Variation in the vertebral levels of the origins of the abdominal aorta branches: a retrospective imaging study / 대한해부학회지

Our aim was to investigate the variation in the vertebral levels of the origins of the celiac artery, superior and inferior mesenteric arteries, paired renal arteries, and common iliac arteries. We conducted a retrospective imaging study in a large public secondary hospital on a nonrandom sample of 227 participants. We consecutively included adult patients who had undergone computed tomography angiography of the abdomen and excluded patients with a history of any vertebral abnormality or whose images revealed evidence of a vertebral abnormality or a congenital anomaly of any of the branches of the abdominal aorta. The primary outcome was the frequency distribution of the vertebral levels of the landmarks. The secondary outcomes were the intercorrelations of the vertebral levels of the landmarks and their relationships with age, sex, weight, height, and body mass index. The celiac artery originated at T11/T12–L1/L2, followed by the superior mesenteric artery at T12–L2, the paired renal arteries at T12/L1–L2/L3, the inferior mesenteric artery at L2–L4, and the common iliac arteries at L3–L5. The vertebral levels of the landmarks were positively intercorrelated and stronger between proximate pairs. In addition, the vertebral levels of the landmarks were related to age, but not sex, weight, height, or body mass index. The intercorrelations suggest that a considerable proportion of the variation is accounted for by ‘trickle-down’ variation; variation in the vertebral level of a proximal landmark results in variation in the vertebral level of the immediate distal landmark. The overarching parameter remains unidentified.

Variation in the vertebral levels of the origins of the abdominal aorta branches: a retrospective imaging study / 대한해부학회지

Our aim was to investigate the variation in the vertebral levels of the origins of the celiac artery, superior and inferior mesenteric arteries, paired renal arteries, and common iliac arteries. We conducted a retrospective imaging study in a large public secondary hospital on a nonrandom sample of 227 participants. We consecutively included adult patients who had undergone computed tomography angiography of the abdomen and excluded patients with a history of any vertebral abnormality or whose images revealed evidence of a vertebral abnormality or a congenital anomaly of any of the branches of the abdominal aorta. The primary outcome was the frequency distribution of the vertebral levels of the landmarks. The secondary outcomes were the intercorrelations of the vertebral levels of the landmarks and their relationships with age, sex, weight, height, and body mass index. The celiac artery originated at T11/T12–L1/L2, followed by the superior mesenteric artery at T12–L2, the paired renal arteries at T12/L1–L2/L3, the inferior mesenteric artery at L2–L4, and the common iliac arteries at L3–L5. The vertebral levels of the landmarks were positively intercorrelated and stronger between proximate pairs. In addition, the vertebral levels of the landmarks were related to age, but not sex, weight, height, or body mass index. The intercorrelations suggest that a considerable proportion of the variation is accounted for by ‘trickle-down’ variation; variation in the vertebral level of a proximal landmark results in variation in the vertebral level of the immediate distal landmark. The overarching parameter remains unidentified.

Risk factors of hepatitis B virus infection in urban and rural areas of Qena governorate, Upper Egypt

Background: HBV infection is a significant health problem in Egypt which is categorized as an HB virus intermediate endemic area, with HB carrier rate ranging from 2%-7%. HBV infection is the 10[th] leading cause of death and HBV related hepatocellular carcinoma is the 5[th] most frequent cancer worldwide

Aims of the study: The present study aims to investigate the most important risk factors for transmission of HBV and HCV in urban and rural areas in Qena Governorate, Egypt

Patients and Methods: A matched case control study was conducted. The study included 600 patients, 100 HBV cases and 500 controls, aged above 20 years and below 70 years. Direct interview was done with each participant separately for filling the questionnaire during the period from January 2013 to January 2014. The collected data were reviewed, entered and statistically analyzed using SPSS version 19

Results: The mean age of cases and controls were 38.83 [ +/- 12.62] and 44.26 [ +/- 11.68] years respectively. Multivariate analysis shows that odds ratio of HBV infection is significantly higher among cases with some risk factors: injection by reused needle, sharing razors with others, dental procedures or oral surgery, blood transfusion and intravenous infusion and/or injection

