ABSTRACT
Background: Coronary artery ectasia (CAE) is a well-recognized but relatively uncommon finding encountered during diagnostic coronary angiography. It is commonly defined as in appropriate dilation of the coronary arteries exceeding the largest diameter of an adjacent normal vessel more than 1.5-fold. CAE is not an isolated and benign disease but a reflection of a generalized vascular media defect. Objective: The aim of this study was to compare 2D-TTEand 3D-TTE measurements of the aortic root diameter in patients with coronary artery ectasia to assess the presence of aortic root dilatation. Patients and methods: This prospective observational study included 50 consecutive patients came to the Department of Cardiology, Al-Azhar University Hospital, New Damietta for coronary angiography. The study was carried out from November 2017 until December 2018. Injection aortography was used as a gold standard and to assess the presence of ascending aorta dilatation in those patients. Results: The present study shows that there was a good correlation between 3D-TTE and aortography at the levels of aortic annulus, sinuses of Valsalva, sinotubular junction (r =0.98,0.95,0.98) but a rough correlation between 2D-TTE and aortography at these levels (r =0.49,0.48,0.46). The present study shows that there was increase prevalence of aortic root dilatation 13 patients (26%) and ascending aorta dilatation 9patients(18%) in patients with CAE. Conclusions: Accuracy of aortic root measurement by 3DTTE was superior to that by 2DTTE, because the values by 2DTTE were underestimated compared to those measured by 3DTTE and aortography. Increase prevalence of aortic root dilatation and ascending aorta dilatation in patients with coronary artery ectasia. Dilated Ascending aorta was associated with a higher prevalence of aortic root dilatation
Subject(s)
Coronary Aneurysm/diagnosis , Coronary Angiography , Echocardiography , Echocardiography, Three-Dimensional , EgyptABSTRACT
A dog model for study of bone formation around bicortically stabilized screw implants is described. Twelve young adult domestic dogs were used. In each animal, the femur was exposed and after preparing the implant site, a bicortical self -cutting screw [Oraltronics Implant Technology, Germany] of diameter 35 mms and length 25 mms was inserted The animals were equally subdivided into three observation groups [four dogs in each group] and sacrificed with an overdose of thiopentone sodium. The first group was killed 2 weeks, the second 4 weeks, and the third 12 weeks post implantation. Specimens were prepared for histologic examination using Haematoxylin and Eo-sin and Trichrome stains after 2, 4 and 12 weeks of healing. Analysis of the results was qualitative. At 2 weeks, a provisional matrix could be detected that was rich in collagen fibrils and sprouting vascular structures. At 4 weeks, the newly formed bone included woven bone often combined with both parallel-fibered and lamellar bone. At 12 weeks post implantation, marked signs of remodeling could be seen in the bone tissue and all implants were histologically osseointegrated without any signs of inflammation or connective tissue interposition at the bone-implant interface. There was a high bone to implant contact [BIC] in the areas of high bone content i.e. in the areas where the cortical plates were engaged. A continuous line of newly formed bone was often noted surrounding major parts of the implant apex. The current findings indicate clearly that osseointegration represents a dynamic process both during its establishment and its maintenance and that high bone to implant contact [BIC] and initial primary stability, both provided by this implant model, play a major role in osseointegration. Accordingly, this experimental model may prove useful for future studies on the use of various procedures that hypothetically may enhance bone formation
ABSTRACT
This study was a randomized blind study performed on twenty adult patients with acute myo-lascial pain of ternporomandibular joint origin. The patients were randomly and equally divided into two treatment groups. In addition to the standard antiinflammatory regimen received in both groups, Group A patients! mean age 33.6 years received laser therapy in the form of 830 nm soft laser of 80 mWatt power maximum output in contact mode in the joint articulation and musculature three times a week for a total period of three weeks [nine sessions]. Group B patients [mean age 28.4 years] received sham laser [0 m1/cm2] Clinical parameters as maximal interincisal opening, lateral movements of the jaw, number of tender points, visual(sensual) analogue scale as well as hae-matological indices such as C-reactive protein and erythrocyte sedimentation rate were all measured and recorded to assess treatment over a period of three weeks. This study has demonstrated a statistically significant superiority [ p < 0.05]of results and improvement of symptoms in patients re-cemrvg, compared were restricted to values did not differ significantly and showed a more symmetrical distribution for both groups. It can therefore be deduced, based on the results demonstrated in this study that LILT in acute myofascial pain of TMJ origin is a successful treatment modality and that while CRP values could be extremely useful in ascertaining the diagnosis of an acute case, ESR can be much more useful in monitoring the response to treatment
