Risk factors and outcomes of occurrence of anastomotic leakage and reoperations for its management after colorectal surgery

Background: Anastomotic leakage (AL) is still the most annoying postsurgery complication after colorectal resection due to its serious complications up to death. Limited data were available regarding differences in AL incidence, management, and consequences for different types of colorectal resection. The aim of the present work was to evaluate differences in incidence of AL, incidence of postoperative complications, and length of hospital stay in a large number of patients who underwent elective colorectal resection for management of colorectal lesions. In addition to detect when and what type of reoperation for management of AL occur after colorectal resection. Patients: All 250 included patients underwent elective surgeries for colorectal resection with performance of primary anastomosis for management of colorectal neoplastic and non-neoplastic diseases in the period between May 2016 and July 31, 2021. We followed the patients for 90 days; we registered the follow-up findings. Results: the rates of AL occurrence were variable after the different procedures. The lowest rate of AL occurrence was found in patients who underwent right hemicolectomy, then in patients who underwent sigmoidectomy, left hemicolectomy, transversectomy and anterior resection (p= 0.004). A stoma was frequently performed during reoperation (79.5%) which was significantly different between different procedures: 65.5% in right hemicolectomy, 75.0% in transversectomy, 85.7% in left hemicolectomy, and 93.0% in sigmoid resection (p< 0.001). Conclusion Rates, types, time of occurrence and severity of AL vary according to the type of colectomy performed and selective construction of stoma during AL reoperation is currently safely applied with comparable mortality rates for patients who did and who did not have a stoma after reoperation. (AU)

Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

Fatores preditivos no tratamento da PseudoAcantose Nigricans por Laser de Dióxido de Carbono Fracionado e Peeling de Ácido Glicólico / Predictive factors in the treatment of Pseudo-Acanthosis Nigricans by Fractional Carbon Dioxide Laser and Glycolic Acid Peel

Introdução: Acantose nigricans é uma doença dermatológica comum caracterizada por lesões cutâneas aveludadas hiperpigmentadas e hiperceratóticas. Pode ser uma manifestação de doença sistêmica. Objetivo: O objetivo deste estudo foi avaliar os fatores preditivos clínicos e laboratoriais no tratamento da pseudo-acantose nigricans. Pacientes e métodos: Vinte pacientes com pseudoacantose nigricans foram incluídos neste estudo, escolhidos no ambulatório. Todos os casos foram submetidos a laser de CO2 fracionado no lado direito do pescoço e peeling de ácido glicólico 70% no lado esquerdo do pescoço. Cada paciente foi acompanhado por três meses e meio. Resultados: Houve melhora geral no índice de área, gravidade e textura no pescoço dos casos com pseudo-acantose nigricans quando tratados com laser de CO2 fracionado ou peeling de ácido glicólico. Conclusão: Não houve significância estatística ao comparar o efeito do laser ou peeling em diferentes faixas etárias e casos de obesidade ou sobrepeso.

Background: Acanthosis nigricans is a common dermatological disorder characterized by hyperpigmented and hyperkeratotic velvety skin lesions. It can be a manifestation of systemic disease. Objective: This study aims to evaluate the clinical and laboratory predictive factors in the treatment of pseudo-acanthosis nigricans. Patients and methods: This study included 20 patients with pseudo-acanthosis nigricans from the outpatient clinic. All cases were subjected to fractional CO2 laser on the right side of the neck and glycolic acid peel 70% on the left side of the neck. Each patient was followed up for three and half months. Results: There was an overall improvement in area index, severity, and texture in the neck of cases with pseudo-acanthosis nigricans treated with fractional CO2 laser or Glycolic acid peel. Conclusion: There was no statistical significance when comparing the effect of laser or peeling on different age groups and obese or overweight cases.