Conclusion and Recommendations: The common risk factors exposures of hepatitis B infection included blood transfusion, dealing with patient blood, hospital admission, surgery, accidental stick with a blood contaminated needle, intravenous catheterization and dental procedures. There are statistically significant differences between HBV cases and their controls in the majority of these risk factors. The presence of these risk factors emphasizes the need for increasing the uptake of HB vaccine. Health care providers, health educators, and other community-based organizations must play an active role in counseling high-risk people

Effect of glimepiride on the aorta of adult albino rats after induction of diabetes mellitus

Diabetes mellitus is a chronic progressive disease that is associated with long-term complications such as diabetic angiopathy. Glimepiride is a third-generation sulfonyleurea that has an extrapancreatic effect on glucose metabolism besides its hypoglycemic action. The aim of the study was to assess the effect of glimepiride on the aorta of the adult albino rat after induction of diabetes mellitus. Forty adult male albino rats were used. They were divided into two main groups: group I and group II. Group I was the control group and group II was the experimental group. Group II was further divided into group IIA, in which 10 rats received glimepiride orally for 8 successive weeks, group IIB, in which 10 rats were given streptozotocin by means of a single intraperitoneal injection, and group IIC, in which 10 rats were given streptozotocin by means of a single intraperitoneal injection and were then given glimepiride orally for 8 successive weeks. Thus, a total of four groups of rats were studied. Five rats were randomly selected and sacrificed after 4 weeks, and another five rats were sacrificed after 8 weeks from the beginning of the experiment. The aorta was taken from each group and prepared for histological and electron microscopic examinations. The aortic tissue of the diabetic rats in group IIB showed apparent intimal thickening and accumulation of fatty cells within the subendothelial region with disturbance in the connective tissue distribution in the intima and the media. Electron microscopic study revealed atrophic endothelial cells in the intima. The internal elastic lamina was interrupted and the smooth muscle cells showed intracytoplasmic fat droplets. In group IIC, the aorta showed mild thickening and minimal fatty deposition in the subendothelial region. Electron microscopy revealed that the intima and the internal elastic lamina were nearly intact as in the control group. It could be concluded that glimepiride could alleviate the progression of aortic affection produced in case of experimentally induced diabetes mellitus

Efficacy of Isolated Nomuraea rileyi and Spinosad against Corn Pests under Laboratory and Field Conditions in Egypt.

Isolates of the entomopathogenic fungus, Nomuraea rileyi and spinosad were tested against the corn insect pests: Ostrinia nubilalis, Chilo agamemnon and Sesamia cretica under laboratory and field conditions. Results obtained showed that the LC50 of N. rileyi for O. nubilalis, C. agamemnon and S. cretica were 124, 146 and 159 conidia/ml under laboratory conditions. The corresponding figure for Spinosad was 166, 179 and 185 microgram/ ml (μg/ml. Under field conditions, results showed that during season 2011, the percentage of O. nubilalis, S. cretica and C. agamemnon infestations were significantly decreased in plots treated with N. rileyi to 25±3.2, 21±2.4, and 24±2.3 individuals after 120 days after the first application as compared to 97±3.3 in the control. When spinosad was applied in the field, the percentage of infestations was significantly decreased to 26±3.3 as compared to 99±1.3 individuals in the control during both seasons. During the harvest season, the corn weight was significantly increased to 3822±45.6 and 3940±60.4 kg/Feddan (Feddan=2400m2) in the plots treated with the fungus N. rileyi as compared to 2810±40.9 and 2710 ±73.2 Kg/Feddan in the control plots. Among plots treated with spinosad the yield significantly increased to 3000 ±60.7 and 3129 ±84.1 kg/Feddan during season 2011 and 2012, respectively.

