Outcomes of side-to-end versus end-to-end colorectal anastomosis in nonemergent sigmoid and rectal cancers: a randomized controlled clinical trial

Purpose@#The outcomes of open colorectal anastomosis of side-to-end versus end-to-end in nonemergent sigmoid and rectal cancer surgery in adults were compared. @*Methods@#A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018. @*Results@#The mean age was 62.58±12.3 years in the side-to-end anastomotic (SEA) group and 61.03±13.98 years in the end-to-end anastomotic (EEA) group. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were significantly associated with leakage. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (P=0.04). There is a statistically significant difference regarding incontinence for flatus in the SEA group only (P≤0.001). A statistically significant change in both groups regards incontinence for liquid stools (P≤0.001) and clustering of stools (P≤0.001 and P=0.043). The quality of life in the SEA group significantly dropped at 6 months and then returned to baseline as regards to physical well-being (PWB), functional well-being (FWB), and colorectal cancer symptoms (CCS) with no difference as regards SWB and EWB, while in the EEA group, the exact change happened only as regard PWB and FWB, but SWB and CCS percentage did not return to baseline. @*Conclusion@#The SEA group offers a safe alternative approach to the EEA group.

Comparison of carbon ion implanted stent with bare metal stent in patients with coronary artery disease

This study was conducted to evaluate the role of the inert stents in decreasing the incidence of stent restenosis after percutaneous coronary intervention [PCI] and to assess the clinical outcome of these stents. The study comprised 57 patients [49 males and 8 females, mean age 53.3 +/- 0.9 years] with angiographically documented CAD. They were admitted to the Coronary care unit at Benha University Hospital and underwent stent implantation in 57 de novo lesions. Patients were categorized into two groups; group I for whom the traditional bare metal Stainless-steel stents were deployed [30 lesions in 30 pts; 26 M and 4 F with a mean age of 50 yrs], group II for whom Inert stents [carbon [on implanted stents] were deployed [27 lesions in 27 pts; 23 M and 4 F with a mean age of 51 yrs]. Procedural success: was defined as 30% residual stenosis post procedure. Clinical success: was defined as procedural success without the occurrence of MACE [Major Acquired Coronary Events] namely, death, myocardial infarction, or Target vessel revascularization].Clinical follow-up for the occurrence of MACE was performed one and six months after the procedure. Angiographic follow-up was done after six months or after the occurrence of any of the clinical endpoints. Procedural and clinical success were documented in 100% of patients during hospital stay, there was no MACE in both groups. None of patients developed MACE during the 30-days follow-up period. Also, at 6-months follow-up, there was no statistically significant difference between the 2 groups regarding the occurrence of MACE as 4 patients [13.3%] of group I and 3 patients [11.1%] of group II developed MACE. Re-stenosis rate showed also statistically insignificant difference between the 2 groups [5 patients [16.7%] in; group I and 5 [18.5%] patients in group II, [P= > 0.05]. The implantation of Inert stent is safe and feasible, with a high acute procedural success. These stents proved also favorable short term results regarding the thrombotic complication. Inert stent did not add any beneficial effect to the bare metal uncoated stainless-steel stents regarding 6-months in-stent restenosis

