[Low-pressure] variant of idiopathic intracranial hypertension: a unique subtype of chronic daily headache

Headache, papilledema and elevated CSF pressure above 200 mm H2O [250 mm H2O in obese patients] in a patient with normal neurological examination and neuro-imaging meet the international headache society [IHS] diagnostic criteria for idiopathic intracranial hypertension [IIH]. However variants of the classic syndrome have been reported i.e apapilledimic [without papilledema] and pure ophthalmic [without headache]. The aim of this study was to investigate a series of patients with refractory chronic daily headache [CDH] without papilledema, and with borderline CSF pressure [160-200 mm H2O in non-obese patients; 160-250 mm H2O in obese patients] to highlight their clinical, and neuroimaging findings. Twenty five cases with refractory chronic daily headache [CDH] who presented at the neurosurgery and neurology outpatient clinics were included in the study. All patients were evaluated clinically and radiologically and CSF manometry was recorded. All patients had unclassified chronic daily headache, visual field defects, a partial empty sella on imaging studies and borderline CSF pressure [160-200 mm H20 in non-obese patients; 160-250 mm H2O in obese patients]-. The majority of patients showed headache improvement after treatment with medications that lower intracranial pressure in combination with their conventional headache therapy regimens. The constellation of chronic daily headache, field defects, a partial empty sella and borderline CSF pressure in a patient with normal neurologic examination may constitute a [low-pressure] variant of idiopathic intracranial hypertension

Prediction of visual acuity improvement after intravitreal, triamcinolone acetonide injection in cases of diffuse diabetic macular edema

This study aims at identifying which factors affect the visual improvement following intravitreal triamcinolone acetonide [IVTA] injections. This is important in order to avoid injection of cases with expected poor improvement. 62 eyes with diffuse- diabetic macular edema of 48 patients were received IVTA injections of 4 mg. Visual acuity assessment, Fluorescein angiography and measurements of macular thickness by Optical Coherent Tomography [OCT] were done before and 3 months after injection. The data are collected and statistically analyzed. Visual improvement was found to he affected by the pre- injection macular thickness, macular ischemia, duration of visual loss, previous laser treatment. Age of the patient did not show significant influence on the degree of improvement of vision. The effect of IVTA can be expected by meticulous preoperative assessment. This is important in order to avoid useless injections

Some sociodemographic and lifestyle factors associated with primary arterial hypertension: a hospital-based case control study

This hospital-based case control study was conducted in Al-Azhar University hospitals, Cairo, Egypt, to examine the association of some sociodemographic and lifestyle factors with primary arterial hypertension. The sociodemographic and lifestyle data were collected from cases and controls by interview questionnaire. Risk estimates were generated by applying logistic regression methods to 193 cases and 200 controls aged 41-63 years. The analysis revealed the risk of primary hypertension to increase with increased age, male gender and moderate family income. Furthermore, adjusted risk of primary hypertension was significantly increased among smokers [OR = 1.75; 95% CI = 1.01-2.97], particularly among heavy smokers who reported more than 20 pack years of smoking [OR- 1.90; 95% Cl = 1.00-3.77], sedentary life subjects [OR = 1.90; 95% CI = 1.15-3.02], and among those drinking more than 3 glasses of black tea/day. Additionally, stratified analysis revealed more effect of smoking pack years and consumption of black tea on the risk of stage II hypertension. These results suggest that increased age, male gender and moderate level family income, smoking, sedentary life and black tea drinking are risk factors of primary hypertension in Egyptian population. However, these findings need to be verified in larger confirmatory population-based studies

Evaluation of ocular surface cytological changes in jaundice

The aim of our work is to evaluate any cytological changes in the ocular surface in Jaundice. Thirty patients with Jaundice due to different causes were included in this study. All cases were from Ain-Shams University Hospital, outpatient clinic, of different age group and of the same social class. Full ophthalmological and Physical examination were done for each patient, in addition to conjunctival Impression C'ytology technique to roll out any Cytological Changes. All data were recorded. Thirty Jaundiced patient were included in this study, with Peak age 31, of the same social class and of different sexes. Full physical examination revealed presence of constitutional symptoms with different mode of onset and with presence of mild abnormalities in general examination in some cases. Full ophthalmological examination revealed no abnormalities other than the yellowish discoloration of the sclerae and conjunctiva. Impression cytology shows a striking criterias in the cytological picture. Impression cytology is a useful tool to find out any ocular surface cytological changes to avoid complications

Transuethral injection of botulinum A toxin into the urethral sphincter in patients with functional bladder outlet obstruction

Botulinum A toxin [BTX-A] injection into the external urinary sphincter has been reported in men with detrusor-sphincter dyssynergia [DSD] in few recent studies. Botulinum A toxin injection into external urethral sphincter to paralyze it and to relieve urethral obstruction was reported as a new mode of treatment to reduce infra-vesical resistance in cases of functional obstruction. The present study investigated the effect of injection of Botulinum A toxin into the external urinary sphincter to improve voiding in patients with functional bladder outlet obstruction. 7 patients [78%] showed a significant subjective and objective improvement in voiding patterns compared to that of their pre-operative condition. Botulinium toxin injection is a safe, reversible, conserative option in the treatment of functional infra-vesical obstruction. The effect of the toxin is of short-duration and requires successive injections before reaching a satisfactory long-term improvement in voiding pattern