Values of transforming growth factor beta-1, thrombopoietin and interleukin-6 in regulation of megakaryopoiesis in various platelets disorders

Megakaryopoiesis requires a highly complex series of cellular events in which a hematopoietic stem cell generates a cascade of committed progenitors and culminates with the production of circulating blood platelets. Megakaryopoiesis is regulated by several factors and cytokines that affect the proliferation and differentiation of megakaryopoietic cells. The aim of this study was to evaluate the role of some cytokines namely Thrombopoietin [TPO], Transforming growth factor [TGF-beta1] and lnterleukin 6 [IL-6] in regulation of megakaryopoiesis in various platelet disorders. This study was conducted on 72 patients with various platelet disorders; they were either thrombocytopenic [ITP "group I" or liver cirrhosis [LC] "group II" patients] or they presented with reactive thrombocytosis "group III". [According to modified Child classification group II patients was divided into three subgroups; Child A, Child B and Child C]. Twelve apparently healthy volunteers were included in the study for comparison. Estimations of serum TPO level, TGF-beta1 level and IL-6 level by ELISA technique were done for all studied groups. A highly significant increase in TPO and significant increase in IL-6 levels was noted in ITP group compared with the control group while TGF-beta1 was non significantly increased. In LC group and subgroups [Child A] a significant increase in TPO was noted on comparing with the control group but non significant increase in Child B and C; with progressive decrease of TPO level from Child A to Child B and Child C respectively. In LC group and Child C and B the TGF-beta1 was highly significantly increased on comparing with control group. Also it was significant increased in Child A when compared with control group i.e. there was progressive increase in TGF-beta1 with the progression of liver damage. A significant reduction in IL-6 was noted in LC group on comparing with the control group. A non significant reduction in IL-6 was noted in Child A, B and C group on comparing to the control group. In thrombocytosis group a significant increase in TPO, TGF-beta1 and IL-6 levels were noted compared to the control group. Estimation of serum TPO in ITP, liver cirrhosis and reactive thrombocytosis seems to be of benefit in diagnosis and evaluation of megakaryopoiesis state in these platelet disorders. Also estimation of TGF- beta1 can be used as good indicator of liver disease progress. TGF-beta1 was increased in thrombocytosis and this makes highlight to its role in feed back inhibition of megakaryopoiesis. Serum IL-6 was significantly increased in reactive thrombocytosis and this may confirm its role in stimulation of megakaryopoiesis

Parasitic leiomyoma: a rare cause of inguinal mass in females

Leiomyoma of the uterus is a common tumor during the reproductive age of females. It is classified as intrauterine and extrauterine. Extrauterine leiomyomas may occur without a concurrent uterine pathology. Different growth patterns have been described, like retroperitoneal and parasitic growth. We report a case of a 28-year-old female who was found to have inguinal mass, and it was finally diagnosed as parasitic leiomyoma. The mass was coming through the posterior inguinal wall into the subcutaneous region, like a direct inguinal hernia. She underwent excision of the mass, and repair of posterior inguinal wall. Parasitic leiomyoma can be a rare cause of inguinal swelling. When diagnosed, surgical excision is the treatment of choice

Development of harderian gland in female guinea pig: histological and ultrastructural study

The harderian gland is a large orbital structure which open by a duct onto the surface of the nictitating membrane. It is widely assumed that its primary function is to lubricate the surface of the eye. However, a variety of secondary functions have been ascribed to it, with suggestions that it is a site of immune responses for the conjunctival sac, a source of pheromones and/ or thermoregulatory lipids, a source of photoprotective secretions and part of retinal-pineal axis. By means of histological examination, harderian gland of female guinea pig was investigated to demonstrate the structural appearance of the gland at different age and the results were discussed with reference to functional aspect. A total number of thirty animals of different ages [5 animals each] were used in this study. The ages were [newborn, one week, two weeks, three weeks, two months and six months old]. Specimens from HG of each animal were prepared for light, electron and fluorescent microscopy and immunohistochemical examination. This study revealed that the newborn harderian gland showed signs of maturity features of secretory epithelial cells but continued differentiation with the age. Ultrastucture revealed two types of dark secretory epithelial cells [type I, the principle most common and type II, the vesicular]. The latter possess neuro vesicles with dense cores. Three types of light cells I, II and III present. The chief feature of the cytoplasm of these epithetlial cells was large numbers of lipid vacuoles which dominate the apical half of the cell. Secretory endpieces were surrounded by a network of myoepithelial cells. Heterogenous populations of mast cells with cytopasmic granules in different stage of maturity, size and electron density were detected in intersitium since birth. The glandular epithelial cells fluroscences pale yellow green with fluorescent microscope immunohistochemical result showed some glandular cells with chomogramin positive reaction. The present study will give a systematic description on the structure of the female guinea pig harderian gland at different ages

