Role of magnetic resonance imaging in assessment of acetabular and femoral version in developmental dysplasia of the hip / Papel da ressonância magnética na avaliação da versão acetabular e femoral na displasia do desenvolvimento do quadril

Abstract Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

Resumo Objetivo: Avaliar o papel da ressonância magnética (RM) na avaliação da versão femoral e acetabular na displasia do desenvolvimento do quadril (DDQ). Materiais e Métodos: Estudo transversal de 20 pacientes consecutivos com DDQ (27 quadris displásicos) que foram examinados com RM. Nos quadris displásicos e normais (grupos DDQ e comparação, respectivamente), avaliamos os seguintes parâmetros: anteversão acetabular óssea (AAO), anteversão acetabular cartilaginosa (AAC), anteversão femoral, índice de Mckibbin ósseo (IMO), índice de Mckibbin cartilaginoso (IMC) e espessura da cartilagem acetabular anterior e posterior. Resultados: A AAO foi significativamente maior nos quadris displásicos. A AAC, anteversão femoral, IMO e IMC não diferiram significativamente entre os quadris normais e displásicos. Nos grupos DDQ e comparação, a AAO foi significativamente menor que a AAC, o IMO foi significativamente menor que o IMC, e a cartilagem acetabular posterior foi significativamente mais espessa que a anterior. Conclusão: Nossos achados confirmam que a RM é uma ferramenta valiosa para a avaliação da versão femoral e acetabular na DDQ. A avaliação pré-operatória por RM tem grande potencial para melhorar o planejamento das osteotomias pélvicas e femorais.

Genotyping of nosocomial methicillin resistant Staphylococcus aureus with tracingthe source of infection: a guideline step in infection control strategy at General Surgery Department of Tanta University Hospital

Background: Methicillin-resistant Staphylococcus aureus [MRSA] represents a serious causal agent in nosocomial infections that are becoming increasingly difficult to cure due to their emerging resistance. Therefore, it becomes essential to understand the epidemiology of MRSA where pulsed field gel electrophoresis [PFGE] is considered to be the gold standard for the this

Objectives: This study aimss to make genotyping for the nosocomial strains of methicillin-resistant Staphylococcus aureus [MRSA] isolated form General Surgery Department of Tanta University Hospitals with tracing the source of infection as a guideline for infection control

Methodology: 159 different samples were collected from patients and 41 from suspected sources of infection. MRSA isolates were screened by Cefoxitin disk diffusion method then confirmed by detection of MecA gene by PCR. Phenotyping of the isolates was done by using the antibiogram while genotyping was done by using pulsed field gel electrophoresis [PFGE]

Results: MRSA isolates were found in 60 patients and 5 health care workers [HCWs]. Genotyping revealed 26 patterns [A - N and[ a - l] where type [A] was the most predominant. Isolates which had identical genotypes had different antiograms .Each ward revealed infection with muliple strains indicating multiple sources of infection while certain strains were found in multiple patients and multiple wards. Genotyping revealed that 2 HCWs were the most probable source of infection in 4 patients

Conclusions: Genotyping using PFGE is highly significant in studying the epidemiology of MRSA. HCWs should be seriousely considered, not only as a source of infection, but also as a major cause for transmitting infection between patients in different wards

Study for the relationship between lupus nephritis and anti-C1q antibodies

Background: lupus nephritis [LN] is an inflammation of the kidney caused by systemic lupus erythematosus [SLE], a disease by the immune system. Anti-C1q antibodies have been found in many different systemic autoimmune diseases, they are strongly linked to immune complex disorder most prominently SLE and severe rheumatoid arthritis and have been suggested to be closely associated with lupus nephritis [LN]. Generally anti-dsDNA antibodies have been acknowledged as an important tool in the diagnosis of SLE, however their predictive value as to the activity of the disease remains controversial, on the contrary anti-C1q antibodies appear to have a clear-cut relationship with renal complications of SLE not only have they been shown to play a pathogenic role in the development of lupus nephritis but also their serum levels correlate with the presence of active proliferation lupus nephritis

