The relation between serum levels of epidermal growth factor and necrotizing enterocolitis in preterm neonates / 소아과

PURPOSE: Necrotizing enterocolitis (NEC) is one of the most serious complications of prematurity. Many risk factors can contribute to the development of NEC. The epidermal growth factor (EGF) plays a major role in intestinal barrier function, increases intestinal enzyme activity, and improves nutrient transport. The aim of this study was to assess the role of epidermal growth factor in the development of NEC in preterm neonates. METHODS: In this study, 130 preterm neonates were included and divided into 3 groups, as follows: group 1, 40 preterm neonates with NEC; group 2, 50 preterm neonates with sepsis; and group 3, 40 healthy preterm neonates as controls. The NEC group was then subdivided into medical and surgical NEC subgroups. The serum EGF level was measured using enzyme-linked immunosorbent assay. RESULTS: Serum EGF levels (pg/dL) were significantly lower in the NEC group (median [interquartile range, IQR], 9.6 [2–14]) than in the sepsis (10.1 [8–14]) and control groups (11.2 [8–14], P<0.001), with no significant difference between the sepsis and control groups, and were positively correlated with gestational age (r=0.7, P<0.001). A binary logistic regression test revealed that low EGF levels and gestational ages could significantly predict the development of NEC. The receiver-operating characteristic curve for EGF showed an optimal cutoff value of 8 pg/mL, with 73.3% sensitivity, 98% specificity, and an area under the curve of 0.92. CONCLUSION: The patients with NEC in this study had significantly lower serum EGF levels (P<0.001), which indicated that EGF could be a reliable marker of NEC in preterm neonates.

Evaluation of ledipasvir plus sofosbuvir for treatment of compensated and decompensated HCV cirrhotic patients

Background: unlike human immunodeficiency virus [HIV] and hepatitis B virus [HBV], hepatitis C virus [HCV] infection is a curable disease. Current direct acting antiviral agent [DAA] targets are focused on HCV NS3/4A protein [protease], NS5B protein [polymerase] and NS5A protein. The first generation of DAAs includes boceprevir and telaprevir, which are protease inhibitors and were approved for clinical use in 2011. The cure rate for genotype 1 patients increased from 45% to 70% when boceprevir or telaprevir was added to standard PEG-IFN/ribavirin. More effective and less toxic second generation DAAs supplanted these drugs by 2013. The second generation of DAAs includes sofosbuvir, simeprevir and fixed combination medicines containing ledipasvir plus sofosbuvir and Viekira Pak. These drugs increase cure rates to over 90% without the need for interferon and effectively treat all HCV genotypes. With these drugs the "cure HCV" goal has become a reality. The aim of this study was to assess of ledipasvir plus sofosbuvir as treatment of HCV infection in patients with advanced liver disease including cirrhotic patients with child B and C

Patients and methods: in this prospective study, seventy five HCV PCR positive patients were classified into three groups according to child score. Each group included twenty five patients. All patients received ledipasvir plus sofosbuvir for six months. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg, alpha fetoprotein as baseline screening. HCV PCR done for all patients at end of treatment and three months later to detect sustained virological response [SVR12]. Patients with combined HCV and HBV infection, hepatic or extrahepatic malignancies and late child C were excluded

Results: showed that no statistical significant difference were detected in patients of group A as regard liver function tests before and after treatment and SVR12 achieved by 96%. Patients of group B showed significant statistical difference as regard liver function tests before and after treatment with SVR12 achieved by 88%. In patients of group C there were significant statistical difference in liver function tests with SVR12 achieved by 80%. Also there were clinical improvement in patients of group B and C after end of treatment

Conclusion: it could be concluded that there will be a dramatic improvement in HCV therapy followed the introduction of oral medicines that directly inhibiting the replication cycle of HCV. The combination pill contains a fixed-dose of ledipasvir 90 mg and sofosbuvir 400 mg, two direct-acting antiviral agents against HCV. Ledipasvir is an inhibitor of the NS5A protein, which is required for HCV replication. Sofosbuvir inhibits the HCV NS5B RNA-dependent RNA polymerase, which is also required for viral replication. Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form a pharmacologically active triphosphate that can incorporate into the HCV RNA. Ledipasvir plus sofosbuvir can be used safely in treatment of compensated and decompensated post hepatitis C liver cirrhosis. SVR12 can be achieved by 96% in patients with early cirrhosis [child A], 88% in patients with child B cirrhosis and 80% in patients with child C with subsequent improvement in liver functions