A comparison between different management surgical approaches in the treatment of splenic flexure colon cancer

Background: There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective: In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results: We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion: We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure. (AU)

Serum and ascitic fluid high sensitive C reactive protein as prognostic marker in patients with spontaneous bacterial peritonitis

Background: Spontaneous Bacterial Peritonitis (SBP) is the most frequent bacterial infection in cirrhotic patients with ascites. The mortality rate in those patients ranges from 40-70%.Aim: to assess level of serum and ascetic fluid polymorph nuclear leucocytes (PMN), high sensitive C reactive protein (hs-CRP) in patients with SBP before and after treatment. Methods: A cohort study was done on 114 patients SBP admitted in the Internal Medicine, Faculty of Medicine, Zagazig University during the period from December 2017 to September 2018. All patients were subjected to full history taking, thorough clinical examination, routine laboratory investigation, ultrasonography and ascitic fluid sampling. They was followed up for 5 days from starting treatment by parenteral third generation cephalosporin and peripheral blood (PMN), serum (hs-CRP), ascitic fluid PMN and hs-CRP were measured again.Results: the largest percentage of the patients were male, had posthepatitic C cirrhosis and child C score. There was statistically non-significant difference between antibiotic responders and non-responders regarding peripheral blood PMN before or five days after antibiotic use. There was statistically non-significant difference in ascitic fluid PMN, serum and ascitic fluid hs-CRP before treatment while the difference is significant between both groups regarding them five days after treatment. Percent change in serum hs-CRP was equal to that of ascitic fluid PMN. Percent change in ascitic fluid hs-CRP was comparable to that of ascitic fluid PMN. Conclusion: Serum and ascitic fluid hs-CRP level can be considered as alternative prognostic markers in cirrhotic patients with SBP

Atorvastatin: In-Vivo Synergy with Metronidazole as Anti-Blastocystis Therapy

Blastocystis is an enteric Straminopile in tropical, subtropical and developing countries. Metronidazole has been a chemotheraputic for blastocystosis. Failures in its regimens were reported and necessitate new studies searching for alternative therapeutic agents. Aim of current study is to investigate potential effects of Atorvastatin (AVA) compared to the conventional chemotherapeutic MTZ in experimentally Blastocystis-infected mice. Anti-Blastocystis efficacy of AVA was evaluated parasitologically, histopathologically and by transmission electron microscopy using MTZ (10 mg/kg) as a control. Therapeutic efficacy of AVA was apparently dose-dependent. Regimens of AVA (20 and 40 mg/kg) proved effective against Blastocystis infections with high reduction in Blastocystis shedding (93.4–97.9%) compared to MTZ (79.3%). The highest reductions (98.1% and 99.4%) were recorded in groups of combination treatments AVA 20–40 mg/kg and MTZ 10 mg/kg. Blastocystis was nearly eradicated by the 20th day post infection. Genotype analysis revealed that genotype I was most susceptible, genotype III was less. Histopathologic and ultrastructural studies revealed apoptotic changes in Blastocystis and significant improvement of intestinal histopathological changes more remarkable in combinational therapy groups. Thus, the present study offers AVA as a potential candidate for Blastocystis therapy combined with MTZ.

Assessment of localized therapeutic effect for prolonged release biodegradable implants loaded with 5-fluorouracil on rats with induced liver cancer

The objective of this research was to assess ability of biodegradable implantable 5-Fluorouracil dosage forms, to maximize the regional exposure of the drug while limiting its systemic toxicity in rats with induced liver cancer. Liver cancer was successfully induced in male Wistar rats using a selected protocol followed by surgical implantation of prepared 5-FU biodegradable implant. Rats were sacrificed at time intervals and the pooled blood used to perform the different tests and the implant was retrieved, and analyzed to calculate the amount of drug left in implant. The amount of 5-FU in blood was quantified using high pressure liquid chromatography [HPLC]. Gross examination of rat liver, calculation of liver to body weight percentage, and complete blood picture analysis were also performed. Liver biopsies were examined to assess signs of liver necrosis. Localized necrotic areas were noted in rat liver biopsies after 5 days with a perimeter of 0.3 to 0.6 cm around the implants indicating the localized 5-FU therapeutic effect. Sustained drug release was detected in rats for about 2 months and the amount of 5-FU released from implant into the systemic circulation was found to represent less than 13%.PLA coated injection molded implants loaded with 5-FU could present a promising dosage form for liver cancer treatment.