Aim of the study: this study aimed to investigate association between serum titer of anti-C1q antibody and disease manifestation of SLE

Methodology: the study was carried out in three different groups: healthy group, rheumatoid arthritis group and lupus nephritis group. All groups were subjected to determination of anti-C1q antibody, blood urea nitrogen [BUN] and serum creatinine

Results: there was no significant difference in BUN levels between the normal and rheumatoid arthritis groups in contrast there was a highly significant difference in BUN between the normal and lupus groups also, between the rheumatoid arthritis and lupus nephritis groups [p<0.001]. No significant difference was detected in serum creatinine levels between the normal and rheumatoid arthritis groups in there was a highly significant difference in serum creatinine between the normal and lupus groups and also between the rheumatoid arthritis and lupus nephritis groups [p<0.001]. No significant difference was realized in serum anti-C1q antibodies levels between the normal and rheumatoid arthritis groups in contrast there was a highly significant difference in serum anti-C1q antibodies between the normal and lupus groups and also between rheumatoid arthritis and lupus nephritis groups [p<0.001]. In the control group and rheumatoid arthritis groups, only BUN showed a highly significant positive correlation with serum creatinine concentration [r=0.906, r=0.404] and [P<0.001, P<0.05] respectively, while in lupus nephritis group, BUN showed a highly positive correlation with serum creatinine concentration [r=0.773, P<0.001] also serum creatinine concentration showed a positive concentration with serum anti-C1q antibody [r=0.513, P<0.05]

Conclusion: the present study suggested that anti-C1q antibody might be a new parameter for the development of lupus nephritis since the increased of anti-ds DNA antibody and hypocomplementemia [C3 and C4] are serological markers of SLE activity, but they are not enough to identify which organ may be affected, while anti-C1q antibody either alone or in combination with other serological markers could give information of the diagnosis of a renal flare with 100% sensitivity and specificity

Four petal evisceration: pros and cons

Purpose: To evaluate four petals evisceration as one of the best modifications in evisceration surgery, allowing the use of large orbital implant with low incidence of complications

Methods: We conducted a retrospective, interventional study on evisceration with placement of spherical non porous orbital implant after four petal evisceration. Preoperative examination included full history, ophthalmological examination, indication for surgery, B-scan ultrasonography, axial length in cases of atrophic and socket surface in secondary cases. All patients were operated a four petal evisceration with spherical non porous implant of size 18 to 22. Postoperative, all patients were followed for at least 6 months for presence of complications, implant and prosthesis motility and the final cosmetic results

Results: 18 eyes were included. Diagnosis necessitating evisceration was atrophia bulbi in 8 patients, endophthalmitis in 2 patients, and implant exposure in 4 patients, corneoscleral melting due to caustic exposure in 1 patient, self-eviscerated globe due to severe trauma in 1 patient and anopthalmic socket following evisceration without implant in 2 patients. Implant size was 18 in 1 patient, 20 in 6 patients, and 22 in 11 patients. No implant exposure occurred; superior sulcus deformity occurred in 3 patients, downward implant migration occurred in 1 patient. Regarding implant motility, it was good with mean of 75% in 14 patients; moderate with mean of 66% in 4 patients. The prosthesis motility was fair with mean of 35% in 12 patients [66.6%] and poor with mean [10%] in 6 patients

Conclusion: Four petals evisceration facilitates the use of large sized implant in all cases even in implant exposure with deficient sclera with good post-operative final cosmetic results, very low rate of complications and moderate prosthesis motility

Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby

Sonographic evaluation of maternal kidneys in normal pregnancy

Background and Objectives: Renal disease can affect the outcome of pregnancy. The renal system undergoes significant physiological and anatomical changes during pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy. The purpose of this study was to sonographically evaluate the kidneys in normal pregnancy

Methods: A prospective descriptive study in which real time B-mode renal ultrasound was performed on 500 pregnant women attending for a routine obstetric ultrasound scan. Questions about the age, parity and presence of loin pain were asked. Obstetrical ultrasound examination was initially performed followed by examination of maternal kidneys

