Spontaneous intracranial hypotension: an interesting cause of intractable headache

Intracranial hypotension [ICH] is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history and characteristic imaging findings. Further confirmation by Lumbar Puncture to document low CSF pressure is necessary in some cases. Treatment is mainly conservative. However, surgical intervention might be required if conservative measures fail. In this report we present a case of 42 year old male patient who presented with symptoms of orthostatic occipital headache of three months duration and was subsequently diagnosed with Intracranial Hypotension based of characteristic MRI findings

Cystic biliary atresia: why is it important to distinguish this from congenital choledochal cyst?

We present a 2-month-old jaundiced infant with a rare type of biliary atresia who appeared to have a choledochal cyst on magnetic resonance cholangiopancreatography [MRCP] and ultrasound. Intra-operative findings were the only proof of biliary atresia. Following portoenterostomy, the liver function tests [LFTs] and bilirubin levels were returned within normal range and his jaundice was resolved. Any neonate presenting to a pediatric clinic with prolonged jaundice lasting more than two weeks, especially in cases of direct hyperbilirubinemia, must be thoroughly assessed and referred as early as possible for a pediatric surgical opinion to rule out the possibility of biliary atresia

Pelvic floor electrophysiology patterns associated with faecal incontinence

Pelvic floor electrophysiological tests are essential for assessment of patients with faecal incontinence. The present study was conducted to determine the patterns of pelvic floor electrophysiology that are associated with faecal incontinence. The present study included 40 patients with faecal incontinence and 20 apparently healthy subjects as a control group. All patients were subjected to history taking, clinical examination, proctosigmoidoscopy, anal manometry and electrophysiological studies. Electrophysiological studies included pudendal nerve motor conduction study, pudendo-anal reflex, needle electromyography of the external anal sphincter and puborectalis muscles, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The control group was subjected to electrophysiological studies which include pudendal nerve motor conduction study, pudendo anal reflex, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The most common pelvic floor electrodiagnostic pattern characteristic of faecal incontinence was pudendal neuropathy, abnormal pudendo-anal reflex, denervation of the external anal sphincter and puborectalis at rest, incomplete interference pattern of the external anal sphincter and puborectalis at squeezing and cough and a localized defect in the external anal sphincter. There were characteristic pelvic floor electrodiagnostic patterns for faecal incontinence

Impact of different nursing interventions on nocturnal enuresis of school age children

The aim of this study was to investigate the impact of different nursing interventions on nocturnal enuresis of school age children. A convenient sample of 100 school age children suffering from mono-symptomatic nocturnal enuresis and their parents who attended the outpatient clinics of pediatric and Urology departments at Assiut University Hospital included in the study. The subjects were randomly assigned into four groups: group [I] received motivational interventions, group [II] received motivational and bladder-training interventions, group [III] received motivational interventions and used enuresis alarm and group [IV] received drug therapy. Data was collected through interview using a structured questionnaire sheet and a calendar where the parents sign in front of the wet nights. Instructional handouts about the different interventions were developed and given to children and their parents. Children were followed for three times. The study revealed that children who received motivational and bladder training interventions had significantly the highest prevalence of cure followed by those received motivational intervention and used enuretic alarm, then those who received motivational intervention only. Children who were on drug therapy had the lowest cure percent throughout the study period and the highest relapse rate at six months. The present study concluded that the combination of motivational and bladder training interventions were superior to enuresis alarm and the drug therapy. Combined nursing interventions should be encouraged in the management of children with nocturnal enuresis

Orfxin A level and its relation to sleep disorder among chronic renal failure patients on maintenance hemodialysis

Dialysis patients frequently complain of insomnia, excessive daytime sleepiness, restless leg syndrome and sleep apnea. Uremia is considered as a major factor for developing sleep disorders in chronic renal failure patients. The aim of this work was to study the types of sleep disorders found in uremic patients on maintenance hemodialysis and to try to find the possible role of orexin A in the development of these sleep disorders. This study included forty subjects classified into three groups. Group I [n=20], included those patients with chronic renal failure on maintenance hemodialysis. While group II [n=10] included those patients with chronic renal failure in predialysis stage. and compared with 10 age and sex matched control subjects [group III]. All subjects were subjected to full history taking and complete clinical examination and routine laboratory tests. Overnight polysomnographic study in a specialized sleep lab was done for all subjects. Serum orexin A levels were assayed for all subjects by commercial Kit by EIA. Polysomnographic data in uremic patients, compared with control group showed significant rise in sleep onset and arousal index. Also sleep efficiency and deep sleep were significantly reduced in uremic group of patients. Restless leg syndrome was prevalent in uremic patients with significant increase of limb movement index than in control group. There was no significant difference between patients on hemodialysis and predialysis patients in most sleep parameters. Serum orexin A level was significantly higher among uremic patients compared to the control. Serum orexin A level showed significant positive correlation with arousal index and significant negative correlation with sleep efficiency in the two uremic groups. It was concluded that several sleep disorders as insomnia and restless leg syndrome are prevalent among uremic patients. High serum orexin A level may play an important role in the development of these sleep disorders which did not show any improvement with the conventional hemodialysis