Occult hepatitis B and carcinogenesis markers in chronic hepatitis C infection

The presence of HBV-DNA in the patient's serum without detectable HBV surface antigen [HBsAg.] called occult infection. Detection of occult HBV infection in chronic hepatitis C virus patients was investigated by using qualitative PCR. Co-infection with occult HBV in chronic HCV patients increases the risk for progression to hepatocellular carcinoma [HCC].Detection of CD45-CD90+ as a biomarker in HCC patients by flow cytometry. We searched for serum HBV DNA in 30 patients with histologically verified HCV-related chronic liver disease, in addition to 10 healthy control subjects collected at National Liver Institute in Shebin El-Kom, Monofiya University, Egypt from January, 2010 to October, 2010. Off 40 patients, the sera of 9 [15.0%] were positive for HBV DNA by the different PCR assays, documenting an occult HBV infection. It found that 5 patient samples are positive for HBV DNA [Surface gene] [12.5%] of total 40 patient samples, also 3 patient samples are positive for HBV DNA [X gene] [7.5%] of total 40 patient samples, and only one patient sample was positive HBV DNA [core gene] [2.5%] of total 40 patient samples. Only two samples from the nine positive samples were positive for both Xgene and Surface gene. In conclusion these data suggest that occult HBV infection may have clinical significance in chronic hepatitis C patients

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

Wound ageing through evaluation of transforming growth factors alpha and betai expressions in human skin

Wound age provides valuable information for the reconstruction of crime scenes and determination of the cause of death. As skin covers the outersurface of the body, it is the most vulnerable part, and dermal wound age is a critical issue in routine forensic autopsies. The aim of this study was to determine the wound age by the use of immunohistochemical study of transforming growth factors [TFG-a and TGF-pl] on human skin wounds. Samples were collected from human skin wounds after operative incisions [from a few minutes to 6 weeks] and investigated using immunohistochemistry. TGF-a was started to increase after a wound age of approximately l0min. The maximum level was between 30-60min then decreased significantly. TGF-pl was also markedly increased within 60min and remained detectable in elevated levels in older wounds [6 weeks]. Thus, it appears that TGF-a and TGF-pl can efficiently contribute to the estimation of wound age based on the evaluation of their expressions. In particular, this applies to TGF-pl because it remains in high level for long time post injury

Non invasive evaluation of liver fibrosis in children with chronic liver diseases

To noninvasively assess liver fibrosis in children with chronic liver diseases by diffusion weighted MR imaging and 13Cmethacetin-breath test and compare the diagnostic accuracy between these tests referring to hepatic histology as gold standard. Fifty children [31 boys, 19 girls, median age 9.1 years], with chronic liver diseases and 20 age matched volunteers underwent diffusion weighted MR imaging of the liver and13C-methacetin-breath test Liver biopsy was obtained with calculation of METAVIR score. The ADC value of the liver and values of MBT was correlated with METAVIR score. Receiver operating characteristic curve was done for diagnosis and grading of hepatic fibrosis. There was statistical difference in the mean ADC value between volunteers and patients with hepatic fibrosis [P = 0.001] and in patients with different grades of METAVIR scores [P = 0.002]. There was correlation between the mean ADC value and METAVIR score. The cut off point to predict fibrosis [1.7x10-3mm2/s] revealed 84% accuracy, 88% sensitivity, 85% specificity, 81% PPV, and 87% NPV. The area under the curve was 0.91 for F1, 0.85 for F2, 0.86 for F3 and 0.90 for F4. Receiver operating characteristic analysis of the 13C methacetin breath test results revealed a cut-off <1.79 best with 94% sensitivity and 95% specificity in predicting cirrhosis. The area under the receiver operator curve was 0.968. The apparent diffusion coefficient value is a promising quantitative parameter used for diagnosis and quantification of hepatic fibrosis in children with chronic liver diseases. The non-invasive 13C-MBT proved to be safe, easy to perform and reliably differentiates between stages of hepatic fibrosis

