelvic girdle bones and sternebrae. Large dose of phoxim caused aplasia of some vertebrae, metacarpals, metatarsals and digits. Pregnant rats were given amitraz orally in doses of 40 and 80 mg kg[-1] b.wt. during the period of organogenesis had resorbed, dead and growth retarded viable fetuses. Anencephaly and dilatation of cerebral ventricles and renal pelvis were observed in the examined fetuses. Skeletal abnormalities of viable fetuses were incomplete ossification of skull bones and aplasia of sternebrae. Large dose of amitraz induced aplasia of some vertebrae, metacarpals, metatarsals and digits. Oral administration of phoxim in doses of 110 and 220 mg kg[-1] b,wt. to pregnant rats from the 15[th] day of gestation till the end of weaning period [the 21[st] day post-parturition] caused a significant decrease in the weight of delivered offsprings. Death of all newborns occurred in the 21[st] and the 14[th] day post-parturition by the small and large doses respectively. Oral administration of amitraz in doses of 40 and 80 mg kg[-1] b.wt. to pregnant rats for the same period significantly decreased the number of delivered offsprings. Death of all newborns occurred in the 14[th] and 4[th] day post-parturition by the small and large dose respectively

Clinical and biochemical assessment of nutritional status in patients with chronic renal failure on regular haemodialysis

Malnutrition is common in patients with chronic renal failure [CRF] on regular haemodialysis [HD]. The aim of this study is to evaluate the extent of this problem in haemodialysis unit in Assiut University Hospitals. Sixty male patients with CRF on regular HD and 20 age and sex matched controls were enrolled in this study. All patients and controls were subjected to complete history, physical examination and estimation of anthropometric measurements [body weight [wt], body mass index [BMI], midarm circumference [MAC] and triceps skin fold [TSF]. The following investigations were done for all subjects including; peripheral hemogram, kidney functions, lipid profile, serum phosphorus [P], calcium [Ca], albumin, transferrin and ferritin, in addition to serum leptin and C-reactive protein [CRP]. The patients were classified according to uraemic score into 3 groups [A; 13 patients, B; 34 patients and C; 13 patients]. Cases were also classified, according to subjective global assessment score [SGA] of nutritional status into group A [no malnutrition, 6 patients], group B [mild to moderate malnutrition, 35 patients] and group C [severe malnutrition; 19 patients]. According to serum albumin level also patients were classified into group A [serum albumin> 40 g/L; 27 patients], group B [serum albumin 30-40 g/L; 30 patients] and group C [serum albumin< 30 g/L, 3 patients]. The mean values of wt, BMI, TSF, MAC, albumin and transferrin were significantly lower in patients than controls [P<0.001, 0.001, 0.001, 0.001, 0.01 and 0.001 respectively]. Mean levels of serum P, leptin and ferritin were significantly higher in patients than controls [P<0.001 for all]. Mean values of wt, BMI, TSF, MAC and Hb were significantly lower in group B and C than group A when patients were classified according to SGA score [P< 0.05 for B vs A and P<0. 001, 0.00!, 0.001, 0.01 and 0.05 for C vs A]. The mean values of wt, BMI, TSF, MAC, Hb and serum leptin were also significantly lower in group C than B [P<0. 001, 0.01, 0.01, 0.05 and 0.05 respectively] but mean values of ferritin were significantly higher in malnourished patients group B and C than group A [P<0.001 for each]. Mean values of TSF were significantly lower in group C than A [P<0. 05] and mean values of wt, BMI, and TSF were significantly lower in group C versus B [P<0.05 for all] when patients were classified according to uraemic score. 75% of patients had positive CRP and 20% had lymphopenia. Positive correlations were found between Hb and wt, BMI and MAC [F<0.05 for all]. Positive correlation was found between ferritin and CRP [P<0. 05] and negative correlations with BMI, TSF and MAC [P<0. 01, 0.05 and 0.05 respectively]. Malnutrition was common in patients with CRP on regular HD. Anthropometric measurements were lower in malnourished patients than well-nourished patients. Hyperleptinaemia may participate in the pathogenesis of uraemic anorexia. Inflammation may play a role in occurrence of malnutrition in CRF patients. We recommended dietary education of patients with CRF and follow up patients with anthropometric measurements. Further studies are needed to substantiate role of leptin in the development of malnutrition

use of gated cardiac single photon emission computed tomography [SPECT] in healthy smokers