Results: Renal collecting system dilatation was the main abnormal finding; it was present in 18.2% of cases, [15.2% right side and 3% left side]. Bilateral hydronephrosis was seen in [2.6%] of cases. Rate of hydronephrosis was more in primiparous women. Other findings were renal stones [2.8% right and 1.8% left sides, respectively], ureteric stone [0.2%] and acute pyelonephritis [1%]

Conclusions: This study established the value of renal sonography in the pregnant women, though not a common condition. Renal collecting system dilatation was the main finding. A significant proportion of patients with asymptomatic renal calculi were detected incidentally

effectiveness of breath carbon monoxide analyzer in screening for environmental tobacco smoke exposure in Saudi pregnant women

Exposure to environmental tobacco smoke [ETS] has harmful effects on the pregnancy outcomes similar to those observed in actively smoking pregnant women. The aim of this study was to estimate the sensitivity and specificity of the breath carbon monoxide [BCO] analysis in the assessment of smoking status among Saudi pregnant women, including ETS exposure compared to self-reported tobacco smoke exposure. A cross-sectional design was used during January 2012, 560 pregnant women, irrespective of their gestational age, agreed to undergo BCO testing and completed the data collection sheet for the study. Sensitivity, specificity, positive and negative predictive values were calculated to compare the BCO test with self-reported exposure to ETS. Of the study population 151 [27%] women self-reported ETS exposure during the index pregnancy, 409 [73%] self-reported non-exposure. Sensitivity of the test was 32.5% [95% CI; 25.2-40.3%], the Specificity was much higher at 69.2% [95% CI; 64.4-73.5%], the positive predictive value was 28% [95% CI, 21.9-35.1%], and the negative predictive value was 73.5% [95% CI; 68.9-77.7%]. The BCO test is an ineffective tool to detect the level of ETS exposure among Saudi pregnant women

Effect of pentoxifylline on serum hyaluronic acid in patients with non-alcoholic fatty liver disease

Liver fibrosis is the excessive accumulation of extracellular matrix proteins that occurs in most types of chronic liver diseases. Non-alcoholic fatty liver disease [NAFLD] can be associated with progressive hepatic fibrosis. In this study we evaluated the effect of pentoxifylline [PTX] on serum hyaluronic acid [HA] levels as a marker of fibrosis. In this study we included 30 subjects [14 males and 16 females], divided into three groups. The NAFLD group included 20 patients with fatty livers as shown by ultrasound examination. Patients were randomised into a placebo group of 10 patients who received a placebo, and a pentoxifylline PTX group of 10 patients who received pentoxifylline at 400 mg/day for 6 months. The control group included 10 normal individuals. In the NAFLD group the mean value of the base line serum HA was 133 +/- 150.48, while in the control group it was 33.5 +/- 10.01; the difference between the groups was statistically significant [p < 0.001]. The mean value of the base line serum HA in the PTX treated group was 169.5 +/- 156.19, while after 6 months of treatment it was 59 +/- 44.34, with a statistically significant difference [p = 0.007]. In the placebo treated group the mean value of the base line serum HA was 96.5 +/- 143.004, while after 6 months of treatment it was 59.7 +/- 44.29; this difference was not statistically significant [p = 0.594]. Our showed that, when administered for 6 months, PTX caused a significant decline in HA levels, which may be an index reflecting improvement of hepatic fibrosis. Further investigations should be conducted with a large number of patients to confirm our and correlate this with histological findings

Expression of the putative tumor suppressor gene gravin and beta actin in acute leukaemias: clinical importance and prognostic value by real-time quantitative PCR

