Incidence and outcomes of cases of caesarean scar ectopic pregnancy in a tertiary referral centre

Background. Caesarean scar ectopic pregnancy (CSEP) is a rare condition in which the implantation of the gestational sac takes place within the uterine scar of a previous caesarean section (CS). If the pregnancy continues within the uterus, the risk of placenta accrete or uterine rupture is increased.Objective. To investigate four treatment methods, based on each patient's clinical presentation, gestational age of the pregnancy and haemodynamic stability, for the management of CSEP.Methods. CSEP cases (N=30) were diagnosed by ultrasound at the Shatby Maternity University Hospital, Egypt. Various treatment modalities, based on gestational age, were employed to treat the patients. Treatments included suction curettage (n=12), embryo reduction with local methotrexate injection (n=12), laparoscopic excision (n=3) and excision through laparotomy (n=3). Serum levels of beta-human chorionic gonadotrophin (ß-hCG) were measured at diagnosis and weekly following treatment until the levels returned to non-pregnant values.Results. There was a significant positive correlation between gestational age in weeks and the CSEP management strategy employed. ß-hCG levels decreased from before treatment to the end of the follow-up period 3 weeks later.No cases required a hysterectomy, and no maternal complications were reported in this study.Conclusion. The appropriate CSEP management strategy varies according to gestational age. Suction and embryo reduction with local methotrexate injection offers an effective, safe and minimally invasive surgical treatment to remove ectopic pregnancy tissue. Closely monitored follow-up of patients, including serial measurement of ß-hCG levels and ultrasonographic examinations, is recommended after CSEP management

Association of Plasma Ghrelin Levels with Insulin Resistance in Type 2 Diabetes Mellitus among Saudi Subjects

BACKGROUND: Although the exact mechanism of insulin resistance (IR) has not yet been established, IR is the hallmark characteristic of type 2 diabetes mellitus (T2DM). The aim of this study was to examine the relationship between plasma ghrelin levels and IR in Saudi subjects with T2DM. METHODS: Patients with T2DM (n=107, cases) and non-diabetic apparently healthy subjects (n=101, controls) from Saudi Arabia were included in this study. The biochemical profiles and plasma insulin levels of all subjects were analyzed, and IR was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR) index. Active ghrelin levels in plasma were measured using the radioimmunoassay technique. RESULTS: Only 46.7% (50 of 107) of the T2DM subjects had IR, including 26% (28 of 107) with severe IR (HOMA-IR ≥5), while 5.9% (six of 101) of the controls had moderate IR (3 ≤HOMA-IR <5). HOMA-IR values were not associated with age, disease duration, or gender. Importantly, T2DM itself and the co-occurrence of IR with T2DM were significantly associated with low plasma ghrelin levels. However, ghrelin levels were inversely correlated with the HOMA-IR index, body weight, and fasting plasma insulin levels, mainly in the control subjects, which was indicative of the breakdown of metabolic homeostasis in T2DM. CONCLUSION: The prevalence of IR was relatively low, and IR may be inversely associated with plasma ghrelin levels among Saudi patients with T2DM.

Study of smoking among females students in Ibn Sina national medical college

Background: Prevention of smoking is a key strategy to improve general health. However, survey data from Jeddah, Saudi Arabia have indicated that a large number of female medical students are addicted to smoking despite the knowledge of its harmful effects. This article comparatively explores the impact of smoking on health among female medical students in Jeddah, Saudi Arabia. Data were collected as part of a program of qualitative and quantitative research investigating the prevalence of smoking among female medical students

Objectives: To study the prevalence of smoking among females in the college of Ibn Sina and it is impact on their health in relation to personal and family character, CAP knowledge attitude and practice, and association of medical condition as chronic bronchitis and bronchial asthma

Methods: The study was conducted among female's students attending college of Ibn Sina-Jeddah-Saudi Arabia. An open-ended questionnaire was developed to cover the objectives

Conclusion: This study indicated that across the targeted sites, the descriptions made by female smokers about the harmful impact of smoking on their health were often vague. After assessment of the risk factor and variables that may increase prevalence of smoking among medical students, the prevalence of smoking was only 7.95% and used to practice smoking habit despite the knowledge of its side effects

interpreting physician is essential to avoid inaccurate diagnosis of PET-CT: a case report

The presence of a pulmonogist in the process of interpreting chest PET-CT is quite crucial, as the clinical findings will prevent any miss leading interpretations that result an inaccurate diagnosis

