1,4-Thioarialkylation and/or amination of E-3- [4-bromebenzoyl] acrylic acid and some studies with the products

Recently[1], it was reported that 3-[4-bromobenzoyl] acrylic acid has antibacterial activity towards Staphilococcus aureus, Escherichia coli and Kllebsiella, this was ascribed to the presence of the highly conjugated benzoylacrylic system, which may react with biologically essential-SH groups. This prompted us to investigate the behaviour of 3[4-bromobenzoyl] acrylic acid [1] towards compounds bearing the sulphhydryl group. Thus, when compound [1], was allowed to react with thiophenol and/or thioglycolic acid in dry benzene in the presence of few drops of piperidine is a catalyst[2], it afforded 2-phenyhmercapto-3-[4-bromobenzoyl] propionic acid, and 2-carboxymethyl mercapto-3-[4-bromobenzoyl] propionic acid [2 a and b], respectively. The structure of the acids 2 was proved from their infrared spectra, which show absorptions at 1674, 1683 cm[-1] [V[C=O] of ketone], 1700 and 1725 cm[-1] [V[c=o] of carboxylic acid] and broad basin peak centered at 3300 cm[-1]1 [V[OH] of acids] the electron impact fragmentation of compound 2a exhibits m/e =348[M[+]-18]. The [1]H-NMR spectrum of compound 2b in DMSO exhibits signals at 2.3 [S, 2H, S-CH[2]-COO], 3.1 [octet, 2H, C-CH[2]-] nonequivalent diasterotopic methylene protons, 4[quartet, -CH, methane proton], 7.7-7.9 [m, 4H, Ar-H], 12.79 [broad singlet, OH protons which disappear in D[2]O]

Evaluation of serum interleukin-6 level as a screening/diagnostic marker for patients with nasopharyngeal carcinoma: a comparative study versus Epstein - Barr virus plasma load estimation

The present study was designed to evaluate serum levels of interleukin-6 [IL-6] in pre-treatment samples obtained from patients with biopsy confirmed nasopharyngeal carcinoma [NPC] and to correlate it with Epstein-Barr [EBV] DNA plasma load estimated using quantitative PCR, tumor clinical staging and pathological grading so as to determine its applicability as a screening and/or diagnostic marker for NPC. The study comprised 30 patients had biopsy confirmed NPC and 10 healthy volunteers as control for estimated serum IL-6. Patients were subjected to full history taking, complete clinical examination, nasopharyngoscopy and imaging studies. Blood samples were collected prior to and after completion of chemo-radiotherapy course for qualitative identification and quantitative estimation of EBV DNA plasma load and, estimation of serum IL-6. Ten patients were clinically staged II, 12 patients had stage III lesions and 8 patients had stage IV lesions. Histopathologically, 14 specimens were of WHO type 1, 10 specimens of WHO type 2 and 6 specimens WHO type 3. Qualitative PCR could detect EPV-DNA, in all blood samples and mean pre-treatment EBV DNA plasma load was 2126.2 +/- 665; range: 1098-3248 copies/ml. The mean pre-treatment serum IL-6 was 175.6 +/- 32.8; range: 128-235 ng/ml and was significantly higher than control levels. Mean serum IL-6 was significantly higher in patients clinically staged IV compared to those staged II and III and was significantly higher in patients with lesions type 3 compared to those with lesions type 1 and 2. Mean EBV DNA plasma load was significantly higher in patients staged IV compared to those staged II and III but showed non-significant difference between pathological types. There was a positive significant correlation between estimated serum IL-6 levels and EBV DNA plasma load, [r=0.428, p=0.018], TNM clinical staging of the lesion, [r=0.432, p=0.017] and WHO pathological type, [r=0.513, p=0.004] and between estimated EBV DNA plasma load and TNM clinical staging of the lesion, [r=0.604, p=0.026], but the correlation was non-significant [r=0.344, p>0.05] with WHO pathological type. Evaluation of the specificity of both serum IL-6 and EBV DNA load as a predictor for pathological grade using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] revealed a non-significant difference in the specificity of both parameters for prediction of pathological grade of lesion. Post-treatment mean serum level of IL-6 and EBV DNA plasma load were significantly lower compared to pre-treatment level. In conclusion, estimation of serum IL-6 could be used as a screening test for detection of cases of NPC among suspicious patients and as a diagnostic test for cases with established NPC

