Conservative versus operative management of blunt splenic injuries

Background: The spleen is the most frequently injured organ in blunt abdominal trauma, mainly because of its highly vascularized parenchyma and its anatomic location. In the past the management of blunt splenic injuries was splenectomy, but high rate of operative complications caused paradigm shift from operative to non-operative management [NOM] in hemodynamically stable blunt abdominal trauma patients. Now, nonoperative management of hemodynamically stable patients with blunt splenic injuries is the standard of care and has been proven to be safe and successful in the acute setting. The advent of newer imaging techniques with high resolution CT scanners has enabled the clinicians to exactly diagnose the extent of intra-abdominal organ injury

Objective: This work aim to compare between operative and conservative management of splenic trauma

Methodology: Total numbers of patients in this study were 20 patients classified in two groups, the first group contained12 patients and the other group contained 8 patients. The First group was managed conservative and the second was managed operative with splenectomy and splenoraphy. The first group of patients consisted of 9 males [75%] and 3 female [25%]. The second group of patients consisted of 6 males [75%] and 2 females [25%]

Results: In this study, bunt splenic injury was found to be more common in males because of their risky and hard work. RTA and Falling from a height were found to be the most common causes of blunt abdominal injuries. According to CT, grade one and two of splenic injury are more common than other grades of splenic injury. As regard complication the operative management has more complication as postoperative wound infection and postoperative chest infection. So, NOM of splenic injury is the management of choice in haemodynamically stable patients

Conclusion: The nonoperative management is considered the ideal management for blunt splenic injuries due to less complication, less blood transfusion, less hospital stay and less mortality than operative management

comparative study of primary colonic repair versus stoma in emergency cases

Background: In emergency surgery, management of an enterotomy, either spontaneous or following resection of a bowel segment can be by approximation of cut edges, referred to as primary repair or by exteriorization of the involved segment, referred to as ostomy. Indication of this operation can be a perforated bowel segment [produced as a result of trauma or secondary to an inflammatory process of gut] or a devitalized/redundant segment of bowel requiring resection. Penetrating colon injury or blunt abdominal trauma carries a high risk of a high-risk rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed

Aim of the Work: Comparing the outcome of primary repair versus colon diversion in emergency cases regarding efficacy, safety and usefulness

Patients and Methods: A prospective study on 40 patient undergoing either primary repair of bowel or intestinal stoma formation following emergency laparotomies in the Department of Surgery in El-Hussien and El-Haram Hospitals, which is a big emergency and trauma center and cover large geographic area. All persons will give their informed consent. The people who have the decision in performing and choosing the type of the operation are specialists and consultants [they have the license as decision makers]. All patients presented in ER department with colorectal emergencies, included trauma [penetrating, gunshot and blunt], obstruction [malignant and non-malignant] and acute abdomen due to perforation, and need emergent laparotomy confirmed by history, clinical examination and investigations

Results: It included 40 patients divided into three age groups with main age of 31.2 +/- 20.1 years old. There were 26 males and 14 females. Etiological causes were trauma 30 patients [75%], benign obstruction 2 patients [5%], malignant obstruction 4 patients [10%] and the acute abdomen 4 patients [10%]. Time between injury and admission was less than 8 hours in 28 patients and it was between 9 to 24 hours in 12 patients [30%] and more than 24 hours in 4 patients [10%]. Shock defined by systolic blood pressure less than 90 mmHg was present in 7 [17.5 %] patients and non-shocked patients were 33 patients [82.5%]

Conclusion: After reviewing many literatures and studies, after this work. We recommend primary repair of the colon in colorectal emergent conditions. Especially injuries and benign obstruction and care must be taken when performing primary repair in cases of malignant obstruction and peritonitis due to non-traumatic colonic perforation [PNTCP]. First of all the main indicator for the primary repair is the patient's general condition. Over all the main determine to do primarily repair or to divert is the general condition of the patient

Prognostic Value of Leptin Gene Polymorphisms in Type 2 Diabetes Mellitus Patients in Egypt.

