Continuous sciatic nerve block: compartive study between the parasacral, lateral, and anterior approaches for lower limb surgery

The aim of the present study was to evaluate the ease and reliability of the anterior and lateral approaches to sciatic nerve block compared to the posterior parasacral approach, and their suitability for the specific factors in the patients, positions, and surgeries. Also, the insertion and usefulness of the continuous catheter technique was evaluated. The study was carried out on 120 patients, ASA I, II and III, of both genders, age range between 20 and 70 years, scheduled for orthopedic, general and vascular lower limb surgery. Patients were enrolled in a prospective, randomized, double blind study. Patients were divided into three equal groups, 40 patients each. All the patients received femoral nerve block in addition to sciatic nerve block either parasacral [Posterior group], lateral [Lateral group] or anterior approach [Anterior group]. This was followed by continuous femoral and sciatic nerve blocks in the postoperative period. Patients were assessed as regards the time, duration and intensity of the sensory and motor blocks and also the postoperative analgesia offered by the continuous block. They were also assessed for the hemodynamic changes accompanied these blocks. Radiological study was made to demonestrate the spread of different volumes of the drugs alongside the course of the sciatic nerve. The posterior parasacral approach is the easiest technique to perform and used successfully even in obese patients, but difficult to be done, if at all, in patients with limited movement such as multi-pelvic fractures. The anterior approach was found to be the best for the patients in the supine position, with best results as regards patients' satisfaction and sensory and motor blocks. Only, it is a technique that needs high experience especially in obese patients. The lateral approach was the least performed technique especially its high approach. However, it is useful in patients in supine position, and gives the best results in thin patients. The technique showed to be extremely difficult in obese patients. The insertion of a catheter for continuous nerve block was easy. These blocks provided good or excellent postoperative analgesia for all patients in the different groups and facilitated early mobilization which helped in preventing the lower limb srugery-related morbidity and mortality

Wolman disease in an Egyptian patient

Lysosomal acid lipase deficiency leads to accumulation of cholesteryl esters and triglycerides in different body tissues. This disorder is manifested in two clinical forms; cholesteryl ester storage disease which is a benign adult form and Wolman disease [WD], a fatal autosomal recessive form. We present an Egyptian infant with WD whose diagnosis was based on clinical, laboratory and imaging features. This is the first reported patient with WD from Egypt

Costs, benefits and operational implications of using quantitative techniques to screen for schistosomiasis haematobium in Egypt.

The official strategy for schistosomiasis control in Egypt relies on individual case detection and treatment. Screening for Schistosoma haematobium has traditionally involved urine sedimentation which shows whether or not eggs are present in the urine, thereby providing only a qualitative assessment of infection status. Recently the Ministry of Health introduced the nucleopore filtration technique into a few villages to assess its applicability for broader use in areas where S. haematobium is endemic. This method gives an indirect quantitative measure of morbidity in terms of egg counts/10 ml urine. The overall purpose of this study was to provide rapid feedback to the Ministry on the likely implications of expanding the use of the filtration technique by examining the benefits, costs and operational problems that may be involved. From 2 villages in Giza Governorate, systematic random samples were taken from the general populations and from schools. Each selected person provided a urine specimen on which the two diagnostic techniques were performed. Filtration offered no additional benefits over sedimentation in terms of defining if a person was infected or not, with sensitivities ranging from 59.6%-75% for filtration and from 60%-73.1% for sedimentation. The additional non-labor costs of using the filtration technique in the two villages were calculated and showed that, if extended to all rural health units in Egypt, the Ministry would need to find an additional 31.6 million pounds (US$9.5 million) each year. A number of operational problems would also be involved in the wider application of the technique.

bacterial flora of carious lesions and caries-free surfaces in school students 13-16 years of age in Cairo

This study showed that the difference between group 3 and either of group 1 or group 2 was statistically significant as regards total bacterial count, total streptococcal count and Strep. mutans count. While, this difference was not significant between group 1 and group 2. It was also found that the difference in the mean percentage of total streptococcal count between the three groups was statistically insignificant at 5% level. As regards Strep. mutans, the difference in the mean percentage between group 1 and group 2 was not statistically significant; while it was significant between group 3 and either of group 1 or group 2 at 5% level

Effect of maternal administration of acetaminophen on the development of rat embryos

Acetaminophen a popular nonprescription analgesic-antipyretic drug, wasadministered orally to pregnant rats at a dose levels of 0 [control], 25, 50,100, 200 and 400 mg/kg/day on day 1 to 15 gestation. The dams were sacrificedon the day 21 of pregnancy and the fetuses were removed by cesarean sectionand examined. Body weight showed evidence of maternal toxicity as exhibitedby marked increase in liver weight and decreased body weight gain. Noincrease in the incidence of resorptions was observed even at 400 mg/kg, adose several-folds higher than those used in human clinical practice [10- 20mg/kg]. There was a dose-related decrease in fetal body weights which wasstatistically significant at 200 mg/kg or more. Examination of the fetusesrevealed insignificant increase in the incidence of gross, skeletal andinternal malformations at any dose level in comparison with the controls. However, one of the fetuses in the group which received 400 mg/kg showed shorttail and club foot. Thus, no evidence of embryocidal and teratogenic effectswas observed with this analgesic-antipyretic drug at the recommendedtherapeutic dose in rats. Acetaminophen may be considered the safestanalgesic- antipyretic drug during pregnancy