Meatoplasty with intraoperative topical mitomycin C application: technique and outcome

The present study was designed to evaluate the outcome of meatoplasty using Z-shaped incision with application of mitomycin C as trial to enlarge the external auditory meatus of patients undergoing modified radical mastoidectomy in comparison to classic meatoplasty with application of mitomycin C. The study included 40 patients; 25 males and 15 females with mean age of 38.7 +/- 8.4 years. All patients underwent Jull history taking, complete otorhinolaryngological examination and CT scanning and then were randomly allocated into two equal groups [n=20] according to the procedure assigned: Classic meatoplasty [C group] and Z-shaped meatoplasty [Z group] using Z-shaped skin incision made along the posterior and inferior conchal borders and extended along the posterior ear canal meatus. In both groups, mitomycin C, 0.4 mg/ml solution was applied on a sponge to the edge of the remnants of conchal cartilage for 5 minutes. Patients were examined bi-weekly till the ear was fully healed. Meatoplasty was assessed as regards the feasibility of easy examination and debridement with the use of simple otologic tools and an operating microscope. Both groups were compared as regards age, sex, operative time and amount of intraoperative bleeding. All cases passed smooth intraoperative course with non-significantly longer operative time and non-significantly more bleeding during Z-meatoplasty compared to classic meatoplasty. All Z flaps healed completely with good take without sloughing or change in color and the meatus was so enlarged to allow inspection of mastoid cavity and easy debridement with simple tools and allowed frequent otoscopic examination for cavity inspection. Only one ear, in Z group, developed hypertrophic scar that did not impose significant narrowing of the meatus. On contrary; 3 ears had classic meatoplasty developed keloid formation and significant narrowing of the meatus that hampered cavity examination and debridement. Another ear, in C group, developed postoperative perichondritis that resolved with local care and oral antibiotics, but unfortunately developed meatal stenosis. Thus, Z-meatoplasty showed a success rate of 95% which is significantly higher compared to classic meatoplasty [80%]. It could be concluded that application of mitomycin C in conjunction with Z-meatoplasty is an effective modality for reduction of possibility for hypertrophic meatal scar with its subsequent problems. Also, classic meatoplasty with mitomycin C application provided acceptable frequency of hypertrophic meatal scar and is recommended wherever Z-meatoplasty was technically difficult

Significance of different diagnostic tools for diagnosis of malignant thyroid gland tumours

Objectives: The objective of this study was to determine the diagnostic accuracy of clinical examination ,computed tomography [CT], neck ultrasound [US], thyroid scintigraphy [SC], and fine needle aspiration cytology [FNAC] as a different diagnostic tools for diagnosis of cancer thyroid gland in correlation to the final histopathological examination

Patients and Methods: From a series of 60 patients with different thyroid diseases, this study was conducted on 18 patients [15 females and 3 males with age range from 41 to 63 years] diagnosed clinically and proved histopathologically as cancer thyroid gland. All patients were subjected to full history taking, complete clinical examination, computed tomography [CT], neck ultrasound [US], thyroid scintigraphy [SC] and fine needle aspiration cytology [FNAC]. All the patients with malignant cytological evaluation underwent total thyroidectomy, with selective lateral neck lymph node dissection, for patients with palpable cervical lymphadenopahty, postoperatively histopathological examination of the operative specimens were done. The accuracy, of clinical examination, computed tomography, neck ultrasound, thyroid scintigraphy, and fine needle aspiration cytology, in diagnosis of cancer thyroid was estimated in correlation to the final histopathological examination