Postnatal development of the albino rat renal cortex [histological study]

Renal development involves 2 basic processes: morphologic formation and acquisition of function. The aim of the present study was to obtain histological information about the postnatal development of the filtration barrier and to throw more light upon the concomitant developmental changes of the convoluted tubules in albino rat's renal cortex. Ten pregnant female rats were utilized. Fifteen of their off springs were taken and divided into 3 groups: Group A: studied at the 2[nd] day postnatal. Group B: studied at the 10[th] day postnatal. Group C: studied at the 21[st] day postnatal. Kidneys were removed then 5 micro m thick paraffin sections were obtained and stained with haematoxylin and eosin stain for light microscope study. Renal cortex was cut into minute pieces and prepared for electron microscope study. Light microscope examination of 2 days renal cortex exhibited two cortical zones. The subcapsular zone contained immature forms of the renal developmental stages; the juxtamedullary zone contained mature renal corpuscles. While, electron microscope examination showed podocytes with flat cytoplasmic sheets and foot processes. Endothelial cells had few fenestrations. The filtration barriers revealed double basement membrane. The lining cells of proximal tubules had few short apical microvilli, mitochondria randomly oriented and few basal infoldings. Also, those of distal convoluted tubules appeared with randomly oriented mitochondria and some basal infoldings. The light microscope examination of 10 days renal cortex showed disappearance of all immature forms and maturing glomeruli were observed. Electron microscope examination showed podocytes with its primary processes and foot processes. The endothelial cells showed numerous fenestrations. The filtration barriers revealed fused basement membranes with presence of outpockets. The lining cells of proximal tubules had numerous tall tightly packed apical microvilli. Mitochondria appeared lodged in the basal infoldings in both proximal and distal tubules. The light microscope examination of 21 days renal cortex revealed mature renal corpuscles with lobulated glomeruli. Electron microscope examination demonstrated mature glomeruli showing podocytes with numerous foot processes. The filtration barrier showed regular basement membrane with no outpockets. The endothelial cells appeared attenuated with numerous fenestrations. Proximal and distal tubules showed mature picture. It has been proposed that adult renal diseases may be determined by events that occurred during fetal development. Therefore, results of studies on renal development in experimental models need to be interpreted and correlated carefully with the concomitant functional changes

role of hormone replacement therapy on structural integrity of lacrimal gland in ovariectomized albino rats [histological and immunohistochemical study]

Sex steroid hormones are important regulators of lacrimal gland functions. In addition, dry eye syndrome is conmion in menopausal women. This work was conducted to demonstrate the role of hormone replacement therapy [HRT] on structural integrity of the lacrimal gland of ovariectomized rats. Thirty six adult female albino rats, were used in the present work divided into three equal groups: Group I [control] and group II [bilaterally ovariectomized rats] sacrificed 1 and 12 weeks following ovariectomy. The third group contained ovariectomized rats receiving HRT was subdivided into: Subgroup lila received estradiol benzoate and subgroup III b received androgen. Small pieces of the gland were obtained and processed for different histological and immunohistochernical stains. One week after ovariectomy the connective tissue septa was thickened. Collagen fibers were abundant with extensive cellular infiltration around dilated ducts and congested blood vessels. Some acinar cells were vacuolated and others contained darkly stained nuclei. Twelve weeks after ovarictomy, the acini were lined with low cuboidal cells and their lumina were widened with increased collagen fibers inbetween. In hormone treated group, the gland nearly regained its normal architecture, however few acinar cell nuclei showed hyperchrornatism. In estrogen treated group some interlobular septa were widened. Concerning fiRs inimunoreactivity, in group 11, the acinar cell nuclei showed strong positive reaction in the first week then the reaction was negative after 12 weeks. The immune reaction for ERs remained negative after the HRT. One week after ovariectomy, the immune reaction for bcl-2 was weak in the cytoplasm of ductal cells and moderate in interstitial cells. After 12 weeks, they became immune negative and after estrogen and androgen treatment marked rise in their bcl-2 immune reactivity was observed. Sex hormone balance was proved to be a crucial factor in maintaining structural and functional integrity of lacrirnal gland. So, future clinical therapeutic strategies based on estrogen and/or androgen replacement therapy for aged women and patients with premature ovarian failure could help in preventing or curing dry eye syndrome associated with lacrimal deficiency is adivsed