Expectant management of premature rupture of membranes remote from term

To evaluate maternal and neonatal outcomes of singleton pregnancies complicated by PROM from 16 to 28 weeks gestation, and exposed to conservative management, in a local at Ibn Sina College of Medicine, hospital in Jeddah, Saudia Arabia. When PROM occurred and fetuses were at viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroids and antibiotic therapy. The relevant data related to the maternal and neonatal outcomes as well as maternal and neonatal morbidity were recorded and evaluated. During the study period, there were 4,665 deliveries, and 44 women admitted to the hospital with PROM at 16-28 weeks of gestation. Two women were excluded from the study, one of whom developed chorioamnionitis and the other experienced prolapsed fetal parts outside the vagina. Eight cases [19%] of PROM occurred in women at 16-19 weeks gestation, 14 cases [33.33%] occurred at 19-24 weeks gestation, and 20 cases [47.6%] occurred at 24-28 weeks gestation. Among the 42 pregnant patients, there were 23 [54.7%] still births and 5 [11.9%] neonatal deaths, resulting in a total death rate of 66.66%. Therefore the perinatal survival rate was 33.33%. The survival rate based on gestational age at the onset of PROM was "nil" at 16-24 weeks gestation [4 cases early neonatal deaths and 18 cases were still births]. The survival rate at 24-28 weeks gestation was 70% [14 out of 20]. There was no maternal mortality, however, four women [9.5%] experienced puerpural endometritis. One patient receive blood transfusion for a significant blood loss after a curettage to remove retained placenta. Among the surviving newborn infants, 100% had respiratory distress syndrome; 2 of them [14.2%] developed pneumothorax, and 8 [57.1%] experienced apnea. Intraventricular hemorrhage occurred in one case [7.1%] as did necrotizing enterocolitis. Three cases [21.4%] developed neonatal sepsis and 6 [42.8%] suffered from anemia. Physicians should council their patients thoroughly and well in advance with regard to the poor outcomes and the potential complications for neonates anticipated after this type of delivery. Aggressive expectant management does not seem to increase maternal morbidity

Developmental stuttering and in voluntary movements in schoolaged children in Cairo

Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for a person's age. Developmental stuttering emerges during the period of rapid language development with two sharp peaks of onset between the ages of 2 to 3 1/2 years and 5 to 7 years. It involves a disruption in the smooth connection of sounds or syllables characterized by multiple interruptions within a word, such as repetitions of sounds, syllables and parts of words, elongation of words and blockades. This study aimed to assess developmental stuttering at its second peak in childhood and evaluate associated involuntary movements. A sample of 932 children [480 boys and 452 girls] aged 5-7 years attending 21 different schools and Kindergartens at different locations in Cairo City were included in the study. Speech, language and hearing development within the normal range, except for stuttering, were insured. Stuttering was considered to be present if 10 or more dysfluencies occurred in every 100 words. Stuttering was detected in 38 children with a prevalence rate of 4.07%. Stuttering severity was found to be 36%, 47.5%, and 15.7% for mild, moderate and severe stuttering respectively. The male to female ratio was 3.2:1. Tics were identified in 26.3% of stuttering children, versus 4.58% non stuttering children with a statistically significant difference in prevalence. Tics in the form of repetitive eye blinks followed by prolonged eye closure were found exclusively in the stuttering group. Left handedness was present in 5.26% of the stuttering children versus 4.13% non stuttering children. In view of the high prevalence of developmental stuttering and significant number of involuntary movements revealed - by the study, a mass screening program for early diagnosis and referral in this high risk group is recommended

Predictive value of c-reactive protein for coronary in stent restenosis

C-Reactive protein [CRP] should be measured in all patients undergoing coronary angioplasty for prognostic stratification. Preprocedural levels are of proved efficacy. CRP levels can be used as a guide to therapy in PCI. The aim of this study is to evaluate the predictive value of CRP plasma leve1 for coronary instent restenosis [ISR]. This study included 60 patients who underwent successful coronary stenting. All patients included in. this study were subjected to the following. Full history taking, thorough clinical examination, risk factors evaluation, 12 leads surface ECG, plain chest x-ray echocardiography, coronary angiography and laboratory investigations [Blood sugar level lipid profile and CRP] with follow up period for six month. Patients were classified into two groups according to ISR. Group [I] with ISR included 22 patients [43.1%] and 22 lesions treated with 25 stents [45%]. Group [II] without ISR included 29 patients [59.9%] with 29 lesions treated with 30 stents [55%]. At follow up, focal ISR [<10 mm] was detected in 5 patients [22.7%]. diffuse [>10 mm] in 7 patients [31.8%], proliferative ISR in 5 patients t22. 7%] and total occlusion in 5 patients [22.7%]. In restenotic group [I] 8 patients [36.4%] were asymptomatic, two p [9.1%] had unstable angina and 12 patients [54.5%] had stable angina. In the non restenotic group [II] 22 patients [75.9%] were asymptomatic four patients [138%] had unstable angina and three patients [102%] had stable angina. Clinical, lesional and procedural variables are not associated with in creased risk of ISR. The only variable for exclusion of ISR was a normal level of CRE in plasma [72 hours after coronary stenting]. Its specificity was [100%]

