Neurophysiological assessment of peripheral nerve functions in a sample of egyptian patients with liver cirrhosis

Background: peripheral neuropathy is damage to or disease affecting nerves which may impair sensation, movement, gland or organs function or other aspects of health depending on the type of nerve affected. Peripheral neuropathy is a common complication of liver cirrhosis either due to viral [mostly HCV], NASH, Alcoholic or mixed

Objectives: the aim of this study was to define the prevalence of peripheral neuropathy in a sample of Egyptian patients with liver cirrhosis and to determine any etiologic correlation

Patients and Methods: this descriptive study was conducted on 47 Egyptian liver cirrhotic patients. Patients were subjected to history taking, detailed neurological examination and clinical and neurophysiological assessment

Results: viral hepatitis was the commonest cause of liver cirrhosis 59.6% while non viral causes 25.5% e.g. NASH, the main duration of liver cirrhosis was 10 +/+ 3.98 yrs ranging from 3-23 yrs. The majority of patients were asymptomatic, 48.9%, while the most presenting symptoms were sensory symptoms 25.5%, the prevalence of PN among a sample of Egyptian patients with liver cirrhosis according to neurophysiological assessment was 72.3% mostly of mixed sensory and motor polyneuropathic pattern, not related to the cause of liver cirrhosis but affected by the duration and severity of liver cirrhosis determined by Child Pugh classification

Conclusion: peripheral neuropathy is a common complication of liver cirrhosis related mainly to the duration and severity of liver cirrhosis, but not affected by the causes of liver cirrhosis

Study of parathyroid dysfunction among children and adolescent with alpha-thalassemia major

Background: Parathyroid hypofunction is one the endocrinopathies affecting patients with ?-thalassemia major [TM], while parathyroid hyperfunction is not well assessed. In this study, we aimed to evaluate the prevalence of parathyroid dysfunction in children with thalassemia major and to study its relation to age, gender, splenic status, serum calcium and ferritin. Study Sesign: In 70 children with TM /[41 [58.6%] males and 29 [41.4%] females with mean age 14.8+/-2.9 years; range 6-18 years/]; serum levels of intact pa rathormone [iPTH], calcium, phosphorus and alkaline phosphatase were measured. liver iron content was assessed in 42 cases with magnetic resonance imaging by means of T2*. Average serum ferritin was calculated for 1 year prior to the study. Results: Mean iPTH and serum phosphorus were within normal range. Mean calcium was below the lower limit of normal range. Seventy-three percent had normal parathyroid function with 3 [4.3%] had borderline iPTH. The prevalence of parathyroid dysfunction was evident in 27% cases. Thirteen [18.5%] had low iPTH and 6 [8.6%] cases had elevated iPTH levels. Forty-three [61.4%] cases had hypocalcemiaand5 cases [7.1%] had hyperphosphatemia. Age above 12 years, sex, splenectomy, hypocalecemia, serum ferritin above 1500 ng/ml and being not chelated were not proved to be risk factors of parathyroid dysfunction. There is a good correlation between serum ferritin and liver iron concentation [LIC] [r=0.5, p=0.001]. No correlations were found between PTH and age, frequency of blood transfusion, serum ferritin, serum calcium, phosphorus or alkaline phosphatase. Conclusion: Parathyroid dysfunction is common in patients with ?-thalassemia major and worth screening in early childhood even in the absence of hypocalcemia or iron overload. This might be the first step towards decreasing its prevalence among TM population. In addition, the onset and dose of calcium and vitamin D supplementation in pediatric patients with ß-thalassemia major should be re-evaluated

Endoscopy guided balloon catheter dilatation of non corrosive oesophageal strictures

This study included twenty patients with different non corrosive oesophageal causes of dysphagia that dilated without complications. Followed up for about one year. Improvement occurred in sixteen patients [80 %] whereas failure in-four patients [20%]. Dilatation was done under general anesthesia with endoscopic and fluoroscopic guidance.- Balloon dilatation of esophageal strictures is a safe, effective, low cost technique.- Balloon catheter dilatation is more effective and with less traumatic effect than the traditional dilators.- It is a good and effective technique in those patients who had failure of dilatation with traditional methods due to difficult strictures [long segment, tortous, tight]. Thus, surgery was avoided with its morbidity, mortality and cost.- It is an effective treatment for achalasia with good results and no complications. It also performed in patients less than 12 years old. Using fluoroscopy with guide wire increases its safety as it allows for complete visualization as the balloon is positioned and inflated, thereby decreasing the risk of perforation- Endoscopy plays an important role in direct assessment of the stricture and evaluation the results after dilatatio

Evaluation of preoperative intra-arterial embolization of glomus jugular tumors

Superselective preoperative percutaneous transfemoral catheter embolization by using polyvinyl alcohol particles of feeding vessels in glomus jugulare tumors, followed two-three days by application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete haemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugulare bulb, venous sinuses and dura, while reducing surgical error and functional deficit for the patient. The value of this combined approach was analyzed for the management of ten patients suffered from glomus tumors at Assiut University Hospital. The results showed that even extensive tumors of the middle ear, jugulare bulb and mastoid had only minor blood losses and good surgical outcome with this treatment modality. Combined embolization and surgery offer the best approach for the treatment of respectable glomus jugulare tumors