Anemia, in adolescent females of preparatory schools in rural areas of sohag district

Anemia is generally recognized as the greatest nutritional problem among adolescents, as adolescence is a period of rapid growth, weight gain and blood volume expansion [Beard, et al., 2000][1]. This study aims to measure the prevalence, severity, and risk factors of anemia in adolescent school girls in the rural areas of Sohag district. The present study is a cross sectional study. A cluster sample was used from 6 preparatory rural schools. The total number of the sampled girls was 424 girl, they have undergone, personal interviews and filling of a questionnaire which includes the questions that guide us to the socio-demographic data. General examination which includes observation of the general condition, and pallor, measuring of pulse, weight and height, chest, heart and abdominal examination to detect any gross abnormality. Then every girl was subjected to measuring the blood HB% by Sahle's method. 34.4% have hemoglobin level less than 70% [cut off point] considered anemic. There were significant relationship between hemoglobin level and some socio-demographic characteristics and dietary practices of the studied girls. There is significant increase in the number of anemic girls among those who had early menarche than those who had late menarche. Anemia is prevalent in adolescent girls. However, this is the group that deserves particular attention, as they are the future mothers

Value of MRI and inflammatory markers in assessment of erosive osteoarthritis hand

To investigate the role of MRI and inflammatory markers [serum C reactive protein [CRP] as a marker of erosive osteoarthritis [EOA] of the hand. Thirty three patients, 22 with EOA and 11 with non-EOA of the hand, were included in the study and analysed for radiographic score [RS], number of erosions, and joint count [JC] at clinical observation and at MRI CRP was assayed in a serum sample by a highly sensitive immunonephelometric method. The median [interquartile range] CRP level was 5.2[2.7-7.2] mg/l in the EOA and 2.8 [0.7-5.2] mg/I in the non-EOA group [p = 0.001]. In all patients, CRP correlated with RS [p<0.001], and mainly with JC at clinical observation [p<0.001] and MRI [p<0.001]. The correlation of CRP with RS and JC was confirmed at clinical observation and at MRI in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup. CRP levels are higher in EOA than in non-EoA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and MRI. BMI, body mass index; CRP, C reactive protein; EOA, erosive osteoarthritis; ESR, erythrocyte sedimentation rate; hsCRP, high sensitivity CRP; MRI, Magnetic Resonance Imaging; IL, interleukin; JC, joint count; OA, osteoarthritis; RS, radiographic score

Surgical treatment and histopathology of different forms of olecranon and presternal bursitis in cattle and buffalo

Thirty seven cases of bursitis presented to our Veterinary Teaching Hospital from 2001 to 2005. There were 10 adult female buffalos with olecranon bursitis (one had bilateral bursitis) and 26 calves (7 cattle and 19 buffalos, 16 males and 10 females) with presternal bursitis. There were 10 out of 11 cases of olecranon bursitis and 21 out of 26 cases of presternal bursitis with different forms (cystic, proliferative and fibrous) that were removed surgically. The remaining 6 cases, cystic bursitis (olecranon = 1, presternal = 5), were treated by aspiration of their contents and injection of 4% iodine tincture intrabursally. Only 2 cases recovered, 3 cases progressed to fibrosis and required further surgical treatment 2 to 3 weeks later, and 1 case continued to have a cystic lesion. Histopathological examination of tissue specimens from different forms of bursitis revealed that the acquired bursae were generally lined with synovial-like membrane formed from 2-3 cellular layers that covered the connective tissue capsule. The connective tissue capsule differed from one type to another and consisted of fibrous tissues containing numerous small blood vessels, blood capillaries, lymphatics and nerves. There was also evidence for inflammation within the capsule represented by congestion of blood vessels and the presence of perivascular inflammatory cells, mostly mononuclear. In conclusion, surgical treatment was successful and effective for treatment of olecranon and presternal bursitis particularly for the chronic proliferative and fibrous form in cattle and buffalo. The histological structure of the acquired bursae was relatively similar consisting of a synovial-like membrane and a connective tissue capsule with varying degrees of the inflammatory process.

