Comparison and validation of laminin-based score and fibroscan for prediction of liver fibrosis in Egyptian patients with chronic hepatitis C

The constraints of liver biopsy and the limitations of single parameters in assessing liver fibrosis have boosted the development of scores combining markers to improve accuracy. Laminin-based score was devised by the study group in 2006. The present study was conducted to validate the diagnostic accuracy of this score and of transient elastography [T.E.] In another group of ninety Egyptian patients with chronic hepatitis C. Patients were biopsied and subjected to assessment of score parameters [serum albumin, AST, prothrombin concentration, laminin, portal vein diameter] and liver stifihess by T.E. Patients were classified using modified Knodell score into 7 groups [stage 0-stage 6]. A significant relation between the stage of fibrosis and the laminin-based score was found. The score demonstrated high accuracy for diagnosing significant fibrosis and cirrhosis. Liver stiffness correlated significantly with staging of fibrosis as well as with laminin-based score. T.E. demonstrated high accuracy for diagnosing significant fibrosis and cirrhosis. Both methods proved useful to discriminate stages F4 and F5. When both methods were combined, the diagnostic accuracy was increased to 93.7% for diagnosing significant fibrosis. Laminin-based score and T.E. Proved their clinical value and may reduce the need for repeated liver biopsies

Orofacial tumours; complexity and outcome

The anatomic, physiologic and aesthetic complexity of the head and neck poses significant challenges to the management of all neoplasm arising in this compact region. The oral cavity is the most common site for malignancies of the head and neck region [about 30%] with the tongue and floor of mouth, are the most frequent primary site. The primary objective of a reconstructive effort is an aesthetic result that approaches a normal appearance. Functional consideration, including oral competence, articulation, speech, and the role of the lip in mastication, must be kept in mind during reconstruction of the large lip defects. The aim of this work is to study the different available surgical techniques for reconstruction of orofacial area after tumour excision and to address the outcome of surgery, aesthetic result and recurrence after surgery. This prospective study included 75 patients with different orofacial tumours, who were admitted at both Plastic and General Surgery Departments, Sohag University Hospital, Egypt, in the period from Mars 2004 to October 2006. The age of the patients ranged from 7 months to 83 years, 40 patients [53.33%] were females and 35 patients [46.66%] were males. The aesthetic and functional results were evaluated by patients questionnaires, photographing and physical examination. The overall aesthetic and functional results were excellent in 65.41%, very good in 14.66%, good in 17.33% and fair in 2.6% of the cases respectively. The local and regional flaps are ideal methods for reconstruction of facial defects because they give excellent color and texture match. Distant flaps have a great role in reconstruction of large facial defect. Although split or full thickness grafts proved to be an easy, simple and fast technique of reconstruction, however the aesthetic results are usually unsatisfactory

Assessment of plasma carnitine and acylcarnitine levels in preeclampsia

Objective: carnitine plays a crucial role in fatty acids oxidation. The aim of the study is to assess plasma carnitine and acylcarnitines levels in preeclamptic womedas a measure of abnormal fatty acid oxidation

Methods: the study included 40 women with preeclampsia and 30 normotensive control women in the third trimester of pregnancy. Women with multiple pregnancy, chronic hypertension, diabetes mellitus and renal diseases were excluded. Plasma levels of free carnitine and acylcarnitines were measured with high performance liquid chromatography [HPLC]

results: total and free carnitines and acylcamitines were significantly increased in preeclamptic cases in comparison to the control group. A positive correlation was found between acylcarnitines and diastolic blood pressure [r=0.382, p= 0.018]

Conclusion: the significantly high plasma carnitine concentrations found in this study supports the hypothesis of abnormal fatty acid metabolism in the pathophysiology of preeclampsia. This may contribute to the endothelial cell dysfunction of preeclarnpsia

Maternal periodontal disease as a risk factor for preterm labour and low-birth weight

Objective: The purpose of this study was to test the link between periodontal disease in pregnant women and preterm labour or low-birth- weight

Subjects and methods: The study included 50 mothers who delivered at term and 45 mothers who delivered preterm. All participants were subjected to full general, obstetric, and ultrasound examination upon admission to labour unit. After delivery, recording the weight of all newborn infants was done within 48 hours of delivery, dental examination of all participant women to detect evidence of clinical periodontitis which was defined when there are 4 or more teeth with one or more sites with probe depth [PC] > 4 mm and with clinical attachment loss [CAL] >/= 3mm at the same site

Results: The group of women with preterm labour showed significantly higher prevalence of clinical periodontitis in comparison with those who delivered at term [42.4% vs. 20%, P=0.034]. Among criteria of periodontal disease, only "CAL" and percentage of sites with [CAL] >/= 3mm were significantly higher in the group with preterm labour. There was significant negative correlation between "CAL" and prevalence of periodontitis and both gestational age [weeks] r=-0.459, r=-0.516 respectively and neonatal birth weight [gms] r=-0511, r=-0.445 respectively. The mean of [CAL] was significantly higher [1.71 +/- 0.4] in low birth weight group than in the group with normal birth weight [1.53 +/- 0.33] p=0.020

Conclusion: Maternal periodontitis may be a considerable risk factor for preterm delivery and low birth weight