Hemodynamic changes in patients with liver cirrhosis and tense ascites after large volume paracentesis

The aim of this study was to assess the short-term effects of a single 5-L paracentesis without albumin replacement on the systemic and portal hemodynamics. Thirty patients with liver cirrhosis and tense, diuretic resistant ascites were studied before and 24 hr after a single 5-L paracentesis without albumin infusion. An abdominal duplex Doppler examination and echocardiographic study were carried out for all patients. Heart rate and blood pressure were measured. The mean arterial pressure was calculated. Serum sodium, potassium, blood urea and creatinine were also measured. There were no significant changes from the baseline values for heart rate, mean arterial pressure and cardiac output. As regards portal hemodynamics, there were no significant changes in portal vein diameter, portal flow velocity and portal blood flow before and 24 hr after large volume paracentesis. The study concluded that single large volume paracentesis without albumin replacement is safe and satisfactory short-term option for the management of patients with cirrhosis and tense, diuretic resistant ascites

Fractures of the humerus with radial nerve palsy

The radial nerve was explored in seven cases of fracutres of the distal third of the humerus with radial nerve palsy which are often oblique or spiral with or without butterfly fragement and typically angulated laterally, with the distal fragment displaced proximally. In all the cases, the nerve was found caught in the fracture site. This paper presents seven cases of fracture of the humerus complicated by radial nerve injury. The fracture occurs in the distal third of the bone at the point where the radial nerve traverses the lateral intermuscular septum and is in contact with the bone. The apex of the distal fragment is displaced nerve between the bone fragments. Primary open reduction and internal fixation is the treatment of choice for this kind of injury. Closed manipulation is contraindicated when the criteria of the syndrome are present

Reconstruction of the medial ligament complex of the knee for chronic anteromedial instability using a modification of the Nicolas procedure

Reconstruction of the medial ligament of the knee for chronic anteromedial instability possesses a major problem. Lots of methods and varieties of techniques were described. Hey Grove in 1917 described an operation for reconstruction of the Anterior Cruciate Ligament using the ilio-tibial band. In 1920, he expanded the technique to include reconstruction of the tibial collateral ligament. Slocum and Larson in 1968 described transfer of the pes ansencrius tendons. Opinions varied whether to attack the femoral attachment of the ligament [Augustine 1956 and Nicolas 1974] or the tibial attachment of the ligament [Mauck 1936 and O'Donoghue 1973]. However, no technique proved to be satisfactory. None was able to restore a ligament with proper isometric attachment which, in our opinion is the major cause of failure. In this paper we are presenting our experience with a rather new technique which is based on the principles used by Nicholas in 1973

Chronic anterior cruciate ligament deficiency: result after extra-articular tenodesis and combined extra-articular with intra-articular reconstruction using a free patellar tendon graft

58 patient with chronic anterior cruciate deficient knees were treated by surgical stabilizing procedures. Of these 28 cases had Macintosh's lateral substitution reconstruction and 30 cases had combined extra-articular and intra-articular reconstrusction using a free pateller tendon graft. Results were evaluated after an average follow up of 29. 8 months. In the group treated by extra-articular substitution alone jerk test was abolished in 21 cases [75%] and Lachman's test was abolished in only 8cases [28.5%], while in the group treated by combined extra-articular and intra-articular free patellar tendon graft, jerk test was abolished in 24 cases [80%] and Lachman's lest was abolished in 22 cases [73.3%] but at the expense of prolonged rehabilitation and some limitation of knee motion

Reconstruction on the anterior cruciate ligament using the ilio-tibial band by Marshall procedure

32 pateints with anterolateral instability who underwent Marshall procedure using the ilio-tibial band for reconstruction of the anterior cruciate ligament have been reviewed after a mean follow up of 22.8 months, the procedure abolished a positive pivot shift test in 23 patients [71.8%]. A review of literature on the different procedures used to correct this instability, as well as the underlying theoretical advantages of this procedure were presented

Result of surgical repair of acute medial ligament complex of the knee

Fourty two cases were the subject of repair for acute medial ligament injuries. Twenty five cases [59.5%] were rated as excellent, thirteen [30.9%] as good and four [9.5%] as poor. Repair or reconstruction of a concomitant cruciate injury should be attempted to at the same time: a peripherally detached meniscus should be sutured and preserved

treatment of unstable Colle's fractures using the external fixator

Fifty cases of unstable Colle's fracture were treated using small Hoffman external fixator using the principle of ligamento taxis across the wrist-joint. They were followed for a minimal period of one year. The final end results were; 32 cases as excellent [64%], 15 good [30%], 2 fair [4%] and 1 poor [2%]. This technique is strongly recommended by the authors in cases of unstable Colle's fracture

scapular spine a potential free vascularised bone graft anatomical study

Since the use of free vascularised rib graft by-Buncke 1978 and free vascularised fibular graft by Taylor 1975, investigators were on the search for new bones to be used as free vascularised grafts. Several bones where investigated since then, the iliac crest based on the superficial circumflex illiac or the deep circumflex iliac [Taylor 1979], the lateral crest of the scapula [Teot 1981] based on the circumflex scapular, the second metatarsal based on the dorsalis pedis artery [Macleod et al 1979]. Recently we have been trying to investigate the possibility of using the scapular spine based on the suprascapular vessels as a free vascularised graft