Comparative study between open anterior approaches using the prolene patch and open posterior [pre-peritoneal] using a configured prolene mesh in treatment of recurrent inguinal hernia

Recurrence of inguinal hernia is not an infrequent problem seen by the surgeon. Usually repair of such hernia is technically more demanding than a primary repair, with a potential for new recurrence and a high risk of complications. The objective of this study is to compare between the anterior approach using the prolene patch and a pre-peritoneal approach with prolene mesh configuration. A comparative study was done from June2004 to December 2006, at Assiut university hospital on thirty patients with recurrent inguinal hernia selected for this prospective comparative study. The studied patients were allocated into two groups: group A [anterior approach n=15 patients] and group B [posterior approach n= 15 patients]. Thirty patients with recurrent inguinal hernia were operated. All of them were males. Incidence of cord injury in group A was 6.6%, while no injury of the occurred in group B. the incidence of haematoma [6.6%], scrotal oedema [20%] and testicular atrophy [6.6%] were encountered in group A while no reported cases were seen in group B. Although both anterior and posterior approachs are effective treatment modalities for treatment of recurrent inguinal hernias, yet the open pre-peritoneal approach is technically easier, safer, cheaper, is followed by minimal morbidity and has a low re-recurrence rate

Patent vitello intestinal duct, transumbilical treatment

Patent vitello-intestinal duct is a rare gastrointestinal tract anomaly. It was used to be treated by entering the abdomen through an incision away from the umbilicus. This study reports duct treatment by entering the abdomen through the umbilicus. Over a seven years period, ten patients 8 males and 2 females, with patent vitello intestinal duct were treated by trans-umbilical approach; wedge resection was done for 9 patients and one patient required resection and end to end anastomosis. The age of the patients ranged from 1 day up to 23 days. The mean operative period was 75minutes, [range 50 to 90 minutes]. There were no intraoperative complications. Post operative complications included abscess at the upper edge of the umbilicus, with discharge in one patient. The healing was sound with good cosmetic appearance. The trans-umbilical approach for treatment of patent vitello-intestinal duct is feasible relatively easy to perform with a good sound healing and excellent cosmetic appearance

Transanal pull through operation for Hirschsprung's disease, preliminary results

This study was done on 32 patients [30 males and 2 females] who were diagnosed to have Hirschsprung's disease for them transanal pull through operation was done. There was no operative or early post operative complications. Late post operative stricture of the anastamosis occurred in one patient who responded well to dilatation There was frequency of defecation up to 10 times per day in most patients which improved gradually over few weeks. We concluded that trasanal pull through operation for Hirschsprung's disease is safe and feasible in selected patients

Plasma markers of thrombin generation, fibrinolysis and activated platelets in sickle cell disease

Thrombotic phenomenon has an important role in the vasooclusive manifestations of sickle cell disease [SCD] that dominate its clinical spectrum. For evaluation of thrombotic activities in SCD patients, the markers of thrombin generation: thrombin anti-thrombin complex [TAT] and prothrombin fragment 1, 2 [F 1, 2], enhanced fibrinolysis markers: plasmin anti- plasmin complex [PAP] and D-dimer and platelet activation markers: platelet factor 4 [PF4] and B - thromboglobulin [BTG] were measured in 35 patients with SCD [25 during steady state and 10 during crisis], compared to 12 normal controls. The measurements were performed by enzyme-linked immunosorbent assays. The thrombotic markers [TAT and F 1, 2], fibrinolytic markers [PAP and D-dimer] and platelet activation markers [PF4 and BTG] were significantly increased in SCD patients during steady state. During vasooclusive crisis, there were marked increase in TAT, D- dimer, BTG and PF4 while there was no significant increase in the levels of PAP and F 1, 2. Also, there was significantly positive correlation among thrombin generation markers, platelet activation markers and fibrinolysis markers in SCD patients during steady state. During episodes there was significant positive correlation among markers of thrombin generation, fibrinolysis and platelet activation except PAP and F 1, 2 markers as compared with asymptomatic intervals. We concluded that, during pain episodes, there was enhanced platelet procoagulant activity, elevated fibrinolytic activity and thrombin generation. These changes may predict the frequency of pain. These findings suggested that increased their levels may increase the risk of thrombosis in these patients and establish a relationship between the laboratory determination of these parameters and clinical pain episodes in patients with SCD. The findings of platelet activation, fibrinolytic activity and thrombin generation in asymptomatic patients indicate ongoing subclinical thrombogeinc activity in patients with SCD