Diagnostic, prognostic and predictive value of posterior chest leads in acute inferior myocardial infarction

The aim of this work was to study the diagnostic, prognostic and predictive value of posterior chest leads [PCL] V7- V9 in patients with acute inferior myocardial infarction [AIMI] and its correlation coronary angiography. 30 patients with AIMI were included in this study they were into 2 groups: group A, 11 patients with AIMI and ST-segment elevation [STE] in PCL group B, 19 patients with AIMI without STE in PCL. Routine laboratory investigation, creatine phosphokinse [CPK], 15 leads ECG, echocardiographic examination and coronary angiongraphy. The prevalence of STE in PCL in-patients with AIMI was 36.7% [group A], were older, more hyperlipidemic, had higher incidence of R/S>1 in V1-V2, more STD in V1-V3, taller upright T wave, higher CPK level, lower EF, higher incidence of MR and more complication [heart failure, MR, arrhythmia and postinfarction angina] than group B [P <0.05] they had more wall motion abnormalities [WMA] mainly posterolateral and inferolateral [P<0.01]. Left circumflex coronary artery was the infarct related artery in virtually all patients in group A while right coronary artery was in 89.5% of patients in group B there was a higher incidence of multivessel disease proximal and diffuse lesions in group A the sensitivity and specificity of STE in PCL, R/S >1 in V1-V2 and STD in V1-V3 in relation to PWMA in diagnosis of posterior myocardial infarction was 100%, 82.6%, 71.4%, 100%. 100% and 78.3% respectively. We recommend routine recording of leads V7 to V9 in all patients with an AIMI and suggest that STE identifies a group of big infarction who at higher risk

Functional and structural cardiac abnormalities in cirrhotic patients with and without ascites

This study was done to clarify the nature of cardiac involvement in liver cirrhosis, the study comprised 40 patients with liver cirrhosis and 10 healthy control subjects. These patients were categorized under 3 groups: Patients with liver cirrhosis and tense ascites: This group comprised 20 patients [7 females [35%] and 13 males [65%] with age range from 40 to 70 years [mean = 55 +/- 8] [Group 1]. Patients with liver cirrhosis with no evidence of actual ascites at clinical and abdominal ultrasound examination but with history of clinically previous episodes of ascites. This group comprised 20 patients [5 females [25%] and 15 males [75%] with age range from 46 to 70 years [mean 55 +/- 5] [Group 2]. 10 healthy subjects [3 females [30%] and 7 males [70%]] with age range from 45 to 70 years [mean= 56 +/- 7], served as normal control for comparison [Group 3]. All patients were subjected to full history taking, full clinical examination, laboratory investigation [assessment of liver function, hepatitis marker, indirect haemaglutination [IHA] for bilharziasis, arterial blood gases], abdominal ultrasound, X ray chest and heart, electrocardiography, doppler echocardiography. The results showed that patients with liver cirrhosis with and without ascites showed increased prevalence of Q-Tc interval prolongation that correlate positively with the severity of liver cirrhosis and Child Pugh Score and was attributed to autonomic dysfunction, adrenergic hypertone, electrolyte imbalance and female gender. The study showed also irrespective of the ascites and the cause, patients with advanced liver cirrhosis had left ventricular diastolic dysfunction and wall thickness increase while the left ventricular systolic function still normal and impairment of left ventricular diastolic function correlates positively with the severity of liver disease and Child Pugh Score. The possible mechanisms responsible for the cardiac changes in liver cirrhosis include left ventricular overload induced by hyperdynamic circulation, impairment of B adrenergic receptors and its signal transudation pathway, abnormalities of circulating humoral factors and changes of cardiac plasma membrane physical properties