Motivation in self-regulated learning and learning strategies in self-regulated learning in relation to Academic procrastination among first year secondary school students

Purpose: The purpose if this study was to explore motivation in self- regulated learning and learning strategies in self- regulated learning in relation to Academic procrastination among first year secondary school students

Sample: 140 first year .secondary school students participated in this study. The consent of the participants was sought before they participated in this study. The majority of the participants were female 80 [57.0%] and the rest male 60 [43.0%]

Result: The result of a Pearson correlation analysis revealed that intrinsic goal orientation, task values, rehearsal, elaboration, meta cognitive self regulation, resource management strategies, organisation and critical thinking as self- regulated learning components that have significant negative correlations with academic procrastination. In addition, anxiety was found to have a significant positive correlation with academic procrastination. Extrinsic goal orientation and control of learning beliefs were not significantly correlated to academic procrastination

Hepatitis C virus in peripheral mononuclear cells in patients on regular hemodialysis

Background: Occult hepatitis C virus infection [OCI] was identified as Hepatitis C virus [HCV], characterized by undetectable HCV antibodies and HCV RNA in serum, while HCV RNA is detectable in liver and peripheral blood mononuclear cells [PBMCs] only. Nosocomial transmission in dialysis units maintains a higher prevalence of hepatitis C virus [HCV] infection in patients on maintenance dialysis than in the general population. HCV infection has a detrimental effect on survival in patients on maintenance dialysis and after renal transplantation. The excess risk for death in HCV-positive patients was partially attributed to chronic liver disease with its attendant complications, particularly hepatocellular carcinoma and liver cirrhosis

The aim of this study: was to evaluate the hidden infection of hepatitis C virus among regular hemodialysis patients in Bab Al Sharia University Hospital with negative ELISA and PCR by using PCR in mononuclear cells as a marker in the serum of these patients

Patients and methods:in this prospective study, 60 patients with end-stage renal disease on regular hemodialysis [for at least 6 months duration] were included. For all patients thorough medical history, clinical examination, kidney function tests, liver function tests, complete blood count, pelvi-abdominal ultrasound, HCVantibodies, hepatitis C viral RNA, quantitative, HbsAg,. HCV PCR done for all patients in serum and mononuclear cells.. Patients with acute or chronic HCV infection as marked by positive hepatitis C antibody,acute or chronic HBV infections marked by hepatitis B surface antigen,other causes of liver dysfunction [e.g., primary biliary cirrhosis, autoimmune hepatitis, HIV infection] and patient on anti HCV treatment.were excluded

Results: showed detection of HCV-PCR in PBMCs in the absence of HCV-PCR in plasma; was found in three of the 60 patients [3.3%]. All patients had negative HIV, HBsAg, HCV Ab and serum HCV PCR

Conclusion: it could be concluded that testing for HCV-RNA in PBMCs is more reliable than hepatitis serological markers in identifying patients with an OCI when a liver biopsy is not available

Comparison of endoscopic ultrasound and computed tomography for detecting and staging malignant pancreatic masses

Introduction: Endoscopic ultrasound [EUS] is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral computed tomography [CT] scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than endoscopic ultrasound guided fine needle aspiration [EUS-FNA], cheaper and, therefore, more frequently used In this study, we evaluated the use of EUS-FNA in comparison with spiral CT for detection and staging of malignant pancreatic massesMethods: This prospective study was carried in El-Ebrashi unit of Gastroenterology and Hepatology, Internal Medicine department, Cairo University over 3 years from 2011 to 2014. It included 68 patient with suspected pancreatic mass lesions based on abdominal ultrasound, CT or MRI and patients with obstructive jaundice due to common bile duct [CBD] stricture as proved by endoscopic retrograde cholangiopancreatography [ERCP] or Magnetic resonance cholangiopancreatography [MRCP]. The patients were subjected to dual phase pancreatic control multi-detector computed tomography [MDCT] to be followed by EUS-FNA, then cytopathological examination of the studied patients to determine the nature of pancreatic masses, normal and benign cases are followed up after 6 months by EUS for exclusion of malignancy

