Assessment of retinal nerve fiber layer thickness using optical coherence tomography in patients with type 2 diabetes mellitus

Background: Diabetic retinopathy (DR) is the most common ocular complication of diabetes mellitus (DM) and considered one of the leading causes of blindness in developed countries. Diabetic retinopathy is predominantly amicroangiopathy in which high glucose levels can make small blood vessels particularly, vulnerable to damage. Objective: The aim of this work was to assess the thickness of peripapillary retinal nerve fiber layer (RNFL) measured by Swept Source optical coherence tomography (SS-OCT) in patients with Type 2 Diabetes Mellitus (DM). Patients and Methods: The study was an observational cross-sectional study. The study was conducted on 40 eyes of diabetic patients from the outpatient clinic in ophthalmology department of Al-Azhar University Hospitals. All patients were subjected to a complete ophthalmic examination including OCT. Results: The current study showed a negative correlation between parameters related to DM (duration of DM, and state of glycemic control measured by HbA1C) and all the parameters related to RNFL, and RGCL thickness but this correlation was statistically insignificant, and there was statistically significant decrease in superior RNFL thickness in patients with mild DR than patients with no DR, however, this difference was statistically insignificant in all parameters related to RGCL thickness in the two groups. Conclusion: Optical coherence tomography (OCT) provides non-invasive, quantitative and objective measurement of RNFL thickness, optic nerve head, and RGCL thickness with high resolution and accuracy. This could be the method of choice for monitoring the neurodegenerative changes in DR

Soft tissue changes after anterior maxillary osteotomy by using 3D CBCT scanning / Cambios en los tejidos blandos después de la osteotomía maxilar anterior mediante el uso de la exploración 3D CBCT

The objective of this study was to evaluate the soft tissue changes after anterior maxillary osteotomy using cone beam computed tomography. The study included twelve patients diagnosed as suffering from an excess of the anterior part of maxilla and required surgical correction by anterior maxillary osteotomy. Assessment of Cone beam computed tomography in evaluation the soft tissue changes. All cases subjected to anterior maxillary osteotomy using modified Cuper technique. Follow up of cases was does clinically and radio- graphically by cone beam computed tomography. The results of the study proved that the statistically significant increase in mean Nasolabial angle after 6 months was 5.2 degrees, the mean value of nasal width after 6 months was 0,9mm. The mean value of Philtrum length was 3.3mm. In conclusion, Cone Beam Computed Tomography can be used to obtain dimensionally accurate linear and angular measurement from bony maxillofacial structure and landmarks and allows accurate, three-dimensional imaging of hard and soft tissues

El objetivo de este estudio fue evaluar los cambios en los tejidos blandos después de la osteotomía maxilar anterior mediante tomografía computarizada con haz cónico. El estudio incluyó a doce pacientes diagnosticados que sufrían un exceso de la parte anterior del maxilar y requirió corrección quirúrgica mediante osteotomía maxilar anterior. Evaluación de la tomografía computarizada del haz cónico en la evaluación de los cambios de tejidos blandos. Todos los casos sometidos a osteotomía maxilar anterior con la técnica de Cuper modificada. El seguimiento de los casos se realizó de forma clínica y radiográfica mediante tomografía computarizada de haz cónico. Los resultados del estudio demostraron que el aumento estadísticamente significativo en el ángulo Nasolabial medio después de 6 meses fue de 5,2 grados, el valor medio del ancho nasal después de 6 meses fue de 0,9mm. El valor medio de la longitud de Philtrum fue de 3,3mm. En conclusión, la tomografía computarizada Cone Beam se puede utilizar para obtener mediciones lineales y angulares dimensionales precisas a partir de la estructura ósea maxilofacial ósea y permite obtener imágenes precisas y tridimensionales de los tejidos duros y blandos

Primary posterior mediastinum hydatid cyst

Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum.

Renal duplex doppler ultrasound in patientswith HCV related liver cirrhosis.