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The treatment of vascular malformations remains controversial because the oral and max-illofacial surgeon must always balance potential morbidity with projected benefit. A minimally in-vasive technique is described, with the neodymium: yttrium-aluminium-garnet [Nd:YAG] laser being used for interstitial photocoagulation of hemangiomas and vascular malformations in a series of twelve patients of mean age 12.4 years. Interstitial photocoagulation was performed by using the fiber-based Nd:YAG laser. This was accomplished by introducing the laser fiber with an angiocath and delivering various amounts of energy [6VV to 10W]. There were no complications. The procedures were easy to perform and well tolerated, with all patients being discharged on the same day of surgery. The following outcome measures were statistically analyzed: Decrease in the area of the target lesion, [% reduction] and number of treatments required to achieve reduction in size and their relation to size of the lesion. A follow up period of 6 months showed no regression in all but 2 patients with good cosmetic results. The range of reduction in size was 100% for hemangiomas while it ranged from 71.6%[2 weeks postoperative] to 96.2% at 6 months for capillary malformations. Capillary malformations needed greater number of sessions to be fully treated with a highly sig-jjficant p value [p< 0.00]]. The percent reduction in size was significantly different in capillary malformations than for hemangiomas at 3rd day, 2nd week, till the end of the follow up period. Correlation between the number of sessions needed and the size of the lesion showed a relatively high coefficient of positive correlation [r =.67]. Interstitial Nd:YAG laser photocoagulation offers the oral surgeon a therapeutic alternative in the treatment of refractory vascular malformations or in cases where there is a considerable projected surgical morbidity. Although multiple treatments may be required, the procedure is effective, simple and well tolerated
ABSTRACT
Twenty patients [twelve males and eight females]aged 7 to 52 years who had presented to the Oral Surgery Department, Faculty of Dentistry, Cairo University for treatment of various soft-tissue and intra-bony lesions of the maxillofacial region were enrolled in this study. The patients were divided equally into two groups according to the type of surgical procedure. Group I consisted of ten patients [age range 7-52, mean age 30.6] undergoing soft-tissue surgery of short duration and was considered to be small surgical tissue damage, such as cystectomy or extirpation of small benign tumour. Group II consisted of ten patients (age range 23-42, mean age 32.6) undergoing a surgical extirpation of a lesion that involves bone manipulation and of duration exceeding 3 hours and was considered to be of middle to great surgical tissue damage such as extirpation of mandibular cyst, intrabony benign tumours or locally malignant tumours. Blood samples for measuring CRP levels were obtained by venepuncture immediately before induction of anesthesia, immediately after surgical incision [time 0], 2, 6, 24, 48 , 72 hours and one week after the incision. The elevation and time course of plasma CRP levels in patients undergoing oral and maxillofacial surgery were analyzed. The results indicated that elevated plasma CRP levels could be detected starting from 2 hours after incision and reached a peak within 24 hours for surgeries involving only the soft tissues, whilst the peak was attained at 48 hours in surgeries involving the manipulation of bone. The elevation of CRP levels was highest and most significant for more aggressive surgery involving the bone, and more especially with the segmental excisional procedure followed for the locally malignant ameloblastoma. The results of this study suggest that CRP would be released by surgical injury and is associated with magnitude of tissue damage in oral and maxillofacial surgery. CRP has been thought to also be a mediator in various host responses other than the acute phase response. However, it is unclear how the elevation of plasma CRP affects physiologic, immunologic, or metabolic status during and after surgery. Therefore, further studies for exploring the role of CRP in host responses to surgical injury will be required.