Results: The final diagnosis in this study was that, 61 patients were malignant and 7 benign cases. The sensitivity of CT was 75% compared to 100% for EUS. While the specificity for CT was 14% compared to 100% for EUS. The negative predictive value for CT was 6.25% compared to 100% for EUS. With an overall accuracy of MDCT was 69% compared to 100% for EUS for diagnosing pancreatic cancer. The sensitivity of CT for detection of small lesions

Conclusion: EUS is more accurate than CT for detection of pancreatic cancer especially in small tumors. EUS is more accurate than CT in staging of pancreatic cancer in early stages

Recommendation: Early diagnosis of pancreatic cancer is the most important step in the way of decreasing its mortality rate. For screening of patients with suspected pancreatic cancer, initially CT should be performed to be followed by EUS whether to exclude masses in negative CT patients or to confirm the mass and to provide a tool for sample/or cytopathological diagnosis in patients with positive CT We recommend a future study to correlate the accuracy of staging by EUS and CT with post-operative histopathological staging

Uric acid metabolism in a sample of Egyptian hypertensive patients with normal kidney function

Hyperuricemia is commonly associated with hypertension. Also, it is well known to coincide with the metabolic syndrome but is still not recognized as a risk factor. So, we aimed to evaluate hyperuricemia among a sample of hypertensive Egyptians with normal renal function. This study was performed on 303 hypertensive patients aged 30-69 years. Patients were divided into 2 groups according to the level of uric acid: group 1 composed of 168 hypertensive hyperuricemic patient sand group 2 composed of 135 hypertensive normouricemic patients. All patients were subjected to complete medical history and detailed clinical examination including body mass index [BMI], complete blood count [CBC], serum creatinine, BUN, FBS, cholesterol, triglycerides, uric acid, sodium, potassium, urinary uric acid, urinary creatinine, urinary uric acid to creatinine ratio and fractional excretion of uric acid[FEUA]. The overall prevalence of hyperuricemia was 55.4%. Uric acid correlated significantly with age [p<0.05]. BMI was significantly higher in group1 than in group 2 [p<0.05], and there was a significant positive correlation between serum uric acid and BMI [p<0.01].Serum triglycerides and cholesterol were significantly higher in group 1 than in group 2 [p<0.05for both] denoting risky metabolic effects. Serum uric acid correlated significantly with systolic blood pressure [p<0.05], but not with diastolic blood pressure. No significant difference found between group 1 and group 2 as regards SBP, DBP or blood pressure control [all p values > 0.05]. Serum uric acid found to correlate significantly [p<0.001] with urinary uric acid, urinary creatinine and negatively with FEUA denoting early tubular defect of the kidney. Also, Urinary uric acid, urinary creatinine and urinary uric acid/creatinine ratio were higher in group 1than in group 2 [p values were<0.001, <0.001 and <0.05 respectively]. FEUA was found to be significantly lower in group 1 than in group 2 [p<0.01]. We found, also, that serum sodium level was significantly higher in the hyperuricemic group than in the normouricemic group [p<0.001] denoting the role of Na[+] in the development of hypertension and defective renal excretion of uric acid. We conclude that the incidence hyperuricemia in our sample of Egyptian hypertensive patients was [55.4%]. Impaired renal clearance of uric acid occurs before deterioration of GFR. Serum uric acid should be measured in all cases of hypertension together with BMI, total cholesterol, triglycerides and should be treated to avoid consequent metabolic complications. Hypertensive patients with hyperuricemia should be warned strictly of high sodium diet