A-kinase anchor protein 12 [AKAP12] is a scaffold protein that participates in mitotic regulation and other signaling processes and probably exerts tumour suppressor function. Acute leukemias are caused by genetic and epigenetic mechanisms involving tumour suppressor genes and oncogenes. Epigenetic regulation plays a key role in the pathogenesis of leukemia. Aberrant DNA methylation patterns are the most frequent molecular alterations detected in AML. Whereas the pathogenetic importance of these changes has begun to emerge, DNA methylation has thus far only played minor role as a biomarker in diagnosis, prognosis prediction and treatment control. The aim of this study was to determine the expression of tumor suppressor gene gravin which belongs to the A kinase anchoring protein family in acute leukaemia patients samples and controls and to explore its possible prognostic importance. In this study, real time quantitative PCR was used to determine gravin gene expression and beta Actin was used as control gene and expression levels were compared with prognostic factors. Gravin gene expression was found to be decreased in 100% of patients as compared with the control group and it was found that there is significant correlation between its expression and laboratory prognostic markers, prognosis and .treatment outcome of acute leukemia patients. Gravin gene expression was found to be decreased in acute leukemias and the degree of its decreased expression has been found to be correlated with poor prognosis

Estimation of HCV-viral load, interleukin-10 and interferon-gamma in patients with hepatitis C and schistosoma mansoni coinfection.

Patients coinfected with hepatitis C virus [HCV]and schistosomiasis exhibit a unique clinical, virological and histological pattern manifested by viral persistence with high HCV- RNA viral load, higher incidence of cirrhosis, hepatocellular carcinoma, poor response to interferon therapy compared with patients infected with HCV without concomitant schistosomiasis. The aim of the present work was to estimate HCV-RNA viral load, the serum level of interleukin- 10[IL-10] and interferon-gamma [IFN-gamma] in patients with only HCV infection, in patients with only Schistosoma mansoni infestation and in those patients with combined infections and to study any possible correlations. The current study was carried out on [69] of chronic HCV liver disease patients and [18] healthy individuals as a control. Patients were selected from Inpatients and Outpatients of Tropical Medicine and Infectious Diseases Department, Tanta University Hospitals. Patients in this study were subjected to the following: Thorough clinical examination, and lab investigations including; liver function tests, estimation of HCV- RNA viral load by real time PCR and estimation of serum level of IL-10 and IFN-gamma by ELISA. The present study showed that: There was marked and significant increase in the serum level of IL-10 in patients with schistosomiasis and in coinfected patients compared with control group. A significant but mild increase in the serum level of IL-10 was also found in HCV patients compared to control. Regarding IFN-gamma, patients infected with HCV had significant and marked increase in the level of IFN-gamma compared with control and with patients with schistosomiasis and coinfected patients

Conclusions: Schistosoma mansoni infestation seems to induce a Th2-related cytokines with increase in serum levels of IL-10 even in the presence of HCV coinfection. Schistosomiasis may downregulate the stimulatory effect of HCV on Th1 cytokines, leading to inhibition of release of IFN-gamma; and this may lead to the chronicity of HCV infection, hence the poor response to interferon therapy

Expression of toll-like receptor-2, human beta -defensin-2 and interleukin-8 in inflammatory acne vulgaris

Background: The etiologic factors of acne are multifactorial, including ductal epidermal hyperproliferation, excess sebum production and the presence of propionobacterium acnes [P. acnes]. Immune response to P. acnes include humoral and cell- mediated immunity as well as complement activation. The burgeoning knowledge of Toll like receptors [TLR] and its effect on innate immunity are modifying our concepts regarding comedogenesis and inflammation. Much remains to be learned about the pathogenesis of acne regarding the role of P. acnes and TLR

Objective: The aim of this work was to study the expression of TLR2, Human beta-Defensin-2 [HbetaD2] and Interleukin-8 [IL-8] in acne vulgaris patients compared to non lesional skin in order to evaluate their role in the pathogenesis of inflammatory acne

Patients and Methods: This study was conducted on 10 patients with inflammatory acne lesions. Two biopsies [from lesional and non lesional skin] were taken from each patient. Reverse transcriptionpolymerase chain reaction [RT-PCR] was conducted for the skin biopsies to detect the expression of the m-RNA of TLR-2, HbetaD-2 and IL-8

