Viscotrabeculotomy with anterior chamber irrigation versus Ahmed glaucoma valve implantation for silicone oil glaucoma in the pseudophakic eye / Viscotrabeculotomia com irrigação da câmara anterior versus implante de válvula de Ahmed para glaucoma por óleo de silicone em olho pseudofácico

ABSTRACT Purpose: To compare viscotrabeculotomy with anterior chamber irrigation to Ahmed glaucoma valve implantation for secondary glaucoma following silicone oil removal. Methods: A prospective study was conducted on 43 vitrectomized pseudophakic eyes with persistent glaucoma after silicone oil removal. Patients were randomized to either viscotrabeculotomy with anterior chamber irrigation or Ahmed glaucoma valve implantation. All patients were examined on day 1, week 1, and months 1, 3, 6, 9, 12, 18, and 24 postoperatively. Postoperative complications were noted. Success was defined as an intraocular pressure between 6 and 20 mmHg and with an intraocular pressure reduction of >30% compared with the preoperative intraocular pressure. Results: There were 22 eyes in the viscotrabeculotomy with anterior chamber irrigation and 21 eyes in the Ahmed glaucoma valve implantation group. The mean preoperative and postoperative intraocular pressure in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 35.5 ± 2.6 mmHg and 35.5 ± 2.4 mmHg and 16.9 ± 0.7 mmHg and 17.9 ± 0.9 mmHg respectively (p˂0.0001). There was a statistically significant intraocular pressure reduction at all follow-up time points compared to preoperative values (p˂0.0001) in both groups. The unqualified success rate in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 72.73% and 61.9%, respectively. A minimal self-limited hyphema was the most common complication. Conclusions: Both viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation are effective in lowering the intraocular pressure in glaucoma after silicone oil removal with viscotrabeculotomy with anterior chamber irrigation providing greater reduction, higher success rates, and minimal complications.

RESUMO Objetivo: Comparar a viscotrabeculotomia com irrigação da câmara anterior com o implante de válvula de glaucoma de Ahmed para glaucoma secundário após remoção de óleo de silicone. Métodos: Foi realizado um estudo prospectivo de 43 olhos pseudofácicos vitrectomizados com glaucoma persistente após a remoção de óleo de silicone. Os pacientes foram randomizados para viscotrabeculotomia com irrigação da câmara anterior ou implante de válvula de Ahmed. Todos os pacientes foram examinados no primeiro dia, na primeira semana e 1, 3, 6, 9, 12, 18 e 24 meses após a cirurgia. Observaram-se complicações pós-operatórias. O sucesso foi definido como uma pressão intraocular entre 6 e 20 mmHg e uma redução da pressão intraocular >30% em comparação com a pressão intraocular pré-operatória. Resultados: Foram designados 22 olhos para o grupo da viscotrabeculotomia com irrigação da câmara anterior e 21 olhos para o grupo do implante de válvula de Ahmed. A pressão intraocular média pré-operatória foi de 35,5 ± 2,6 mmHg para o grupo da viscotrabeculotomia com irrigação da câmara anterior e pós- e de 35,5 ± 2,4 mmHg no grupo do implante de válvula de Ahmed. e Os valores pós-ope­ratórios foram de 16,9 ± 0,7 mmHg e 17,9 ± 0,9 mmHg para esses mesmos grupos, respectivamente (p<0,0001). Ambos os grupos tiveram uma redução estatisticamente significativa da pressão intraocular em relação aos valores pré-operatórios (p<0,0001) em todos os momentos do acompanhamento. A taxa de sucesso não qualificado nos grupos da viscotrabeculotomia com irrigação da câmara anterior e do implante de válvula de Ahmed foi de 72,73% e 61,9%, respectivamente. A complicação mais comum foi o hifema, autolimitado e mínimo. Conclusões: Tanto a viscotrabeculotomia com irrigação da câmara anterior quanto o implante de válvula de Ahmed são eficazes na redução da pressão intraocular no glaucoma após injeção de óleo de silicone, mas a viscotrabeculotomia com irrigação em câmara anterior proporcionou maior redução da pressão intraocular e maiores taxas de sucesso, com complicações mínimas.

