Variations of Suprascapular Notch in Adult Egyptian Scapulae.

Background: The suprascapular notch (SSN) lies on the superior border of scapula, close to the root of coracoid process. The suprascapular nerve passes through the notch, below superior transverse scapular ligament. The objective of the present study was to determine variations in the size and shape of SSN in adult Egyptian scapulae to provide a better diagnosis and management of suprascapular nerve entrapment syndrome. Material and methods: A total of 85 dry adult unpaired scapulae of unknown age and sex were randomly selected. The shape of SSN was determined by direct inspection and the vertical and transverse diameters of the notch were measured in each specimen. The results were recorded and statistically analyzed. Results: In the studied scapulae, the SSN was revealed in 89.41%, absent in 8.24% and replaced by a scapular foramen in 2.35% . Three morphological types of SSN were observed; U-shaped (60.53%), V-shaped (31.58 %) and J-shaped (7.89 %). The SSN had a longest transverse diameter (type II) in 55.26% and had a longest vertical diameter (type III) in 44.74%. The U-shaped variety was observed in 32.61% of type II and 67.39% of type III. All of J-shaped variety (100%) were exclusively observed in type II, whereas half (50%) of the V-shape variety were observed in type II and the other half (50%) in type III Conclusion: The diameters and morphological type of SSN documented in the present study might be easily identified on a plain radiograph that might be helpful in diagnosis of suprascapular nerve entrapment syndrome. Moreover, these anatomical data would improve the safety of arthroscopic nerve decompression.

Morphometry of Glenoid Fossa In Adult Egyptian Scapulae.

Background: Knowledge of normal variations in shape and size of the glenoid fossa are required to improve efficacy and minimize failure rates in shoulder arthroplasty, particularly those involving the glenoid component of shoulder joint. Studies concerning glenoid morphometry among Egyptian population are scarce. The objective of the present study was to determine morphological types and diameters of glenoid fossa in adult Egyptian scapulae . Material and methods: A total of 68 dry adult unpaired scapulae of unknown age and sex were randomly selected. The shape and diameters of glenoid fossa in each specimen were recorded and collected data were statistically analyzed. Results: Glenoid fossa revealed a superior - inferior diameter of 3.31 ± 0.39 and 2.87 ± 0.41 centimeters and an anterior - posterior diameter of 2.44 ± 0.44 and 2.21 ± 0.44 centimeters on the right and left sides respectively. The anterior margin of glenoid fossa presented a notch in 76.47% of studied scapulae, and accordingly the fossa was classified into three morphological types; pear-shaped (45.59%), inverted comma-shaped (30.88%) and oval – shaped (23.53%). Conclusion: The documented findings about glenoid fossa in the present study would help to decide the proper size of glenoid component in shoulder arthroplasty among Egyptians. Moreover, approximately one third of Egyptians are liable to Bankart lesion.

Prevalence and outcome of bacterial endocarditis in patients with implantable cardiac devices infections

Cardiac device infection [CDI] is a devastating complication of permanent pacemakers [PPM] or implantable cardioverter-defibrillators [lCD]. The incidence and outcome of endocarditis among patients [Pts] with CDI is not well defined. Is to report the experience in the prevalence, clinical presentations and management of bacterial endocarditis [BE] among patients with CDI in a tertiary care cardiac center over 25 years. A total of 2630 cardiac devices implanted in a cohort of 2367 patients [pts] over 25 years were studied. Out of these, 117 [4.4%] Pts presented with CDI. Clinical, bacteriologic and both transthoracic [TTE] and transoesophageal Echocardiographic [TEE] assessments were done. Of the 117 Pts with CDI [90 males, age ranging 18-82 yrs, mean=63 +/- 6 ys], 87 [74%] had redo procedures [battery replacement in 50, repositioning of leads in 12, device extrusion in 15 or evacuation of significant haematoma in 10 pts]. Of these 87 pts, 65 had re-implants on the same day of explantation. In 30 pts [26%] no apparent cause of P1 was identified. Out of the 117 Pts with CDI, 30 pts [26% of CDI and 1.1% of total procedures] had device-related BE with vegetations appeared in all pts by TEE [15 DDD, 9 VVI, 3 CRT and 3 lCD]. The clinical presentations were prolonged fever in 25 pts [83%], significant pulmonary hypertension with thrombo-embolism in 3 pts [10%], severe sepsis and multi-organ failure in 2 pts [6%]. Twenty-eight pts [93%] had positive blood cultures Istaph.aureus in 23 [77%] and enterococci in 5]. There were only 2 Pt with negative blood cultures. Device lead vegetations were evident in 20 pts [>10mm diameter in 13 pts]. Ten pts presented with only right heart valves vegetations. Out of the 30 BE pts, 28 [93%] had P1 while 2 pts had no apparent cause but frequent intravenous injections [one drug addict and one on regular haemodialysis]. Out of the 20 pts with lead endocarditis 15 had their leads removed surgically with re-implantation of either epicardial [6 pts] or endocardial leads [9 pts]. Fifteen pts had only medical treatment with proper antibiotics [5 pts with lead BE and all 10 pts with valvular BE]. Four pts [13%] died; all had their devices implanted on same day of explanation. Conclusion: Cardiac devices Redo procedures are major risk factors for CDI specially re-implantation on same day. Device related BE carries a serious morbidity and mortality yet surgical removal of the whole system is the management of choice. Blood stream bactraemia is a potential risk factor in patients with cardiac devices and warrant prophylaxis against BE