Aim: The work wasto study polymorphisms in the LEP gene in type 2 diabetics in Minia, Egypt and determined the relationship between the leptin and c-peptide levels in different genotypes and insulin resistance in obese patients. The study also has evaluated the role of leptin gene polymorphism in prediction of diabetes mellitus prognosis and its prevention. Study Design: Investigative. Place and Duration of Study: Samples were analyzed at Biochemistry Department, Faculty of Medicine- Minia University, Egypt, between August 2012 and April 2014. Methodology: This study was performed in 80 patients with type 2 diabetes mellitus (54 men and 26 women) and 15 normal controls (12 men and 3 women). In our thesis we measured HbAc, fasting blood glucose, leptin hormone and c-peptide. DNA extracted and the human leptin gene (for product 242 bp) was amplified by PCR, Restriction analysis of the PCR products was performed with restriction enzyme HhaI and genotyped at the restriction site located -2549 bp from the transcription initiation site of leptin gene. Presence of allele (C at -2549 bp) and absence of allele (A at the same position) were identified through the GCGC sequence. Results: Our study showed C-2549 A variant is associated with the fasting leptin levels, the results which are in agreement with previous studies. The polymorphism in leptin gene has an effect on the level of plasma leptin in different genotypes, and individuals with AA genotype have the lower plasma levels of leptin and also c-peptide than AC and CC variants. Conclusion: Our study reveals that both diabetic patients and their non-diabetic relatives have different basal leptin and c-peptide specific to different leptin genotypes. This suggests that the association between leptin and insulin in members of diabetic families may be controlled by inheritance.

Prevalence of common skin diseases among the elderly patients at Assiut University Hospital

To identify the prevalence of common skin diseases among elderly patients attending to the Dermatology Outpatient Clinics at Assiut University Hospital. Patient and methods: This study was conducted in Dermatology Out-patient Clinics at Assiut University Hospital. The sample of this study included all elderly patients attending to the previously mentioned setting during one year starting from the first of May 2009 to the end of April 2010. The total numbers of them were 450 elderly patients suffering from skin diseases. An interview sheet, which include Part I: It includes items related to socio-demographic characteristics such as age, sex, resident, marital status, level of education. Part II: Present, past history of skin diseases, and Family history of skin diseases. Among elderly patients 75.3% aged between [60- <70] years, 68.9% were males and 80.7% from rural areas. Also, 72.2% of the elderly patients had non-infectious skin diseases, while 27.8% of them had infectious skin disease. The highest percent 29.8% of skin diseases among of the elderly patients were in spring season. Less than three quarters of the studied sample had non-infectious skin diseases, while more than one quarters of them had infectious skin disease. Encouragement of the elderly people about the importance of follow up and periodic check-up to detect early health deviation to make early management and to prevent complication or any deterioration of the skin health. Utilizing the mass media, health classes in different health agencies could be achieved to increasing awareness of elderly people about the importance of prevention, early detection and control of skin diseases

Serum autoantibodies in chronic hepatitis C: influence on disease profile

Non-organ-specific autoantibodies [NOSAs] are commonly detected in chronic hepatitis C [CHC] bat their significance remain on debate. To determine the prevalence of anti-nuclear [ANA], anti-smooth muscle [ASMA] and anti-liver kidney microsomes type 1 [anti-LKM1] antibodies and assess their association with patient demographics, biochemical and histological parameters of disease activity and response to antiviral therapy. One hundred and thirty naive chronic hepatitis C [CHC] patients were included. Clinical demographic and laboratory data at the time of liver biopsy were obtained. All cases were screened for autoantibodies by an enzyme linked immanosorbent assay [ELISA]. A pathologist reviewed all pathologic specimens using the modified histological activity index [HAL] of Ishak. All patients received combined antiviral therapy in the form of Pegylated Interferon alpha 2a-l60 micro g plus Ribavirin. Non-organ-specific autoantibodies [NOSAs] were observed in 38 patients [29.23%]: ANA in 25 [19.23%], ASMA in 18 [13.85%] and anti-LKM1 was the rarest occurring in only two CHC patients [1.54%]. Concomitant positivity for ANA and ASMA was observed in 7 of these 38 cases [5.38%]. The presence of NOSAs was associated with higher aspartate trasaminase [AST], alanine trasaminase [ALT] and gamma-globulin. There was a significant association between seropositivity of NOSAs and higher histological activity score of inflammation and hepatocellubr injury [P=0.024] and with increased plasma cell infiltrate [P=0.000]. In contrast, no differences were observed regarding age, gender, viral load, stage of fibrosis and response to combined antiviral therapy. The presence of non-organ-specific autoantibodies [NOSAs] in CHC is associated with more necroinflammatory grade without increased degree of fibrosis or failure of combined antiviral therapy

