Comparative Study between Spinal Anesthesia and Lumbar Plexus Block for Intraoperative Anesthesia and Postoperative Analgesia in Fracture Femur Surgery

Background:Fracture femur is common in elderly. Spinal anesthesia (SA) in elderly patients can be associated with major hemodynamic changes whereas lumbar plexus block (LPB) can provide ideal perioperativeanalgesia as there is no hemodynamic instability or depression of pulmonary functions. The purpose of this study is to compare the efficacy of SA versus LPB for intraoperative anesthesia and postoperative analgesia in fracture femur surgery.Materials andMethods: This prospective randomized controlled study was carried out 70 patients of either sex with age >20 years, ASA physical status I -III scheduled for fracture femur surgery. Patients were randomly classified into two equal groups (n = 35); group I(SA) received SA by heavy bupivacaine HCL 0.5% 2.5-3.5 ml and group II (LBP) received posterior LPB by 30-35 ml bupivacaine 0.5% Results:The time for performing the block was significantly longer in group LPB than group SA. The onset of sensory and motor block was significantly increased in group LPB than group SA. The intraoperative HR was significantly increased, and intraoperative MAP was significantly decreased in group SA compared to group LPB at 5, 10, 15, 20, 25 and 30 minutes. Postoperative HR and MAP was significantly increased in group SA compared to group LPB at 1 and 6 h. Postoperative VAS was significantly increased in group SA than group LPB at 1 and 6 h. The duration of sensory and motor block was significantly increased in group LPB than group SA. The time of postoperative first analgesic requirement was significantly longer and the total pethidine consumption in the 1st24 h was significantly lower in group LPB than group SA. SA was associated with significant increase in hypotension, nausea, vomiting and headache.Conclusion:LPB is an effective alternative to SA as an anesthetic technique for femur fracture surgeries. LBP offers a more stable intraoperative hemodynamics and provides longer duration of analgesia postoperatively with less side effects. However, SA has shorter time for performing the block with earlier onset of sensory and motor block

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

PURPOSE: To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept. RESULTS: Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 µm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 µm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR. CONCLUSIONS: Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.

Role of PET/CT in differentiating bronchogenic carcinoma from inseparable pseudo-neoplastic lesions

Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with approximately 1.5 million cases worldwide every year. Computed tomography [CT] scanning can only estimate the proximal extent "with difficulty in visualization the real borders" of a tumor. The role of MRI in local staging of bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT [PET/CT can accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, This information cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for biopsies if histological confirmation is required Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the pseudo progression as well as pseudo regression

Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history taking, reviewing medical sheet and PET/CT examination. The study was done in private center [Techno-scan holding center, Heliopolis branch using PET-CT machine [GE Discovery VCT 64 PET/CT, USA]; in which PETCT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams University, Radiology department

Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32 patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it was 5.77 +/-3.38 SD as measured by PET/CT in centimeters

Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in local staging and follows up in patients of bronchogenic carcinoma

Comparison between cabergoline and coasting in prevention of ovarian hyperstimulation syndrome and their effect on intracytoplasmic sperm injection outcome

Aim of the work: ovarian hyperstimulation syndrome [OHSS] is an iatrogenic, serious and potentially fatal complication of ovarian stimulation, affecting1–14% of all IVF/ICSI cycles. This study aimed to compare cabergoline after hCG administration with delayed hCG administration [coasting] in high risk patients to prevent OHSS in ART cycles

Patients and methods: this prospective comparative randomized study included 100 patients at risk of OHSS performed in the Assisted Reproductive Technologies Center, Al-Azhar University and in Private IVF Centers during the period from November, 2015 to October, 2016

Results: comparison between the two groups showed no significant difference regarding age, BMI, presence of risk factors of OHSS, but there was a significant difference regarding FSH, LH and the mean diameter of follicles on day of hCG administration

Conclusion: PCOS affects 5 to 10% of women of childbearing age and is the most common cause of anovulatory infertility in developed countries