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Thirty nude female Swiss Albino mice of weight 18-22gm were used in this study. The mice were subdivided into three subgroups of 10 mice each. Group A was to be maintained without any tumor cell implantation to provide normal cell readings on the spectrometer and to supply a reference for normal histopathological specimens. Groups B and C were to be injected with tumor cells and methylene blue dye intralesionally. Group C mice were to receive PDT treatment while Group B mice were intended to act as a control for such treatment modality by receiving MB+ injection only without any irradiation. Measurements performed included the change in tumor volume as compared to the value recorded at the start of the experiment, after a one week incubation period. Ceased mice were dissected to remove the tumor mass and thereby measuring its volume. Survival rates for each group were calculated throughout the following weeks. The tumor investigated in this study was a solid Ehrlich carcinoma which is a transplantable, poorly differentiated malignant tumor which appeared originally as a spontaneous breast carcinoma in mice. A line of Ehrlich ascites carcinoma [EAC] was supplied from the breading unit of the National Cancer Institute Cairo University. A line of 1X10 [EAC] cells was transplanted by subcutaneous inoculation in the submandibular area. The tumor developed seven days after injection at which time its size was considered appropriate for PDT treatment. Thereafter, Methylene blue 0.1 ML concentration 2% was injected into the lesion. The statistical significance of the therapeutic effect of PDT as a treatment modality was analyzed. Methylene blue intratumoral injection alone without irradiation did not result in any macroscopic cytotoxicity or inhibition of tumor growth. PDT as a treatment ' modality proved to be highly effective. Irradiation of the incubated tumors with 550 J/cm[2] led to almost complete macroscopic regression of the tumors towards the end of the third week. Histological examination of the scar proved complete destruction of the lesion. Overall comparison of tumor volume regardless of the time of death or sacrifaction showed a highly statistical significant difference in favor of PDT treated group. [p=0.001] Median overall survival was 4 weeks in PDT treated group compared to one week in the group injected with methylene blue only, [p = 0.02]. The variation in the structural integrity of the cells as studied by Raman spectroscopy indicated a] shifting of bands which indicate chemical reaction and structural changes, b] difference in relative intensities of the bands of untreated and treated specimens. Readings were recorded for Group A [normal cells] mice, Group B [methylene blue injected only] mice and Group C [PDT] treated mice. The results of the Raman spectroscopy of the test specimens were recorded. The spectra of transformed malignant tissues differed markedly from those of normal and treated tissues .In most regions of spectra, the difference was evident as increase in the intensity of the absorbance from malignant tissues in comparison to normal and treated tissues. It thus seems that Raman spectroscopy could be used for the study and characterization of cells at various stages of their life cycles. Our results support the feasibility of developing spectroscopy as an easy yet sophisticated method for detecting malignant cells and possibly also for discriminating among cells at various stages in their life cycles
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The involvement of the right ventricle in acute myocardial infarction [AMI] has been shown to be associated with an increased risk of life-threatening arrhythmias and sudden cardiac death. The study aimed at investigating the right ventricular function in AMI and the interaction between left and right ventricles using Doppler tissue imaging [DTI]. The study included 125 patients admitted to coronary care units and diagnosed as AMI at all sites [anterior and inferior] [100 males and 25 females] with age ranging from 36 to 82 years. They were classified according to clinical, ECG and angiographic data into: group I included 52 patients with RV myocardial infarction [RVMI], group II: included 73 AMI patients without RVMI. They were compared to 25 age and sex matched healthy individuals as a control group. Conventional Doppler mitral and tricuspid inflow velocities and tricuspid annulus systolic excursion using 2D echocardiography were used to evaluate LV and RV functions. Also, Peak systolic and peak early and late diastolic velocities [S,E,A, E/A], contraction time [CT], pre-contraction [PCT], acceleration [AT] and deceleration time [DT] of S velocity were acquired from the apical four-chamber view at the lateral side of tricuspid annulus[ta], the septal, lateral, anterior and inferior sides of the mitral annulus [ma] using DTI. RV function using DTI; S[ta] PCT[ta] IRT[ta] were significantly impaired in group I compared to group II and control [9.2 +/- 1.4 vs 12.3 +/- 1.96 vs 14.6 +/- 2.2], [103.5 +/- 16.5, vs 84.6 +/- 24.3 vs 78.4 +/- 16] and [110.6 +/- 18.7 vs 84.9 +/- 30.2 vs 56 +/- 18.9] respectively. [P< 0.001]. Similarly, TASE was significantly lower in group I vs II and group II vs control [7.2 +/- 2.6 vs 12.4 +/- 4.9 vs 15.7 +/- 5.3 respectively [P<0.001]. LV functions S[ma], PCT[ma], CT[ma], E[ma], E[ma]/A[ma], were significantly decreased in group I and II compared to control [P< 0.001] but no significant difference of LV functions between patients with or without RV infarction. Almost all DTI parameters used in evaluation of systolic and diastolic RV functions showed strong direct correlation to the corresponding LV parameters [P<0.001]. RV end diastolic pressure was passively correlated to S[ta] but not E/E[ta] of the RV in all AMI patients. The interaction between the two ventricles can be identified using DTI which now plays a relevant role in clinical scenarios. In AMI, despite the proved increased risk of morbidity and mortality in RVMI, LV dysfunction adversely affects RV function even in absence of RV infarction
