Impact of lymph nodes involvement after radical cystectomy on patient survival

To evaluate the role of pelvic lymph node dissection [PLND] during radical cystectomy for bladder cancer as regards to the extent of nodal dissection and the necessary number of lymph nodes to be removed. Retrospective study was done on 198 patients with invasive bladder cancer treated with radical cystectomy and urinary diversion. Regional PLND include internal iliac, external iliac, and obturator nodes. The study evaluates the impact of pelvic lymph node involvement and the number of nodes removed during surgery on survival of patients. Lymph node metastases were detected in 54 patients [27.3%]. The average number of nodes removed in the node-positive and node-negative patients was 13.7 and 14.4 respectively. Although no difference was found in disease-specific survival in the node-negative patients when stratified by the number of nodes removed [13 or more versus less than 13], a significant survival advantage was found in the node-positive patients with 13 or more nodes removed versus less than 13 nodes removed. The patients with four or more positive nodes had a worse outcome than those with less than four positive nodes. However, even if the patients had less than four positive nodes, the survival of patients with less than 13 nodes removed was as poor as that of the patients with four or more positive nodes. In this series, the removal of 13 or more pelvic lymph nodes was essential for more accurate pathologic examination to predict patient outcome and contributed to an increased chance of survival

Portal hypertensive gastropathy [PHG]: clinical, endoscopoc, and portal haemodynamic assessment

Portal hypertensive gastropathy [PHG] is an important complication of both generalized and segmental portal hypertension. The pathophysiology of PHG is still unclear. The aim of this study was to detect the prevalance of PIEIG and factors influencing its development. This study was conducted on 82 patients with portal hypertension. They were divided into 2 groups: Group I [non-bleeders] comprised 31 patients, serves as a control group. Group II [bleeders] comprised 51 patients and were subdivided into: Group IIa 28 patients who were followed up by endoscopic sclerotherapy [[EST] and Group IIb: 23 patients who were followed up by endoscopic band ligation [EBL]. Endoscopy was repeated every 2 weeks till variceal obliteration. All patients were subjected to thorough history taking, clinical examination, laboratory investigations and Doppler ultrasonographic evaluation. In this study the prevalance of PHG was 756%, with no age or sex difference, with increased frequency and severity in patients with child-pugh class B than in patients with class A and C but without statistically significant difference. Again the prevalance of PHG was higher in patients with post-hepatitic cirrhosis than in patients with mixed cirrhosis and patients with pure bilharzial fibrosis but without statistically significant difference. The prevalance and severity of PI-IG was in the presence of esophageal varices, large variceal size, and presence of red signs, while the prevalance and severity was decreased in the presence of gastric varices; however, there were no statistically significant difference. The prevalance and severity of PHG were collectively after endoscopic managment especially with EBL without statistically significant difference. PHG was associated with insignificantly increased portal cross-sectional area, congestion index and portal blood flow. Also, it was associated with decreased portal maximum and mean velocities but the difference was statistically insignificant. We concluded that PHG is quite frequent in patients with cirrhosis, however, the factors studied are not good predictors for its presence

Incomplete abortion: a randomized controlled trial comparing expectant with medical management using oral misoprostol

This study was carried out on 160 women who had incomplete first trimester miscarriages and consented to pretreatment randomization to compare the efficacy of medical management using oral misoprostol with expectant management. The patients were randomized to treatment with misoprostol 400 microgram [ug] orally every four hours for maximum three doses [n = 80] or expectant management [n = 80] and were re- evaluated 24 hours later. If retained intrauterine products of conception were found with anteroposterior diameter above 15 mm on transvaginal ultrasound, surgical evacuation of the uterus was performed. 47.5% of the women randomized to oral misoprostol treatment and 2.5% of those randomized to expectant management had an empty uterine cavity after 24 hours. Less side effects necessitating management had been observed with the use of misoprostol orally. It was concluded that treatment with oral misoprostol compared with expectancy alone can reduce the demand for surgical evacuation in cases of incomplete abortion by a clinical important degree and its use was associated with fewer medical complications