Recommendations: further studies including large number of cases and for longer duration will further confirm the efficacy of cabergoline and coasting on prevention of OHSS

Wandering spleen in the pelvic region in an adult man with symptoms of acute abdomen

Wandering or ectopic spleen is a condition characterised by migration of spleen in the abdomen or pelvis. This anomaly is rare, with a reported incidence of <0.2%. It occurs mostly in women between 20 and 40 years of age. Clinical diagnosis is difficult because of lack of precise signs, symptoms, and nonspecific laboratory data. Diagnosis of a wandering spleen highly depends on the results of imaging studies such as abdominal ultrasound and abdominopelvic computed tomography [CT] scanning. Treatment includes surgery with the choice between splenopexy in a noninfarcted spleen and splenectomy when infarction has occurred. We report a rare case of wandering spleen in a 27-year-old man with infarction due to torsion of its pedicle, which was diagnosed by CT and treated by splenectomy. Conclusion: Despite the rarity of wandering spleen, the possibility of torsion of its long pedicle with acute splenic infarction should be considered in the differential diagnosis of acute abdomen

Prevalence of suspected tuberculosis in the Kingdom of Saudi Arabia according to conventional and molecular methods

Although the prevalence of suspected tuberculosis [TB] in the Kingdom of Saudi Arabia remains high, there has been a modest decrease in recent years. In this multi-center cross-sectional study, the prevalence of TB was determined by various techniques with the aim of identifying differences and indicating where there is uniformity in findings. A total of 3404 samples were collected from Saudi TB patients from different regions in Saudi Arabia: Riyadh, Dammam, Jeddah, Madinah, Hail, Qassim, Jazan, and Taif. Different techniques including Ziehl-Neelsen [ZN], Mycobacteria growth indicator tube [MGiT], Lowenstein-Jensen [LJ], and polymerase chain reaction [PCR] were used to screen for the presence of Mycobacterium tuberculosis [MTB]. ZN stain showed that Riyadh and Dammam had the highest prevalence of MTB with 22% and 21%, respectively, while prevalence was lowest in Jazan and Hail with an incidence of 2% and 3%, respectively. MGiT culture showed that Riyadh, Dammam, and Jeddah had the highest prevalence with a rate of 26%, 22%, and 22%, respectively. LJ culture showed the highest prevalence in Riyadh and Dammam with 22% and 21%, respectively. Of all the techniques, the highest detection rate was by PCR which was 10.46% while ZN stain technique was 6.64%, for MGiT culture it was 8.34%, and for LJ culture it was 7.7%. This study is the first in which different methods have been used for detection in the various regions of Saudi Arabia. Collected data are important not only for patients and physicians but for future epidemiological studies to monitor the spread of MTB infection in Saudi Arabia

Effect of glimepiride on the aorta of adult albino rats after induction of diabetes mellitus

Diabetes mellitus is a chronic progressive disease that is associated with long-term complications such as diabetic angiopathy. Glimepiride is a third-generation sulfonyleurea that has an extrapancreatic effect on glucose metabolism besides its hypoglycemic action. The aim of the study was to assess the effect of glimepiride on the aorta of the adult albino rat after induction of diabetes mellitus. Forty adult male albino rats were used. They were divided into two main groups: group I and group II. Group I was the control group and group II was the experimental group. Group II was further divided into group IIA, in which 10 rats received glimepiride orally for 8 successive weeks, group IIB, in which 10 rats were given streptozotocin by means of a single intraperitoneal injection, and group IIC, in which 10 rats were given streptozotocin by means of a single intraperitoneal injection and were then given glimepiride orally for 8 successive weeks. Thus, a total of four groups of rats were studied. Five rats were randomly selected and sacrificed after 4 weeks, and another five rats were sacrificed after 8 weeks from the beginning of the experiment. The aorta was taken from each group and prepared for histological and electron microscopic examinations. The aortic tissue of the diabetic rats in group IIB showed apparent intimal thickening and accumulation of fatty cells within the subendothelial region with disturbance in the connective tissue distribution in the intima and the media. Electron microscopic study revealed atrophic endothelial cells in the intima. The internal elastic lamina was interrupted and the smooth muscle cells showed intracytoplasmic fat droplets. In group IIC, the aorta showed mild thickening and minimal fatty deposition in the subendothelial region. Electron microscopy revealed that the intima and the internal elastic lamina were nearly intact as in the control group. It could be concluded that glimepiride could alleviate the progression of aortic affection produced in case of experimentally induced diabetes mellitus