Results: The expression of the m-RNA of TLR-2, HbetaD-2 and IL-8 was statistically significantly higher in lesional skin biopsies compared with that in non lesional skin. A strong positive correlation was detected between TLR-2 and both HbetaD-2 and IL-8 in lesional skin biopsies

Conclusions: TLR-2, HbetaD-2 and IL-8 may have a role in the pathogenesis of inflammatory acne vulgaris. In acne lesions, keratinocytes express HbetaD-2 and IL-8 in response to P. acne and this is dependent on TLR-2. So, TLR-2 could be a target of therapeutic intervention to block the inflammatory cytokine response in acne patients

Estimation of anti-toxoplasma antibodies and Toxo-IgG avidity in the tear film as a diagnostic tool for early detection of human ocular toxoplasmosis

Objective: This study was designed to ascertain the diagnosis of active human ocular toxoplasmosis by detection of local anti-Toxoplasma IgA,IgM and IgG, as well as Toxo IgG avidity in tear samples

Subjects and methods: Patients attending the Outpatient Clinic of Ophthalmology Department-Tanta University Hospital during the period from April 2005 to June 2006 were examined and those suspected to have ocular lesions compatible with ocular toxoplasmosis were selected. The patients were classified into two groups: Group [I]: 14 patients with signs of active posterior uveitis presumably due to toxoplasmosis [APUPT]. Group [II]: 26 patients with chronic retinochoroidal lesion without active uveitis. A third group of 20 healthy individuals were chosen as a control group [group III]. Tears and serum samples were collected and were investigated for anti-Toxoplasma IgA, IgM and IgG. The positive samples for anti-Toxoplasma IgG were further investigated for Toxo-IgG avidity

Results: Regarding group [I] with APUPT, It was found that the tears of 9 out of 14 examined patients [64%] showed secretory IgA [sIgA]. In addition, 10 out of 14 patients [71%] had positive IgG values in their tears, nine of them had low avidity IgG, with only one patient had high avidity IgG. The simultaneous presence of sIgA and low avidity IgG in the tears denoted recent active infection. The serum samples showed the detection of IgA in 5 patients [36%] and IgG in 8 patients[57%]. In group II, sIgA could be detected in tear samples of 2 out of 26 patients [8%], whereas 19 patients [73%] had positive IgG values that all were high avidity. In serum samples, there were 3 patients[12%] with positive IgA, while 21 patients [81%] had positive IgG that all had high avidity. In the control group [III], only one subject out of 20 controls [5%] had IgA in both tear and serum samples. There were 4 and 7 patients [20% and 35%] presenting IgG in tear and serum samples respectively. All IgG had high avidity in both tear and serum samples. Anti-Toxoplasma IgM antibodies were not detected in any of tear or serum samples of all subjects in all groups

Conclusion: From this study it can be concluded that the simultaneous detection of anti-Toxoplasma sIgA and low avidity IgG in tear samples could be considered as a useful marker for early diagnosis of active ocular toxoplasmosis .Moreover, the tear fluid can be considered as a promising candidate for detection of local ocular antibodies because its collection is simple, easy and noninvasive

Detection of helicobacter genus and helicobacter pylori species in gastric fluid from patients with non-ulcer dyspepsia using a multiplex polymerase chain reaction