Results: The results showed that, the diagnostic accuracy of fine needle aspiration cytology [FNAC] in diagnosis of cancer thyroid gland was 88.9%, while the diagnostic accuracy of computed tomography [CT] was 76% where the diagnostic accuracy of neck ultrasound and clinical examination were 72%, and finally the diagnostic accuracy of scintgraphy was 55.6%

Conclusion: Fine needle aspiration cytology is a safe, cost-effective, sensitive and still the most accurate diagnostic tool in diagnosis of malignant thyroid lesions in clinically suspected cases [cases with regional lymphadenopathy, hoarseness of voice, history of rapid tumour growth, hard and fixed tumour and cases with tumour size >4cm], while CT and sonography, had a nearly similar results in detection of the thyroid malignancy. It is suggested that sonography, is a useful adjunctive test after detection of thyroid lesions on CT

Comparative study between virtual laryngoscopy and direct laryngoscopy in diagnosis of cancer larynx

The purpose of this study was to evaluate the accuracy, clinical value and limitation of virtual laryngoscopy in diagnosis of cancer larynx in comparison to direct laryngoscopy with histopathological correlation. Thirty patients diagnosed clinically and proved pathologically as laryngeal carcinoma were subjected to fiberoptic endoscopy [FO], biopsy, spiral computed tomography [CT]. and virtual laryngoscopy [VL]. The accuracy of fiberoptic endoscopy. virtual laryngoscopy and CT was estimated with pathological correlation. It was found that; the accuracy of fiberoptic endoscopy. virtual laryngoscopy and CT for detection of the site of the lesion was different. Regarding to the epiglottis. the accuracy of FO, VL and CT. were 100%. As for the false vocal cord, the accuracy of FO was 81% while CT and VL were 100%. For the ventricle, the accuracy of FO was 71% while VL, and CT were 100% .For the true vocal cord, the accuracy of FO was 70% while in CT and VL was 100%. For the anterior commissure, the accuracy of FO was 72%. VL was 94% and CT was 100%. For the posterior commissure, the accuracy of FO was 50%, VL was 83% and CT was 100%. For the subglottic region, the accuracy of FO was 62% while 100% in virtual and CT. For the vallecultae, the FO, VL, and CT showed the same accuracy, 100%. In conclusion, virtual laryngoscopy is sensitive in assessment of the larynx beyond the large supraglottic and glottic masses obscuring the view of fiberoptic endoscopy. It is particularly useful in the presence of sever laryngeal stenosis especially in the subglottic regions and does not require sedation and additional scanning. It is of a value In follow up patients with previous laryngeal carcinoma treated by radiotherapy or conservative surgery. On the other hand. virtual laryngoscopy show limits In the identification of early laryngeal lesion which can be detected by fiberoptic endoscopy

Efficacy of tension free vaginal tape [TVT] and burch colposuspension in patients with genuine stress urinary incontinence