In situ modified screen printed and carbon paste ion selective electrodes for potentiometric determination of naphazoline hydrochloride in its formulation / 药物分析学报

The construction and performance characteristics of new sensitive and selective in situ modified screen printed (ISPE) and carbon paste (ICPE) electrodes for determination of naphazoline hydrochloride (NPZ-HCl) have been developed. The electrodes under investigation show potentiometric response for NPZ-HCl in the concentration range from 7.0 ? 10-7 to 1.0 ? 10-2 M at 25 1C and the electrode response is independent of pH in the range of 3.1-7.9. These sensors have slope values of 59.770.6 and 59.270.2 mV decade?1 with detection limit values of 5.6 ? 10-7 and 5.9 ? 10-7 M NPZ-HCl using ISPE and ICPE, respectively. These electrodes show fast response time of 4-7 s and 5-8 s and exhibits lifetimes of 28 and 30 days for ISPE and ICPE, respectively. Selectivity for NPZ-HCl with respect to a number of interfering materials was also investigated. It was found that there is no interference from the investigated inorganic cations, anions, sugars and other pharmaceutical excipients. The proposed sensors were applied for the determination of NPZ-HCl in pharmaceutical formulation using the direct potentiometric method. It showed a mean average recovery of 100.2%and 102.6%for ISPE and ICPE, respectively. The obtained results using the proposed sensors were in good agreement with those obtained using the official method. The proposed sensors show significantly high selectivity, response time, accuracy, precision, limit of detection (LOD) and limit of quantification (LOQ) compared with other proposed methods.

Helicobacter pylori Infection and its response to treatment in diabetic Patients versus non diabetics

Background: H. pylori has been recognized as a public health problem worldwide affecting approximately 50% of the world population and more prevalent in developing than the developed countries. It is a common infection in diabetic patients

Aim of the work: The study designed to study the prevalence of H. pylori infection in diabetic patients in comparison with non diabetic patients and the response to treatment ofH. pylori in both groups

Methods: WO patients were enrolled in the study. They were classified into 2 groups: Group [I] 50 patients complaining of dyspepsia with DM, and group [2] 50 non-diabetic patients complaining of dyspepsia. Serum H.pylori IgG antibodies and stools H.pylori antigen were determined for all patients by Gen Way H. pylori IgG ELISA and OneSite H pylori rapid test respectively

Results: H. Pylori stools Ag was positive in 58% of diabetics and 40% of non diabetics with no significant difference [P value 0.085]. Serum H.pylori Ig G were significantly positive in diabetes [52%] compared to non diabetic patients [32%]; P value 0.05. HE Ale was significantly higher in diabetics positive H.pylori cases compared to diabetics negative for H.pylori. Change in the HBAlc blood level before and after H.pylori treatment was highly significant in diabetic cases [P value <0.001]

H.pylori was more resistant to treatment in diabetic patients compared to non diabetics

Conclusion: No significant difference between both diabetics and non diabetics regarding prevalence of H pylori infection. Type 2 diabetic patients showed a significantly lower eradication rate than non diabetic patients. Successful eradication of H pylori infection significant I improve HBAlc

Pharmaceutical and clinical evaluation of intravenous admixture of dobutamine and dopamine used in treatment hypotension in neonatal intensive care units