Minimally invasive gastrointestinal surgery current status and future perspective: an evidence based review

The history of laparoscopy started as a primitive diagnostic procedure and it took close to a century before it became an effective therapeutic tool in the management of surgical problems. In this review, we examine the history of laparoscopy, methods of access, and the current application of minimally invasive surgery for the management of common gastrointestinal surgical problems. An evidence based review was utilized with emphasis on systematic reviews published from 1987 to 2009. Following the wide spread use of laparoscopic techniques for gall bladder removal, the benefits of laparoscopic surgery was established in the management of common gastrointestinal surgical problems. Laparoscopic management of colorectal cancer, morbid obesity, and gastroesophageal reflux diseases [GERD] are examined in this review based on the current review of the literature

Effect of some antihypertensive drugs on serum creatinine and tubulointerstitial index in adenine induced nephropathy in rats

The progression of chronic kidney disease [CKD] is more than just a simple, creeping loss of kidney function finally resulting in end-stage renal disease [ESRD]. The present study was intended to study the potential renoprotective effect of ramipril [angiotensin-converting enzyme inhibitors -ACEI] and valsartan [angiotensin receptor-1 blocker- ATI blacker] on adenine-induced nephropathy in rats. Also, to study the possible effect of combination of above mentioned drugs. Seventy- six male albino rats were used through out the study in Clinical Pharmacology Department, Mansoara University. Twelve rats were taken as negative control without any manipulation. Sixty four male albino rats were given adenine diet [I50mg] in 0.5 ml saline by gavage feeding once daily for 10 days to confirm induction of adenine-induced nephrotoxicity. Sixteen rats died during induction. Rats that survived, started treatment and divided into two main groups: animals in each group were classified into 4 subgroups [each contain 6 rats], each of them took the test drugs once daily by stomach tube for 4 weeks Group I: started treatment after 2 weeks from administration of adenine and Group II: started treatment after 4 weeks from administration of adenine. The sera were taken for measurement of creatinine. The kidneys are rapidly dissected and put in formalin containing bottles and taken for pathological examination by H and E and special stains that included PAS and trichrome stains. Administration of each of -amipril, ualsartan and combination of both ramipril and valsartan showed that they produced highly significant reduction of the mean serum creatinine level [p<0.01, p<0.001, p<0.001] respectively as compared with the positive control. There was non-significant decrease of tubulointerstitial index when comparing ramipril treated group, valsartan treated group, and ramipril plus vaisartafi treated group, versus positive control group. We concluded that adenine induced nephropathy is important model in elucidating tubulointerstitial injury and coincident with chronic renal insufficiency. Drugs under the study play some degree of renoprotectin

Myeloid sarcoma of the kidney preceding acute myeloid leukemia

Myeloid Sarcoma is a rare extramedullary tumor, consisting of primitive granulocytic precursor cells. We report the case of a 50-year-old man, who presented with a renal mass. After nephrectomy, histological examination revealed a myeloid sarcoma in association with a renal cell carcinoma. Seven weeks after nephrectomy the patient developed acute myeloid leukemia