Obesity and lung health

Obesity among population has increased dramatically and has received considerable recent public health attention. The impact of obesity on lung health has become a recognized problem worldwide and an area of intense research. Obese people are at greater risk for asthma, impaired lung mechanics, sleep-disordered breathing, and obesity hypoventilation syndrome. Complete pulmonary function testing [measuring spirometry, lung volumes, and diffusion] often shows a restrictive disease pattern with decreased expiratory reserve volume [ERV] and functional residual capacity [FRC]. For more information on pulmonary function testing, see http:/www.nlm.nih.gov/ medlineplus/ency/article/003853.htm. [Also see Guide to respiratory abbreviations]

Percutaneous image guided lumbar disc nucleoplasty: a minimal invasive technique for lumbar disc decompression

Nucleoplasty is a minimally invasive, percutaneous procedure that uses radiofrequency energy to ablate nuclear material and create small channels within the disc. To evaluate the efficacy of nucleoplasty technique in patients with leg pain caused by radicular encroachment. This study was performed on 29 patients [23 males and 6 females] with lumbar disc prolapse causing unilateral sciatica with or without lower back pain for duration more than 3 months with no response to conservative treatment[in the form of medications, bed rest, and physiotherapy] in the period from November 2006 to November 2008. The Perc-D Spine Wand with 1 mm diameter and bipolar tip was used for coblation and the coagulation on the disc utilizing both radiofrequency coblation technology and thermal technology using a radiofrequency Arthrocare [Trade mark] generator system 2000 [Arthrocare Corporation [Trade mark], Sunnyvale, CA] to generate coblation and coagulation energy. The mean visual analogue score [VAS] for the treated patients preoperative was 8.3 and there was significant reduction in VAS in follow-up visits with the mean VAS = 3.4, 3.2, 2.5, 3.1, 3.5 at 1 week, 1 month, 3 months, 6 months, and 1 year duration respectively. All patients were satisfied with the procedure and the degree of pain relied at all follow-up visits. Percutaneous image guided lumbar disc decompression using nucleoplasty technique seems to be an effective, safe, simple and minimal invasive procedure for relief for sciatica due to lumbar disc prolapse in well selected cases. Nonetheless a longer follow-up period and a larger number of patients is needed to assess the long-term efficacy of this procedure

Endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: a review of 23 procedures

Primary hyperhidrosis of the upper limbs is a distressing and often socially disabling condition. Conservative treatment is usually not effective in controlling the disease due to either patient non-compliance or adverse effect of therapies. Endoscopic thoracic sympathectomy is considered the treatment of choice, causing minimal morbidity and high success rates. The aim of this work is to evaluate endoscopic thoracic sympathectomy [ETS] for the treatment of palmar and axillary hyperhidrosis. A total of 23 procedures done to 12 patients, with hyperhidrosis, 10 males and 2 females, with mean age of 23 years. All patients were assessed clinically for the presence of palmar and/ or axillary hyperhidrosis. Hyperhidrosis was defined as an individual's perception of their sweating as excessive. Social and work related inconveniences are considered. The procedures were done by single port technique under general anaesthesia with double lumen endotracheal tube to allow single lung ventilation in lateral position. A mean follow-up of one year [4 - 18 months]. Bilateral procedures done to 11 patients, one patient preferred to go for single side only. Mean operative time was 25 minutes per side. An average of one day hospital stay postoperatively, as all patients done on day surgery basis. Intercostal tube was used in early cases [5 patients] and was not necessary for the rest of the cases following more experience and confidence. No patients readmitted for procedure related complication. Two cases developed moderate pneumothorax in the group without chest drain usage and were treated conservatively. No cases of distressing compensatory hyperhidrosis or recurrence of complaint encountered during the follow-up period. Endoscopic thoracic sympathectomy is a minimally invasive and highly successful treatment for patients with hyperhidrosis of the upper limbs. Apart from anaesthetic challenges, the technique is surgically simple for those surgeons with good knowledge of endoscopic skills

Ultrasound in the detection of breast masses associated with mammographically identified isolated clustered microcalcifications

To determine whether ultrasonography [US] can depict breast lesions associated with mammographically detected clustered microcalcifications and whether the visibility at US is different between benign and malignant lesions. Fifty-two patients with mammographically detected microcalcification clusters underwent US with a 10MHz transducer before biopsy was done. The visibility of breast masses at US was correlated with histologic and mammographic findings. Surgical biopsy revealed seven benign lesions, 36 intraductal cancers, and nine invasive cancers. At US, breast masses associated with microcalcifications were seen in 94.2% of cases. US depicted more breast masses associated with malignant 100% than with benign 57% microcalcifications [statistically significant]. In malignant microcalcification clusters larger than 10mm, US depicted associated breast masses in all cases. There was no statistically significant difference in shape and distribution ofcalcific particles, as well as in breast composition, at mammography between US visible and invisible groups. Given a known mammographic location, US with a high-frequency transducer can depict breast masses associated with malignant microcalcifications, particularly clusters larger than 10mm. US can be used to visualize large clusters of microcalcifications that have a very high suspicion of malignancy.