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Comparative study between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on endotracheal tube cuff as regards postoperative sore throat / Estudo comparativo entre cloridrato de benzidamina em gel, lidocaína a 5% em gel e lidocaína a 10% em spray no balonete do tubo endotraqueal em relação à dor de garganta pós-operatória

ABSTRACT Postoperative sore throat is a common complication after endotracheal intubation. After tracheal intubation, the incidence of sore throat varies from 14.4% to 50%. The aim of the study was to compare between benzydamine hydrochloride gel, lidocaine 5% gel and lidocaine 10% spray on the endotracheal tube cuff as regards postoperative sore throat. The present study was carried out on 124 patients admitted to Alexandria university hospitals for lumbar fixation surgery requiring general anesthesia. Patients were randomly allocated into 4 groups. Benzydamine hydrochloride gel, 5% lidocaine hydrochloride gel, 10% lidocaine hydrochloride spray, or normal saline were applied on endotracheal tube cuffs before endotracheal intubation. The patients were examined for sore throat (none, mild, moderate, or severe) at 0, 1, 6, 12, and 24 h after extubation. The results were collected, analyzed and presented in table and figure. The highest incidence of postoperative sore throat occurred at 6 h after extubation in all groups. There was a significantly lower incidence of postoperative sore throat in the benzydamine group than 5% lidocaine gel, 10% lidocaine spray, and normal saline groups. The benzydamine group had significantly decreased severity of postoperative sore throat compared with the 10% lidocaine, 5% lidocaine, and normal saline groups at observation time point. Compared with the 5% lidocaine the 10% lidocaine group had significantly increased incidence and severity of postoperative sore throat after extubation. Compared with normal saline the 10% lidocaine group had increased incidence of postoperative sore throat. There were no significant differences among groups in local or systemic side effects. So in conclusion, benzydamine hydrochloride gel on the endotracheal tube cuff is a simple and effective method to reduce the incidence and severity of postoperative sore throat. Application of 10% lidocaine spray should be avoided because of worsening of postoperative sore throat where incidence increased but not the severity in relation to 5% lidocaine gel. Applying 5% lidocaine on the endotracheal tube cuff does not prevent postoperative sore throat but its application is better than lidocaine 10% spray or saline.

RESUMO A dor de garganta pós-operatória (DGPO) é uma complicação comum após a intubação traqueal. Em seguida a esse procedimento, a incidência de dor de garganta varia de 14,4 a 50%. O objetivo do estudo foi comparar os efeitos da aplicação de cloridrato de benzidamina em gel, lidocaína a 5% em gel e lidocaína a 10% em spray no balonete do tubo endotraqueal, no que diz respeito à dor de garganta pós-operatória. O presente estudo foi feito com 124 pacientes internados em hospitais universitários de Alexandria para cirurgia de fixação lombar que necessitavam de anestesia geral. Os pacientes foram aleatoriamente alocados em quatro grupos. Procedeu-se à aplicação de cloridrato de benzidamina em gel, cloridrato de lidocaína a 5% em gel, cloridrato de lidocaína a 10% em spray ou salina normal nos balonetes do TET antes da intubação endotraqueal. Os pacientes foram examinados para dor de garganta (nenhuma, leve, moderada ou intensa) a 0, uma, seis, 12 e 24 horas após a extubação. Os resultados foram coletados, analisados e apresentados em tabelas e figuras. A maior incidência de DGPO ocorreu seis horas após a extubação em todos os grupos. Houve incidência significativamente menor de DGPO no grupo de benzidamina versus grupos de lidocaína a 5% em gel, lidocaína a 10% em spray e salina normal. O grupo tratado com benzidamina exibiu redução significativa na intensidade da DGPO, em comparação com os grupos de lidocaína a 10%, lidocaína a 5% e salina normal no ponto no tempo de observação. Em comparação com lidocaína a 5%, o grupo tratado com lidocaína a 10% exibiu incidência e intensidade significativamente aumentadas na DGPO após a extubação. Em comparação com salina normal, o grupo tratado com lidocaína a 10% exibiu maior incidência de DGPO. Não foram observadas diferenças significativas entre grupos quanto a efeitos colaterais locais ou sistêmicos. Assim, em conclusão, o uso de cloridrato de benzidamina em gel no balonete do TET é um método simples e eficaz para reduzir a incidência e a gravidade da DGPO. Deve-se evitar a aplicação de lidocaína a 10% em spray, devido ao agravamento da DGPO, visto ter ocorrido aumento na incidência, mas não na severidade, em relação à lidocaína a 5% em gel. A aplicação de lidocaína a 5% no balonete do TET não impede a ocorrência da DGPO, mas a sua aplicação oferece melhores resultados do que lidocaína a 10% em spray, ou solução salina.