Some characterizations of Egyptian wools pretreated with organic solvents

The effects of various solvents on Egyptian wool varieties; namely, Mariouty and Fallahi, as compared with Merino wool were investigated with respect to the capability of inducing physical and/or chemical changes. Nitrogen content, alkali solubility, yellowing index, tensile strength as well as electron microscopic examination, X-ray diffraction and infrared analyses were performed. All solvent pretreatments showed a small decrease in the nitrogen content values as compared with the untreated wool mates. No significant alkali solubility was seen for wool fibers pretreated with the studied solvents. Reduction in the tensile strength was noticed to a certain extent in the pretreated wools. Electron microscopy showed some modifications in the cell membrane complex. Solvent treated wools exhibited relatively lower crystalline orientation and lower intensity as compared with the untreated ones. Infrared spectroscopic analysis gave absorption bands that varied according to the nature of solvent pretreatments

Pharmacognostical study of hyoscyamus boveanus

The macro-and micromorphology of the leaf, stem and flower of Hyoscyamus boveanus [Dun. in DC.] Asch. et schweinf. [Solanaceae] are presented with the aim of finding their diagnostic characters by which the plant can be easily identified from other closely related Hyoscyamus species

Experience with the use of betadine for the local management of burn wounds

Since infection remains the major unsolved problem and the great hazard threatening the survival of seriously burned patients, the search for new effective topical agents has to be constantly pursued. This study was carried out on 100 patients with variable types of burn wounds in an attempt to assess the role of Betadine as a topical agent in control of burn wound infection. Betadine was used alone for 50 patients, Flamazine was used for another 15 patients and both agents were applied simultaneously for different areas for 35 patients. The time needed for complete healing of second degree burns and the time needed to prepare deep dermal burns for grafting were used to compare the efficacy of both agents. Also, swab cultures were done for some patients for whom both agents were used. Results were discussed and it was concluded that Betadine is very effective agent in burn wound prophylaxis and management. Minor problems encountered during its use were also reported

Experience with the use of betadine for the local management of burn wounds

Since infection remains the major unsolved problem and the great hazard threatening the survival of seriously burned patients, the search for new effective topical agents has to be constantly pursued. This study was carried out on 100 patients with variable types of burn wounds in an attempt to assess the role of Betadine as a topical agent in control of burn wound infection. Betadine was used alone for 50 patients, Flamazine was used for another 15 patients and both agents were applied simultaneously for different areas for 35 patients. The time needed for complete healing of second degree burns and the time needed to prepare deep dermal burns for grafting were used to compare the efficacy of both agents. Also, swab cultures were done for some patients for whom both agents were used. Results were discussed and it was concluded that Betadine is very effective agent in burn wound prophylaxis and management. Minor problems encountered during its use were also reported

Macro- and micromorphology of Gallium sinaicum boiss

The macro-and micromorphology of the stem, leaf and root of Gallium sinaicum boiss [Rubiaceae] are presented with the aim of finding their diagnostic characters by which the plant can be easily identified

Effect of tonsillectomy on meningoccal carrier rate

Acute bacterial meningitis has its unique and specific clinical presentation and it has been recognized and described since the earliest days of medicine the purpose of this work was to study the effect of tonsillectomy on the carrier rate of meningococcal meningitis among students aged 6-15 years, as well as to access IgA level in the nasopharyngeal secretion and diagnosis of meningococcal serotypes. These goals were achieved through a survey conducted on 750 children belonging to public and private schools located in the Eastern Zone of Cairo. Follow-up for 580 students was carried out for a period of 20 months. Analysis of the collected data revealed the following 1- The meningococcal carrier rate among the examined students was 10.4%. 2-The results revealed a relation between the history of tonsillectomy and the carrier rate, as the carrier rate was 14.7% among the tonsillectomized students compared to 9.1% of non-tonisllectomized children, and this difference was statistically significant. This relation appeared clearly in the results of the follow-up study as the carrier rate was 36.8% among tonsillectomized group compared to 6.2% among the control group. 3- Estimation of IgA level in the nasopharyngeal secretion revealed that the pre-exisiting mean IgA antibody titre in the nasopharynx declined in all students studied 3 months after tonsillectomy. This difference was statistically significant. 4- The serological classification of the isolated meningococci revealed that the higher serogroup percentage [about 41%] belonged to group A, followed by 26.9% for group C and the lowest percentages [8% and 5.1%] belonged to group B and D, respectively

Primary hyperparathyroidism presenting with skeletal lesions

Twenty one cases of primary Hyperparathyroidism are presented. The clinical presentations, radiological findings and biochemical studies are discussed. This series stresses the frequency of Incorrect first diagnosis. Three examples are presented. The surgical management of the patient as well as the post-operative course and follow up are outlined