The aim of this study was to evaluate compatibility and stability of the maximum concentration used for binary admixture containing dobutamine and dopamine in 5% glucose. The maximum concentration of each drug was 5.76 mg/ml of dobutamine and 2.88 mg/ml of dopamine in 50 ml of 5% glucose. The physical compatibility of binary admixtures was assessed using visual inspection and pH determination immediately after preparation [at 0 time] and after 24 hrs. The chemical stability was assessed using high performance thin layer chromatoghraphy [HPTLC]. The method is based on HPTLC separation of the two drugs followed by densitometric measurements of their spots at 254 nm using Camag TLC Scanner 3. The mobile phase comprised ethyl acetate: n-propanol: water: glecial acetic acid [60:24:9:3, v/v/v/v]. The results revealed that no precipitation, gas evaluation, color change, pH change or chemical incompatibility were observed over the entire time of mixing of two drugs in 5% glucose solution

Combined spinal epidural anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body

Dilated cardiomyopathy [DCM] is characterized by ventricular dilatation and impaired systolic cardiac Junction. Anesthetic management, of patients with cardiomyopathy with reduced systolic Junction, is challenging and may be associated with high mortality. The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia [CSEA] in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP [measured at base line and then every 10 min], in addition to cardiac complications during the hospital stay period were studied. patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min [-14.7%], while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min [13.1%]. CVP showed insignificant changes in all readings except at 90 and 100 min which showed significant increase [p< 0.05]. Four patients developed ECG changes in the postoperative period, while no significant changes in EF. combined spinal epidural anesthesia [CSEA] may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely im eventful postoperative recovery with good pain control

Compatibility and stability of ternary admixture of midazolam, dobutamine and dopamine in 5% glucose or 0.9% sodium chloride solution

The aim of this study was to evaluate compatibility and stability of the maximum concentration used for ternary admixture containing midazolam, dobutamine and dopamine in 5% glucose and 0.9% sodium chloride solutions. The maximum concentration of each drug was 0.144 mg/ml of midazolam, 5.76 mg/ml of dobutamine and 2.88 mg/ml of dopamine in 50 ml of 5% glucose or 0.9% sodium chloride solutions. The physical compatibility of ternary admixtures was assessed using visual inspection and pH determination of ternary admixtures immediately after preparation [at 0 time] and after 24 hrs. The chemical stability was assessed using high performance thin layer chromatoghraphy [HPTLC]. The method is based on HPTLC separation of the three drugs followed by densitometric measurements of their spots at 254 nm using Camag TLC Scanner 3. The mobile phase comprised ethyl acetate: n-propanol: water: glecial acetic acid [60:24:9:3, v/v/v/v]. There were no visual changes [such as precipitation, gas evaluation or change in color] during 24 hrs after preparation of admixture. Also, there was no change in pH values of admixtures during that time. The results revealed chemical stability of midazolam, dobutamine and dopamine over the duration of mixing [24 hrs] in 5% glucose or 0.9% sodium chloride solutions

Childhood's acute toxicity pattern at the poisoning treatment unit, zagazig university hospitals, from January 2009 to august 2010 a retrospective study