Salivary testosterone measurements in diagnosis of polycystic - ovarian syndrome

The aim of this study was to evaluate the reliability of a non- invasive method[saliva] for determination of testosterone level in diagnosing cases of Polycystic Ovarian Syndrome [PCOS], and comparing it with serum free testosterone. Fifty women with PCOS and 20 normal women as control group were selected for the study. BMI was calculated for all participants and transvaginal ultrasound to determine ovarian morphology, ovarian volume. Serum follicle stimulating hormone [FSH], lutinizing hormone [LH] were assessed for all patients, serum free testosterone [FT] was assessed by Radioimmunoassay [RIA] and salivary testosterone [ST] by ELISA kit. The present study showed a significant positive correlation between salivary testosterone, as measured by ELISA, and serum free testosterone measured by RIA [p=0.001 and r= 0.52]. Using the receiver operator curve, salivary testosterone was found to be more sensitive than serum [FT] [84% Vs 66%] in diagnosing PCOS patients. In conclusion, determination of salivary testosterone is a reliable method to detect changes in the concentration of available biologically active testosterone in the serum. Salivary testosterone provides a sensitive, simple, reliable, non-invasive and uncomplicated diagnostic approach for PCOS

Relation of urinary prostaglandin E2 levels to uteroplacental blood flow and renal functions in preeclampsia

The objective of this study was to investigate the association between urinary prostaglandin E2 [PGE2] levels and uteroplacental blood flow and to test whether PGE2 contributes to the vasospasm and altered renal functions in pregnancies complicated by preeclampsia. Serum and urine samples of 63 pregnant women [29 preeclamptic and 34 normotensive] were investigated by means of PGE2 levels and urea, creatinine and creatinine clearance values. To all participants of the study, uteroplacental blood flow was assessed by uterine artery Doppler sonography flow patterns. Data from preeclamptic patients were compared with normotensive pregnancies as controls. Mean urinary PGE2 levels were significantly lower in preeclamptic patients than in normotensive women [2.67 +/- 0.65 vs. 4.35 +/- 0.89 pg/g creatinine, respectively, P < 0.001]. Preeclamptic patients had significantly higher serum urea and creatinine concentrations, and significantly lower creatinine clearance values compared to normal controls. Preeclamptic patients also showed significantly higher mean uterine artery resistance index [RI] values than controls. Correlation analysis revealed a significant inverse correlation between urinary PGE2 levels and uterine artery RI values [r = -0.84, P < 0.001]. Prostaglandin E2 [PGE2] is a relevant mediator of uteroplacental blood flow and its deficiency suggests a possible role in the vasospasm of preeclampsia. PGE2 deficiency is of relevance to preeclampsia by leading to reduced uteroplacental blood flow and altered renal functions

Arthroscopic pinning of osteochondritis dissecans of the knee

Nine cases with osteochondritis dissecans were treated by arthroscopic pinning using K-wires. The average age of the patients was 18.5 years. These cases were followed up clinically and radiologically for an average period of 14 months. The results of this surgery were satisfactory with no significant complications and the patients were able to resume their normal activities within a reasonable period of time

use of calcium phosphate bone substitute in the treatment of unicameral bone cysts of the humerus

There are several modalities for treatment of unicameral bone cyst. One of these modalities is the use of calcium phosphate as a bone substitute to fill the cyst after curettage. Thirteen cases of simple bone cysts of the upper humerus were treated by this method. The patients were followed up for 1 to 4 years. The success rate was 92.3%. These results were compared with other studies using autogenous bone graft or intralesional injection of prednisolone

Posterior wall acetabular fractures clinical outcome of surgical treatment

Fifteen patients with postterior wall acetabular fractures were treated surgically. All the fractures resulted from high energy traum a, most with associated injuries. Forteen of these patients were followed up to at least 9 months, only one was lost for follow up. Clinical outcome was analyzedd according to Harris hip score and also radiografically. In 78.4% of the patients the surgical procedure was judged successful [Harris hip score 80 points or more]. Injury of the femoral head lead to bad clinical outcome though no significant statistical correlation was possible because we had this injury just once in our series and because this case had another complication as well [Avascular necrosis of the head of femur]. Quality of reduction was found to influence the clinical outcome with positive statistical correlation. Open reduction and internal fixation of displaced posterior wall acetabular fractures though surgically demanding procedure can give very good result when patients are managed properly through experienced and organized team with clear and stable system of management

Evaluation of transpedicular fixation in treating dorso-lumbar injuries

From April 1996 through July 1999, we encountered 27 patients with dorso-lumbar injuries of the spine and were treated by transpedicular rod fixation systems. 17 patients had burst fractures, and 10 patients had fracture-dislocations. Posterolateral fusion was done to all patients. 5 patients had complete paraplegia, 15 patients had various neurological deficits, and 7 patients were neurologically free before surgery. Indirect decompression was done for the patients who have canal compromise less than 50%. The average follow-up period was 18 months [range 6-30 months]. The average correction of the anterior wedge compression angle postoperatively was 11.5° with an average loss of 3.1° at follow-up. The average correction of the local kyphosis angle was 12.2° with an average loss 4.2° at follow-up