Flexural strength of preimpregnated fiber reinforced composite bars simulating fixed parital dentures

The fiber-reinforced composite [FRC] systems produced for constructing fixed restorations which are available in the market are Sculpture Plus/ FiberKor [Jeneric/ Pentron] and Targis/ Vectris [Ivoclar]

Objectives: To determine the flexural strength of preimpregnated FRC bars simulating fixed restorations in vitro using different thickness and different span lengths and examine them under the scanning electron microscope [SEM]

Method: In this study rectangular bars with different thickness were constructed from these two systems according to the manufacturer's instructions. Flexural load of these bars was obtained by subjecting them to 3-point loading. Tests were performed in different experimental designs using special jigs and flexural strength was then calculated. Data was statistically analyzed using one way analysis of variance [ANOVA]. Some fractured bars were examined under SEM

Results and Conclusions: It was found that increase the amount of fibers does not increase the flexural strength; however in some cases the flexural strength was reduced. When the bars had the same amount of fibers, increasing the distance between the supports would increase the flexural strength which the bars can withstand before fracture in most cases. The SEM evaluation of the bars after flexural strength testing, showed that, for the Sculpture plus/ Fiberkor specimens there was effective wetting and coupling of the fiber bundles by the resin confirmed by absence of gaps between them. The failure occurred usually away from the fiber-matrix interface. However for Targis / Vectris rods, there were gaps between the fiber bundles and the resin indicating poor wetting

prevalence of dermatological manifestations in chronic hepatitis C Egyptian patients

Background: Numerous extrahepatic disorders have been recognized in association with hepatitis C infection among which dermatological diseases occupy a central part. The true prevalence of these manifestations among hepatitis C infected patient and the role of HCV in the pathogenesis of these conditions has not been established in Egypt

Objectives: The aim of this study was to determine the prevalence of dermatological manifestations related to chronic hepatitis C infection in Egypt

Patients and methods: Three hundred and thirteen naive chronic hepatitis C patients were subjected to an interview questionnaire, clinical examination and laboratory tests including liver enzymes [alanine aminotransferase enzyme [ALT] and aspartate aminotransferase enzyme [AST], cryoglobulin, rheumatoid factor, bilirubin, prothrombin, HCV antibody, HCVRNA, blood sugar and liver biopsy if indicated

Results: Fifty-three patients [16.9%] were found to have dematological manifestations in the current study. The skin manifestations were xerostomia [8.3%], pruritis [4.0%], lichen planus [2.9%], psoriasis [2.2%], necrolytic acral erythema [1.4%], urticaria [1.4], vitiligo [ 1.1%], purpura [0.7%] and vasculitis [0.4%]. The mean age of patients [44.9+/-10.6 years] with dermatological manifestations was statistically significantly higher than that of patients [41.3 +/- 10.7] without dermatological manifestations. The percentages of patients with dermatological manifestations having HCV RNA positive were significantly lower [93.8%] than patients without dermatological manifestations [99.4%]. The dermatological manifestations [especially pruritus] were found with statistical significance more in patients with advanced fibrosis and cirrhosis [stages 3 and 4] [p: 0.04]. Otherwise there were no statistical significant differences found between both groups regarding other laboratory findings

Conclusion: Cutaneous manifestations may be the only, the earliest and the most apparent sign of the underlying HCV infection. so we recommend that the health care providers should screen for these diseases in patients with hepatitis C

Effect of using adhesive resin cements on the retention of fixed restorations cemented to preparations having several convergence angles

Objectives: To compare the retention and mode of failure of cast crown restorations bonded to prepared natural teeth and cast core build up of different convergence angles using different luting cements

Materials and Methods: Lathed natural molar teeth and cast core specimens were constructed with different convergence angles 6°, 12°, 18°, 24°. Cast crown restorations were fabricated to fit on prepared specimens and cemented using two types of adhesive resin cements [Super-bond C and B and Panavia 21] and zinc phosphate cement as a standard. The cemented specimens were stored in water at 37°C for 7 days prior to application of a tensile pull-off force. The loads at failure were recorded and statistically analyzed using one way analysis of varience [ANOVA] and Scheffe multiple comparison lest [p < 0.05]. The mode of failure was also investigated