Impact of hyperuricemia on cardiovascular system in ESRD patients

Hyperuricemia was found to be associated with hypertension, coronary heart disease, metabolic syndrome and chronic kidney disease. However there are no specific data about the relationship of uric acid to cardiovascular disease and mortality in ESRD patients on chronic hemodialysis. So, we aimed to study the impact of hyperuricemia on cardiovascular system in chronic kidney disease and in ESRD patients on regular hemodialysis. This study included 100 patients in Ashmoun hospital, nephrology department. Patients were chosen and divided into two groups: Group A, 50cases with chronic kidney disease and Group B, 50cases of ESRD on regular hemodialysis. All cases were subjected to full clinical examination, measurement of eGFR, laboratory tests for blood urea, serum creatinine and serum uric acid and ECG. Serum uric acid was significantly higher in dialysis group than CKD group [p<0.01]. There was a highly significant correlation between uric acid and both systolic and diastolic blood pressure in Group A [all p values <0.01]. Also, there was a significant correlation between serum uric acid and eGFR [p<0.05].No significant difference found between Group A and group B as regards ECG findings [p>0.05]. In cases of CKD uric acid is involved in the pathogenesis of renal failure and hypertension. In patients with ESRD, hyperuricemia is not a risk factor for the development of cardiac disease; but it shows reversed epidemiology and becomes a marker of good nutritious status. Further studies should be done on wider scales to evaluate the impact of hyperuricemia on cardiovascular system in hemodialysis patients

Accuracy of multidetector computed tomography coronary angiography in the diagnosis of coronary artery disease

The standard of reference diagnosis of CAD is the conventional coronary angiography. However its invasive nature necessitates a new non-invasive imaging modality. MSCT coronary, angiography is a new development non-invasive technique in the diagnosis of coronary disease. The aim of this study is to investigate the accuracy of 64-slice CT coronary angiography for assessing coronary artery disease in comparison with conventional coronary angiography. The study included 45 patients out of 50 patients with suspected coronary, artery disease underwent both MSCT coronary angiography and conventional coronary angiography. The total sensitivity and specificity of MSCT coronary, angiography were 99% and 94.5% respectively and the overall accuracy was 95.5%. The negative predictive value was 97.5% while the positive predictive value was 83.5%. Non-invasive CT angiography of the coronary arteries can diagnose and exclude hemodynamically significant coronary stenoses with high accuracy

Mirazid in treatment of three zoonotic trematodes in Beni-Sweif and Dakhalia governorates

A total of 60 patients with schistosomiasis [40], fascialiosis [15] and heterophyiasis [5] were selected Beni-Swejf and Mansoura Districts and subjected to history taking, clinical examination, Kato thick smear, sedimentation and hatching test [for schistosomiasis cases] at the beginning of the study, 2 and 3 months after treatment with Oleo-resin of Myrrh [Mirazid] in a dose of 10mg/kg/day for 6 consecutive days an hour before breakfast. The results showed a significant improvement in symptoms with minimal negligible or no side effects. The cure rates, 2 and 3 months after treatment were 80.7% and 11.8% for schistosomiasis, 93.3% and 6.6% for fascioliasis, and 100% for heterophyiasis. The clinical picture of schistosomiasis before treatments were easy fatigability, anorexia, nausea, vomiting, epigastria pain, abdominal distention, right upper guardant pain, colicky abdominal pain, left upper andlor lower guardant pain, abdominal rumbling, dysentery, diarrhea, rectal bleeding, constipation, and alternating bowel habit. Those of fascioliasis were abdominal distention, dripping of saliva, right upper guardant, colicky abdominal pain, weight loss, easy fatigability, intermittent jaundice, anorexia, nausea, vomiting, epigastria, left upper and/or lower quadrant pain, right layer quadrant pain, loin pain, abdominal rumbling, diarrhea, constipation, and alternating bowel habit The safety and efficacy of C. molmol extract in treating heterophyiasis [100%], fascioliasis [100%] and schistosomiasis [92.5%] were documented

Histopathological lesions of apparently normal skin in leprosy patients

This study was carried out on 50 patients with different clinical types of leprosy 38 males [76% and 12 females [24%], ages ranged from 14 -70 years with a mean age +/- SD 49.22 +/- 12.97 years. Mean disease duration was 5.65 years +/- SD = 9.27 selected to study a group of leprosy patients and compare the clinical parameters with histopathological findings and bacteriologic status of the skin to evaluate the relevance of their patients. Patients were subjected to full medical history taking including disease duration, type and duration of previous or current therapies. Complete clinical examination, for the determination of the clinical type of leprosy. Skin slit smear [SSS] and skin biopsies were taken and examined after staining for histopathological assessment and Acid fast bacilli [AFB]. SPSS package version [statistical Package for Social Sciences] was used for data analysis. The biopsy of normally looking skin showed classic histopathological features of leprosy in more than half of the cases [26 cases, 52%]. The histopathological types of leprosy diagnosed in such cases were as follows: indeterminate leprosy [IL] in 4 cases [15.38%], Tuberculoid leprosy [TL] in 2 cases [7.69%], Borderline tu-berculoid [IL] in 4 cases [15.38], Borderline Borderline [BB] i.e Query in 8 cases [30.76%], Borderline Lepromatous [BL] in 7 cases [26.92%] and Lepromatous leprosy [LL] in a patient [3.84%]. Other 24 cases showed either no evidence of leprosy in [9 cases, 37.5%], or query findings [in the form of sweat gland changes either alone or in combination with thickened nerves and superficial and deep perivascular lymphohistiocytic infiltrate] in 15 cases [62.5%]. Histopathology of skin lesion biopsies showed TL in 3 cases [6%], BT in 8 cases [16%], BB in 8 cases [16%], BL in 14 cases [28%], LL in 12 cases [24%] and leprosy in reaction in 5 cases [10%]. In 16 cases [32%], histopathological type of leprosy detected by microscopical examination of biopsies from skin lesions differed from that diagnosed by clinical examination

