Urotensin II as a novel marker for portal hypertension and bleeding varices: an Egyptian survey

Background and aim: Urotensin II [U-II], a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension [PHT] and its complications in patients with hepatitis C virus [HCV]-related cirrhosis

Patients and methods: After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presenting with bleeding esophageal varices [EV]. Group B included 25 patients with PHT with no history of bleeding EV. Group C included 25 patients without PHT or EV. In addition, 25 apparently healthy volunteers were included as controls [group D]. All participants were investigated for liver tests, Child-Pugh scoring, and serum U-II

Results: Serum U-II was significantly higher in cirrhotic patients with PHT with and without bleeding EV compared with the other groups; also, it correlated with the severity of liver disease [P<0.0001]. U-II, at a cutoff value of 2.07 ng/ml or more, could predict the presence of PHT with 98% sensitivity and 100% specificity [P<0.05], whereas at a cutoff value of 2.51 ng/ml or more, it could predict the presence of bleeding EV with 96% sensitivity and 93.3% specificity [P<0.05]

Conclusion: Serum U-II in HCV-related cirrhosis could be a simple and easy predictor of the presence of PHT and bleeding episodes in patients with EV

value of recurrent laryngeal nerve identification and stimulation by usig intraoperative disposable nerve stimulator during thyoid operation

Recurrent laryngeal nerve [RLN] iatrogenic injury is one of the most serious complications in thyroid surgery. Paralysis of vocal cords can repesents a srious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. This work is to study the importance of searching, identification and exposure of the RLN surgically and confirming this by using a disposable nerve stimulator to avoid its injury.Design: prospective study. Patients and Records of forty patients who underwent thyroidectomy by the authers at several Hospitals were reviewed for RLN paralysis between January2001 and December 2003. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator [Xomed, Jacksonville, Florida] set at 0.5 milliamper [mA]. Without the use of neuromuscular blockade during anesthesia, RLN function was assessed by palpating of the cricoarytenoid joint and posterior cricoaryteniod muscle while the stimulus was applied directly to nerve after identificantion. Postoperative, assessment of RLN integrity was determined by using flexible nasolaryngoscopy 7 days after the procedure to visualize the vocal cord mobility. RLNs were identified and stimulated intraoperatively in all patients. Concerning the postoperative results, flexible nasolaryngoscopy was utilized in all patients one week after the procedure. All patients had bilateral mobile vocal cords after the first week postoperatively. Conclusions: The authors concluded that iatrogenic injury to the RLN or to its branches could be avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In addition, using intraoperative disposable nerve stimulator is very helpful in confirming the location and function of the RLN

Comparative study of the use of CA125, procollagen type III and the risk of malignancy index in diagnosis of ovarian cancer

This study included 140 women with ovarian mass for laparotomy. Serum was obtained preoperatively for measurement of CA125, amino-terminal propeptide of type III procollagen. Ultrasonography of the ovaries was performed and scored according to specific criteria. Main outcome measures the sensitivity, specificity of CA125, procollagen type III and the risk of malignancy index to differentiate between benign and malignant ovarian tumors. Using a cut-off level of 55 mIU/l for CA125 sensitivity was 83.3% and specificity was 88.9% and for procollagen type III using 11 ng/l as a cut-off level the sensitivity in detecting ovarian cancer was 76.7% with a specificity of 90.5%, while using a cut-off value of 200 the risk of malignancy index showed a sensitivity of 86.67% with specificity of 92.5%. In conclusion, although both CA125 and procollagen type III showed a reliable sensitivity for detecting ovarian cancer, the risk of malignancy index was superior in diagnosing ovarian cancer among patients with ovarian mass

Cardiopulmonary evaluation before and after gastroplasty for morbid obesity

This work was conducted to evaluate cardiopulmonary performance before and after gastroplasty in morbid obesity. Fifteen male patients with morbid obesity were included in this study. The results showed a significant reduction in body weight of about 38% and there was about 31% reduction in BMI after surgery. The improvement in VC [L] and MVV was statistically significant. The parameters of exercise tolerance were improved after surgery. The power attained at maximal exercise was significantly increased after surgery. It was concluded that vertical band gastroplasty was followed by a marked reduction in body weight with a subsequent improvement in pulmonary function, exercise tolerance, ventilatory reserve as well as cardiac reserve

new sling operation for the treatment of genital prolapse in young females

A review of 26 cases of genital prolapse in women less than 35 years of age is presented. Twenty [77%] of the women were less than 30 years of age and six [23%] were less than 25 years. All the patients had primary symptomatic prolapse and five [19%] of them were unmarried. The new abdominal sling operation was performed on all of them. In the beginning, sling was made from the rectus abdominis sheath and from January 1992 [for the last 10 cases] only mersilene mesh or tape was used as a sling to avoid recurrence of genital prolapse

clinicopathological analysis of ovarian tumours

We performed a retrospective analysis of patients with ovarian tumors who were admitted to the Aga Khan University Hospital from January 1985 to December 1989. Sixty one cases were reviewed. Mean age of the whole group was 44 years. Majority of the patients presented with abdominal pain and distention. Most frequent physical finding was a palpable mass on pelvic or abdominal examination. Overall these patients had a higher incidence of breast cancer than expected in the general population. Two-thirds of the tumors were malignant. Comparison of the patients with malignancy against those with benign tumors failed to show any correlation with parity. Majority of the patients with malignant disease were above forty and had ultrasound showing a cystic mass over 10 cms in size. Cancer was mostly epithelial in origin, with widespread disease [stage III or IV] at the time of presentation. Benign tumors, mostly of germ cell type, were predominantly seen in patients under the age of forty with ultrasound showing cystic mass of any size from under 5 cms to over 10 cms