Outcome of pregnancy in patients with liver cirrhosis

To evaluate the maternal and foetal outcomes in patients with liver cirrhosis and to determine the impact of pregnancy on the hepatic disease process. A prospective observational study. Setting: Sohag University hospital. Fifty one pregnant women with liver cirrhosis. They were followed throughout pregnancy to detect signs of hepatic decompensation and to detect any obstetric complication. Foetal growth curve was done bimonthly or monthly. 18% of patients developed hepatic decompensation during pregnancy; of whom 88% have occurred during the last 4 weeks of pregnancy. Only 2% of this decompensation has occurred before 32 weeks of gestation. 60% of patients developed obstetric complications. Preterm labour, HELLP syndrome, pre-eclpmsia and non-traumatic postpartum haemorrhage increase in patients with liver cirrhosis. The vast majority of these complications have occurred in patients delivered beyond 36 weeks of pregnancy. 30% of fetuses showed IUGR and 15% died intrauterine mainly in patients who developed hepatic decompensation. The maternal mortality was 8% and all were the result of hepatic coma occurring during labour. The risk of hepatic decompensation increases during the last 4 weeks of pregnancy. Preterm labour, HELLP, PET and PPH increases in decompensated patients. Hepatic coma during labour is the leading cause of maternal death. Termination of pregnancy at 36 weeks of pregnancy can decrease the maternal morbidity and mortality

Evaluation of triple screening test in prenatal diagnosis of Down syndrome

To evaluate the triple screening test [using AFP, beta-HCG and uE3] in prenatal diagnosis of Down syndrome through comparing the results of the test with the outcome of pregnancy. We will also compare these results with the results of the double test [using AFP and beta-HCG] or MSAFP test to evaluate the value of combining beta-HCG, alpha-fetoprotein [AFP] and unconjugated estriol with maternal age in this three-analyte maternal serum screening program for Down syndrome. This study was conducted on 50 pregnant women, 35 years or older. Their gestational age ranged from 14th to 19th week of pregnancy detected through 1st day of last menstrual period. Blood samples were taken from them for measurement of alpha-fetoprotein, HCG and unconjugated estriol. Risk ratio was calculated for Down syndrome detection using three protocols: MSAFP alone, MSAFP and HCG, MSAFP, HCG, and unconjugated estriol [triple test] using Prisca software [DPC, France]. The [cut-off] median MoM values in pregnancies with Down syndrome were 0.73 [AFP], 2.02 [beta-HCG] and 0.74 [uE3]. After labour, the newborns of selected women for the study were evaluated clinically for diagnosis of Down syndrome. The results of all tests done before labour are compared with the clinical evidence of cases to evaluate them. The detection rate of triple test, double test, MSAFP test was 75%, 50%, 25% respectively. The false positive rate was 40%, 75% and 94% respectively. The correlation coefficient between each test and actual outcome of pregnancy was 0.626 for triple, 0.267 for double and 0.146 for MSAFP test. Using cut-off value 1:190 kept the same detection rate for triple test and lowered the false positive rate to 25%. Triple screening test using AFP, HCG and uE3 has the upper hand over MSAFP and double test in detection of Down syndrome as it has the highest detection rate and lowest false positive rate. The value of correlation coefficient means that other factors or analytes need to be added to improve the detective power of the tests. It is strongly recommended to lower the cut-off value to be 1:190 instead of 1:270. These results need to be evaluated on a more large scale

Prevalence, symptomatology, and risk factors for depression among high school students in Saudi Arabia

To assess the prevalence and pattern of depression in a secondary school sample of Saudi Arabia adolescents. Four hundred and ninety secondary school students, comprising 306 males [62.4%] and 184 females [37.6%], in the age group 16-20, were surveyed from January to May, 2005 in Taif, Saudi Arabia, using the Arabic Beck's Depression Inventory [BDI] by a team consisting of a psychiatrist and psychologist. The prevalence of depression according to the Beck Depression Inventory [CBDI] [cut-off point: 19] was 110 [22.4%] for moderate [19-29], 36 [7.3%] for severe [30-40], and 18 [3.7%] as very severe [>40] in this study group, with a clear predominance of prevalence of depression in girls than in boys [1.5 times]. Multivariate logistic regression analysis demonstrated that the most significant risk factors involved were: gender, birth order, history of psychiatric illness, history of relative loss, and familial history of chronic diseases. Factor analysis revealed that self-criticalness, agitation, and loss of energy had the highest scores in the total sample. In the male subgroup, loss of energy, self-criticalness, punishment feeling, and agitation had the highest score while in the female subgroup, self-criticalness, agitation, and crying had the highest scores. Our findings provide gender differences in the prevalence and presentation of depressive symptoms. The experience of stressful life events increases the risk of depression. Assessment using screening is recommended. The increased risk for the onset of depression in adolescents reinforces the importance of early recognition and intervention