Intravitreal bevacizumab [avastin] versus triamcinolone acetonide for treatment of diffuse diabetic macular edema

To evaluate and compare the anatomical [central macular thickness] and the functional [visual acuity] outcomes associated with a single intravitreal injection of bevacizumab [Avastin] versus triamcinolone acetonide for the treatment of diffuse diabetic macular edema. The study included 74 eyes [56 patients] with diffuse diabetic macular edema, which were randomized into 2 groups according to the line of treatment used; bevacizumab group [group B] and triamcinolone group [group T]. The inclusion criteria are diffuse diabetic macular edema with fluorescein angiography evidence and central macular thickness [CMT] of at least 400u as measured by OCT. All eyes were subjected to complete ophthalmic examination, including best corrected visual acuity [BCVA] with the logarithm of minimal angle of resolution [log MAR], lOP and fundus biomicroscopy. Fundus photography of the macular region, fundus fluorescein angiography and OCT were performed for all eyes at baseline. 1.SmgIO.6m1 of bevacizumab or 4mgIO.lml of triamcinolone acetonide was injected into the vitreous cavity using a 27-gauge needle inserted through the inferotemporal pars plana 3.5mm from the limbus Patients were scheduled for follow-up examinations at 1, 4, 8, 12 and 24 weeks postoperatively. The outcome measures are the changes in CMT, changes in BCVA and any reported complication. There was no significant difference between the baseline mean CMT and mean BCVA [log MAR] of both groups [p>0.05]. Four weeks following the intravitreal injecthin, there was significant improvement in the mean CMT of both groups, but the difference between both groups was not statistically significant. The mean BCVA [log MAR] was significantly improved in both groups [p<0.05]. At 12 weeks, the mean CMT was still better than baseline in both groups, but this improvement was significant in group T only. The difference between both groups was statistically significant [p < 0.05]. The mean BCVA [log MAR] was significantly better in both groups and this improvement was significantly better in group T also. At 24 weeks, the mean CMT has increased to approximate the baseline again with a corresponding deterioration in the mean BCVA in both groups. In group T, the mean TOP was increased throughout the study and the maximum increase was reported at the 4th week [p < 0.05]. In group B, no significant change in the mean TOP was reported during the follow-up period. A single intravitreal injection of triamcinolone acetonide may be associated with greater beneficial effects on vision and central macular thickness than a single intravitreal injection of bevacizumab for the short-term management of diffuse diabetic macular edema. However, careful monitoring of the TOP should be done in eyes receiving triamcinolone acetonide

Tethered spinal cord syndrome: neurosurgical and radiological assessment

MRI was utilized as a mean modality for assessing and diagnosis of tethered spinal cord syndrome. This study was conducted on twenty children 12 boys and 8 girls selected from pediatric neurology, urology and neurosurgery outpatient clinic at Al-Azahar University Hsopitals, Al-Sahel teaching hospital and Insurance Hospitals. They were complaining of urinary incontinence associated with other neurological deficit, four cases had past history of surgical closure of lumber meningocele during neonatal life. Plain lumbosacral radiography revealed scoliosis and straightening of lumber lordosis in all cases, spina bifida in 15 cases, sacral agenesis in 4 cases, calcified spinal spur in one case. MRI showed short thickened filum terminal in all cases, associated with anterior sacral meningocele in one case, diastematomyelia another one case, lumbosacral swelling in 5 cases and postoperative spinal adhesion in 4 cases. MRI is the most ideal imaging modalities, Neonatal spinal ultrasound are helpful. All cases underwent filum terminale division. Dural graft was done in 4 cases. Lipoma excision in 4 cases. Dermoid cyst excision in one cases. Dissecting the epidural scar adhesion in 4 cases. Wound infection was the commonest postoperative complication occurring in 5 cases. Postoperative outcomes showed urinary symptoms improvement in 15 cases and of the motor function in 14 cases. The choice of radiological imaging modalities and operative approach and result will be discussed

