Heart rate and blood pressure variability among hypertensive and normotensive patients with acute thrombotic stroke: clinical relevance and implications

This study was aimed to assess the circadian changes in the blood pressure, heart rate variability and the circadian changes of cortisol level in normotensive as well as hypertensive patients with acute thrombotic stroke to determine whether there is abnormality or not in their diurnal changes and their relation to stroke severity. The heart rate variability [time domain and frequency domain] from 24-hour ECG recordings were analyzed in 30 patients with first acute ischemic stroke [within 24 hours of onset]. Eighteen were known hypertensives and 12 were normotensives. Brain C-T scan and NIHSS were done after admission. Patients were monitored with a bedside monitor for 24 hours to assess blood pressure every 15 minutes and blood cortisol level was measured every 6 hours. The parasympathetic oscillation, the diastolic and mean blood pressure variability indices were reduced in hypertensive patients than normotensives. However, in the late night the parasympathetic oscillation increased in hypertensives but tend to be reduced in normotensives. Increasing in sympathetic daily variation and reduced systolic blood pressure variation were associated with increasing in the stroke severity in normotensives, but decreasing in parasympathetic daily changes were associated with increasing the stroke severity in both groups. Hypertension seemed to cause significant changes of the cardiovascular autonomic regulatory system manifested as abnormalities of heart rate and diastolic pressure variability [especially late night]. The stroke severity was increased with reduced diurnal changes of parasympathetic fluxes in both normotensives and hypertensives and excess sympathetic daily fluctuations in normotensives

Seroma formation after surgery for breast cancer

Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy [MRM] or breast preservation [BP] was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument [electrocautery or scalpel], use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years [SD +/- 11.9]. Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy [OR = 2.83, 95% CI 1.01-7.90, P = 0.04]. No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. The findings suggest that the type of surgery is a predicting factor for serorna formation in breast cancer patients

Non-ligation of the hernial sac during repair of indirect inguinal hernia

The present study was designed to study the effect of. non-ligation of the hernial sac of indirect inguinal hernia during repair. As ligation of the hernial sac has been considered mandatory for a successful repair and essential for preventing recurrence, the recent studies found that non-ligation of the hernial sac has no effect on recurrence rate and may decrease post operative pain, so we can recommend that it is not necessary to ligate the hernial sac during inguinal hernia repair, as ligation of the hernial sac is a hallowed and time consuming concept and result in increase post operative pain, however, this concept has been contested in recent studies. We conducted a prospective study on sixty patients of indirect inguinal hernia repair. In thirty cases the sac was ligated at the neck and excised [control group] in the other thirty cases the sac was not ligated at all, and either inverted or excised without ligation [test group]. The chosen type of repair was Lichtenstein's repair. Post-operative pain was significantly less in those cases where hernial sac was not ligated as it is recorded by pain score. Also there were no recurrence in either groups at one year follow up. Ligation of the hernial sac during inguinal hernia surgery is not only unnecessary and time consuming but also may increase post-operative pain. And has no effect on recurrence rate

Rhomboid flap versus fasciocutaneous V-Y advancement flap in treatment of pilonidal sinus

Pilonidal sinus of the natal cleft is one of the common surgical problems and represents a challenge to many surgeons, because the high incidence of recurrence and long postoperative morbidity course. Although many methods of surgical and non surgical approaches have been proposed to overcome these problems, an optimal treatment modality has not been achieved yet. Evaluation of two different types of surgical procedures for surgical treatment of Sacrococcygeal pilonidal sinus; Rhomboid flap technique and V-Y advancement flap technique, comparing the results of each one separately. 30 patients with chronic pilonidal sinus disease were admitted to surgical department in Ain Shams University hospital during the period from December 2002 to August 2003. The patients were divided into two groups. Group [A]. 15 patients, 13 of them were classic cases while 2 cases were recurrent cases. This group was treated by excision of the sinus and closure the wound by Rhomboid flap technique. Group [B] 15 patients, 12 of them were classic cases while 3 cases were recurrent cases. This group was treated by excision of the sinus, and closure the wound by V-Y advancement flap technique. In group [A], mean hospital stay was 5 days, mean healing time was 15 days, and only 2 cases developed wound infection, while in group [B], mean hospital stay was 7 days, mean healing time was 17 days, and only one case of wound infection. No recurrence detected in both groups during the whole period of follow up [12 months]. Treatment of chronic pilonidal sinus of the natal cleft can be efficient using one of the both techniques mentioned above, as both techniques having the same principles [flattening of the natal cleft and keeping the scar away from the midline]. We advise the use of one of both techniques for the treatment of chronic pilonidal sinus disease, specially the V-Y flap advancement for treatment of recurrent complex cases allowing removal of all pathological tissues, and rhomboid flap for simple classic cases