Spontaneous bacterial peritonitis: clinico-epidemiological and microbiological study

Spontaneous bacterial peritonitis [SBP] is a frequent severe and potentially life-threatening complication of cirrhotic patients with ascites. The clinical presentation of SBP depends on the stage at which the infection is diagnosed. In early stages, most patients are asymptomatic or present with insidious, non specific symptoms. As the disease progresses, patients show signs and symptoms of peritoneal infection. To determine the prevalent pathogens responsible for SBP in our locality and their sensitivity pattern, to test the efficiency of different culture techniques in microbial isolation, and to study the diagnostic predictors of such cases. Two hundred fifteen adults with cirrhotic ascites consecutively admitted to Tropical Medicine Unit Mansoura University Hospital were screened for SBP. One hundred eight SBP episodes from 92 adult patients were compared to 88 cirrhotic ascites patients cross-matched with age and sex without SBP. Diagnosis of cirrhosis was based on clinical biochemical radiological and/or histo-pathological data. Ascitic fluid was subjected to cytological biochemical examination and culture on both conventional and blood culture bottles at the bedside for bacterial identification and antimicrobial susceptibility testing. Diagnosis of SBP and its variants were made depending on ascitic fluid poly-morphnuclear count >/= 250 cell/ mm[3] and/or monomicrobial growth in ascitic fluid culture without evidence of an infra-abdominal surgically treatable source of infection, and no recent use of antibiotics. A total of 432 diagnostic paracentesis were performed in 215 cirrhotic patients with ascites. The prevalence of SBP was 25.02%. History of previous episode of SBP or history of paracentesis were significantly more frequent in SBP patients [P=0.000 and P=0.001] respectively also, Abdominal wall edema and redness [cellulitis], presence of ascetic fluid with numerous fine internal hyper-echoic particulates by ultrasonography and the aspiration of slightly turbid ascites were significantly more frequent in SBP patients [P= 0.01, P=0.031 and P=0.035] respectively. Ascitic fluid protein levels and serum albumin levels were significantly lower and serum creatinine levels were significantly higher in SBP patients. [P=0.009, P=0.03, and P= 0.003] respectively. Applying the model of logistic regression analysis between SBP and Non SBP clinical and laboratory data revealed that; previous SBP episode, low ascitic fluid protein levels, high serum creatinine and low serum albumin levels were significant predictors of SBP [P-0.000]. Fourty-nine [45.37%] episodes of SBP were detected by the conventional culture compared to 79 [73.15%] by modified technique with a significant P value <0.001. Gram-negative bacteria were the cause of SBP in 46 [58.23%] culture positive episodes while Gram-positive bacteria were the isolated organisms in 33 cases [41.77%]. Escherichia coli and Staphylococcus aureus were the most commonly detected organisms in 40 [50.63%] and 26 [32.91%] cases respectively. In this study, 31.65% of cultures were highly sensitive to Levofloxacin, 29.11% were sensitive to Cefotaxime, 20.25% were sensitive to Amoxicillin-Clavulanic acid, 18.99% were sensitive to Meropenem, 17.72% were sensitive to Ciprofloxacin and 15.19% were sensitive to Ceftazidime. On the other hand, antibiotic resistant rates to Ciprofloxacin were 25.32%, 24.05% to Ceftazidime and 21.52% to Cefotaxime. Previous SBP episode, low ascetic fluid protein levels, high serum creatinine, and low serum albumin levels, all had a significant prediction of SBP. Beside cytological and biochemical examination, culture of ascitic fluid in blood culture bottles at bedside increases the sensitivity of SBP detection and must be a routine in every hospitalized patient with cirrhotic ascites. Gram-negative organisms still, the prevalent microorganisms causing SBP but there is a significant recent increase in Gram-posittue pathogen with emergence of maltidrug resistance especially for Ciprofloxacin, Ceftazidime and Cefotaxime. These recent changes may have an impact on guidelines for management and treatment of SBP in oar locality