Role of Three-Dimensional Ultrasound and Three-Dimensional Doppler in Imaging of Endometrium for Diagnosis of Bleeding in Women with Post-Menopausal Bleeding.

Objective: To determine whether the Three-Dimensional Ultrasound and Three Dimensional Doppler have a role in detection of Endometrial lesions in woman with post menopausal bleeding. Methods: 36 woman in Zagazig University Obstetrics and Gynaecology Department outpatient clinics were recruited. Three-Dimensional Ultrasound and Doppler were done. Then after one week endometrial sampling was done & histological diagnosis was made. After tabulation, all data were analyzed using statistical procedures were carried with SPSS software. Result: Twenty four patients were negative for atypia or cancer and Twelve patients were positive for atypia or cancer. Mean age was 58.1 years in benign endometrium and 62.2 year in malignant endometrium (p=0.1). The mean BMI was 24 in benign and 31.75 in malignant endometrium (p<0.001). Mean endometrial thickness was 11.1 m.m in benign and 26 mm in malignant endometrium (p<0.001). The mean endometrial Volume was 5.6 cc in benign and 54.8cc in malignant endometrium (p<0.001). The VI was 2.24%and 19.5% in the two groups respectively (p<0.001). The FI was 6.7 and 27.2 in two groups respectively (p<0.001). The VFI was 3.3 and 11.5 in two groups respectively (p<0.001). In this study using endometrial volume, vascularization index percent (VI) %, flow index (FI) and vascularization-flow index (VFI) rather than endometrial thickness provided a greater sensitivity for predicting atypia or malignancy. Conclusion: The Three-Dimensional Ultrasound scanning of endometrial volume (3D-US) and Three-Dimensional Doppler Angiography (3D-DA) of the Vascular Indices (vascularization index percent, flow index, and vascularization-flow index), might predict endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline ultrasound scanning.

Role of multi detector computed tomography and virtual bronchoscopy in evaluation of pulmonary neoplasms

Objectives: The aim of this study was to evaluate the accuracy of Mlti detector CT with multiplanar reconstruction images, virtual bronchoscopy [VB] and volume rendering technique compared to the results of fiber-optic bronchoscopy [FOB] in defining bronchial pathologies in patients with pulmonary neoplasms

Methods: Fifty four patients with symptoms or chest X-ray abnormality raising the suspicion of pulmonary neoplasm in which FOB and CT chest were ordered for the initial investigation. Patients underwent both FOB and MDCT

Results: Fifty four patients were enrolled in the study [including 41 with an endobronchial lesion at FB] the sensitivity and specificity of VB to detect endobronchial lesions were 100% and 86.7% respectively [95% CI]. The positive and negative predictive values of VB were 95.3% and 100% respectively. The accuracy was 962%. Overall, the agreement between VB and FOB regarding the location on endobronchial lesions was perfect [weighted kappa: 0.9]. In 12 cases with obstruction of the main bronchi [5 in left main, 7 in right main bronchus], VB is able to bypass beyond the mass level in 4 cases [33.3% of cases]. The FOB was able to bypass beyond the mass lesion in only 2 cases [16.7% of cases], both of them were partially obstructing masses. FOB cannot by pass beyond the mass level in any case with totally obstructing mass. As regard to the extrabronchial structures evaluation, 34 of the 41 endobronchial lesions were associated with extrabronchial part of the endobronchial lesion [ratio about 63% of cases]. The FOB was not able to detect the extra-bronchial lesions in any case. In evaluating extrinsic compressions of the airway, FOB detected 11 lesions; VB+MPR [multi planar reconstruction] detected 10 lesions [5 of them caused by enlarged LNS, the remaining 5 were caused by extrabronchial soft tissue mass], VB could not see one of the external compressions with sensitivity, specificity 90.0% and 97.6% respectively. Curved planar reformation detected 13 lesions with sensitivity, specificity 90.9% and 95.3% respectively. Volume rendering detected 12 lesions with sensitivity, specificity 100.0% and 97.7% respectively. While FOB detected 4 mucosal lesions, VB cannot detect any of them with sensitivity and specificity 0%