Pattern of pathogens in acute diarrhea in children

Most cases of diarrhea in children occur due to infectious agents that are transmitted faeco-orally. Diarrhea may follow bacterial, viral, protozoal infections of the intestine, and also biochemical. To study the main enterpathogens causing diarrhea, the faeces of 150 children less than 6 years old from both sexes were analyzed. Microbiological analysis was carried out on these samples to identify which intestinal pathogens were present. Of the samples studied 129 cases [86%] were pathogen positive. Co-infection with more than one agent was detected in 44 cases [29.3%] of all patients. The most common pathogen isolated was E.coli detected in 78 cases [52%] with predominance of serotype O119 isolates [44.4%], followed by O111 [26.6%]. The second frequent one is rotavirus, it was detected in 39 cases [26%]. Other pathogens that were detected include: Shigella 9: cases [6%], Salmonella one case [0.66%], Campylobacter sp. 9 cases [6%], Cryptosporidium sp. 4 cases [2%], Giardia lamblia 17 cases [11.3%]. Neither Entamoeba histolytica nor Schistosoma mansoni was detected in any of the children studied. We concluded that bacteria were the most frequent pathogens detected in acute diarrhea, among which E. coli was highly predominant and the majority of E.coli strains belong to EPEC varieties. Rotavirus was found in a great number of diarrheal cases, often associated with bacteria, efforts to prevent transmission of E.coli. and rotavirus to young children should be a public health priority. We suggest the introduction of rotavirus diagnostic tests in microbiological examination of diarrheic stool of children below 6 years of children. Protozoa showed reduced importance

Cardiac troponin T and end stage renal disease

The aim of this study is to investigate the relationship between serum concentration of cardiac troponin T [cTnT] and other cardiac markers and ischemic heart disease [IHD] in end stage renal disease [ESRD] patients on chronic hemodialysis [HD]. This study was carried out at King Fahd Specialist Hospital, Buraidah, Kingdom of Saudi Arabia from July 2002 to September 2003. Cardiac troponin T was measured using Elecsys 2020 immunoassay system, a method that is specific for cTnT. The analytical range of cTnT assay was 0.01-25.0 ug/L. Seventy-three patients were divided into 4 groups: 20 patients with history of IHD, 17 patients with diabetes, 19 patients with diabetes and IHD and 17 patients without evidence of myocardial damage. Cardiac troponin T concentrations were >/= 0.1 ug/L in 58% of HD patients. Fifty-three% of diabetic patients had an increased cTnT, 37% of IHD patients had an increased cTnT, 59% of IHD and diabetic patients had an increased cTnT and 29% of noncardiac disease patients had an increased cTnT. Cardiac troponin T was increased more frequently in post-hemodialysis samples [13% pre-hemodialysis and 21% post-hemodialysis]. Dialysis may alter measured cTnT concentrations in ESRD patients undergoing chronic dialysis. Sporadic or persistently increased cTnT appear to be the most specific of the currently available biochemical markers to predict subclinical myocardial damage in ESRD patients

Lipid peroxidation productts and anaemia in patients with chronic renal failure undergoing hemodialysis

Three groups of patients with chronic renal failure [CRF] undergoing hemodialysis [HD] were selected for this study. Twenty healthy individuals were selected as a control group. Plasma malondialdehyde [MDA] and 4-hydroxynonenal [HNE] were measured in these groups of patients and compared with the healthy control group. In conclusion, the present study showed that there are increased amounts of lipid peroxidation [LPO] in HD patients, particularly who showed a poor response to treatment with recombinant human erythropoietin [rhEPO] and a significant decrease in the oxidative stress occurs in patients with a good response to rhEPO therapy