Acute poisoning represents one of the most common medical emergencies in childhood. Poisoning patterns change according to age group, type of exposure and the nature and dose of the poison. This study's objective is to understand the pattern of childhood poisoning in the poisoning treatment unit, Zagazig University Hospitals and to compare these results with those of other countries. retrospective descriptive study. Poisoning treatment Unit, Faculty of Medicine, Zagazig University Hospitals during the period from January 2009 to August 2010. All children 12 years old and below. 304 poisoned children were enrolled in this study. 1.6% of the cases involved children below 1 year old. 81% of the cases were between 1-6 years. Children between 7-12 years composed 17.4% of the cases. In all age groups more male cases [57%] were found as compared to female cases [43%]. 32% of the poisoned cases were living in Zagazig city while 68% were living in the suburban. In 90.5% of the cases, the accident happened at home while in 9.5% of cases, the accident occurred outside the home. 99.4% of the cases were accidental. The oral route was involved in 72% of the cases. The presenting symptoms were classic in 70% of the cases. 10.2% of the cases were admitted to the Intensive Care Unit. 3.6% were discharged against medical advice. In 86.2% of the cases, observation with or without supportive measures together with decontamination and antidotal therapy whenever needed were sufficient. Pesticide poisoning constituted 28.6% of the total cases. Petroleum products were implicated in 13.15% of the cases. Cleaning and disinfectant agents were the culprits in 17.1% of the cases. Therapeutic drugs constituted 22.9% of the causes of poisoning. Carbon monoxide poisoning was detected in 1.64% of the cases. Natural poisoning was detected in 7.89% of the cases. Conclusion: Our study showed that a relatively large proportion of the visits to the poisoning treatment unit were done by children between 1 and 6 years and that pesticide especially organophosphorus insecticide were the most incriminated agents. Good supportive care is the cornerstone of management for childhood poisoning. We need to reorganize the data collection and use modern techniques of information technology. Public health authorities can adopt the results as the basis for designing prevention measures for different age groups in the population

Toxic effects of lead exposure during gestation and lactation on testicular development in albino rat offspring: a hormonal and histopathological study

This study aims at exploring the effect of lead exposure during pregnancy and lactation on the rat testis, which was evaluated via light and electron microscopic examination of testicular tissue, besides estimation of serum follicle stimulating hormone [FSH], luteinizing hormone [LH] and testosterone [TT] levels. Dams were intoxicated with 10 mg/kg body weight [BW]/day lead acetate throughout the gestational period and lactation. Pups were sacrificed on postnatal [PN] days 1 and 21. The weights of the body and testes, as well as serum gonadotropins and TT concentrations were significantly reduced in pups from lead-intoxicated mothers compared with their controls. Light microscopic examination of testicular samples from lead-exposed pups revealed thin-walled seminiferous tubules with significant reduction in their size. In addition, multiple vacuoles were seen within the tubules and in the interstitium, and the interstitial spaces appeared enlarged with reduced number of Leydig cells. Apoptotic bodies were found among the basal parts of the spermatogenic epithelium. Examination of testicular tissue from the same group by electron microscopy revealed more cellular details confirming the toxic effects of lead. The altered seminiferous tubules showed multiple cytoplasmic vacuoles and precipitates along the nuclear membranes in Sertoli cells. Several seminiferous tubules showed apoptotic cells with heterochromatic nuclei and dense cytoplasm, whereas other tubules appeared ensheathed by single layers of myoid cells. Leydig cells revealed cytoplasmic vacuolations and irregular nuclei with chromatin masses. The results of this study indicate that lead intoxication affected the normal development of germinal cells and disrupted the testicular structure and endocrinal functions

Comparative study between two obidoxime regimens in acute organophosphate toxicity among some Egyptian patients

Organophosphorus [OP] poisoning is commonly encountered in agricultural communities probably due to the easy accessibility to the insecticide. In vitro studies in animals and on human erythrocytes have suggested beneficial effects of oximes on reactivating acetylcholine esterase [AChE] enzyme. This study was a single blinded randomized clinical trial to investigate the comparative effectiveness of the World Health Organization [WHO] obidoxime regimen with recommended dose - 250 mg IV shot loading dose then infusion of 750 mg every 24 hours [high-continuous dose regimen] versus the regimen of National Egyptian Center of Toxicology and Research [NECTR], Faculty of Medicine, Cairo University with recommended dose 250 mg in 150 ml saline, IV infusion over one hour and repeated every 6 hours over a period of 24 hours from the time of admission [low-interrupted dose regimen]. Twenty normal individuals were recruited as control [group I], with their AChE enzyme level determined to assess the normal level in the population. Fourty patients exposed to OP and treated with the WHO obidoxime regimen were classified as group II. Fourty patients exposed to OP and treated with the NECTR obidoxime regimen were classified as group III. There were significantly higher percent of patients in group III with respiratory depression than in the patients of group II [p<0.05]. There were no statistically significant differences between the patients of group II and the patients of group III regarding all other signs and symptoms of OP poisoning as well as AChE enzyme levels in the first 12 hours [p>0.05]. After 12 hours from admission, the AChE levels were progressively and significantly higher in the patients of group II than the patients of group III until discharge [p<0.05]. The severity of respiratory failure, as measured by the need for ventilation and the number of ventilated patients were significantly. higher in the patients of group III than in the patients of group II [p<0.05]. The outcomes, such as the occurrence of respiratory depression and the number of deaths, were reduced in the patients of group II. There was statistically significant difference between the patients of group II and the patients of group III regarding the time of recovery [p<0.05]. There were no deaths between the patients of group II but one patient died from group III. This indicates that the WHO regimen [high-continuous dose regimen] is more effective than the NECTR regimen [low-interrupted dose regimen] in reactivating AChE enzyme, reducing the duration of hospital stay and the mortality rate and increasing the early recovery rate. Regarding the collected results of the present work, we recommend the use of the WHO obidoxime regimen