Surgical, radiological and histopathological studies of cases of superficial glioma in children

The clinical, Radiological findings and the Surgical results of 20 patients with superficial glioma in children who were operated in the period from March 2004 to September 2006, 12 boys and 8 girls aged from 8 months to sixteen years old [mean age 12 years]. The patients were presented to neurosurgery, neurology, and pediatric outpatients clinics at Al-Azhar University Hospitals and Al-Sahel teaching Hospital, with repeated attacks of partial complex seizures of different time of onset and progressive course as increase of frequency and prolonged duration of fits. The disease duration expressed between seven months and two years since time of onset. The most common presentation was epileptic fits in all cases, and focal manifestations and increased intracranial pressure were 16 cases. Papilledema was found in the 8 cases, hemiparesis and hemianesthesia of the contra lateral side of the tumor in 11 cases. The most common site of the tumors were temporal lobe 14 cases. Complete tumor removal was accomplished in 18 cases. The most common radiological and histopathological diagnosis among these group of patients of this study were Gangliogliomas 6 cases, and Gangliocytoma 5 cases. Comparative radiological studies between CT [Computerized tomography], MRI [Magnetic resonance imaging] and histopathology were evaluated. Sensitivity, Specificity and accuracy were 83%, 87% and 89% in CT and for MRI were 87.8%, 91.5%, 93.3% respectively. Transcortical approach were done in most cases, post operative radiation therapy was used in one patient. The choice of the radiological modalities, surgical approach, and result will be discussed

Midline posterior microendoscopic discectomy. Is it the future procedure of choice?

This is prospective study of 20 cases with solitary unilateral lumbar and lumbosacral disc prolapse were managed in Al-Azhar University Hospital, Ain, Shams University Hospital and Al-Sahel Teaching Hospital from January 2005 to January 2007. All the cases were operated by posterior midline microendoscopic discectomy procedure, utilizing microendoscopic tubular retractor system [METR'x] and Destandeau method. The postoperative clinical outcome was assessed according the MacNab's criteria. We assessed the factors which affect the outcome including the age, the value of clinical evaluation, pre operative MRI, degree of disc prolapse and duration of symptoms. Complication in the form of dural tear, discitis and superficial wound infection were recorded. We compare the result of our study to those reported in literature and the result of open microdiscectomy. Endoscopic lumbar discectomy is considered an alterative option of traditional open discectomy in appropriately well trained and experienced hands for appropriately selected patients

Evaluation of cerebrospinal fluid diversion procedures in treatment of pediatric midline posterior fossa tumors

Neurosurgeons still divided in their opinions concerning the best way to manage obstructive hydrocephalus secondary to posterior fossa tumors. Some authors proposed a preoperative indwelling cerebrospinal fluid shunt as the most advantageous method for the subsequent surgical approach to the tumor. Others proposed direct approach to the posterior fossa tumor, when possible, or external ventricular drainage, when necessary. This study aimed to evaluate the role of cerebrospinal fluid diversion procedures in treatment of hydrocephalus due to midline posterior fossa tumors in children. Eighty-eight patients were included in this retrospective study. They were classified into two groups: 22 patients operated for direct tumour attack without CSF diversion and 66 patients operated for CSF diversion before tumour attack. The later group was further subdivided into three subgroups according to the method of CSF diversion; V-P shunt, ETV, and EVD. This study carried out in the Neurosurgery Department, at Suez Canal University Hospital in the period between March 1995 and February 2005. The use of CSF diversion procedure was associated with improvement of hydrocephalus in 70% of patients while direct tumour attack was associated with improvement of hydrocephalus in 31% of patients. The best results were found in ventriculoperitoneal shunt [100%] followed by endoscopic third ventriculostomy [60%] then the external ventricular drainage [31%].The use of CSF diversion is beneficial in treatment of hydrocephalus due to midline posterior fossa tumour in children

study on cryptorchidism a comparison of histological finding in the germinative epithelium before and after the age of 2 years