Results: Statistical analysis showed significant differences between cements investigated and also between different convergence angles of each cement. The mode of failure for casted cores was adhesive between the lathed surfaces and the luting cements while for prepared natural teeth, it was adhesive/cohesive in nature for resin cements and adhesive for zinc phosphate cement

Conclusions: Super-bond C and B has the highest retention load for all the cements investigated. Increasing the convergence angle reduced the retention load for each cement

Significance: Resin adhesives especially Super-bond C and B can compensate for reduced retention as in cases of short clinical crowns or preparations with higher convergence angles

Evaluation of bacterial colonization on different treated ceramic surfaces

Objectives: To assess the effect of different finishing techniques of porcelain surfaces on microbial adherence and colonization

Materials and Methods: Three different types of ceramic materials were subjected to three types of finishing. Microbial adherence and colonization were assessed by optical density using spectronic 21 DV Spectrophotometer to found the best combination. Data was recorded and statistically analyzed using one way analysis of variance [ANOVA] and Scheffe multiple comparison tes

Results: Statistical analysis showed Significant differences between mean optical densities of the different types of ceramic materials and also between different finishing techniques of each type

Conclusions: This study demonstrates that both ceramic type and variations in ceramic finishing and glazing are important factors which may enhance plaque accumulation on dental restorations

Significance: Finishing technique had a great effect on microbial adherence and colonization which may lead to failure of dci tat restorations due to recurrent caries and generation of periodontal disease

Serum thrombopoietin levels in patients with liver cirrhosis; relation to severity of the disease, spleen size and platelet count

Background: thrombopoietin [TPO] is an important regulator of megakaryocyte maturation and platelet production. The role of TPO [which is mainly produced by the liver] in thrombocytopenic cirrhotic patients is still under investigation. The aim of this study was to measure the serum TPO levels in cirrhotic patients and examine its relationship with circulating platelet count, splenic size and clinical stage of liver cirrhosis

Study design and methods: this study was conducted on 88 subjects, divided into 2 groups, group I [patient group] included 72 patients with liver cirhosis [diagnosed by combination of clinical, laboratory, ultrasound and histopathological data], they were further divided into 2 subgroups, group IA: included cirrhotic patients with thrombocytopenia [36 patients, 28 males and 8 females with age 50.3:8.5 years], and group IB: included cirrhotic patients with normal platelet count [36 patients, 26 males and 10 females, with age 50.64+/-6.8 years]. Group ll comprised 16 healthy persons with matched age and sex, used as a control group. All included persons were subjected to: thorough history taking, full clinical examination, beside the following investigations: complete blood picture, kidney and liver function tests, Hepatitis B and C markers, serum TPO level [by sensitive sandwich ELISA] and abdominal Doppler ultrasound. The following invasive investigations were done for group I [patients] only: bone marrow aspiration, upper gastrointestinal endoscopy, sigmoidoscopy and liver biopsy [the latter was done for 21 patients only]. Patients with pure schistosomal fibrosis were excluded from the study. Patients were classified according to the Child-Pugh score into 3 classes of clinical severity A, B and C

Results: cirrhotic patients were thrombocytopenic in comparison to control [P<0.0001]. Serum TPO levels were lower in cirrhotic patients [130.6-79 Pg/mi] than control group [225.5-36 pg/m] [P<0.0001] and also in patients with thrombocytopenia [101-77.5 pg/m] than in patients with normal platelet count [160.2-70.3 pg/m] [P<0.001]. TPO had a significant positive correlation with platelet count [P-0.0001 for sub-group IA and P=0.04 for subgroup 1B]. However serum TPO did not correlate with spleen size. Splenic size had a significant negative correlation with platelet count in cirrhotic patients [P-0.03 for subgroup IA and P=0.004 for subgroup 1B]. In cirrhotic patients, serum TPO levels were found to be decreased as the disease progressed in subgroup IA, 188.25+73.05 pg/ml in patients of Child-Pugh class A, 63.8:23.28 pg/ml in class B and 51:26 pg/ml in class C, while in group 1B, 247.3:40.49 pg/ml in class A 121.3+/-29.6 pg/ml in class B and 112+/-27 pg/ml in class C]. Child-Pugh score has a significant negative correlation with TPO level in both sub-groups IA and 1B [P=0.0001] and with platelet count [P=0.0001 for subgroup IA and 0.01 for subgroup IB], but no significant correlation with spleen size. In comparing class A, B and C in both subgroups [IA and IB], spleen size was significantly larger in Child class A of subgroup IA when compared to same class of subgroup 1B [P-0.0001] with slight significant decrease in TPO in class A of subgroup I than class A of subgroup B [p-0.02]

