Comparison of usefulness of percutaneous coronary intervention guided by angiography plus computed tomography versus angiography alone and its impact on instent restenosis

Background: Optimal stent selection and placement would be expected to improve clinical outcomes. Coronary computed tomography angiography [CCTA] may permit better preprocedural planning

Objectives: To assess the impact of incorporating coronary computed tomography angiogaphy guidance in defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison to quantitative coronary angiography and its effect on incidence of instent restenosis

Methods: The study was conducted on 153 diabetic patients with stable coronary artery disease. Patients were divided into two groups: group A and group B according to PCI guidance either with quantitative computed tomography angiography [QCTA] datasets or quantitative computed tomography [QCA] datasets respectively. Follow up clinically for six months to assess incidence of major adverse cardiac events [MACE] and angiographically by coronary angiography at six months or before if clinically indicated to assess incidence of instent restenosis [primary end point]

Results: QCTA was associated with longer lesions [p=0.001] and larger reference vessel diameter [p=0.001] than that measured by invasive QCA in group A. No statistical significant difference between group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of MACE

Conclusions: CCTA guided percutaneous coronary intervention [PCI] is a safe and effective strategy for treatment of coronary artery disease however it didn't add a beneficial role in reducing incidence of instent restenosis or MACE in comparison to angiographic guidance alone

Pollution from gerga sugar factory monitoring and assessment

Air quality was studied in Gerga sugar factory to assess and evaluate pollution levels that are generating from sugar manufacturing process. Pollution levels of NO, SO[2], CO, CO[z] and THG gasses and paniculate matter were detected and determined. Also, associated parameters of meteorological conditions such wind speed, wind direction, temperature and pressure were evaluated. This was done using the mobile monitoring unit. The mobile monitoring unit is a mobile laboratory with rapid response instruments for real-time measurements of gasses and particulate distribution and emission source characteristics. The results showed that air quality in Gerga sugar factory has been affected from total hydrocarbons and sulfur dioxide gases that exceeded the acceptable levels. As, for particulate matter, it is considered the worst pollution problem hi the core of the sugar factory and neighbouring colonies. In general we can say that Gerga Sugar factory affects the air quality with a limit range of pollution

Supraglottic cyst as a rare pathology

Cysts of the larynx are rare lesions, most frequently located on the supraglottic region. This study included eight cases with supraglottic cyst. Five cases were males with an age average of 32 year old [22-60 years]. Two cases were females with an age average of 28 years [20, 36 years respectively]. One case was a boy, 8 years old. The cases were classified into four groups: three cases with aryepiglottic cyst [37.5%, two cases on the left side and one case on the right side], three cases with epiglottic cyst on the pharyngeal surface [37.5%, two on the left side and one case on the right side], one case with ventricular cyst [12.5%] and one case with vallecular cyst [12.5%]. Presentation, histopathological evaluations, acoustic and aerodynamic presentation were discussed

Outcome of different treatment modalities in preschool children with otitis media with effusion

The problem of otitis media with effusion [OME] in infants and young children is worldwide. Although medical treatment is tried first, many children do not respond to it. In this study, seventy preschool children with OME received medical treatment for 3 months; 52 of them do not respond and treated surgically. A group of the children with obstructive symptoms were treated by adenoidectomy alone while the remaining were treated by adenoidectomy and bilateral myringotomy with insertion of grommet tube in the left ear only. Those without obstructive symptoms were treated by bilateral myringotomy with insertion of grommet tube in the left ear only. Follow up for six months including clinical and tympanometric assessment was done. The results revealed that medical treatment was successful in 25.7% of patients. Removal of adenoids, when indicated, improves the outcome of treatment. The use of grommet tube is more beneficial than myringotomy alone

Gastric pedicle tube in reconstruction of gastrointestinal continuity after total laryngopharyngectomy

Gastric pedicle tube placed retrostrenally was performed to reconstruct gastro- intestinal continuity after laryngopharyngectomy in 11 patients [7 males and 4 females] aged from 50 to 67 years, with a mean age of 56 +/- 0.4 referred to hospital in the period from January 1999 to December 2000. These patients had extensive pyriform fossa tumors in five patients, posterior pharyngeal wall tumor in three patients and localized postcricoid tumor in three patients. A reconstruction of the gastro-intestinal tract was done in the same sitting after excision of the tumor by ENT surgeons. The postoperative complications were pneumothorax in two patients, cervical fistula in three patients, which closed spontaneously after 2-3 weeks and two patients suffered from stenosis of cervical anastomosis, but responding to intermittent dilatation. Two patients died from severe chest infection during the postoperative period. Temporary gastrotomy was done for all patients to be used for feeding during the postoperative period removed after complete healing of the anastomosis. Apart from two patients who died during the postoperative period, the remaining patients were discharged from the hospital in a fair general condition. They were subjected to regular follow up