Undescended testis is a common problem with high risk of infertility and cancer. Early surgical correction is important for prevention of those risks. In the last year 1999, multi-disciplinary projects were done between surgical, dermatological and pediatric departments aiming to re-explore the histological and morphological changes in cryptorchid testis and its relation to age. Twenty four [24] male patients were recruited from El-Minia University Hospital and were divided into 4 main groups. Group A included 6 infants under the age of 2 years; group B included 4 patients aged from 2-9 years [pre-pubertal]; group C included 6 patients aged from 9 to 14 years [pubertal]; and group D included 8 patients aged from 14 to 21 years [post-pubertal]. Orchiopexy was done for all patients in one stage and bilateral testicular biopsy was taken and fixed immediately in Baun's solution and then stained by H and E for histopathological preparations. Our results showed that, for boys under the age of 2 years, there was no change from the normal spermatogonia and Sertoli cells with no thickening of their basement membrane. In pre-pubertal children, we found that changes were evident by the age of 7 and 8 years in the form of decreased number of spermatogonia, delayed maturation of Sertoli cells, widening of interstitial spaces and increased number of fibroblasts in the interstitium. In pubertal patients, the spermatogonia became rare and Sertoli cells were immature. Biopsy specimens from post-pubertal patients showed marked reduction of spermatogonia and arrest of spermatogenesis at primary spermatocyte stage. We concluded that early correction of cryptorchidism is vital for preservation of testicular integrity and maintenance of fertility

Remifentanil versus esmolol for control of hyperdynamic responses during electroconvulsive therapy

Background: Electroconvulsive therapy [ECT] is usually accompanied by a cardiovascular response that can be dangerous in patients with cardiovascular disease. Aiming to attenuate the transient autonomic changes that occur in response to noxious stimuli of ECT and to facilitate prompt recovery, we designed this study to assess the effect of esmolol and remifentanil on the acute hemodynamic response and seizure duration during ECT

Methods: Twenty ASA 1-2 patients of both sexes, aged between 20-50 years, scheduled for ECT because of major depressive episode, were enrolled in the study. Every patient received six sessions at a rate twice weekly. Patients were randomized to receive either esmolol Irrig/kg IV or remifentanil 1 jig/kg IV before induction of anesthesia. A total of 100 ECT sessions were evaluated for heart rate [HR], systolic [SBP], diastolic [DBF], and mean arterial pressure [MAP]. Seizure duration was recorded both clinically using cuff method, and by a two-channel electroencephalograph [EEC]. Time to awakening and incidence of postoperative nausea and vomiting [PONV] were also recorded

Results: HR, SBP, and, MAP became significantly lower in esmolol group compared with remifentanil group [P-value<0.05]. There was no difference as regard DBP. Also, esmolol significantly shortened seizure duration measured clinically using cuff method, and by two-channels EEG compared with remifentanil group [P-value<0.05]. There was no statistically significant difference as regard awakening time [P-value>0.5] but incidence of PONV were more common in remifentanil group compared with esmolol group [P0.05]

Conclusion: Esmotel 1mg/kg IV bolus when compared with remifentanil 1 ug/kg IV bolus, it proved to be more effective in attenuation of acute hemodynamic response associated with ECT when just given before anesthesia. Inspire that both adjuvants provided a rapid emergence from anesthesia with few side effects, esmolol significantly reduced seizure duration and so, its routine administration may not be advisable because it can possibly interfere with the psychotherapeutic efficacy of ECT

Remifentanil versus magnesium sulphate for facilitation of laryngeal mask airway insertion

Background:The laryngeal mask airway is used to maintain airway during general anesthesia especially for short day-case procedures. A successful insertion of LMA necessitates adequate mouth opening that allows easy insertion of the mask and adequate depth of anesthesia to prevent adverse responses of coughing, gagging, and laryngospasm. The aim of this study was to compare remifentanil -propofol regimen versus magnesium-propofol regimen for induction of anesthesia for LMA insertion