effect of mild hypothermia on jugular venous bulb oxygen saturation and CSF glutamate in severe head trauma

Hypothermia has been used as a method of brain protection in patients with traumatic brain injury for many years. The protective effects of hypothermia are related to the inhibition of the excitatory amino acids [EAA] release including glutamate. The hypothermic decline of the cerebral metabolic rate of oxygen [CMRO[2]] is also another mechanism of brain protection because it maintains the aerobic metabolism of the brain. To study the effect of mild hypothermia on brain oxygenation and the release of the EAA glutamate in severe head trauma. Forty two patients [16 - 60 years old] with severe head trauma [Glasgow coma scale < 8] were classified according to the diagnosis by computed tomography into group 1 [global brain damage] [n=20] and group 2 [focal brain damage] [n=22] two cases in group 2 were died before completion of the study so they were excluded. The cerebrospinal [CSF] glutamate, the jugular venous bulb oxygen saturation, the jugular venous lactate, the Glasgow coma scale [GCS], the acute physiological and chronic health evaluation score [APACHE II] and the length of lCU stay and other hemodynamic variables were measured and recorded. Hypothermia decreased the cerebrospinal [CSF] glutamate, improved the jugular venous bulb oxygen saturation, decreased the jugular venous lactate, improved the Glasgow coma scale [GCS] and decreased the acute physiological and chronic health evaluation score [APACHE II], There were significant statistical differences [p < 0.001] in each group but there were no statistical significant differences between both groups. The length of ICU stay was shorter in the group 1 than in group 2. Mild Hypothermia is one of the mechanisms of brain protections through decreasing the level of the neurotoxic cerebrospinal excitatory amino acid glutamate and by improving the cerebral oxygenation and preventing the anaerobic metabolism by decreasing the level of serum lactate

Congenital lobar emphysema: peri-operative evaluation and management

Congenital lobar emphysema [CLE] is one of congenital lung malformations and is characterized by overdistension and airtrapping in the affected lobe. It is one of the causes of neonatal and infantile respiratory distress. This study was performed on 10 children with congenital lobar emphysema with a age range from 2 days to 7 months. The age of the first presentation was the neonatal period. It is frequently diagnosed in males. Tachypnea and dyspnea were present in all cases. The diagnosis was confirmed by Chest x-ray and computed tomography of the chest. All patients underwent total lobectomy or segmental resection. All cases survived after operation without early or late post operative complication

Effect of concommitant Helicobacter pylori infection in patients with Giardiasis lamblia in Egypt

Giardiasis is one of the most common enteroprotozoal diseases; its association with Helicobacter pylori is a common clinical finding. This work studied the impact of such association. Fifty giardiasis patients were classified into two groups according to the concomitant presence of H. pylori and ten normal healthy controls were also included. All patients were subjected to complete history taking, thorough clinical and stool examination, endoscopy, and biopsy of gastric and duodenal mucosa as well as histopatological examination. Results revealed significant upper gastrointestinal symptoms [epigastric pain and anorexia] in giardiasis patients with H. pylori. Also, endoscopic and histopathologic examination showed significant gastric lesions in this group of patients as compared to those suffering only G. lamblia