Aim: To study the renal resistive index (RI) and pulsatility index (PI) measured by renal Doppler in various stages of liver cirrhosis and their values to detect cirrhotic patients at risk for developing the hepatorenal syndrome Methods: This study included 60 cirrhotic patients divided into 4 groups (15 patients each): compensated liver cirrhosis (group A) , diuretic responsive ascites (group B), refractory ascites (group C) , hepatorenal syndrome (group D) and ten healthy persons as the control group (E). All patients were subjected to detailed history taking and clinical examination. Laboratory investigations included simple urine analysis, complete blood picture, liver function tests, blood urea and serum creatinine, serum sodium and serum potassium, 24-hour urine collection for sodium concentration, creatinine concentration and protein concentration. Ultrasonographic examination and renal duplex Doppler ultrasonography were undertaken to assess the RI and PI Results: The RI of both interlobar and arcuate arteries was significantly higher in all patient groups than in the control group (p‹0.01). The RI was significantly higher in patients with refractory ascites than in patients with diuretic responsive ascites, and also in patients with diuretic responsive ascites than in patients with compensated cirrhosis (p‹0.01); in patients with hepatorenal syndrome than in patients with diuretic responsive ascites and patients with compensated cirrhosis (p‹0.0001). The PI was significantly higher in all patients groups than in the control group (p‹0.01) and in patients with refractory ascites than in patients with diuretic responsive ascites and was also higher in patients with responsive ascites than in patients with compensated cirrhosis (p‹0.0001). Also, the PI was significantly higher in patients with hepatorenal syndrome than in patients with responsive ascites and patients with compensated cirrhosis (p‹0.0001). Creatinine clearance in patients with the hepatorenal syndrome was significantly lower than that of other different groups (p<0.0001) but there was no significant change in creatinine clearance between patients with compensated cirrhosis and control group. While creatinine clearance in patients with diuretic responsive ascites was significantly higher than that in patients with compensated cirrhosis (p<0.05) there was no significant change between patients with diuretic responsive ascites and patients with refractory ascites Conclusion: Both renal resistive index and pulsatility index increase with the degree of hepatic decompensation. Renal duplex ultrasound which is a non-invasive, simple and easy method to study intrarenal hemodynamics in patients with liver cirrhosis may predict patients at risk of hepatorenal impairment.

Surgical management of post endoscopic retrograde cholangiopancreatography [ERCP] duodenal perforation

Traditionally post ERCP duodenal perforations have been managed surgically; however, in the last decade, management has shifted toward a more selective approach. Those who favor a selective approach have not elaborated distinct management guidelines. To evaluate the authors experiences in management of post ERCP duodenal perforations to define the criteria for operative management and a systematic management approach. A retrospective review of consecutive cases of ERCP related perforation [from May 2000 to May 2004] was carried out. Seventy-four out of 3050 ERCP performed [2.4%] were complicated by duodenal perforations and were included in the study. Forty-two perforations [56.8%] were discovered at ERCP while 32 cases [43.2%] required additional radiological assistance. Twenty-nine patients [39.2%] were operated early within 6 hours whereas 45 patients [60.8%] were initially treated conservatively. Fifteen patients had surgery after failure of medical treatment. Four cases [8.9%] died under conservative treatment and 14 cases [31.8%] died after surgical intervention. Pyloric exclusion procedure [PE] was done for 33 patients [75%]. Early diagnosis is important but difficult especially for retroperitoneal perforations. Clinical and radiographic features of ERCP - related duodenal perforations can be used to stratify patients into surgical or non-surgical cohorts. A selective management scheme is proposed based on the features of each type. Pyloric exclusion procedure is the operation of choice when the diagnosis is delayed and when the perforation is not detected or can't be repaired

Radiofrequency ablation of chronic atrial fibrillation in patients undergoing mitral valve surgery

In this study, 11 patients affected by rheumatic mitral valve disease and chronic atrial fibrillation underwent mitral valve surgery and radiofrequency [RF] ablation. The mean duration of atrial fibrillation [AF] was 3.6 +/- 1.2 years. A control group [no RF] included 11 patients underwent mitral valve surgery only during the same period. RF endocardial ablation was performed under temperature control after left atriotomy. RF pulses were delivered in order to obtain a circumferential isolation of each pulmonary vein alone without any additional lines. Firstly, all patients received a loading dose of amiodarone in the early postoperative period, followed by a maintenance dose of 200 mg/day for three months. It was concluded that circumferential isolation of each pulmonary vein [PV] in patients with chronic AF undergoing mitral valve surgery is a feasible, safe and effective procedure in restoring sinus rhythm [SR] at an average follow-up period of six months

Nasal allergy in children with watery rhinorrhea

This study was carried out on 40 children with watery rhinorrhea since 3 months or more. Detailed history, general and ear, nose and throat examinations were done in addition to blood esinophils count and nasal smears for esinophils. From this study it is noticed that in children with allergic rhinitis, nasal and blood esinophilia counts were statistically significant. Also there is concomitant increase in both parameters. It is also noticed that allergic children who have undergone adenotonsillectomy have got a higher blood and nasal esinophils than in those who were not operated upon. It is concluded that both blood and nasal esinophils can be a simple and significant tool of investigation to help the physician to select cases of nasal allergy from cases presenting with watery rhinorrhea. Controversies as regard adenotonsillectomy in allergic individuals were also discussed and analyzed