Aim of the work is to compare the new urethropexy technique, the T.V.T and the gold standard Burch colposuspension, both clinically and urodynamically in patients with genuine urinary stress incontinence. Prospective randomized study. The study was held in Ain Shams University Maternity Hospital between June, 2002, and March, 2003. A randomized study involving 20 patients of combarable age and parity. Randomization were done using a table of random numbers then each patient were given a serial number and received the corresponding therapy. They were divided into two groups. The first group underwent T.V.T for treatment of genuine S.U.I. The second group underwent Burch colposuspention for treatment of genuine S.U.I. The tension free vaginal tape fulfill the criteria of minimal invasive incontinence surgery which are short hospital stay, early postoperative mobilization, no need for urinary catheter or drains, normal everyday physical activity, the use of regional anaethesia, minimal tissue destruction, short duration of operative technique and less need for postoperative analgesia. Results showed that TVT procedure is highly effective in treating female genuine stress incontinence. The results TVT was comparable to the results of the gold standard Burch colposuspension. The study also showed the effect of TVT on the bladder neck mobility and rotational angle which differs from the effect of colposuspension. In the T.V.T. group, the subjective success rate was 90% three month postoperatively. In the Burch group, the subjective success rate was 90% three month postoperatively. In the T.V.T. group, the objective success rate was [90%] three month postoperatively. In the Burch group, the objective success rate was [90%] three month postoperatively. Duration of the operation descriptive statistics and analytical difference between the two studied groups [in minutes] showed that there is very highly significant difference between the two groups, as regards operative time in favour of TVT group. As regard postoperative hospital stay descriptive statistics and analytical difference between the two studied groups [in days], There was very highly significant difference between the two groups, as regards the postoperative hospital stay, in favour of TVT group. From the present study, it is concluded that the tension free vaginal tape is a safe and effective minimally invasive surgical procedure for the treatment of female genuine stress incontinence. The TVT procedure appears to be technically feasible and effective as a treatment for stress urinary incontinence when combined with other pelvic floor reconstructive surgery. Care must be taken to make sure that the sling does not migrate to the bladder neck and that it is not at all obstructive

Effect of laparoscopic ovarian electrocautery on lipid profile in patients with polycystic ovarian syndrome

The study aims to characterize the effect of laparoscopic ovarian electrocautery on serum lipid profile in women with PCOS. Prospective randomized study. Infertility clinic of Ain Shams University Hospital, Department of Obstetrics and Gynecology. The study included 30 infertile women diagnosed to have PCOS. The patients were diagnosed on the basis of two years infertility, primary or secondary, menstrual irregularities, obesity and or hirsuitism, transvaginal ultrasound, the final diagnosis was confirmed by laparoscopy. Patients with chronic illnesses or on drugs that lowering serum lipids were excluded. Routine investigation and ultrasonography, measurments of cholesterol, triglycerides, low density lipoprotein and high density lipoprotein were done. The patients were undergone laparoscopic electrocautery of the ovaries. Four weeks post operative serum lipid profile was repeated and statstically analysed to evaluate the effect of electrocautery of the ovaries on lipid profile. The study group included 24 patients with primary infertility [80%] while 6 patients with secondary infertility [20%]. Menstrual irregularities were present in 80%, while regular menses were present in 20%. Obesity were in 7 patients [23.4%] with body mass index more than 30% and in 15 patients [50%] showed hirsutism. The preoperative measurments of the profile showed mean value of cholesterol 207.8 +/- 25.2mg/dl, triglycerides 145.8 +/- 34.8mg/dl, LDL-chol 128.2 +/- 21.7mg/dl and HDL-chol 48.8 +/- 8.9. Four weeks postoperative, the mean value of cholesterol 181.6 +/- 21.2mg/dl, mean value of triglycerides 124.1 +/- 33.9mg/dl, LDL-chol 107.8 +/- 15.8mg/dl and HDL-chol 50.66 +/- 8.9mg/dl. There is a highly significant [P < 0.001] decrease in the mean level of cholesterol, triglycerides, LDL-chol, and significant [P < 0.05] increase in the mean level of HDL-chol. The mean level of cholesterol decreased by 12.5%, triglycerides by 14.4% and LDL-chol by 15.9% while the mean value of HDL-chol increased by 3.58%. Laparoscopic ovarian electrocautery significantly improve the dyslipidemia usually found in PCOS women and hence decreasing the risk of coronary heart diseases, myocardial infarction and atherosclerosis. Other benefits are improvement of ovulatory rate, pregnancy rate, low cost of infertility treatment, less monitoring demand comparing to HMG and GnRH analogue