Non invasive mechanical ventilation in patients with respiratory failure of neuromuscular origin

The boundaries for the use of the non invasive ventilation [NIV] continue to expand, till now a few number of trials studied the application of NPPV in specific neuromuscular disorders [NMD] as myasthenia gravis and Guillain-Barre Syndrome, while many studies supported the use of NPPV in Duchenne muscular dystrophy. For chronic respiratory failure, a wide consensus now favors the use of NPPV as the ventilatory mode of the first choice for patients with neuromuscular diseases. It is important to predict those likely to fail with NPPV due to the expensive and intensive medical care used for these patients. The aim of this study was to evaluate the efficacy of NPPV specially in correcting gas exchange abnormalities and in avoidance of tracheal intubation in the management of respiratory failure of neuromuscular origin. This study was carried out on 13 patients with respiratory failure [6 patients with ARF, 7 patients with CRF] of neuromuscular origin. These patients fulfilled the diagnostic criteria for each specific disorder [9 with GB syndrome, 3 with MG, and one with DMD] with either acute or chronic respiratory failure. The patients were classified into 2 main groups; group I with ARF [6 patients] and group II with CRF [7 patients]. They all received NPPV using bilevel positive pressure ventilation plus standard medical treatment. All cases were subjected to thorough history taking and physical examination, chest x-ray, neuro-physiological studies, ABG, some hematological and biological indices, derived variables with regular follow up and recording of ventilator variables with detection of associated complications of NPPV. The overall success rate of NPPV was 69.2%, this was 50%for group I with ARF and 85.7%, for group II with CRF. In group I with ARF when compared with the base line values, there was a significant decrease in RR, HR, MAP, and PaO2 after one hour of the study, while the rise in SaO2, pH and the decrease in PaCO2 were significant after the 2nd hour of the study. In group II with CRF when compared with the base line values, we have observed a significant reduction in RR after the first day, while both the rise in PaO2 and the decrease in PaCO2 were significantly after the second day of the study. Also SaO2 and HR were improved only after the 7th day of the study while, on the other hand, PH and MAP were unchanged significantly till the end of the study. Application of NPPV as a safe and a routine line of therapy in patients with respiratory failure of neuromuscular origin for correction of arterial blood gas abnormalities, stabilizing vital signs, and avoiding tracheal intubations and its complications in these patients. Results of NPPV therapy in chronic respiratory failure of NM origin is much better than in acute respiratory failure of NM origin. Use of NPPV in ARF due to Guillain-Barre Syndrome with a great precaution especially with those having severe bulbar palsy for fear of aspiration events

Total thyroidectomy in treatment of non-malignant goiter: is it worthwhile?

Total thyroidectomy is increasingly being accepted as a treatment of choice for differentiated thyroid cancer. However, because of presumed increased morbidity associated with this procedure, it is still not considered a viable option for management of benign thyroid disorders. To assess the safety and efficacy of total thyroidectomy for management of benign thyroid disorders, we analyzed our data from 100 total thyroidectomies performed for benign thyroid disorders. Demographic details, biochemical findings, indications for operation, specimen weight, and complications were noted. Among these patients, 35 had a toxic goiter and 65 had a non toxic goiter. The mean duration of goiters was 3.8 +/- 3.06 years [3 - 8 years], and the mean weight of the specimens was 85 gm +/- 180 gm. The incidence of permanent hypothyroidism and permanent recurrent laryngeal nerve plasy were 1% in both. According to this study, we can conclude that: total thyroidectomy should be considered as the treatment of choice for multinodular goiter and Graves' disease in a setting of palpable nodule[s] or ophthalmopathy [or both] because reoperation for recurrent goiter in such a setting would be hazardous with distressing complications