value of magnetic resonance cholangiopancreatography and selective use of endoscopic retrograde cholangiopancreatography in patient management prior to laparoscopic cholecystectomy

Different diagnostic modalities have been used to asses patients with cholelithiasis before laparoscopic cholecystectomy [LC] for the suspicion of choledocholithiasis. The aim of this study is to define predictive guidelines for patient management with selective use of magnetic resonance cholangio-pancreatography [MRCP] and endoscopic retrograde cholangiopancreatography [ERCP] before LC. ERCP is considered the gold standard for diagnosis and clearance of common bile duct [CBD] stones before LC. MRCP has recently developed as a noninvasive imaging modality for the detection of choledocholithiasis. However it needs further evaluation as regards its diagnostic accuracy in patient management before LC. Between October 2001 and December 2004, 128 patients [88 females, 40 males; mean age 48 [range 14-78 years] with cholelithiasis were prospectively evaluated before LC applying predictive guidelines that include patient information obtained from clinical assessment, blood chemistry tests, and abdominal ultrasonography. Patients were put into one of four groups according to the level of suspicion for choledocholithiasis [group 1, high; group 2, moderate; group 3, low; group 4, very low]. Group 1 patients underwent ERCP with or without endoscopic sphincterotomy for clearance of common bile duct stones; group 2 patients were subjected to MRCP; group 3 patients were operated on by LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography. CBD stones were demonstrated in 15 [11.7%] of 128 patients. The incidence of choledocholithiasis in groups 1, 2, 3 and 4 was 83.3% [10/12], 27.3% [3/11], 7.1% [1/14], and 1.1% [1/91]. rescectively [P < 0.001]. ERCP was successfull in diagnosis and therapeutic clearance of CBD stones before LC in 91.7% [11/12] of patients. It showed a sensitivity, a specificity, and an overall accuracy of 92.3%, 100%, and 91.7% respectively. MRCP was utilized in 8.6% [11/128] of patients. It was unable to detect a CBD stone in one patient, with a sensitivity, a specificity, and an overall accuracy of 75%, 100%, and 91% respectively. lntraoperative cholangiography detected a CBD stone in one patient in group 2, and in another patient in group 3 which were extracted using postoperative ERCP. Only one patient in group 4 had a missed CBD stone which was manifested three months after operation and the patient underwent ERCP with stone clearance. It was concluded that initial evaluation using certain predictive guidelines in patients with cholelithiasis can accurately predict the probability of choledocholithiasis with selective use of MRCP which is an accurate non invasive diagnostic method and ERCP for therapeutic clearance of CBD stones before LC. Thereby improving patient care and resource utilization

Mitral annular calcification, aortic valve sclerosis and aortic root calcification as a predictor for coronary artery disease

