Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

[Cigarette smoking and periodontal condition in Syrian adults]

Smoking is an important environmental risk factor that negatively affects periodontal tissues. The aim of this case-control study was to confirm the possible relationship between cigarette smoking and clinical periodontal parameters in Syrian adults within a private practice situation. 198 healthy adults, 20 to 72 years of age participated in this study. 98 smokers and 100 non-smokers, both groups were matched in age, sex and plaque level. Clinical measurements of plaque index, gingival index, probing depth, clinical attachment level and tooth mobility were recorded. Probing depth and clinical attachment level were significantly greater in smokers than non-smokers, whereas gingival index and tooth mobility did not show differences. It can be concluded that cigarette smokers are at increased risk for periodontal destruction

Roux-en-Y hepatico Jejunostomy versus end-to-end anastomosis for intraoperatively detected bile duct injuries

to compare the results of end-to-end anastomosis of common bile duct with T--tube drainage and Roux en-Y hepatico jejunostomy in the management of intra-operatively detected complete transection of common bile duct during cholecystectomy either open or laparoscopic. Prospective, study. Ain Shams University Hospitals and New Jeddah Clinic Hospitals. Sixteen patients with complete transection of C.B.D., divided into two groups. Eight patients managed by end-to-end anastomosis of C.B.D "group A", and eight patients managed by Roux-en-Y. Hepatico-jejunostomy "group B". Operative mortality, post-operative complications, liver function tests, biliary fistula, anastomotic dysfunction and reoperations. No operative mortality occurred. The post operative outcome of both groups were compared. Good long term results were obtained in group B in 87.5%.Early post operative complications and course were comparable in both groups but late stricture and anastomotic dysfunction were more frequent in group A. [37.5%]. Also re-operations were more frequent in groupA [50%]. Good long term results were obtained with Roux-en-y hepatico jejunostomy, it should be the mainstay of management in this context. Although end-to end anastomosis of C.B.D. provides optimal internal biliary drainage with a reasonable chance for cure, yet, it should be a second option in management of intra operatively detected complete transection of C.B.D

Early enteral immunonutrition after elective colorectal surgery: tolerance, clinical outcome and effect on duration of hospitalization

Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated, and some recent studies demonstrated the safety of early oral feedings. Also, with the growing interest in cost effectiveness of hospital care, true elevations of the economics of post operative complications after major abdominal operations and the duration of hospital stay are of increasing importance. To test the hypothesis that early post operative enteral feeding can be tolerated safely by patients after colorectal surgery and if an enteral diet supplemented with arginine, dietary neucleotides, and omega-3 acids started early post operatively will have an effect on clinical outcome i.e. reduced infections, wound complications and treatment costs, finally the effect of early post operative feeding on the duration of post operative hospitalization. 75 patients with elective colorectal surgery operated upon during the period from Jan 2000 till July 2003 at New Jeddah clinic hospitals [KSA] and Ain-Shams University Hospitals [Egypt]. All patients had intra operative orogastric tubes that were removed at the end of surgery. Clinical examination and adverse gastro intestinal symptoms were recorded on a daily basis. Infectious complications were defined as sepsis or systemic inflammatory response syndrome, pneumonia, urinary tract infection, central venous catheter sepsis, wound infections, and anastomotic leakage. The complication events were prospectively divided into two groups, early [post operative days. One to five], and late [after fifth post. Op day]. Post operative hospital stay was recorded for each patient in the study. No significant differences were noted in age, type of procedures, or in prior abdominal surgery in groups. Patients in group B [EF p] and group C [EF, imm] tolerated early enteral feeding well. No significant differences were seen in rates of nausea [24% in EF imm, 20% in EF p. and 20% in TF] or vomiting [16% in EF imm, 12% in Efp and 12% in TF]. One patient in EF p developed aspiration pneumonia, 2 patients developed anastomotic leakage one radiological in EF imm and one clinical in TF groups. in the early phase [post operative day one to five], infectious complications occurred to a similar extent in the three groups [5 patients in TF, 4 patients in EF p and 4 patients in EF imni]. However, in the late phase [after post op. day five], considerably fewer patients in group C experienced complications compared with other groups [2 in EF imm, 4 in Efp and 6 in TF1. Significant differences were observed in the length of post operative hospital stay between groups: Mean +/- SD 6.2 +/- 2.4 days in EF imm Vs 8.1 +/- 2.3 days in EFp and 12.3 +/- 3.3 days inTF. Early-oral feeding after elective colorectal surgery is safe. Most of the patients tolerated early feeding. In patients who received the supplemented diet, a significant reduction in the frequency rate of late post operative infectious and wound complications was observed and hospital post operative stay was significantly reduced in this group

[ incidence of complications and pain following periodontal treatment]

Both dentists and patient are interested to know the complications following periodontal therapy. The purpose of this study was to document this incidence following periodontal therapy carried out in a postgraduate periodontal clinic at Damascus university, and to identify factors that influence postprocedural pain. 214 patients between 18 to 57 years of age, most of them women [ 57,94% ] enrolled in this study. Pain was reported by 51,86% of the patients, which means they needed analgesics after the first post operative day. Infections were present in only 4 patients, two of them were under antibiotics. Females experienced significantly more pain than males after periodontal treatment. Pain decreased significantly in patients over 45. Also smoking and prophylactic antibiotic reduced the incidence of postprocrdural pain. In this study , ther e were no correlation between pain and the following: periodontal dressing, systemic diseases, oral hygiene, types of periodontal surgery and extent of the surgery. Surgical periodontal treatment is more painful than non-surgical treatment, but even non-surgical therapy is painful sometimes. 29,72% of the non-surgical therapy patients experienced postprocedural pain. On the basis of this study ,it appears that minimal complications were associated with periodontal therapy

Corneal topography after clear penetrating keratoplasty: qualitative classification

The topography of corneas after penetrating keratoplasty is highly variable. We classify the topography into five groups. We performed videokeratography on 45 clear compact penetrating keratoplasties, with all sutures removed. Three ophthalmologists classified the keratographs into five previously defined topographic groups, based on the pattern of the normalized color-coded videokeratograph. The five topographic patterns included: prolate bow tie, 14[30%]; oblate bow tie, 14[30%]; mixed prolate and oblate bow tie, 8[17%]; asymmetric, 3[9%]; and radially asymmetric 6[14%]. The three ophthalmologists agreed in their initial classification in 87% of the cases and after discussion, in 96%. The topography of the cornea after penetrating keratoplasty can be classified into five qualitative groups by trained observers, with good clinical reliability

Astigmatism after extracapsular cataract extraction

Astigmatism following extracapsular cataract extraction was not studied in the literature before. An attempt was made to study the type and amount of astigmatism after extracapsular Cataract extraction. Twenty cases of cataract were operated upon using the micro-irrigation-aspiration technique adopted in Alexandria University, the same technique of incision and wound closure was used in every case. Preoperative astigmatism was measured. Postoperatively, astigmatism was measured as early as possible and then weekly for at least 6 weeks. Early post operative astigmatism was high [about 5.0 D] and was mostly of the direct type. However, it decreased gradually with time and was shifted mainly to the inverse type