Evaluation of the anti-ischaemic effect of selective COX-2 inhibitor [rofecoxib] in permanent left middle cerebral artery occlusion [focal cerebral ischemia model] in rats

Cyclooxygenase-2 [COX-2] enzyme is induced in the central nervous system after various insults. It has been localized to neurons and in cells associated with the cerebral vasculature where the system is involved in the inflammatory component of the ischaemic cascade. COX-2 is part of the initial reaction that involves the arachidonic acid cascade, which produces molecules that involved in inflammatory response. The present of study evaluated the pharmacological effects of a specific COX-2 inhibitor [rofecoxib], in a permanent focal cerebral ischaemia model in albino rats and its effects were compared to those of calcium channel blocker [nimodipine]. Experiments were carried out on sixty male albino rats. Focal cerebral ischemia was induced by middle cerebral artery occlusion. Rofecoxib and nimodipine were administered 30 minutes after the occlusion of middle cerebral artery [MCA] and then daily IP for successive 6 days during which neurobehavioral evaluation was done. On the 7[th] day of occlusion, the infarction size, was measure and the remote hippocampal cell death were determined. Treatment with either rofecoxib or nimodipine caused significant equal improvement of the neurological score, significant attenuation of the infarction size and hippocampal cell death. While, the decrease of the infarction size was 50% by both drugs, the percentage of reduction of hippocampal degeneration was only 10% by both drugs. This difference in the percentage of improvement of infarction sizes and hippocampal degeneration may be due to presence of the hippocampus in a remote site from MCA blood supply. The present study suggests that COX-2 plays an important role in the ischaemic cascade of events. Furthermore, selective COX-2 inhibitors may be useful in the treatment of ischaemic stroke to improve motor functions

Platelet aggregation abnormalities in end-stage renal disease; a possible cause of hemorrhagic diathesis

End-stage renal disease patients [ESRD] are at risk of hematological complications. Hypercoagulability and paradoxically hemorrhagic tendency have been described in uremic patients. Hemorrhagic complications are primarily due to uremic platelet dysfunction and intermittent anticoagulation therapy used in hemodialysis. The aim of this study was to investigate the effect of hemodialysis [HDD] on platelet aggregation abnormalities and hence its role in bleeding in ESRD patients on maintenance hemodialysis. Forty two patients with ESRD on maintenance HD, in the hemodialysis unit at Sohag University Hospital utilizing polysulphon memrance and using Fresenius machines 94008 B] were included in this study and compared with a control group; of fourteen healthy adult volunteers. Blood samples were obtained for laboratory investigations form patients and controls before HD session and after the session from patients only the following laboratory investigations were performed; Complete blood cont [CBC]. serum urea, creatinine, Bilirubin, AST, ALT and hepatitis markers [HBsAg and anti HCV antibody]. tests for coagulation screening; PT and PTT, Study of platelet aggregation with ADP and Ristocetin. For all patients and controls bleeding time [BT] was performed at the time of sample taking. Bleeding time is significantly prolonged after the HD session comparing to results before the HD session and that of controls, platelet aggregation with ADDP and Ristocetin were significantly decreased in HD patients before and after session comparing to controls and also statistically significant comparing the results of patients before and after HD session. There is no statistically significant difference in the results of INR and PTT when comparing results of patients before and after sessions and when comparing the results of patients to controls, HD sessions in ESRD patients lead to platelet aggregation abnormalities which may resulted in hemorrhagic disorders in HD dependent patients

Anemia in systemic lupus erythematosus [SLE] patients; types, simple diagnosis and role of erythropoietin [EPO]