Mitral annular calcification [MAC], aortic valve sclerosis [AVS], and aortic root calcification [ARC] are degenerative disease associated with the same risk factors for CAD. Histological and biochemical studies suggests similarities between the mechanisms involved in the development of [MAC, AVS and ARC] and atherosclerosis, suggesting that various calcification processes are part of the spectrum of atherosclerosis and degenerative diseases. This study aimed at evaluation of MAC, AVS and ARC detected by transthoracic echocardiography as a marker for high prevalence of coronary artery disease and to study there to predict the presence of CAD. This study included 50 patients, 30 males and 20 females with mean age of 57.8 +/- 8.5 years. All Patients were subjected to: Careful History taking and Thorough clinical examination, Resting 12 leads surface ECG, Chest X ray, Laboratory investigation for diabetes mellitus and hyperlipidemias, Exercise stress test, Coronary angiography and Complete Echocardiographic study with special comment on MAC, AVS, ARC and calculation of the Calcium Deposits Score. Subjects were classified into five groups, Group [1]: patients MAC alone, Group [2]: patients with AVS alone, Group [3]: patients with ARC alone, Group [4]: patients with two of the above and Group [5]: with All of the above. There was significant difference between patients with and without MAC as regards the incidence of DM and HPN [P < 0.05]. Also the age was higher in patients with MAC [61.6 +/- 7.6 vs. 57.6 +/- 8.5 years] but this difference did not reach statistically significant level [P > 0.05]. The incidence of three vessel disease was significantly higher in patients with MAC [P < 0.05]. The calculated sensitivity of MAC in prediction of CAD was 50%, specificity was 100%, predictive value positive was 100%, predictive value negative was 33.3% and total accuracy was 60% This relatively low sensitivity means that the absence of MAC could not exclude the presence of CAD but the presence of MAC strongly suggest CAD even Severe CAD can be predicted if there is MAC [increased incidence of three vessel disease in patients with MAC]. There was significant difference between patients with and without AVS as regards the age and sex [P < 0.05]. The incidence of DM [77.8% vs. 64.3%], HPN [69.4% vs. 57.1%] smoking [33.3% vs. 7%] was higher in patients with AVS but these differences did not reach statistically significant level [P > 0.05]. The calculated Sensitivity of AVS for prediction of CAD was 75%, specificity 40%, predictive value positive 83.3% and negative 28.5% and accuracy 68%. There was significant difference between patients with and without ARC as regards the incidence of HPN, single and two vessel disease in coronary angiography [P < 0.05]. Although the patients was older [60.1 + 8.3 vs. 58 + 8.3 years], the incidence of dyslepidemia [86.7% vs. 70%] was higher in patients with ARC than patients without ARC, yet these differences did not reach statistically significant level. The calculated Sensitivity of ARC in prediction of CAD was 65%, specificity 60%, predictive value positive 86.7% and negative 30% and accuracy 64%. There was significant difference between patients with different scores regarding the age, incidence of normal coronary angiography, single vessel, two vessels and three vessel disease in coronary angiography. [P < 0.05] the calculated Sensitivity of calcium deposit score one [stated above in MAC, AVS and ARC], but when there is more than one site of calcification [score 2 and 3] the Sensitivity, specificity, predictive value positive, predictive value negative and accuracy all reach 100% for detecting CAD even in the presence of negative exercise stress test. The presence of MAC, AVS, and/or ARC detected by TTE are simple, noninvasive method for prediction of the presence of CAD with accepted sensitivity, specificity, predictive value positive, predictive value negative and accuracy. And when there is more than one site of calcification [calcium deposit score 2 or 3] the sensitivity, specificity, predictive value positive, predictive value negative and accuracy reach 100% for detection of CAD

Brown tumors of hyperparathyroidism [BTHPT]. Experience with fifteen patients

Brown tumors of hyperparathyroidism [BTHPT] are non neoplastic lesions. They may be associated with primary, secondary or tertiary hyperparathyroidism. However it occurs far more common with the primary one. The maximum reported cases in the literature were three cases, but we have encountered 15 patients in the last 8 years. All these cases were associated with primary hyperparathyroidism due to parathyroid adenomas in 14 cases and parathyroid carcinoma in one case. All the adenomas were excised after proper pre-operative localization. Ten were found in the neck and live were found in the superior mediastinum. The intraoral tumor like lesions were not touched and regressed in size till completely disappeared within 6 -18 months post operatively. One patient underwent surgical excision of the disfiguring upper jaw swelling that was also interfering with mouth opening, chewing and swallowing. The clinical presentations of the cases, the preoperative methods of localization, the surgery done and the follow up [i.e. the change in tumor size and the blood chemistry] are presented and discussed

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis Iymphadenitis, 90% in Hodgkin's lymphoma. 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading

Direct coronary stenting and conventional PTCA followed by coronary stenting comparitive study

Multicenter randomized trials have demonstrated that restenosis and repeat revascularization are reduced and event-free survival at 6 months is increased when elective stent implantation is performed' in carefully selected patients and coronary lesions. Therefore, in the majority of centers intracoronary stent placement is now used in more than 80% of the percutaneous coronary interventional procedures. The standard stent implantation technique includes pre- dilatation of the lesion with a balloon cather followed by stent implantation. The new generation of stents is reliably pre-mounted on high pressure compatible balloons with a very low profile stent delivery system that allows direct stent implantation without pre- dilatation in high proportion of patients who are candidates for. PCI