As cigarette smoking is a major cardiovascular risk factor, this study was designed to find the effect of chronic cigarette smoking on cardiovascular system of apparently healthy subjects by using gated SPECT. This study included 20 healthy young males heavy smokers with smoking index 379 +/- 193.4. Also 10 age and sex matched non smokers volunteers served as controls. Smokers and non smokers persons were subjected to complete history taking, thorough clinical examination, X-ray chest, resting ECG and resting echocardiography to exclude any abnormalities. In addition the following laboratory investigations were done; blood urea, serum creatinine, serum glucose, lipogram and C-reactive protein. Also, stress gated cardiac SPECT using Tc99m MIBI was performed for all subjects. Mean values of serum cholesterol and LDL-c were significantly higher in smokers than non smokers [p <0.001, p <0.05 respectively]. Mean values of HDL-c were significantly lower in smokers than controls [p<0.05]. The percentages of positive CRP were significantly higher in smokers versus non smokers [p<0.05]. The mean values of EF% and SV were insignificantly lower in smokers versus controls at post-stress SPECT. Also, 50% of smokers had diminished myocardial perfusion versus 0% of non smokers [p<0.01] at post stress SPECT. There were also abnormal wall motion and thickness at post stress SPECT. Cigarette smoking is a major risk factor for atherosclerosis in young adult male. Post stress cardiac SPECT may be useful for early detection of cardiovascular events of smoking

Serum leptin, insulin and parathyroid hormone levels in chronic renal failure patients

Chronic renal failure patients whether they are treated with hemodialysis or on conservative treatment frequently suffer uremic anorexia and malnutrition, which is associated with increased morbidity and mortality. In this study we have measured serum leptin, serum insulin and parathyroid hormone in addition to routine kidney function tests, serum glucose, total protein, albumin, lipogram, total serum calcium and inorganic phosphorus. This study was conducted on forty five male patients with chronic renal failure and ten healthy male subjects as control group [Group I.]. According to management of chronic renal failure the patients were divided into two groups: 22 patients on conservative treatment [Group II] and 23 patients on hemodialysis [Group III]. Serum levels of both leptin and insulin revealed significant elevation in patient groups [either on conservative or on hemodialysis,] compared to controls, also in hemodialysis group compared to group on conservative treatment. Serum level of intact parathyroid hormone, also showed significant elevation in groups II and III compared to controls with no difference in comparing group Ill versus group II. Correlation study in whole patients group revealed significant negative correlations between creatinine clearance with both leptin and insulin. Also significant positive correlations were found between leptin and insulin and between leptin and intact parathyroid hormone [iPTH]. Anorexia was found in both patient groups II and III [90.9% and 91.3% respectively,]. Chronic renal failure patients have hyperleptinemia and hyperinsulinemia and there are important interactions between leptin and insulin in which each hormone may be involved in regulating the function of the other. Excess parathyroid hormone may play a role in the pathogenesis of both hyperleptinemia and hyperinsulinemia. Hyperleptinemia may be an important contributing factor for uremic anorexia

Transforming growth factor beta 1 in essential hypertension and glomerulonephritis: the effects of inhibition of the renin angiotensin system on its serum level in glomerulonephritis

This study was carried out on 12 patients with essential hypertension without micro or macroalbuminuria [group I] and 15 patients with chronic glomerulonephritis with mean 24-hour urinary protein = 4.3 + 3.l g/24 hours, [group II], 7 patients had hypertension [group IIa] and 8 patients had normal blood pressure [group IIb]. Ten healthy subjects were taken as controls. Blood urea, serum creatinine, fasting and 2-hour postprandial plasma glucose, urine analysis, 24-hour urinary protein and serum TGF-beta 1 were measured in diseased groups and controls. TGF-beta 1 was significantly higher in group I with essential hypertension [mean +/- SD 80.4 +/- 18.2 ng/dl] and group II with glomerulonephritis. [387.2 +/- 89.0 ng/dl], compared to control group [36.3 +/- 12.9 ng/dl]. In group II, patients with glomerulonephritis mean serum TGF-beta 1 was significantly higher than group I patients with essential hypertension [p <0.001]. In group II, TGF-beta 1 was not significantly different in hypertensive [group IIa] or normotensive patients [group IIb] [mean serum TGF-beta l = 393.3 +/- 92.0 and 379.0 +/- 84.l ng/dl, respectively]. Patients with glomerulonephritis received the angiotensin converting enzyme inhibitor ACE-I [captopril 25-75 mg/day] for four weeks then blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta 1 were re-estimated. There was significant reduction in both 24-hour urinary protein and TGF-beta 1 after captopril with no significant changes in urea and creatinine. It might be concluded that serum TGF-beta 1is elevated in patients with essential hypertension and glomerulonephritis. In patients with glomerulonephritis the use of ACE-I may reduce proteinuria and serum TGF-beta 1. Reduction of TGF-beta 1 might be a possible mechanism in the reduction of proteinuria in patients with glomerulonephritis, however, other mechanisms cannot be ruled out