Role of MRI in evaluation of patients with anorectal malformations

The goal of surgical correction of anorectal anomalies is to establish socially acceptable function and to avoid undesirable effects sequelae such as fecal incontinence, urinary incontinence, and sexual inadequacy. The goal of this study was to review the various findings on pelvic MRI in postoperative anorectal malformation [ARM] patients with complications, to see how far these findings can explain the patients condition and to help the surgeon's planning for proper management regimen for each patient, either surgically or medically. This study included 41 children [31 post-operative anorectal malformation patients and 10 controls]. They were 28 boys [21 patients and 7 controls], and 13 girls [10 patients and 3 controls].Their age ranged between 5 months and 16 years. The patients were subjected to the followings: 1]-Full history taking and clinical examination. 2]-Imaging modalities including: a]-Pelvic MRI. b]-Spinal MRI for 17 patients. c]-Radiographs of the abdomen and pelvis. d]-Voiding cystourethrogram [VCUG] for 8 patients. e]-Water soluble contrast enema for 26 patients. f]-Ultrasonography of the urinary tract for 16 patients. The mean age of the studied children was 5 years and 6 months. The most common clinical presentation encountered after repair was incontinence in 18 cases, followed by constipation in 8 patients. The most common complication noticed on MRI was misplaced rectum in relation to the levator sling in 11 cases, and the commonest associated congenital anomaly was urinary bladder involvement seen in 8 patients [neurogenic bladder in 4 patients, atrophic bladder in 2 patients, and hemibladder remnant in the remaining 2 patients]. Patients with high anomalies [18 cases] had an equal chance of having either good, air, or poor sphincter mechanism muscle development on MRI. Also fair sphincter mechanism muscle development was common in patients with incontinence, and good muscle quality was common in patients with constipation. There was a good correlation between the sphincter quality and the degree of sacral development [7/12 patients with dysplastic sacrum showed poor sphincter quality, and 12/14 cases with normal sacrum showed good and fair sphincter quality]. Pelvic MRI could be used in adjunction with other imaging modalities in assessment of post operative anorectal malformations patients with complications. Pelvic MRI is the method of choice to show details of their initial repair and to detect any anatomical abnormalities which could relate to their condition. Information collected by different imaging modalities could help the surgeon in decision taking concerning the best management plan for the patient, either surgically or medically

Percutaneous ablation [radiofrequency and ethanol injection] versus hepatic resection in treatment of HCC in Egypt

Hepatocellular carcinoma [HCC] is common in Egypt due to the high prevalence of HCV infection and the intermediate prevalence of HBV infection. There is no unequivocal evidence to establish the first line treatment in patients with HCC and compensated cirrhosis and thus studies comparing the different options are needed. Is to compare the effectiveness of percutaneous ablation [PEI, RFA] versus hepatic resection in treatment of HCC patients. This study included 45 HCC patients subjected to medical history, clinical assessment and complete investigations. They were distributed randomly between 3 lines of therapy; Group [1]: 14 patients who underwent RFA, Group [2]: 15 patients who underwent PEI and Group [3]: 16 patients who underwent surgery. Follow up was done for 12 months. The mean age of the patients was 53.19 +/- 4.08 years, 34 [75.6%] were males and 11 [24.4%] were females. All patients came from slum or rural areas in Egypt with low socioeconomic status and 85.1% were smokers. Thirty six [80%] were HCV Ab positive, 5 [11.11%] HBs Ag positive and 4 [8.89%] negative for both markers. Rectal biopsy for Bilharzial ova was positive in 20 [44.44%] patients; 57.6% had cirrhosis, 29.2% had chronic hepatitis and 13.2% had normal liver parenchyma. The tumor was a solitary nodule in 41 [091.11%] patients, two or three nodules in 2 [4.45%] patients. A tumor with a diameter <3cms was found in 28 [62.2%] patients and between 3 and 5cm in 17 [37.8%] patients. The tumor was located in the right lobe in 33 [73.3%] patients and in the left lobe in 12 [26.7%] patients. Child's class A was found in 41 [90.9%] patients and 4 [9.1%] were Child's class B. The response rate between the three modalities of therapy [resection, RF or PEI] showed no statistical significance. There were minimal changes of liver function tests with no statistically significant difference between pre and post percutaneous ablation therapy [PEI, RFA]. The deterioration of liver function [increase in liver transaminases and decrease of serum albumin] and complications were statistically significantly higher in the surgically managed group compared to PEI and RFA groups. PEI showed lower complications than RFA or surgery. Both percutaneous ablation and surgical resection did not significantly differ in terms of efficacy, however, percutaneous ablation therapy showed no mortality and low rate of complications. The choice between either forms of percutaneous ablation should be individualized to every case according to the cost, tumor site and the availability of the therapeutic modality. Surgical resection should not he chosen as a therapy for HCC unless functional hepatic reserve allows it. More studies on large number of cases and follow up for at least five years are needed