Autoantibodies to phospholipids-binding plasma proteins [protein C, protein, propthromin, B2GPI and annexin V] and occurrce of thrombosis in systemic lupus erythematosus

This study was carried out on 83 patients [75 females and 8 males] with SLE aged from 20-65 years and classified into 5 groups according to thrombotic and thrombocytopenic complications, 10 had thrombocytopenia, 12 had arterial thrombosis, 10 had venous thrombosis, 10 had foetal loss and 41 patients were without complications. The prevalence of IgG antibodies to each of these plasma proteins in patients was 22-54%. Lupus anticoagulant [LA] was detected in 52% of the patients. The concentration of anti beta2 glycoprotein I [anti-beta2 GPI] antibodies increased significantly in the patients with arterial and venous thrombosis compared to patients without complications. The mean concentration of anti-prothrombin antibodies was higher in patients with arterial thrombosis, venous thrombosis and thrombocytopenia than in those without complications. The concentrations of IgG antibodies to protein C and protein S were significantly higher in patients with venous thrombosis than in patients without complications, but no statistical difference was observed in the patients with arterial thrombosis or thrombocytopenia. Anti-annexin V antibodies were higher in patients with venous thrombosis and foetal loss. Both anti-beta2GPI and anti-prothrombin antibodies were significant risk factors for arterial thrombosis [odds ratio [OR], 10.2 and 16.7, respectively, 95% confidence intervals [CIs] 4.2-31 and 2.9 - 112, respectively], but not for venous thrombosis. Anti-protein S was a significant risk factor only for venous thrombosis [OR, 29.6; CI, 3.18-27.0]. The only significant risk factor for foetal loss was the presence of anti-annexin V antibodies [OR, 6.8; CI, 1.6-17.7]

Complement and complement receptors in systemic lupus erythematosis and rheumatoid arthritis in children and adults

Complement 3, complement 4, properdin; and properdin C3b complex and Complement receptors [CR] [CR1 + CR11 and FC GAMA receptors] were studied in 61 patients. [8 - 20 yr.] 26 males, 35females, from AI-Azhar University Hospitals, 14 were SLE, 47 were RA. The results obtained were compared with 24 normal control. A significant decrease in C3, C4 in SLE and RA. A non significant difference in properdin in SLE and RA. A significant increase in P-C3b complex in SLE and RA. Asignificant decrease in CR1 receptor expression on neutrophils and lymphocytes of SLE, while no change with RA. Ahigh significant increase in CR11 expression on blood lymphocytes, in SLE but a non-significant difference with RA The results of FC GAMA receptor II expression on blood cells showed non significant difference in SLE and RA. Complement CR III expression on Blood cells showed a non significant diference in RA. The results of [FC- GAMA RIII] expression on monocytes showed significant increase and on neutrophils decreased and no difference on lymphocytes of SLE patients. From the study: C3, C4, and properdin-C3b complex can be used as an indicator of activity of the disease in SLE and RA inspit of no change of properdin Level. Also in cases in which C3 level is normal [30%] of SLE. Cases. C RI expression was found decrease on neutrophils of SLE while no change on expression in RA. It is possible to say that to diagnose SLE. C3, C4, P-C3b complex and CR1 expression should be measured to confirm the diagnosis of SLE

Study of haemoglobin electrophoresis in the anaemic Egyptian children

The present study included 252 children [200 male and 52 females] whose age ranged from one to fifteen years, suffering from different types of anemias. 26 healthy children were taken as a control group and they were subjected to careful history taking and thorough clinical examination. CBC, reticulocytic count, alkali denaturation test, test for sickling, osmotic fragility test, direct coomb's test, G6PD, serum iron, TIBC, serum ferritin, total and direct serum bilirubin, bone marrow iron stain [some cases] and hemoglobin electrophoresis were done. A decrease in HbA2 in both iron deficiency and sideroblastic anemia was observed. There were a return to normal sideroblastic anemia was observed and a return to the normal level after correcting iron deficiency in case of iron deficiency anemia. HbA2 was significantly elevated in cases of thalassemia trait