Serum neopterin, tumor necrosis factor-alpha and soluble tumor necrosis factor receptor II [p75] levels and disease activity in patients with systemic lupus erythematosus

This study was undertaken to determine the clinical value of assaying serum levels of neopterin, tumor necrosis factor-alpha [TNF-alpha] and soluble tumor necrosis factor receptor II [p75] [sTNFRII] and the development of major flares [active disease] in patients with systemic lupus erythematosus [SLE] manifested clinically with lupus nephritis [LN], neuropsychiatric lupus erythematosus [NPLE] or vasculitis. Patients and Serum concentrations of neopterin, TNF-alpha and its soluble receptor sTNFRII p75 were studied in 40 female patients with SLE at various degrees of disease activity and in 10 matched for age and sex healthy controls by enzyme linked immunosorbent assay [ELISA]. SLE disease activity index [SLEDAI] score was used to assess disease activity. Thirty five, 30 and 28 of patients had LN, NPLE and vasculitis respectively as the main clinical manifestation. Renal biopsies were taken from 35 SLE patients who manifested with nephritis. Their pathology revealed that 7, 8, 9 and 10 had mesangial, membranous, focal and lastly diffuse LN. Of the 30 patients with NPLE, six patients were classified as having mild, 9 as having moderate, and 15 as having severe NPLE. Twenty eight of SLE patients manifested with vasculitis in the form of skin gangrene and ulcer or nail infarction or splinter hemorrhage. Serum levels of neopterin, TNF-alpha and sTNFRII of SLE patients were significantly higher than those of healthy controls [p<0.0001 for all]. While, TNF-alpha/ sTNFRII ratio was decreased significantly in SLE patients compared to healthy subjects [p<0.0001]. sTNFRII and TNF-alpha/sTNFRII were the only parameters that showed significantly higher or lower levels in SLE patients with mild activity classified according to SLEDAI score compared to normal subjects [p=0.0004, 0.0001]. Otherwise, the levels of neopterin, TNF-alpha and sTNFRII were significantly higher in either moderate or severe activity as scored by SLEDAI score compared to normal subjects [in moderate: for neopterin, TNF-alpha, sTNFRII p=0.0001, 0.03, 0.0001; for severe: p= 0.0001 for all respectively]. Patients with focal and diffuse LN had significantly increased serum levels of neopterin, TNF-alpha and sTNFRII, and a significantly higher SLEDAI score in comparison with those patients without LN [in focal: for neopterin, TNF-alpha, sTNFRII and score p=0.001, 0.01, 0.0001, 0.0002; for diffuse: p=0.0002,0.0004, 0.0001. 0.0001 respectively]. Patients with membranous LN had only increased sTNFRII level in comparison with those patients without LN [p=0.03]. Serum concentration of neopterin. TNF-alpha and sTNFRII were significantly elevated in both moderate, and severe NPLE and also patients' SLEDAI score as compared to those patients without NPLE [in moderate: neopterin, TNF-alpha, sTNFRII and score p= 0.008, 0.04, 0.001, 0.001 and in severe NPLE p =0.0001 for all respectively]. Serum concentrations of TNF-alpha and SLEDAI score were significantly higher in patients with severe NPLE than in mild NPLE [p=0.009, 0.004 respectively]. Serum concentration of neopterin was significantly elevated only in the mild NPLE [p=0.02] as compared to those patients without NPLE. Patients with vasculitis had significantly increased score and elevation of serum neopterin, TNF-alpha and sTNFRII compared to patients without vasculitis [p=0.02, 0.02, 0.0001, 0.009 respectively]. SLEDAI score were correlated positively with serum neopterin, TNF-alpha, sTNFRII and TNF-alpha/ sTNFRII levels [r=0.77, 0.75, 0.83, 0.35; p<0.0001 for the first 3 and 0.02 for the last respectively]. Also, serum neopterin levels showed significant positive correlation with serum TNF-alpha, sTNFRII and TNF-alpha/ sTNFRII levels [r=0.89, 0.94, 0.40 p<0.0001 for the first 2 and 0.008 for the last respectively] Measurement of serum sTNFRII is more better than TNF-alpha as a predictor of mild activity of SLE. However, serum neopterin is a useful parameter for detection of mild NPLE. Serum sTNFRII is a good parameter for better detection of all pathological types of lupus nephritis. Also, it was the one amongst other parameters measured that exhibited the higher significant elevation when comparing patients with different LN pathology. Even more, SLEDAI score showed the highest correlation with sTNFRII Lastly, TNF-alpha showed the highest significant elevation in patients with vasculitis

