Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Efficacy of cyclosporin on behcet's disease vasculopathy: a comparative study of cyclosporin and corticosteroid on long-term prognosis

Behcet's disease is a vasculitis typified by intimal hyperplasia, internal elastic membrane disruption with medial thining, and an advential periadvential infiltrate of plasma cells and neutrophils. It is more common in the Mediterranean and is seen slightly more often in males. This mulisystem vasculitis is characterized by clinical triad of oral ulcerations that recur at least 3 times a year, recurrent genital ulceration and uvietis. Vasculo-Behcet's disease affect veins more often than arteries. Arterial complications occur in about 10% of those affected, and venous thrombosis occurs in about 30%. Thirty- five patients with vasculo-Behcet's disease were included in the study. Diagnosis was based on the clinical criteria, namely, recurrent oral ulceration and involvement of the skin, eye or genitalia in addition to positive pathergy test and duplex scan. Twenty patients [group A] were given Cyclosporin [5mg/kg daily for 6 months] and 15 patients [group B] were give, corticosteroid [60 mg daily for 6 months]. Eighteen patients of group A had complete reversion of the disease process without further vascular complications and 2 patients developed iliofemoral and caval thrombosis although they were on anticoagulation therapy. Seven patients of group B underwent revascularization surgery for peripheral aneurysms and developed anastomotic disruption. Two patients developed aortic aneurysms. One patient had pseudoaneyrysm at the puncture site for angiography. One patient had progressive ocular deterioration ended with blindness. 1- Cyclosporin is acting by suppressing HLA expressions which is an initial step in triggering the immune system to the vessel wall, a mechanism that is different from that achieved by cortiosteroids 2-C'yclosporin should be used as a first option in the treatment of Behcet's disease as the goal of therapy is to minimize systemic complications by the use of appropriate immunosuppressive agents. 3-patients with complex aphthosis should be monitored for the onset of Behcet's disease through close follow-up and investigations of systemic complaints. 4-Revascularization should be deferred until acneiform eruption subsides because these eruptions significant the disease activity during which operative tasks will carry a high risk of complications

Endoscopy and computed tomography [CT] in lower respiratory tract scleroma

Out of fifty two patients with scleroma, twenty patients with laryngotracheal scleroma [38.5%] were examined by CT and endoscopy. Tracheal involvement was found in 65% [13/20] of cases, whereas bronchial affection was found in 15% [3/20] of cases with laryngeal scleroma and in 23.1% [3/31] of cases with tracheal scleroma. Two patients were presented with supraglottic scleroma. The first one showed supraglotric granulomata, and the second one showed bilateral lateral saccular cysts. Culture of the cyst contents showed klebsiella rhinoscleromatis. Endoscopy was very efficient in diagnosis, staging, and management of these patients. Although diagnosis could not be made on the basis of CT only, CT was useful in determining the extent of the disease as well as the response to therapy