Polymerase chain reaction and indirect immunofluorescent assay for the diagnosis of bartonella henselae infections in patients with fever of unknow origin and / or patients with lymphadenopathy

This study was conducted on 60 patients and 30 apparently healthy controls The 60 patients were attending Ain Shams University Hospitals in the period from January 2002 to December 2002. They were suffering from fever of unknown origin [FUO] and/or lymphadenopathy. They were classified into: group I including 15 patients having lymphadenopathy, group II including 28 patients suffering from fever of unknown origin, and group III which included 17 patients suffering from fever and lymphadenopathy. The patients were selected after exclusion of other common causes of FUO and lymphadenopathy. All the studied patients were subjected to history, clinical examination which included general and abdominal examination, laboratory testing of serum and blood samples of patients and controls for the presence of Bartonella henselae by indirect immunofluorescent assay [IFA] and polymerase chain reaction [PCR]. Five patients were positive by IFA for Bartonella hensetae [B hensetae] two out of 15 patients with lymphadenopathy [13.3%], and one [3.6%] out of 28 having FUO in addition to two patients [11.8%] out of 17 patients having fever and lymphadenopathy. The control group was B. henselae negative by IFA technique. Meanwhile, 7 patients were positive for B. henselae by PCR using Bartonella univerasl primer, 5 of them were positive for B. henselae [they were also positive by IFA], the other two [7.1%] belonged to FUO group, and were positive by PCR for B. bacilliformis. None of the control group was positive for Bartonella by PCR.Our work showed that there was no statistical significant difference between the 3 studied groups of patients regarding PCR and IFA results [P>0.05]. Also, no statistical significant difference was found between patients and controls [P>0.05]. Moreover, there was no statistical significant association between Bartonella infection and hepatosplenomegaly [P>0.05]. The specificity and sensitivity of IFA test as compared to PCR was 100% and 71.4% respectively, the diagnostic accuracy was 97.8%. Moreover, there was a perfect agreement between IFA and PCR techniques as the value of kappa was 0.822. We concluded that B. henselae should be taken into consideration while following up patients with FUO and/or lymphadenopathy. Moreover, IFA is a very good screening test for the diagnosis of B. henselae with good sensitivity and specificity, however, it should be confirmed by PCR. PCR is a rapid, highly sensitive and specific test which is important and helpful to clinician to confirm the diagnosis of Bartonella

Comparative study on valsartan [angiotensin II receptor antagonist] and benazepril and captopril [two angiotensin converting enzyme inhibitors] in experimental animals

The renin angiotensin system is present in both circulating and tissue forms. Its ultimate product, angiotensin II, is among a diversity of substances that control blood pressure. In the present work, comparison between valsartan [AT[1] antagonist] and benazepril and captopril [ACE inhibitors] revealed the following: Valsartan [15 mg/kg/day], captopril [15 mg/kg/day] and benazepril [3 mg/kg/day] p.o. for 4 weeks in renovascular hypertensive rats induced significant reduction in systolic blood pressure starting from the first week of treatment. There was no significant difference among the three groups except in the fourth week when captopril and benazepril groups were significantly different from valsartan group. In isolated rabbit aorta, all the three drugs reduced the force of angiotensin-I induced contraction, significantly for valsartan and captopril and insignificantly for benazeprilat