Clinical evaluation of son invasive biomarkers for monitoring liver fibrosis and disease progression

Liver biopsy is the gold standard for assessment of hepatic fibrosis. However, it is invasive with possible complications, costly and prone to sampling errors. Many non-invasive markers of liver fibrosis have been recently proposed and assessed in the clinical setting as surrogates of liver biopsy. Although several non invasive markers of liver fibrosis have been developed in the last decade their implementation in clinical practice has been slow and is still limited. This study aimed to describe the different non invasive markers and methods that have been proposed for the assessment of liver fibrosis, to discuss their advantages and limits and to suggest a rational use in clinical practice. This study included 40 patients with chronic liver disease, 21 of chronic hepatitis C [CHC] as group I, and 19 patients with liver cirrhosis [group 11] as well as 20 healthy subjects with age and sex matched was enrolled as control group. Serum levels of tissue inhibitor of metalloproteinase- 1 [TIMP-I], laminin and cystatin C were measured and correlate with laboratory and histological findings. This study revealed that, significantly elevated serum level of cystatin C in CHC [group I] and cirrhotic patients [group II] than healthy controls [p<0.001] for each. Moreover, cystatin C concentrations were significantly higher in patients with liver cirrhosis [p<0.01] than in patients with CHC. Furthermore, serum cystatin C levels correlated significantly with the stage of liver fibrosis [p<0.01] but revealed no significant difference with the grade of necroinflammation of the disease process [p>0.05]. However, serum TIMP-1 values showed a significant increase in group I and 11 patients than in controls. Serum TIMP-1 levels correlated significantly with both the stage of fibrosis [p<0.05] and the grade of activity [p<0.01]. Serum larninin levels showed significant increase in patients with chronic hepatitis and liver cirrhosis than controls [p<0.001]. While, no significant difference of on comparing chronic hepatitis patients with control group [p>0.05]. Also, serum laminin levels showed a significant correlation with fibrosis stage [p<0.001] but not with inflammatory grade [p>0.05]. Based on available evidence, it can be anticipated that non-invasive markers of liver fibrosis [cystatin C, TIMP-1 and laminin] and their combined use will soon become a most useful tool in the clinical management of many forms of chronic liver disease. However, their implementation is expected to reduce, but not to completely eliminate, the need for liver biopsy

Effect of PH changes in some irreversible hydrocolloids on surface qualities of dental stone casts

Irreversible hydrocolloid [alginate] is the impression material used most commonly in making dental casts for diagnosis, treatment and fabrication of prostheses. The aim of this study was to evaluate the effects of pH value of four alginate impression materials on dimensional accuracy, surface roughness and surface hardness of dental stone casts. Samples were prepared from each irreversible hydrocolloid and pH values were measured after 5, 10, 15 and 20 minutes from mixing. Five specimens of dental stone from each alginate impression material were obtained and evaluated as regards dimensional accuracy, surface roughness and surface hardness. The results have shown nonsignificant correlation between pH changes of different alginates and dimensional accuracy and surface hardness of dental stone casts when compared with each other. The stone casts showed greater surface roughness with alkaline pH value

Complicated frontal osteomas

Nineteen patients of frontal osteoma were diagnosed in the period between May 1995 and November 1998. Five cases were asymptomatic and follow up was our policy in those cases. Four cases presented with chronic/recurrent frontal headache. Ten patients were complicated. Six showed secondary mucoceles, which extended to the orbit and/or the intracranial cavity in 5 cases. Other complications included recurrent acute sinusitis, orbital extension of the tumor, gross involvement of the anterior table of the frontal bone and osteomyelitis with fistulation. Frontal osteoplastic flap was our procedure to resect these tumors