H. pylori stool antigen [HpSA]: anew simple test for detection of infection

Thirty patient with duodenal ulcer who underwent upper gastrointestinal endoscopy were selected for assessment of HpSA immunoassay test in detection of H.pylori infection [16 male [53.3%], 14 female [46.7%] mean age 42 +/- 1 year]. Patients with previous surgery, use of antibiotics, proton pump inhibitors or any compound containing bithmus up to one month before study were excluded. All patients were assessed clinically, upper endoscopy and biopsies from antrum were taken for urease test and culture, blood samples were analyzed for H.pylori IgG antibodies by ELIZA. Stool samples were taken for HpSA immunoassay using [Medridian-Diagnostic-inc-cinncina oH immunoassay]. From the 27 patients diagnosed by culture as H.pylori positive, urease test detected 96%, IgG antibodies were positive in 93% and HpSA immunoassay detected 70%. The sensitivity and the specificity of HpSA test in comparison to culture were 70.4% and 100% respectively and to urease test were 73.1% and 100% respectively. HpSA immunoassay test is simple rapid non invasive, specific test for detection of H.pylori infection

Laparoscopic versus conventional surgical treatment of genuine urinary stress incontinence

To compare laparoscopic versus the classical open colposuspension in surgical treatment of GSI. The study was conducted on 20 patients diagnosed to have GSI. P re-operative evaluation entailed stress test, Q-tip test and urodynamic study including combined cystometry and pressure flow study. Ten cases were subject to laparoscopic Burch colposuspension using non-absorbable suture between Cooper's ligament and vaginal vault. Ten cases were subjected to classical open Burch procedure. Post-operative evaluation was done. Clinical and urodynamic tests were rechecked one month after surgery. Operating time was significantly longer in laparoscopic group [3.25 hours] as compared to open group [1.25 hours]. One case of bladder perforation was recognized intraoperatively in laparoscopic group. Analgesic requirement was significantly less in laparoscopy cases. Hospital stay was found to be significantly shorter in laparoscopic group [4.8 days] than in open group [8.1 days]. Two cases of wound infection were reported in cases of open group. Urodynamic studies revealed comparable results in both groups one month after operation, all in favour of restoration of normal continence. One case [10%] of recurrence was found in each group. Laparoscopic Burch colposuspension is a safe and effective procedure for GSJ. Laparoscopic approach provides better visibility, more precise haemostasis, less post-operative discomfort, quicker recovery and shorter hospital stay

Evaluation of urethral pressure parameters before and after correction of anatomical support loss in patients with genuine stress incontinence

This study has been carried on 22 patients with genuine stress incontinence, the patients were subjected to history taking, clinical examination, laboratory investigations, and urodynamic studies of urethral pressure parameters before and after correction of the anatomical support loss, to evaluate these parameters. During follow up four weeks after operation, no subjective or objective findings could be detected in all patients. The postoperative functional urethral length was significantly changed, with definite improvement, while MUP, MUCP had insignificant increase after operation. However, the leak point pressure became higher postoperatively more than preoperatively. Also the pressure difference during stress was positive in 13 patients [59.1%] and negative in 9 patients [40.1%] while postoperative the pressure difference during stress was 100% positive in 22 patients It was concluded from the present study that the urodynamic studies are an essential part of the investigative sequence required to make an accurate diagnosis and allowed a more rational approach to treatment

Etiological factors in urinary incontinence in elderly female patients

Thirty incontinent women [above 60 years] were evaluated by full history, physical examination, voiding diary and full urodynamic studies. Another, 10 post menopausal women were studied as a control. Urodynamic data did not correlate with patient's symptomatology. No significant abnormal urodynamic data were encountered in control group. Females with urge incontinence showed detrusor instability in 53.8%, hypocompliance in 46.2% and higher level of infravesical urethral resistance than other types of incontinence, genuine stress incontinence was present in only 13.3% of patients, the above data point to the importance of studying elderly incontinent females urodynamically to establish the exact underlying defect

Excimer laser photorefractive keratectomy in low and medium myopia

In this study, we analysed the refractive results and complications obtained in 430 myopic eyes having myopia less than -9.00 diopters and treated with excimer photorefractive keratectomy. All eyes were treated with excimer laser Aesculap-Meditec MEL - 60 utilizing the program of tapered transitional zone [TTZ]. Patients were followed up for 2 years after the surgery. In the group of low myopia [less than-6.00 diopters]; a refractive result between 0 and-1.00 diopters was adchieved in 81.91% of treated eyes, while in the group of medium myopia [-6.00 to -9.00 diopters] this result was obtained in 77.68%. The predictability of the technique in the correction of myopia lies between 84.04% in low myopia and 78.51% in medium myopia. The obtained results along with their stability with time and low incidence of complications make excimer laser PRK the technique of choice for surgical correction of myopia till -9.00 diopters

Lateral rhizotomy and inverted papilloma of the nose: a conservative approach

The inverted papilloma is a nasal lesion long associated with controversy: while its pathogenesis remains uncertain its neoplastic character and natural history have been well defined, Its tendency towards recurrence and its association with malignancy have been established in many studies. This paper presents our experience in dealing with this condition. The basic approach has been a lateral rhinotomy. Polytomography and C.T. scanning are very important diagnostic aids