Helicobacter pylori [H. Pylori] is a human bacterial pathogen capable of surviving in the hostile environment of the stomach and duodenum. The bacterium has been linked to a number of gastric and extra gastric diseases. Recent reports of gastric infections caused by helicobacters other than H. Pylori created a clinical and research significance for a rapid, sensitive and specific diagnostic method. This is particularly important to make the laboratory-supported clinical diagnosis and follow up easier and specific. In this study, we used a multiplex PCR for the simultaneous detection and identification of Helicobacter genus and Helicobacter pylon in gastric fluid from patients with chronic non-ulcer dyspepsia. Patients with chronic dyspepsia of more than one month duration were recruited through the outpatient clinic in the university of Tanta hospital-Egypt for upper gastrointestinal endoscopy, only patients with no ulcer were involved in this study. Gastric fluid was obtained from 40 patients at the end of diagnostic upper gastrointestinal endoscopy, peripheral blood samples were also obtained and used to prepare serum for serodiagnosis. Gastric fluid was used for DNA preparation and inoculation of Skirrow's medium. Isolated pure colonies of H. pylori were used to prepare bacterial DNA to be used as positive control. Two pairs of primers; Hcom1, Hconn2 specific for Helicobacter genus, and Hicd1, Hicd2 specific for H. pylori species were used in the multiplex PCR. Two fragments of PCR products of 389 bp and 1200 bp were obtained from 34 specimen [85%] using Hcom1-Hcom2 and Hicd1-Hicd2 primers respectively. In five specimens [12.5%] a single band corresponding to the genus-specific gene and not the species-specific gene was obtained. In one specimen [2.5%], no DNA amplification was obtained. No DNA amplification of the negative control Gram-positive or Gram-negative bacteria was detected. The detection limit of the assay used in this study was 0.04 pg of DNA. The results obtained from this study demonstrate that 85% of the symptomatic gastric helicobacter infections are due to helicobacter pylori. They also demonstrate that this used protocol is a rapid, specific and sensitive assay for simultaneous detection of Helicobacter genus members and Helicobacter pylori species in gastric juice samples. This protocol reduces the number of PCR amplifications needed for specific diagnosis of the helicobacter infections. This can help physicians to have accurate and rapid diagnosis to cases of non ulcer dyspepsia, so that the right treatment can be precisely planned

Comparative study on valsartan [angiotensin II receptor antagonist] and benazepril and captopril [two angiotensin converting enzyme inhibitors] in experimental animals

The renin angiotensin system is present in both circulating and tissue forms. Its ultimate product, angiotensin II, is among a diversity of substances that control blood pressure. In the present work, comparison between valsartan [AT[1] antagonist] and benazepril and captopril [ACE inhibitors] revealed the following: Valsartan [15 mg/kg/day], captopril [15 mg/kg/day] and benazepril [3 mg/kg/day] p.o. for 4 weeks in renovascular hypertensive rats induced significant reduction in systolic blood pressure starting from the first week of treatment. There was no significant difference among the three groups except in the fourth week when captopril and benazepril groups were significantly different from valsartan group. In isolated rabbit aorta, all the three drugs reduced the force of angiotensin-I induced contraction, significantly for valsartan and captopril and insignificantly for benazeprilat

Effect of interferon alpha on the islet tissue of langerhans in the pancreas of albino rat [light and electron microscopic study]

Thirty adult male albino rats were used throughout the work. The animals were divided into three groups: the first group was used as control, the second group was injected with 0.5 ml of interferon solution subcutaneously three times weekly for six months, while the third group was left for one month after injections with interferon for recovery. Six months post injection, the islet tissue shows selective damage and disappearance of epithelial cells of the peripheral ducts in majority of animals. These ducts were lined only by basement membrane, few mother cells of A-cells were only found. The process of proliferation either sprouting or mitosis stopped completely. The islet tissue in the majority of animals degenerated completely with heavy lymphocytic infiltration while others appeared partly healthy. One month post last interferon injection, the islet recovered and returned to normal morphology. The rise of glucose in the treated animals at the time of sacrifice, after 6 months, was not significant and was not considered diabetic

Astrovirus diagnosis in admitted infants with acute diarrhea

Viruses are important causes of diarrhea. In addition to rotavirus, other viruses are increasingly being identified as causative agents of gastroenteritis. The objectives of this study were to differentiate between bacterial and non-bacterial diarrhea by rapid methods and to study the role of astrovirus in acute infantile diarrhea and its clinical features. The study was conducted on 100 admitted infants with acute diarrhea and twenty healthy infants were included as controls. The studied infants were subjected to history taking, clinical examination, complete blood count and measuring of interleukin-6 [IL-6] and tumor necrosis factor-alpha [TNF-alpha] in serum. Stool analysis, stool culture and detection of rotavirus and astrovirus in stools of studied patients were carried out. The results showed that TNF-alpha and IL-6 were significantly higher in infants with bacterial diarrhea compared to controls [p<0.05]. Astrovirus was diagnosed in 5% of studied acute diarrheal cases. There was a significant increase in occurrence of viral diarrhea in winter compared to summer. No significant difference in age incidence or clinical features could be detected in cases of astrovirus compared to rotavirus infection [p>0.05]