Conclusion: we concluded that low TPO production may play a role, along with hypersplenism, in the development of thrombocytopenia in patients with liver cirrhosis. In early stage of cirrhosis [Child-Pugh class A], splenomegaly and hypersplenism may be the main path mechanism of thrombocytopenia. While advanced liver cirrhosis [Child-Pugh class B and C], causing more reduction in TPO production, plays a central role in the pathogenesis of thrombocytopenia

Evaluatiion of mckissock technique in reduction mammoplasty for huge breasts

Thirty female patients suffering from huge breast hypertrophy were admitted to the plastic surgery unit of Al-Zahraa university hospital and Saudi-German hospital in Jeddah during the period from March 1999 to June 2002 for reduction Mammoplasty. McKissock technique was performed.The amount of breast tissue resected was in range of 1500 to 2000 gm. Per breast.The nipple-areola complex was safely transposed to 17 cm easily with great success. No cases of nipple-areola necrosis nr sensory loss. Only 4 cases developed minor incisional separation and delayed healing with subsequent hypertrophic scars in the vertical limb. The technique gave vent breast contour and good aesthetic is. The technique and its results as well complications were presented and discussed

Aitologous lipo-injection for breast augmentation: is it a suitable option ?

Autologous transplanted fat has been used over many years for soft tissue correction of many reconstructive and cosmetic problems. It is soft and has a natural consistency without rejection, easily accessible and readily regenerated after harvested.Autologous fat was injected into the breast for augmentation. 20 cases were admitted to the plastic surgery unit of AL-Qahraa University hospital and Saudi-[icrman hospital in Saudi Arabia during the period from June 1999 to June 2002. Ten cases were presented with bilateral hypoplusia of the breast and 10 cases were presented with idiopathic breast nvolution. The amount of fat injected was anes from 250 cc to 450 cc per each breast. The technique gave excellent breast contour aesthetic results. The technique and its -reults as well as complications are presented and discussed

Visceral pleural biopsy with fenestrated cup biopsy forceps versus parietal pleural biopsy with abram's needle and fluid cytology in the diagnosis of pleural effusion

A study on 30 patients with pleural effusion had been carried out to evaluate the usefulness of visceral pleural biopsy using fenestrated cup biopsy forceps in comparison with parietal pleural biopsy using the Abrams, needle and fluid cytology with its complications. Cytological examination of the pleural fluid revealed the diagnosis in 6 cases [20%]. Parietal pleural biopsy by the Abram needle estalished the diagnosis in 13 cases [43.3%] whether the visceral pleural biopsy using fenestrated cup biopsy forceps established the diagnosis in 11 cases [36.6%]. Final-diagnosis was achieved in 18 cases [60%] and 12 cases [40%] remained undiagnosed fourteen cases of them were malignant conditions [3 cases of mesothelioma and 11 cases of metastatic malignant conditions] and 4 cases of tuberculosis. Complications were observed in 7 cases [23.3%]. Six cases developed a small bronchopleural fistula [20%] which was absorbed spontaneously requiring no further management and one case [3.33%] developed a large bronchopleural fistula that required intercostal tube drainage followed by pleurodesis by autologous blood

Tumour markers quantitation in pleural effusion

The aim of this study is to measure the concentrations of the tumour. markers: Carcinoembryonic antigen [CEA], alpha1 acid glycoprotein [AGP] and B[2]- microglobulin [B2 - m] both in serum and pleural fluid of patients with pleural effusion to illucidate the aetiogenesis of this effusion. Serum and pleural fluid samples, collected from 15 patients with malignant effusion and 15 patients with non malignant effusion [due to liver cell failure, congestive heart failure, tuberculosis or post-pneumonic effusion] were subjected to quantitative determination of these markers. Serum, and pleural fluid values of CEA and B2-m were significantly higher in malignant cases when compared with the non malignant ones [serum CEA levels were 18. 0 +/- 5 .2 ng/ml: mean +/- SEM versus 0.8 +/- 0. 3 ng/ml; P < 0.01 and pleural CEA concentrations were 16.4 +/- 5.3 ng/ml versus 2.3 +/- 1 .0 ng/mI; P < 0. 01 respectively Serum B2-m levels were 7. 5 +/- 1. 1 mg/L versus 2.3 +/- 0.3; P < 0. 05 while pleural fluid values were 2.8 +/- 0.4 mg/L versus 1 .5 +/- 0. 3 mg/L; P < 0.05 respectively]. Serum and pleural alpha[1] AGP levels showed no significant difference between malignant and non malignant conditions [Table 1]. In conclusion, there was significant association between malignancy and raised serum or pleural fluid values of both CEA and B[2]-m