Anemia is a common hematological abnormality in Systemic lupus erythematosus and can easily be categorized with simple laboratory tests; the aim of this study was to investigate types and causes of anemia in SLE patients and to evaluate the role of EPO in different types of SLE anemia. Patients and methods; forty three male and female patients with SLE were investigated for types and possible causes of anemia among the follow up patients of the rheumatology outpatient clinic of Sohag university hospital in one year, blood and urine samples were obtained for laboratory investigations, patients with hemoglobin level less than 14 gm/dl for male and 12.3 gm/dl for female were consider anemic and enrolled in the study. Thirty nine patients [90.7%- 1 male and 38 females] were anemic, with mean age of 31 +/- 10 years, the types and incidence of anemia were; iron deficiency anemia [IDA] n = 22 [56.4%], anemia of chronic disease [ACD] n = 12 [30.8%] and autoimmune hemolytic anemia [AIHA] n=5 [12.8%], mean levels of hemoglobin were 10.4 +/- 1.3, 9.6 +/- 1.1 and 7.7 +/- 0.8, in the three groups respectively, low levels of complement C3 and C4 were observed in AIHA, and ACD, but not in patients with IdA. Anti-dsDNA antibodies were seen in all patients with AIHA, and in 10 patients with IDA, CRP concentrations were not related to severity of anemia in the three groups, higher levels of serum creatinine and proteinuria were detected in the three was no difference in the mean levels of EPO among different groups. Anemia in SLE can be easily diagnosed by simple methods, IDA is very common among SLE patients in our community, Erythropoietin [EPO] may have no role in SLE anemia and the presence of Anti Erythropoietin antibodies [AEA] and its role can not be ruled out

Outcome of surgical repair of iatrogenic injuries of major bile ducts

Bile duct injury is a severe and potentially life-threatening complication of open cholecystectomy [OC] or laparoscopic cholecystectomy [LC]. The management of bile duct injuries remains a challenge for most surgeons. The purpose of this study was to evaluate the presentation, characteristics, related investigation, and outcome of patents who underwent immediate or late repair of iatrogenic major bile duct injuries [MBDI]. Twenty three patients with post-cholecystectomy [OC or LC], and postoperative abdominal surgery presented with manifestation of biliary tract strictures or injuries between January 2000 and March 2005 in Sohag university hospital were included in this study. Those patients either underwent their primary surgery in the university hospital or were referred to the university hospital after their primary surgery was performed in other hospitals in our locality. Patients were subjected to clinical examination and to the following; laboratory investigations [blood picture, blood sugar, liver function test, serum urea and creatinine], abdominal ultrasound examination, CT scan, PTC, ERCP, and MRCP in selected cases. These patients then subjected to endoscopic and/or open surgical treatment. This study included 23 patients, 21[91.3%] after cholecystectomy [14 OC and 7 LC], and 2 patients after other abdominal surgeries. Bile duct injuries were recognized immediately in 5 patients [21.7%] [2 after OC and 3 after LC], and 18 patients [78.3%] presented later after the primary surgery. Their clinical presentations were obstructive jaundice in 13 patients [56.5%], external biliary fistula in 5 patients [21.7%], and biliary collection in 3 patients [13%]. The level of obstruction or injury was classified as Bismuth type 1 in 14 cases [61%], Bismuth type 11 in 6 cases [26%], and Bismuth type III in 3 cases [13%]. Bismuth IV and V types were not recorded among the studied cases. End-to-end anastomosis was done for 5 cases [21.7%]. The 5 patients [21.7%] to whom end-to-end anastomosis was done; failure was seen in 4 of these 5 cases [80%] and was corrected by re-exploration and reaired by hepaticojejunostomy. Choledochojejunostomy and hepaticojejunostomy were performed in majority of cases and showed no failures. Cholecystojejunostomy was done for the 2 cases [8.7%] that presented with bile duct obstruction after other abdominal operations. Postoperative complications includes, minor leakage in 5 [21.8%] patients was managed conservatively. Wound sepsis was seen in 8 [34.8%] with burst abdomen occurred in 3 [13%] of them. No operative mortality encountered in our patients. Late stricture encountered on long-term follow up [3 years] in 3 cases [13%]. The overall success after repair by Roux-en-Y hepaticojejunostomy was 78.3%. Major bile duct injuries after cholecystectomy and other abdominal surgeries are a considerable surgical challenge. Surgical reconstruction using Roux-en-Y hepaticojejunostomy mucosa to mucosa repair remains the golden standard procedure of choice for treating these injuries with successful outcome and better long-term result. Early recognition and adequate treatment at socialized institutions account for the key of prognostic parameters. Finally, as always, the true key to successful treatment of these injuries remains prevention