Major airway obstruction as a cause of chest wheezes

Asthma is a disorder characterized by narrowing of airways which is reversible with time either spontaneously or as a result of treatment. Asthma presents mainly with dyspnea wheezes and or cough which are mainly nocturnal. Many diseases can either mimic or worsen asthma. Patients are often subjected to full anti-asthma therapy without improvement. The aim of our study was to investigate the possible causes of chest wheezes rather than bronchospasm. Our study included 50 patients [25 in pediatric age group and 25 in adult age group]. They were all having longstanding wheezy chest with failure to respond to the usual anti-asthma medications. All the patients were subjected to thorough history taking with special emphasis on foreign body inhalation especially in the children's group; complete general as well as local examination; chest radiology; routine laboratory investigations and fiberoptic bronchoscopy. Our results showed that the commonest cause among all patients was laryngotracheomalacia present in 13 patients. The second most common cause was inhaled neglected foreign body in 9 cases, 8 children and one adult with history of foreign body inhalation at age of 10. The third common cause was malignant neoplasm in 6 adult cases. In conclusion when a patient presents with persistent or recurrent wheezing and the typical features of asthma are lacking, other causes for noisy breathing should be considered and one must be very careful in order not to miss another etiology. In childhood laryngotracheomalacia and foreign body inhalation are the commonest while in adults we should think in malignant obstruction. Fiberoptic bronchoscopy and laryngoscopy are essential tools for investigating these patients

Management of acute tibial diaphyseal fractures with interlocking nailing using unreamed technique

In this study, three types of nails were used [Richards Russel and Taylor, Biomet-Klemm and Schellman and Orthofix] in treating acute diaphyseal tibial fractures in 22 adult patients. Unreamed interlocking nails have some advantages; they cause a less thermal and mechanical impairment of cortical and medullary cavity circulation. Union rate was 100%, which was superior to the reported results with the reaming techniques. The statistical results revealed that there was a significant relation between the age of the patient and the time needed for fracture union. The Orthofix nail with its distal aiming device reduced both the surgical and irradiation exposure times

Management of acute and delayed slipped capital femoral epiphysis by percutaneous pinning

Fifteen patients [12 males and 3 females] ranging in age from 13 to 15 years with a mean of 13.5 years had underwent percutaneous pinning for slipped capital femoral epiphysis. Ten patients were admitted with a post-traumatic acute slipping of their femoral epiphysis and 5 were presented and diagnosed as chronic cases. Out of the 15 cases, 3 cases had bilateral slips [18 hips]. The clinical criteria and radiological parameters were used to grade the results. In the acute slipping group, 90% were rated as excellent and in the delayed slipping group only 50% were rated as excellent. Complications were few and recommendations to minimize the complication rate were discussed

Unreamed interlocking nail for management of recent diaphyseal tibial fractures

Different methods were described for treatment of closed and open fractures of the tibial diaphysis, yet each method has its own pros and cons. Interlocking tibial nails had proved to be an effective and superior to other methods of fixation of the tibial shaft with the lowest rate of complications. Unreamed interlocking nails had advantages in that they cause less thermal and mechanical impairment of cortical and medullary cavity circulation. In this study, 3 types of nails were used [Richard's Russell and Taylor, Biomet-Klemm and Schellman, and Orthofix] without reaming in 22 patients. The Orthofix nail with its distal aiming device reduced both the surgical and the irradiation exposure times. There was 100% union rate, this was superior to the reported results with the reaming techniques. Statistical results revealed that there was significant relation between age of the patient and time needed for fracture union, and that the distal aiming device technique took significantly shorter operative time than free hand technique