Von Willebrand factor, thrombomodulin and nitric oxide in Behcet's disease

Twenty-six patients with Behcet's disease [BD] [15 patients with active disease and 11 with inactive disease] and 20 healthy subjects, as a control group, were included in this study. All patients and controls were subjected to measurement of plasma levels of von Willebrand factor [vWF] and thrombomodulin [TM] as well as serum NO, in addition to complete blood picture, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. The results showed that, means of vWF, TM and NO levels were significantly higher in BD patients than controls. Mean levels of vWF were high in patients with recurrent oral ulcer [ROU] and those with arthritis/arthralgia. Mean values of NO were significantly high in patients with ROU, RGU, patients with arthritis/arthralgia and thrombosis. Mean levels of vWF, TM and NO were significantly higher in active group than inactive group. Positive correlations were found between vWF with ESR2, CRP, TM and NO. Also, positive correlations were found between TM with ESR1 and ESR2. Also, positive correlations were found between NO with ESR1, ESR2 and CRP

Thyroid disorders in systemic lupus erythematosus and rheumatoid arthritis

Aim: Thyroid disorders are not uncommon in systemic lupus erythematosus [SLE] and rheumatoid arthritis [RA]. However, the association between SLE and RA with autoimmune thyroid diseases is conflicting. This study was designed to determine the patterns of thyroid dysfunction in SLE and RA in Assiut University Hospital. Subjects and Twenty patients with SLE and another twenty with RA were studied in addition to 20 healthy age- and sex-matched controls. All patients were subjected to complete history taking, thorough clinical examination and joint examination. All patients and controls were subjected to the following investigations: serum T3, T4, TSH, antithyroglobulin antibodies [ATGAb] and thyroid peroxidase antibodies [TPOAb]. Also, complete blood picture, ESR, RF, ANA, CRP and LE cells were determined. Fifty percent of SLE patients showed thyroid dysfunction compared to 15% of RA [P<0.05]. In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidisrn [10% subclinical and 10% overt], and 10% had hyperthyroidism [5% subclinical and 5% overt]. However in RA, 10% had hypothyroidisrn [subclinical] and 5% had subclinical hyperthyroidism. TPOAb was found in 15% of SLE and 5% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Also ATGAb was found in 5% of SLE and 30% of RA patients and 10% of controls, but the titre was higher in SLE and RA patients. Conclusions: Thyroid dysfunction was common in SLE [in particular] and RA. Euthyroid sick syndrome and hypothyroidism were the most common thyroid disorders in SLE. In RA hypothyroidism was more common than hyperthyroidism. SLE and RA were associated with antithyroid antibodies [TPOAb in SLE and ATGAb in RA]. We recommend the performance of thyroid function tests in patients with SLE [in particular] and RA as a part of biochemical and immunological profile

Cytogenetic evaluation of epilepsy

The aim of this study was to detect the chromosomal abnormalities in patients suffering from epilepsy through chromosomal study, and to evaluate the correlation between these results with physical and intellectual disabilities. The present study was conducted on 50 epileptic pediatric patients [29 males and 21 females], their age ranged between 6 months and 11 years. Patients were selected from Pediatric Neurology out-patient clinic in EI-Minia University Hospital, from December 2002 to August 2003. All patients were diagnosed as having epilepsy based on the detailed clinical symptomatology of seizures. The patients were subjected to careful history taking, complete general and neurological examination. Electroencephalography [EEG], computerized tomography of brain [C.T.] and chromosomal study by studying G-bands to facilitate the identification of structural abnormalities were done. The studied patients were divided into 2 groups: Group 1 included 20 epileptic patients with normal physical and intellectual developments and group 2 included 30 epileptic patients with intellectual disabilities and/or physical abnormalities. The results proved that 4 cases [8%] showed chromosomal abnormalities among the group 2 of patients. One patient had distal deletion of the long arm of chromosome 1, one patient had ring chromosome 20 and the remaining two patients had distal deletion of the long arm of chromosome 6

Conclusion : We concluded that epileptic patients not in need for chromosomal study, karyotype analysis should be performed in a child or adult complained from seizures with dysmorphic features and/ or intellectuaidisability