Microscopic versus endoscopic approach to the sellar and supprasellar space, a cadaveric study

Skull base endoscopic endorasal approaches are used more and more liberally to expose the skull base transnasally. However the surgical microscope is still used by some surgeons for sellar exposure transnasally. To provide a qualitative and quantitative anatomical evaluation of the surgical exposure and maneuverability afforded by the endoscope versus that of the surgical microscope in exploring the sellar / suprasellar areas. We used seven embalmed cadaver heads whose vascular system had been injected with colored silicon material. Sublabial trans-septal exploration of the sellar/suprasellar areas was conducted using the endoscope and then microscope. The exposure and maneuverability associated with each mode were evaluated. The endoscope exposed the sellar/superasellar compartment better than the microscope in terms of maneuverability and surgical field exposure. In our model, use of the endoscope provided a better maneuverability advantage over microscope mode in the exploration of the suprasellar compartment

relationship between post stroke urinary incontinence and functional outcome

To identify the risk factors for urinary incontinence [UI] and compare the functional outcome of continent and incontinent stroke patients, in order to determine f UI has any influence on functional outcome after stroke. One hundred patients with stroke, admitted to the hospital, were divided into two groups according to their continence status. Comparative study was done between incontinent [group 1] and continent [group 2] patients. Both groups were subjected to detailed history taking, clinical examination and functional assessment, using the functional independence measure motor scale [M-FIM,] on admission and urodynamic evaluation was done for incontinent patients. Functional assessment of both groups and urodynamic evaluation for the incontinence status were repeated six months later. There was a 52% prevalence of urinary incontinence [UI] on admission and 32% at discharge. 20 out of 52 patients became continent. Predictor risk factors of post-stroke urinary incontinence in this study were age, hypertension, diabetes mellitus, hyperlipideinia, atrial fibrillation, transient ischemic attack and previous stroke. Previous stroke was strong predictor risk factor in the incontinent group of patients. At six months, compared with continent patients, incontinent patients had greater disability measured by M-FIM scales [median [range] of 31.5 [2 7-42] versus 78 [68-85]; p<0.001]. UI is a common and distressing problem after stroke and it is a strong predictor of functional outcome. This study showed that UI on admission had a negative impact on functional outcome at six months. So, early recognition of the risk factors may assist in rehabilitation management of stroke patient particularly for appropriate treatment setting and improvement of their long-term outcome

CXCR3 and CXCR4 receptors expression on peripheral blood T-lymphocytes from patients with rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory condition that affects multiple joints. Chemokines and their receptors are involved together in the development and perpetuation of inflammation Chemokine receptors CXCR3 and CXCR4 are among the main regulators of T cell recruitment in autoimmune diseases. The present study aimed at detection of the frequency of CXCR3 and CXCR4 chemokine receptors expression on peripheral blood T-lymphocytes in patients with rheumatoid arthritis in an attempt to identify suitable targets for therapeutic intervention. Twenty eight patients with rheumatoid arthritis, selected from those attending the Rheumatology and Rehabilitation outpatient clinic, Ain Shams University Hospitals, were studied. Ten age and sex matched healthy subjects were served as controls. All patients were subjected to full medical history, thorough clinical examination, evaluation of the disease activity using disease activity score 28 [DAS28] and radiological assessment by plain X rays of both hands and feet [posterior - antero views] for the erosive changes. Peripheral blood lymphocytes analysis was performed by flow cytometry using anti-CD3, anti-CXCR3 and anti-CXCR4 monoclonal antibodies. High statistically significant difference was determined between patients and controls as regard relative count of T- lymphocytes expressing CXCR4 receptors [35.068 +/- 5.098, 23.59 +/- 4.601, respectively and P< 0.001]. Also, there was a significant positive correlation between relative count of T- lymphocytes expressing CXCR4 receptors and disease activity using disease activity sore 28 [DAS28] disease duration and the hemoglobin level. On the other hand, no significant correlation was determined between relative count of T- lymphocytes expressing CXCR3 receptors and any of the clinical and laboratory parameters of patients. Increased expression of CXCR4 on peripheral T cells of Patients [RA Patients] and its positive correlation with the disease activity indicate that this chemokine receptor plays a central role in the process of chronic inflammation in RA and suggests that targeting CXCR4 could provide a new treatment for this disease. Although our data did not prove that CXCR3 expression is higher in patients with RA, however, it can be expected that it is involved in the inflammatory process based on reported functional studies

Value of renal biopsy in the diagnosis of acute renal failure in children

This work aims to evaluate the role of renal biopsy in the diagnosis of patients presented with acute renal failure [ARE] with correlation between the clinical and pathological diagnosis and their impaction on the prognosis. The study was preformed on fifty patients presenting with the manifestation of ARE received in Pediatric Hospital Mansoura Eaculty of Medicine. Paraffin blocks were cut for hematoxyline and eosin and special stains as well. Analysis of pathological findings with clinical parameters related to outcome of patients. This study delineated that the childhood cause of ARF are acute glomerulonephritis [48%] followed by acute tubular necrosis [18%] then thrombotic microangiopathy [12%], then malignant lymphomatous infiltration [6%], then acute pyelonephritis [4%] lastly renal cortical necrosis [2%] and interstitial hemorrhage [2%]. The renal biopsy confirmed the clinical diagnosis in 58% of cases and altered .the clinical diagnosis in 12% of cases. Moreover in cases with uncertain clinical diagnosis the renal biopsy clarified the accurate diagnosis. More over the biopsy guided the treatment in some cases. The results of this study demonstrate that renal biopsy is essential in many cases of pediatric ARF not only to confirm the diagnosis but also to diagnose cases of unknown causes and changes the clinicat diagnosis in many cases as well

Role of surgical correction of aortic coarctation on hypertension in adults

To diagnose the impact of surgical intervention on systolic hypertension, a retrospective study reviewed 14 adults with a mean age of 27.3 +/- 6.2 years who underwent coarctation repair at Al-Azhar University Hospital between 1995 and 2002. All patients were hypertensive [mean systolic blood pressure 169.3 +/- 21.4 mmHg, range 140 to 220 mmHg] and 9 patients [64.2%] were on a regimen of at least one hypertensive medication at the time of surgical interference. All patients underwent cardiac catheterization and the mean peak systolic gradient across the coarctation was 57.9 +/- 24.4 mmHg [range 25 to 120 mmHg]. Operative procedures included resection of the coarctation segment with an interposition of tube graft [3 patients], resection and end-to-end anastomosis [2 patients], a bypass graft [6 patients] and patch angioplasty [3 patients]. There was no hospital mortality or late morbidity. Early and intermediate follow up was available at a mean of 2.5 +/- 2 years [range 1 to 6 years]. At last follow-up, the peak systolic gradient between the upper and lower body was trivial. All patients had significant improvement in systolic blood pressure compared with preoperative values, specially older patients requiring medication