Frontal sinus oblitration with bioglass

Many alloplastic materials have been used in clinical frontal sinus obliteration. It has been difficult to find reliable obliteration material without short- or long term complications. Most common problem in frontal sinus obliteration is the resorption of occlusion material. This study was made to evaluate the efficacy of Bioglass as an alternative to autologous fat in the obliteration of the frontal sinus. Standard surgical techniques were used to obliterate the frontal sinus. Eight patients underwent Bioglass frontal sinus obliteration. There were 2 women and 6 men in the series with age ranges from 30 to 55 [mean, 38 years]. Two patients underwent obliteration for chronic infections with mucopyocele. Follow-up radiographs were obtained at 3, 6 and 12 months after obliteration of the sinus with Bioglass. No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis. No implant has been rejected. Seven patients reported complete resolution of all symptoms. Bioglass had demonstrated efficacy in obliteration of frontal sinus. The material has the advantage that it takes well, no reaction or rejection and it is also of reasonable expense. The obstruction of the frontonasal duct by this material was ensured. Bioglass offers the advantages of no donor site morbidity and the potential for complete osseointegration

effect of modified Lytic cocktail mixture on hyperpyrexia

This study was done on thirty adult febrile patients with different age. weight and sex and with different infectious aetiologies to evaluate the effect of [modified lytic cocktail mixture] a combination of promazine, pethidine and hydergine to assess their role on hyperpyrexia The results showed that the lytic cooctkail have significant effect on hyperpyrexia and that the combination of promazine, pethidine and hydergine was very excellent in lowering body temperature in this type of fever in short time [8 +/- 1.5 hours] and may be useful when urgent need to decrease body temperature is desired. They also decreased the PCO2, with no effect on haemodynamics and significant improvement in state of body oxygenation

Ureteroscopy: results and complications

In the period from July 1989 to December 1993, a total of 272 ureteroscopic procedures were performed in 258 patients. Indications of ureteroscopy included ureteric stones in 243 patients and ureteric strictures in 15. Successful stone removal or fragmentation was obtained in 216 patients [88.8% of stone group]. Failure occurred in 27 patients, failure to pass the ureteroscope via the ureteric orifice in 3 patients, stone migration in 7 patients, second session procedure in 14 and ureterovesical reimplantation in 3. Complications occurred in 37 patients, 8 major and 29 minor. Major complications included severe ureteric trauma requiring immediate surgery in 3 and delayed ureteric strictures in 5. Ureteric stricture was treated by transureteroscopic lateral or medial ureterotomy followed by balloon dilatation. The later procedure was successful in 7 patients [46.6% of the stricture group]. One patient had total anuria, 2 weeks postureterotomy. These results indicated that ureteroscopy is very valuable tool to urologists, particularly if complete set up of lithotriptors and ureteroscopes are available

value of pupil examination in preterm and term newborn infants

One hundred newborn infants [70 preterm and term] were studied. The pupil diameter was measured by ophthalmic caliper and response to light was determined. The mean [- or + S.D.] pupil diameter in a dark environment [<10 foot candles of illumination] was 36 mm [ +/- 0.9]. The pupils did not consistently respond to 600 foot candles of light before 32 weeks postconceptual age, but responded increasingly thereafter. This progressive light response correlated significantly with postconceptual age, weight and Apgar score. Significant differences in the net miosis between infants with apgar scoring >7, those between 5-7 and those less than 4 scoring [P <0.05] were detected. The pupil diameter and net miosis also correlated with the duration of incubation and the need for admission to intensive care unit. This measurement of the pupil diameter and reaction to light may prove a mandatory part in assessment of the neonatal condition in both term and preterm newborn infants

Keratoplasty with donor cornea from children

The success of penetrating keratoplasty operation depend upon the vitality of the graft. The vitality of the graft is affected with the age of the donor eye. We represent the results of 20 cases of keratoplasty operation where the donor corneas were obtained form children ageing from 2 to 10 years

Photosclerostomy for failed filters

The failure of filtering procedures may be due to several causes. Blockage of the sclerostomy by episcleral proliferation is not uncommon cause for this. The use of the YAQ laser applied to the internal portion of the sclerostomy by a gonioscopy lens has been used successfully to reopen 5 such cases which have remained patent. The authors describe the technique and indications for the procedure