Subject(s)
Humans , Male , Female , Echocardiography, Doppler , Ventricular Function, Right , Coronary AngiographyABSTRACT
Chronic anal fissure is a common and painful condition associated with internal anal sphincter hypertonia. Reduction of this hypertonia improves the local blood supply, encouraging fissure healing. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpatient basis by applying a topical nitric oxide donour [for example, glyceryl trinitrate]
Methods: This study included 40 patients with chronic anal fissures. Group A, including 20 patients with the clinical diagnosis of chronic anal fissure, treatment consisted of topical nitroglycerine. Group B, consisting of 20 patients received topical anaesthetic gel. Manometry was performed before and on days 14, 28 and 56 in the course of topical application of either 0.2 percent glyceryl trinitrate ointment or anaesthetic gel [lignocaine]. Anal pressures were documented by recording the maximum resting and squeeze pressures
Results: Twenty percent of cases treated with topical nitroglycerine healed within 14 days, in contrast to group B in which no healing was observed. The healing rate after eight weeks was 70 percent in group A and was significantly superior to group B [healing rate was 30 percent]
Conclusion: Chemical sphincterotomy is an effective treatment for chronic anal fissure and has the advantages over surgical treatment of avoiding long term complications [notably incontinence] and not requiring hospitalisation
ABSTRACT
In patients with myofascial pain, painful trigger points are often treated using local anaesthetics and/or steroids injections. However, the therapeutic effects of these treatment have not been quantified, and the mechanism underlying the effect is poorly understood. In a randomized clinical trial, thirty adult patients of both sexes and of an age range of 17-42 years were treated for myofascial pain in the jaws. They had presented with myofascial pain that could be traced back to trigger points in the masseter and/or the temporalis muscles. The trigger point number and distribution was mapped prior to the commencement of any treatment form. The treatment results were analyzed after a series of local anaesthetic [xylocaine] injections only of the trigger points [group A], steroid [epidron] injections only [group B] and combined injection therapy [xylocaine + epidron] [group C. Data used for evaluation and statistical analysis included 1- number of trigger points before and after treatment sessions. 2- changes in pain measuring or visual analogue scale and 3-changes in maximal interincisal distance values. Electromyographic readings were used to monitor responses to different kinds of treatment. The results show group C patients to favour a significant and remarkable drop in the median number of trigger points after two weeks of therapy. Likewise, visual analogue scale ratings for group C patients decreased significantly after the second and third weeks of treatment. As for maximal interincisal distance values, they were markedly increased after the third week of treatment in the same group of patients
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This study aims at predicting the relation between the percentage stenosis through quantitation of the atheroma by using quantitative coronary angiography [QCA] in patients with silent ischemia in comparison to those with manifest one, and studying whether the severity of the lesion could affect the symptoms or not. i.e. patients with more tight lesions have painful ischemia and those with less severe lesions have painless ischemia. QCA is a new technique for accurate estimation of severity of coronary stenosis. The severity of coronary artery disease [CAD] in silent myocardial ischemia is reported by some investigators to be less and by others to be more than manifest ischemia. The relation between CAD severity and symptomatology is also a matter of controversy. Thirty patients were included in this study, half of them had silent and the other half has painful ischemia. Resting ECG, exercise stress test, 24Hs Holter ECG monitoring and coronary angiography were done to all patients. The following QCA parameters were measured [[%diameter stenosis [%DS],%area stenosis [%AS], length of the lesion in mm and plaque area in mm2]. The QCA parameters were compared in the two groups and correlated to patients' symptoms. No significant correlation was found between the severity of the CAD measured by QCA and patients' symptoms. There was a significant relation between the severity of ischemia during stress test and the QCA parameters in both manifest and silent ischemia. [R=0.56, P=0.002, n=30]. Also, the total ischemic burden during 24Hs Holter monitoring gives a significant relation to QCA parameters [R=0.53, P=0.002, n=30] with no significant relation to the symptoms. Severity of the CAD measured by quantitative coronary angiography affects the duration of ischemia during exercise stress test and 24Hs Holter ECG monitoring but not the severity of the symptoms