role of electro-diagnosis and therapy in management of fecal incontinence secondary to anorectal congenital anomalies

To assess the diagnostic and prognostic role of electromyography [EMG] of the external anal sphincter and pelvic floor muscles in children born with anorectal anomalies. Also, we tried to assess the role of electric stimulation to the sphincter muscles when applied pre and/or postoperatively in the control of fecal incontinence in those children. Eighty children with congenital anorectal anomalies and ten normal children who served as a control group were enrolled to the study. All were subjected to EMG assessment of the puborectalis [PR], external anal sphincter [EAS] and levator ani [LA]. Accordingly patients were divided into: Group I: Patients with normal EMG subjected to surgery, [posterior sagittal anorectoplasty] and EMG assessment after surgery. Group II: Patients with reduced electric activity of EMG. They were subjected to pre and postoperative electric stimulation and EMG before and after electric stimulation with postoperative EMG assessment. Group III: Patients with reduced EMG; they were operated with no electric stimulation with post-op. EMG assessment. Group IV: Patients with post operative fecal incontinence before being included in the study they were subjected to electric stimulation and post electric stimulation EMG assessment. EMG- showed a reduced value of the mean amplitude/turn [M] and number of turns/sec [T] value in the clinically weak muscles. M value was a more sensitive EMG parameter than T value in assessment of sphincter muscle activity. Electrophysiological stimulation showed significant clinical and EMG improvement in the studied groups in the PR, EAS and LA muscles. EMG can be a good diagnostic and prognostic measure in the assessment of EA, PR and LA muscles. Electric stimulation had a valuable role in strengthening the sphincteric muscles before and after correction, especially if combined, and in the conservative management of older incontinent children

Psychiatric disturbances in rheumatoid arthritis

To study the pattern of psychiatric syndromes that may accompany Rheumatoid arthritis [RA] and their relationship to disease activity, severity, pain and disability. Also, to find out the impact of stressful life events on the same parameters of the disease. The study comprised forty RA patients and 20 apparently normal controls. They were subjected to thorough medical history taking, clinical examination, laboratory investigations, disease activity, spread severity index, functional assessment with the Health Assessment Questionnaire Score, the Social Readjustment Rating Scale [SRRS] and identification of psychiatric disorders using the International Classification of Diseases [ICD,-10] symptom checklist for mental disorders. The prevalence of psychiatric disorders was significantly higher in RA patients than in the control group [p<0.05]. Depressive disorders were the most prevalent of these disorders. The Social Readjustment Rating Scale was significantly higher in RA patients than in the control group [p<0.001]. Also RA patients with psychiatric disorders were found to have higher SRRS than those not suffering from psychiatric disorders [p<0.05]. The stressful life events were found to have a strong impact on disease activity and pain in RA patients. Depression was the most common psychological disturbance associated with RA. This study highlights the role that the rheumatologist can play in the early detection of psychiatric disorders and psychiatric consultation in the proper time. In addition, it should be emphasized that the psychosocial effects of RA should always be put in mind and treated as a part of the illness

Prediction of functional outcome of obstetric brachial plexus palsy

The aim of this work was to identify parameters that might improve the prediction of recovery of obstetrical brachial plexus palsy [OBPP]. Twenty-four OBPP children were included in this study. They were classified into 4 groups: C5-6, C5-7 and C5-T1 without and with Horner's syndrome. Clinical evaluation was done every 3 months and follow-up until the age of one year using the following methods: 1- Hospital for sick children [HSC] grading system: where elbow flexion elbow, wrist, finger and thumb extensors were evaluated. Score 3.5 or more at 3 months is with good prediction of outcome at final assessment. 2- Shoulder function assessment according to Mallet where, global abduction, global external rotation, hand to neck, hand to spine and hand to mouth were evaluated. 3- Hand function grading after Raimondis [6 grades]. 4- Functional recovery good or poor after Mallet. Group I comprised 8 patients, group II 6 patients and groups III and IV 5 patients each. Four [16.6%] patients recovered completely. Two [8.2%] patients had persistent deficit with no treatment and reasonable functions. Seven patients [29.16%] needed a second operation. Eleven patients [45.83%] were operated upon for primary plexus repair; 5 of them were in group IV [all patients]. The HSC system was more than 3.5 in 7 patients at the age of 3 months. All showed good prediction according to HSC at final assessment. In two patients in whom HSC showed a score less than 3.5 improvement occurred at 6 months of age. Shoulder function assessment more than 2 and hand grade more than 3 was with good prediction. The functional recovery system is not suitable for prediction of recovery. From this study we can recommend using for group I and II [3.5 or more] HSC scoring system at 6 months of age together with shoulder function system 2 grade or more. And for group III and IV, abduction of grade 2 and grade 3, hand function or more. Also it is recommended to use functional recovery system graded good, moderate and poor where. Good: Complete recovery or elbow range of motion >90[0] with M3 or higher biceps. And shoulder abduction > 120[0] with external rotation > 25[0]. Moderate: Shoulder abduction <120[0] and weak external rotation. And elbow range of motion >90[0] or biceps power >M2. Poor: Biceps less than M2 or elbow range of motion < 90[0] or absence of recovery

Mast cells in rheumatoid synovial tissue with electron microscopy

The aim of this study was to search for the presence of mast cells in the synovial tissues of rheumatoid arthritis [RA] with electron microscopy in a trial to understand the pathogenesis of the disease. Synovial tissues were obtained from 10 RA patients. The presence of mast cells was examined with electron microscopy. The presence of mast cells was not demonstrated in the synovial tissues of RA with electron microscopy. Electron microscopy is not a suitable method for demonstrating the presence of mast cells in the synovial tissue of RA patients

Cytokine pattern in peripheral blood of early and chronic rheumatoid arthritis

In rheumatoid arthritis [RA], a T [helper] 1 Th1 cytokine profile [interleukin-2, interferon-gamma, tumor necrosis factor-beta] has been described to be dominant over Th2 cytokines [IL-4, 5, 13, 10] in peripheral blood. This profile is not always fixed and it changes with disease activity, but whether it can change over time is not well known. We investigated Th1 [INF-gamma]/ Th2 [IL-10] cytokine balance in early and chronic RA patients for better understanding of the relation of cytokine balance to disease duration and activity. Twenty chronic RA patients and twenty early RA patients of less than one-year disease duration were evaluated for disease activity. INF-gamma and IL-10 were assessed in peripheral blood by stimulated mononuclear cells and ELISA techniques in patients and in twenty healthy controls. Early RA patients were characterized by a significant elevation of INF-gamma [p<0.001] that correlated with disease activity, and INFgamma/IL-10 ratio was 4.7. On the other hand, chronic RA patients were characterized by a significant elevation of IL-10 [p<0.001], which correlated with disease activity and duration, and INFgamma/IL10 ratio was 1.45. There was a significant difference in the cytokine pattern between early and established RA cases that probably reflects differences in the pathogenesis and consequently affects diagnosis and therapeutic interventions according to the phase of the disease

Back pain among Egyptian Doctors

Chronic back pain in one of the most important areas in the entire spectrum of disability. Occupational or job-related back pain due to mechanical stress factors is important. Two hundred doctors were included in this study. They were asked to fulfill a questionnaire format. Results showed that doctors are exposed to back pain where their job necessitates long hour of standing without real exercise. Changes of life style and daily exercises were recommended