Clinico-pathological study of 22 eyes of retinoblastoma in Sharkia governorate

This work aimed at studying the natural history of retinoblastoma [Rb] in our locality in addition to its potential histogenesis and prognostic markers .A series of [22] eyes with Rb of [19] patients were studied clinically [using indirect ophthalmoscopy with scleral indentation under general anaestheisa, ultrasonography and CT scanning] and histopathologically [using Hx and E stained sections, special stains and immunohistochemistry for neuron specific enolase [NSE]]. Metastatic disease work up was done during follow up period of at least 12 months.All cases were diagnosed in children less than 5 years of age [mean of 31 months for unilateral cases and 18 months for bilateral cases]. Male to female ratio was 1.2:1. Leukocoria and strabismus were most common mode of presentation [64%], [18%] respectively. Hx and E stained sections revealed that [75%] of eyes showed the trabecular pattern and [50%] showed the glomeruloid pattern. Homer Wright [H.W.] rosettes were seen in various degrees in all tumours [abundant in well differentiated tumour and few in poorly differentiated one]. Rb cells demonstrated varying degrees of positive or negative reaction to NSE, most Flexner-Winsterstenier [F.W.] and H.W. rosettes being positive and Fleurettes weakly positive or negative. Metastatic disease of retinoblastoma was related mainly to optic nerve invasion reaching the resection margin [75%] and poor tumour differentiation [80%].Regarding the natural history of retinoblastoma in this study, leukocoria and strabismus are the most common modes of presentation. Cases with bilateral lesions tend to present at younger age group. Immunohistochemical findings suggest that Rb is a primitive stem cell neuroectodermal tumour with capability for differentiation in both neural and neuroglial directions. The two main prognostic markers for metastatic disease are optic nerve invasion reaching the resection margin and poor tumour differentiation

Lupus anticoagulant an additional risk factor in the pathogenesis of diabetic retinopathy

During the past decade there has been growing concern for the role of lupus anticoagulant [LA] as a link between the immunological and haemostatic systems in the mechanism ofendothelial alteration in type one diabetic microangiopathy. This work aimed at studying the possible relation between lupus anticoagulant positivity and diabetic retinopathy [DR] as an evidence of clinically manifest diabetic microangiopathy in type one diabetes mellitus [type 1 DM] patients, regarding its incidence, severity and response to laser therapy. The study was conducted on 60 subjects who were classified into two main groups. Patients group: fifty type 1 DM patients, mean age +/- SD [3 8 +/- 8.7] years, mean duration of diabetes +/- SD [12.4 +/- 1.9] years. Patients with poor glycemic control [HbA> 7%], border line hypertension [> 140/90mm Hg], hypercholesterolemia [> 5.6 mmol/L], hyper trigluyceridaemia [> 1.9 mmol/L] or any others systemic diseases were excluded. According to laboratory investigations [coagulation screen including prothrombin time [PT], partial thromboplastin time [PTT], Fibrinogen, activated protein C [Apc], prothrombin degradaton products [F[1]+2] lupus anticoagulant titre [LA titre]. Patients were classified into LA +ve patients [18] LA -ve patients [32]. Dilated fundus examination was done for all patients DR was classified into non proliferative diabetic retinopathy [NPDR] and proliferative diabetic retinopathy [PDR] and according to response to laser therapy PDR patients were classified into active proliferative diabetic retinopathy laser [active PDRL] and quiescent PDRL. Control group: Ten apparently healthy individuals, age and sex matched with patients' group. A significant decrease in Apc concentration and increase in F[1]+2 plasma level were noticed in LA + ve group compared with LA -ve and control groups [P<0.001 and P<0.001 respectively]. The incidence of DR was significantly higher in LA +ve group [77.78%] than LA -ve one [31.25%] [P < 0.001]. In particular a significantly higher percentage of PDR patients was observed in LA +ve [71.43%] compared to LA -ve ones [40% p<0.001]. There was a significantly higher LA titter in patients with PDR than those with NPDR [p < 0.05]. With application of laser therapy to patients with PDR, 70% of LA +ve showed minimal or no improvement [PDRL active] while only 25% of LA -ve did so during the follow up period of 8-12 weeks. In conclusion this study can suggests that lupus anticoagulant positivity might be an additional risk factor in the pathogenesis of DR affecting not only its incidence but also its severity, and even response to laser therapy. If this concept is true it would offer more weapons [antithrombotic, profibrinolytics, and cytoprotective] to the antidiabetic retinopathy campaign that might have a favourable outcome on prevention and /or retardation of progression of that relatively common complication with markedly puzzling aetiopathogenesis and before the need for laser treatments which always destroy the retinal anatomy

Altered platelet function in diabetic retinopathy

The behavior of platelets aggregation has been studied in diabetics with retinopathy compared to diabetics without retinopathy and normal control groups. It has been found that there is significant increase in A.D.P. platelet aggregation% and V-max. In patient with diabetic retinopathy. The use of drugs which inhibit platelet aggregation could have important therapeutic value in prevention of diabetic retinopathy

Relation between diabetic retinopathy and total blood lipids

Total serum lipids were estimated in diabetics with and without retinopathy compared to normal non-diabetic subjects. It has been found that diabetic patients with retinopathy had significantly higher total serum lipids than diabetic patients Without retinopathy and normal control subjects. This finding supports the view that total serum lipids plays an important role in diabetic retinopathy especially exudative lesions. It also explains the value of drugs or low- fat diet which decrease the serum lipids

Lipids patterns in protein calorie malnutrition

Significant increase in total lipids was observed in both Marasmus and Marasmic Kwashiorkor but not in Kwashiorkor. Cholesterol and phospholipids showed significant decrease while NEFA showed significant increase in the 3 syndromes. Lipoproteins were significantly increased in marasmus but decreased in kwashiorkor while infinity-lipoproteins were significantly decreased in both. Triglycerides were increased in marasms only. These changes were attributed to the dietary condition as well as to liver state and function