Aim of the Work: In this work we compare short and long-term [6 months] outcome of direct coronary stenting, with standard PTCA followed by coronary stenting

Subjects and Method: This study included 80 patients with IHD whom were proper candidates for PCI in the form of coronary artery stenting with or without pre- dilatation, patients were divided into two groups: Group [1] Included 40 patients treated by direct coronary stenting technique and Group [2] included 40 patients treated by standard balloon angioplasty and stent implantation. All patients subjected to complete history taking and thorough clinical examination, 12-lead surface ECG, Coronary angiography followed by PCI procedure and stenting with and without predilatation and follow-up repeated clinical evaluation and coronary angiography was done for all patients 6 month's after PCI for detection of restenosis of the dilated vessel

Results: we found no statistically significant difference between the two groups regarding age, sex, prevalence of smoking, hypertension, diabetes mellitus, the family history, history of previous coronary artery disease and cholesterol level. There was no statistically significant difference between both groups regarding lesion morphology before dilatation and after dilatation. And there were no significant difference in maximal inflating pressure. But there was highly. significant difference between both groups regarding mean flouro-time used in both procedure [less flouro-time in group [1]] highly significant difference in total procedural time and amount of dye used in the procedure [less total procedural time and less amount of dye used in the group [1]]. There were no significant difference between two groups regarding procedural complications and follow up complications. Also, there was no significant difference between both groups regarding restenosis rate in the follow up coronary angiography, [restenosis occurred in 11 patients in group [1] 27.5%, and in 13 patients in the group [2] 32.5%]

Conclusion: From this study we concluded that: Direct stenting in selected lesions seems to be safe and feasible procedure. The procedural, in-hospital and long-term clinical and angiographic outcomes are equivalent comparing group [1] with group [2], The demonstrated benefits of direct stenting approach were the reduction of the amount of dye, reduction of fluoro-time, reduction of the total procedure time, saving the balloons of pre-dilatations, so, reduction of the total procedure cost and reduction of radiation exposure risk on intervention team. So, we recommend the use of direct stenting whenever indicated

revolution of MR imaging in evaluation of posterior fossa tumors, is there still a value of CT examination in this respect, an initial-experience comparative study in Assiut University

Althrough a period of time extending from January to December 2001, fifty-one patients [32 males and 19 females] and of ages ranged from 2 months to 70 years were selectively included in our study for the clinical suspicion of posterior fossa space occupying lesions [SOL]. All patients submitted to full clinical assessment that was followed by a dual sitting radiologic work-up including CT scanning [using a Toshiba CT machine] and multiplanar MR imaging [using a Gyroscan MR machine] where comparison of the obtained CT and MR findings was performed depending on the proof obtained from final operative and histopathologic reports to assess the well-established role of the former [CT] to that of superadded latter procedure [MR] in the light of our experience in this respect. According to the histopathologic results, it was noted that cerebellar astrocytomas were the most frequent [18] ones representing 35.8% followed by 12 medulloblastomas [23.6%], 8 brain-stem gliomas [15.7%], 3 meningiomas [5.7%], 3 acoustic neuromas, 3 hemangioblastomas [5.7%], 2 ependymomas [3.9%] and 2 choroid plexus papillomas [CPPs] [3.9%]. It was noted that MR imaging has notably improved the tumour detectability regarding its borders and relation to the surrounding tissues that were sometimes improperly assessed on CT images due to petrous bones imaging artifacts and regarding its ability to detect the CSF seedlings of a tumour that was seen only on contrast-enhanced MR images in six of our patients due to its highest inherent resolution and soft tissue discrimination ability and to the unlimited multiplanar imaging capabilities, although detection of calcification is still a unique advantage of CT over MR imaging in this respect. In our study, the compared overall accuracy of MR to CT was 99.32% to 98.42% respectively. We concluded that when both procedures are available for usage, MR should be that of choice