Cardiac events and cardiac T2[*] in Egyptian children and young adults with beta-thalassemia major taking deferoxamine

Cardiac events and death are not uncommon in adults with beta-thalassemia [beta-TM] taking deferoxamine [DFO] monotherapy because of poor compliance and possibly the less effectiveness of DFO in controlling cardiac iron overload. We sought to assess compliance with DFO, the percentage of shift to other iron chelators, and the occurrence of cardiac siderosis, and cardiac events and death in beta-TM patients on DFO monotherapy. Prospective, observational, 10-year follow-up of patients attending Ain Shams Thalassemia Unit, Cairo, Egypt. For all beta-TM patients aged 2-1 8 years attending the unit during January 1998 and taking DFO, we recorded all cardiac events [whether fatal or not] during January 2008. All patients still on DFO monotherapy and with a normal EKG and not showing symptoms or signs suggestive of heart failure [HF] were evaluated for cardiac siderosis byT2[*]. Of 412 patients, only 126 [31%] were still taking DFO monotherapy [only 43% of those were compliant], 136 were taking combined DFO and deferiprone [DFP], 72 were taking DFP and 32 were taking deferasirox [DFX]. Twenty-one were lost follow-up and 25 died [10 cardiac]. Eight of ten cardiac deaths and 12 of 15 non-cardiac deaths were in the DFO monotherapy group. Those taking DFO monotherapy with no HF and left ventricular ejection fraction [LVEF] by T2[*] >56% had a median age of 19 years and 56% were males; cardiac T2[*] was <20 ms in 30 [22%]; 10-20 ms in 20 [14.7%] and <10 ms in 10 [7.3%]. LVEF ranged from 58%-76% [median 64%]. Forty percent of T2* patients <10 ms were compliant with DFO. Fifty-eight percent of patients on DFO monotherapy were noncompliant, but even compliance did not prevent severe cardiac siderosis and most cardiac events [whether fatal or not] that occurred in the DFO monotherapy group

MR susceptibility sign of the middle cerebral artery in imaging of acute stroke

To evaluate the accuracy of echo-planar T2-weighted, compared to MRA and FLAIR in the detection of acute middle cerebral artery [MCA] thrombotic occlusion. 47 consecutive patients with acute stroke involving the MCA territory underwent MR imaging within 2 to 76 hours after clinical onset. MR examination included echo-planar T2-weighted-, FLAIR, diffusion-weighted-imaging [DWI] and MR-angiography [MRA]. The susceptibility sign on echoplanar T2-weighted images, which is indicative of acute thrombotic occlusion involving the MCA, was assessed and compared to findings on MRA and axial FLAIR in all patients and to CT in 23 patients. National Institutes of Health Stroke Scale [NIHSS] score, which is a clinical scale assessment, was used for evaluating the neurological status of patients. Fourty seven [47] patients [29 males; age range 11-86years [mean: 58.3 +/- 14.7 yrs] and 18 females; age range 35-83 years [mean: 59.4 +/- 12.7 yrs] with acute territorial MCA infarcts were included in this study. Out of these 47 patients, 10 had hyperacute MCA infarction [scanned 2-6 hours after ictus], 7 of those patients presented with very severe stroke [NIHSS score 21 or more] and 3 patients with severe stroke [NIHSS score 15-20]. Thirty seven [37] patients were studied within 76 hours from ictus [acute to early subacute]. Among this group and according to NIHSS score, 5 patients had mild to moderate stroke, 16 patients severe stroke; and 13 patients had very severe stroke. One patient who had very severe stroke with NIHSS score of 22, died. She had left MCA occlusion, presented 4 hours within onset of right hemiplegia and had a history of DM, HTN and COPD. Presence of the susceptibility sign on T2 WI proximal to the MCA bifurcation provides fast and accurate detection of acute proximal MCA thrombotic occlusion. It is considered a warning sign for rapid and efficient intervention for stroke treatment, including thrombolysis and can be used for follow up of thrombus evolution

Blunt injuries of the diaphragm

Over a 9-year period, 15 patients [12 males and 3 females] with blunt traumatic rupture of the diaphragm were managed in Banha University Hospital. Their age ranged from 18-49 years. Automobile accident was the main traumatic mechanism in 12 patients. 3 patients presented with diaphragmatic hernia due to missed detection of diaphragmatic rupture a month to 2 years following the accident. The other 12 patients presented with acute diaphragmatic ruptures which could be diagnosed on emergency laparotomy [4 patients], within 24 hours [6 patients] and after 48-72 hours [2 patients]. Left and right diaphragmatic ruptures were encountered in 12 and 3 patients respectively. Transabdominal repair was the procedure of choice in the acutely injured patients due to the presence of associated abdominal injuries in all of them, with extension to right and left thoracotomy in 4 patients. Thoracic approach was used in the repair of missed cases. Diaphragmatic tears were repaired by interrupted mattress silk sutures [12 cases], or double breasting [3 cases] when enough tissues were available. Mortality rate was 20% which was not related to diaphragmatic injuries but reflecting the severity of associated traumatic injuries. Awareness of the possibility of traumatic diaphragmatic ruptures with major blunt trauma to abdominothoracic region and the presense of strongly suspicious clinical and radiological evidence of diaphragmatic rupture remain the best way of making early diagnosis and hence successful management of the condition

Laparoscopic cholecystectomy in pregnancy: a preliminary report

Laparoscopic cholecystectomy was carried out during the late first, and early second trimesters [11th-20th weeks] of pregnancy in nine pregnant ladies suffering from persistent biliary troubles not responding to conservative medical measures. All patients passed unremarkable postoperative courses. Eight patients passed to full term, and delivered healthy newborns. Pregnancy of the ninth case is still progressing normally at the time of this report. Laparoscopic cholecystectomy appears to be considered a safe procedure, and an optimal management in this particular situation when carried out during the proper timing. Further studies are recommended to determine these preliminary results

Fibrinolytic activity following surgical operations

Fibrinolytic activity before and after different surgical procedures was studied in 100 patients during pre-and postoperative periods. Patients were 54 males and 46 females with an average age of 40 years. Twenty-seven and seventy-three patients were subjected to minor and major surgical procedures, respectively.Thirteen patients who underwent major operations developed deep venous thrombosis [DVT]. Fibrinolytic activity showed obvious depression [shut-down] 24 hours after the operation in major surgery group with a marked effect on the DVT patients