Conclusion: TNF-alpha and IL-6 can differentiate rapidly bacterial diarrhea from non-bacteriai ones" Astrovirus plays a role in causation of acute infantile diarrhea

Genucephalic nailng of supraccondylar femoral fractures

From April 1997, 12 patients with 13 supracondylar femoral fractures were treated with a retrograde intramedullary nail. The average follow-up 13.8 months [range, 4-23 months]. All fractures healed by 4 months. Average knee range of motion was 104°. There were 3 excellent, 8 good, and 2 fair results. The supracondylar retrograde intramedullary nail gives rigid internal fixation and rapid healing compared to lateral fixation devices with significant less soft tissue dissection

Revision of anterior cervical diskectomy and arthrodesis

In this study, eight patients were managed operatively after the failure of an anterior cervical discectomy and arthrodesis. Seven patients had a failure of a previous arthrodesis without deformity [but with different combinations of neck pains, radiculopathy and myelopathy], two of them showed dislodgment of the graft after a Cloward arthrodesis. The last patient showed a failure due to a kyphotic deformity with residual spinal canal compromise after discectomy and a Cloward arthrodesis. Operative revision of the pseudoarthrosis consisted of a repeated resection of the disc space in the area of the failed arthrodesis, followed by repeated anterior Robinson arthrodesis with decompression of the nerve root or the spinal cord. Anterior corpectomy [vertebral body resection] and strut grafting were done for one patient with cervical kyphosis. Revisions were performed from six months to five years after the initial operation. The follow up period after revision ranged from 9-42 months. All reoperated patients got solid fusion of the graft and relief of neck pain with varying degree of neurological recovery

Pregnancy in the obese Egyptian

The obstetric performance and pregnancy outcome in 46 obese pregnant mothers and 578 non-obese controls were studied. The mean weight gain among the obese patients was significantly higher than in the non- obese group. Prenatal problems, such as hypertensive disorders, gestational diabetes, insulin-dependent diabetes, urinary tract infections, abnormal presentations, post-term labor or thromboembolism, were more common in obese compared with the non- obese patients. Intrapartum and postpartum problems, such as prolonged labor, use of oxytocin, operative deliveries, postpartum hemorrhage and wound infection, were found more in obese mothers rather than in the non-obese controls. Fetal problems, such as shoulder dystocia, meconium aspiration, asphyxia or hypoglycemia, showed a higher incidence in the first group when compared with the second one. Perinatal mortality was high in the obese group. This can be attributed to the high incidence of congenital anomalies encountered in obese mothers. Macrosomia was seen more in the obese group compared with the controls. Fetal weight was significantly higher in obese mothers when compared with the controls

Comparative study of ultrasonography and computed tomography in the management of pelvic and pelviabdominal masses

To evaluate and compare the help which the clinical can get from U.S. and C.T. Scanning and to find out when one or both investigations should be done, 56 cases with pelvic or pelviabdominal masses were studied. These cases were prospectively studied by both U.S. and C.T. before surgical management. The results were compared with the findings of laparotomy or laparoscopy when indicated. U.s. and C.T. gave similar results in 37 cases [66%]. C.T. Was diagnostic but not U.S. in 15 cases [26.8%]. U.S. was diagnostic but not C.T. in 2 cases [3.6%]. False positive diagnosis of cysts by U.S. which were excluded by C.T. was found in 2 cases [3.6%]. Although both modalities are complementary, it can be concluded that sonography is the modality of choice for evaluation of uterine neoplasms that tend to be confined to the uterus. C.T. is better than U.S. in detecting extrauterine extension tumors. C.T. Can be considered as a second order diagnostic examination as it is relatively expensive and time consuming procedure