Liberation from mechanical ventilation: targeted weaning versus daily weaning trials

Critical-care clinicians must carefully weigh the benefits of rapid liberation from mechanical ventilation against the risks of premature trials of spontaneous breathing and extubation. Our aim of work was to study the capability of respiratory system mechanics as weaning parameters. In 30 patients who have been mechanically ventilated due to pulmonary causes of respiratory failure, we divided patients into 2 groups: [Group 1] in which weaning was postponed until certain values of lung mechanics have been reached [targeted weaning], and [Group 2] in which patients undergone daily weaning trials once the general criteria of weaning have been fulfilled irrespective of their lung mechanics values. Targeted weaning threshold values were as follows: static compliance >33ml/cmH[2]O dynamic compliance >22ml/cmH[2]O, resistance 0.05]. Targeted weaning group has showed less number of weaning trials and fewer incidences of re-intubation events with no increase in mechanical ventilation time or complications. We concluded that respiratory mechanics were modest weaning predictors. But on the other hand, targeted weaning by respiratory mechanics constituted a much more economic and resource preserving protocol of weaning

effects of different levels of auto-PEEP on hemodynamics in mechanically ventilated patients, correlation with lung mechanics and gas exchange in different ventilator settings

The goal of this study was to detect auto-PEEP in mechanically ventilated patients and monitor how its different levels may affect the patients hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. Another goal was to monitor how the addition of external PEEP may affect the patient hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. This study included 18 mechanically ventilated patients who were classified into three groups: COPD group [10 patients], restrictive group [4 patients] and normal group [4 patients]. Besides the routine clinical examination, ECG, chest X-ray, laboratory investigation and ABG, each individual patient was subjected to serial monitoring of hemodynamic parameters [SV, PCWP, LVSW, RVSW, PVR], lung mechanics parameters [auto-PEEP, external PEEP, total PEEP, P pressure, P mean, P total, Raw, C stat]. This is done for base line readings and after every change in ventilatory settings according to the study on different levels of auto-PEEP and on different levels of external PEEP. The results showed that auto-PEEP was detected in 13 out of 18 patients included in the study [72%] with mean of 6.8 cm H2O SD 5. On application of external PEEP, auto-PEEP had a significantly negative correlation with external PEEP in all groups

HELLP [hemolysis, elevated liver enzymes and low platelet count] syndrome versus severe preeclampsia: a critical care comparative study

We performed this study to assess the clinical spectrum and evaluate the outcome of patients with HELLP-syndrome compared to those with severe preeclampsia but without HELLP managed in the intensive care unit [ICU]. Serum albumin level was measured as a prognostic factor. A prospective clinical and laboratory study that was conducted over 18 months period where sixty seven preecalmptic postpartum women admitted to ICU were studied, and were divided into 2 groups. Group I, 21 patients with HELLP-syndrome, and group II, 46 patients with severe preeclampsia only were compared and contrasted concerning medical and laboratory data. Patients in group-I were older than group II [28.7 +/- 6.6 vs 24.5 +/- 4.6, P < 0.05] and-had higher medical complications than patients in group-I I. Eclampsia 62% vs 20% [odds-ratio = 5.95% C1 = 1.2-20.6, P < 0.01], adult respiratory distress syndrome [ARDS] with respiratory failure 29% vs 4% [odds-ratio=l2.4, 95% CI - 1.2-126.1, p<0.01], multiorgan failure [MOF] 43% vs.4% [odds-ratio = 8.4, 95% CI = 1.4-52,. p<0.01] and mortality 38% vs.7% [odds-ratio=11.6, 95%, CI= 1.9-70.2, p<0.01] respectively. There was no significant difference between both groups concerning disseminated intravascular coagulation [DIC] and circulatory failure. Serum albumin on admission was significantly lower in HELLP syndrome patients [2.2 +/- 0.6 gm/dl] than patients with severe preeclampsia [2.8 +/- 0.6 gm/dI, P < 0.01]. Serum albumin correlated significantly with both MOF [t-value = 2.7, DF = 40, P=0.01] and mortality [t-value = 3.7, DF = 27, p = 0.001]. Preecalmptic patients with HELLP-syndrome are amenable for serious medical complications and higher mortality rate than patients with severe preeclampsia but no HELLP. Serum albumin is lower in patients with HELLP-syndrome and correlates well with the development of MOF and mortality so can be used as a useful predictor of both morbidity and mortality in critically ill preecalmptic patients