Effect of flossing with chlorhexidine gel on proximal caries in 12-15 years old school children in Cairo

Three hundred and fifty three [353] school children aged 12 years in Cairo were included in the study. They were examined for detection of proximal caries clinically and radiographically by using bite wing films. The children were divided into three groups: [1] cholorhexidine gel group [n=121], [2] placebo group [n=117], and control group [n=115]. After 3 years, the mean proximal caries increment [new DFS] was 2.23 in the chlorhexidine, 4.31 in the placebo gel group and 5.14 in the control group. The difference between the chlorhexidine gel and either of placebo and control group was statistically significant [P < 0.05 and P < 0.001 respectively]. The number of new proximal fillings s] was 0.31, 0.93 and 1.12 in chlorhexidine, placebo and control groups respectively

Calcium hydroxide as an activator in induced apexification

This study included 24 schoolchildren of both sexes aged 8-10 years with two traumatized pulpless immature upper anterior teeth. One tooth was filled with calcium hydroxide and compherated parachlorophenol [CPCP], against the other tooth as control canals dressed with CPCP only. Radiographic and clinical observations were used to evaluate the calcific changes, which were formed at the apex of the immature tooth. Apical barrier was detected at the end of the experiment of 15 months period in approximately 91.5% of cases filled with calcium hydroxide, while 1 of empty control canals showed an evidence of bridging at the apex

Study of the effect of pethidine and phenergan on the electronic fetal heart rate monitoring and the neonate

Forty full term pregnant women were studied intra-partum. Twenty cases were given 100 mg pethidine IM, and the other twenty were given 50 mg phenergan IM. Fetal heart rate [FHR] monitoring was done for all cases. Both drugs produced a significant reduction of both long and short term FHR variability, while the reduction of both of them by phenergan was insignificant. About half of the cases studied showed diminished or disappearance of the normally occurring acceleration with uterine contractions, while 25% of cases showed no change at all. Most of the above changes were transient and were found to disappear at the end of the observation time. No adverse neonatal outcome was observed on using both drugs

Effect of different fluoride mouthrinses in prevention of dental plaque among 15-year-old children in Cairo

Six hundred students 15-year-old were examined for assessment of plaque index scores. The children were randomly divided into four groups: three test groups using three fluoride mouth rinses [sodium fluoride, amine fluoride and mixture of sodium fluoride and amine fluoride] and one control group using placebo mouth rinse. Rinsing was done once per day for eight weeks. The results showed that all types of fluoride rinses could not completely prevent the development of dental plaque but they decreased the formation with different degrees. It had been also found that both amine fluoride mouth rinse and mixture of [sodium fluoride and amine fluoride] were more effective in prevention of dental plaque than sodium fluoride mouth rinse

value of determination of paraproteins in malignant lymphoma

Forty three patients in stage III and IV malignant lymphoma [17 H.D. and 26 N.H.L] were investigated in this study for presence of paraproteins in their sera and subsequently of clinical manifestations of paraproteinaemia. Twenty nine of them were males and 14 were females. Their ages ranged between 15 and 65 years. Twenty one [48.8%] presented with one or more of the clinical manifestations related to paraproteins in their sera: cold urticaria was detected in 12 occasions, purpura in 8, chilblains in 6. tingling and numbness in 4, Chronic leg ulcers in 4, acrocyanosis in 2, vasculitis and Raynaud's phenomenon each in one occasion. Qualitative and quantitative determination of the different types of paraproteins was performed. Cryoglobulin was found in the sera of 30 patients [69.7%]. paraglobulin was detected in 14 patients [32.5%]. Simple type of cryoglobulin [mostly of IgG] was present in 19 patients and mixed type [IgG and IgM] in 11 patients and both types were more frequent in females. Cold urticaria, purpura, chilbains and chronic leg ulcers were associated with simple cryoglobulins in most occasions, while patients complaining of tingling sensation and numbness, acrocyanosis and vasculitis had mostly mixed cryoglobulins. Pyroglobulin have no clinical significance, yet it was associated with high level of cryoglobulin. Hypoalbuminaemia was detected in 56% of cases. The main disturbance in globulin was elevation in total globulin, alpha-1 and gamma fractions. Hypergammaglobulinaemia was marked in H.D. [88.1%] than N.H.L. patients [34.6%]. Chemotherapy treatment showed decrease in cryoglobulin level in some cases, while there was an obvious increase in the albumin, normalisation of globulin and improvement in the general condition of patients