Methods: Fifty ASA 1-2 patients of both sexes, aged between 18-55years who were undergoing short day-case procedures were randomized to receive a pre-induction of either IV bolus 0.3jiig/kg remifentanil, or IV bolus of 40mg/kg 10% magnesium sulphate. This followed by induction of anesthesia by IV bolus of 2mg/kg propofol followed by LMA insertion. Pre-induction[base line], post LMA insertion vital data [heart rate ,blood pressure, respiratory rate and oxygen saturation] and frequency of post induction apnea were recorded. The degree of jaw relaxation was assessed as relaxed or rigid and the degree ofease of LMA insertion was graded on three-point scale [gradel: easy, grade 2: moderately easy, and grade 3: difficult]

Results: There were no statistically significant differences between both groups as regards the pre-induction vital data. There were statistically significant differences between both groups as regards post-insertion heart rate, respiratory rate and oxygen saturation [P-value< 0.05] and there was no statistically significant difference between both groups as regards post-insertion blood pressure. In general both drugs effectively maintain stable post-LMA insertion vital data. Regarding the incidence of post induction apnea, it was higher in remifentanil group [56%] compared to [20%] in magnesium group. There were no statistically significant differences between both groups as regards jaw tone or patients graded as easy [grade 1] or moderately easy [grade 2] for insertion of LMA but there was statistically significant difference between both groups as regards those patients graded as difficult[grade 3] for insertion of LMA [P-value<0.05]

Conclusion: Both remifentanil-propofol and magnesium-propofol regimens weresuccessfully maintaining vital data stability during LMA insertion, facilitated LMA insertion, and prevented untoward events of coughing, gagging and laryngospasm. The incidence of post induction apnea was higher in remifentanil group compared to in magnesium group. However, the overall ease of LMA insertion was found to be higher with remifentani 1-propofol regimen in comparison to magnesium-propofol regimen. So, both regimens can be used for LMA insertion and the choice of any should be individualized according to the patient's health status

study on cryptorchidism, a comparison of histological finding in the germinative epithelium before and after the age of 2 years

In the last year 1999, multi disciplinary projects were done between surgical, dermatological and pediatric departments aiming to re-explore the histological and morphological changes in cryptorchid testis and its relation to age. Twenty four male patients were divided into 4 main groups; group A included 6 infants under the age of 2 years, group B included 4 patients from 2-9 years [prepubertal], group C included 6 patients from 9 to 14 years [pubertal] and group D included patients from 14 to 21 years [postpubertal]. Orchidopexy was done for all patients in one stage and bilateral testicular biopsy was taken and fixed immediately in Baun's solution and then stained by H and E for histopathological preparations. The results showed that for boys under the age of 2 years, there was no change from the normal spermatogonia and sertoli cells with no thickening of their basement membrane. For prepubertal children, changes were evident by the age of 7 and 8 years in the form of decreased number of spermatogonia, delayed maturation of sertoli cells, widening of interstitial spaces and increased number of fibroblasts in the interstitium. In pubertal patients, the spermatogonia became rare and sertoli cells were immature. Biopsy specimens from post-pubertal patients showed marked reduction of spermatogonia and arrest of spermatogenesis at primary spermatocyte stage

Active participation of the parturient in epidural analgesia is it worthy? [Comparative study between patient controlled and continuous infusion epidural analgesia]

This randomized, single blind, controlled study evaluated the efficiency of patient controlled epidural [PCEA] analgesia for obstetric management compared with continuous infusion epidural system. Fifty primigravidae were included in this study; 25 received continuous epidural analgesia [Group I] whereas 25 received patient controlled epidural analgesia [Group II]. Bupivacaine consumption was :13.8 mg/h +/- 1.3, in group I and 8.7 mg/h +/- 1.4 in Group II. Number of anaesthetist Top-ups were 34 in group I and 3 in group II. Better satisfaction score and pain score were reported in group II. The use of PCA device in group II led to significant decrease for syntocinon augmentation, significant decrease in the rate of instrumental deliveries, decrease in intrapartum pyrexia not associated with leucocytosis, decrease in duration of labour and decrease in blood loss. Active participation of the parturient in epidural analgesia [by use of PCA device] led to less local anaesthetic consumption/h, better pain control, better satisfaction score with significant lowering of anaesthetic and obstetric complications