Conclusion: VB is an extremely useful modality for evaluation of bronchial lesions, it is noninvasive, and the ability to examine 2D and 3D anatomic detail from multiple directions enables precise assessment of intraluminal, extent of the extraluminal diseases or airway patency distal to high-grade bronchial stenosis. We concluded that multi-slice CT in connection with VB became an essential complementary to FOB in selected patients with bronchial lesions

Permanent complete heart block following surgical closure of isolated ventricular septal defect

A serious complication after surgical closure of ventricular septal defect [VSD] is complete heart block [CHB]. It continues to be a leading cause of long-term postoperative cardiac morbidity despite all surgical technical improvements, especially with performance of more surgical procedures in increasingly younger patients. This study was undertaken to determine the incidence of early postoperative CHB requiring pacemaker implantation following surgical repair of isolated ventricular septal defect, and try to identify possible procedural risk factors. Prospective study design. Multicenter study: Ain-Shams University Hospital, Aboul Reesh Student Hospital and The National Heart Institute. We reviewed four hundred patients who had a surgical repair of isolated VSD from 2009 to 2011. 14 out of 400 patients [3.5%] developed permanent post-operative CHB. All; but one; underwent closure of large perimembranous VSD. CHB patients had a significant lower body weight [8.36 vs. 12.68 kg, p < 0.01], longer ACC time [42.6 vs. 36.4 min, p < 0.01], longer CPB time [75.4 vs. 67.4 min, p < 0.01] and longer hospital stay [19 vs. 8.3 days, p < 0.01] Tricuspid valve detachment was performed in 28 patients [7%] and was associated with a higher incidence of CHB [7% vs. 3.75%, p = 0.6]. Large perimembranous VSD and lower body weight appear to be independent risk factors for permanent CHB following the surgical closure of isolated VSD

Self expanding metal stent for palliation of advanced esophageal carcinoma

Intubation using self-expanding stents was performed in sixty patients with inoperable esophageal carcinoma at the NCI, Cairo University between January1998 and June 2001. The ages ranged from 51 to 72 years including 36 males and 24 females. Most patients had narrowing of the lumen with an average diameter less 10 mm, 38 patients had stricture with diameter 5 mm or less. Stent placement was successful in all patients. The entire procedure was done with minimal discomfort in all patients with immediate improvement of dysphagia. The early complications [within 30 days] were serious haematemesis [3.3%], migration of the stent [3.3%], transient neck pain [6.6%] and retrosternal pain [78%]. Of these, only 12 patients had persistent pain that required potent analgesics. The delayed complications were mainly esophago-gastric reflux in 44 patients [73.3%], tumor overgrowth in 33% and food impact in 6.6%. Procedure related mortality occurred in one patient [1.6%]. The patients who were referred for radiotherapy and/or chemotherapy showed improvement in the general condition before treatment. For patients treated with radiotherapy, 73% were able to continue the radical dose as prescribed. Self-expanding stents for inoperable esophageal cancer is an easy procedure with minor complications and is important in improving the general condition of the patients before radiotherapy and/or chemotherapy

Intra-arterial thrombolytic therapy for acute thrombotic ischemia

Aim: to evaluate the early and late results of thrombolysis in acute thrombotic ischaemia and graft occlusion

Patients and methods: in a prospective randomized study, 40 patients with thrombotic ischaemia were divided into two groups. Group A: 20 patients underwent thrombolytic therapy. Group B: 20 patients underwent surgical reconstruction

Results: group A: Prima y success in 17patients [85%]. Failure of thrombolysis in 3 patients [15%] Primary patency rate 85%. No mortality occurred during follow up. Group B: Primary success rate was 75 % [15 patients]. In 3 patients with acute thrombosis amputation was performed, one due to secondary hemorrhage and ligation of the graft .and the other two were due to graft failure and gangrene during the first month postoperatively. Mortality occurred in 2 patients [10%]

Conclusions: thrombolysis as compared with immediate surgery reduces the number of open procedures required for acute ischemia of the lower limb t7 allows some patients to avoid surgical intervention

Catheter directed thrombolysis versus anticoagulation in the treatment of iliofemoral deep venous thrombosis [DVT]

Current therapy of deep venous thrombosis [DVT] is to use heparin or low molecular weight heparin [LMWH] followed by oral anticoagulation. Patients with iliofemoral DVT represent a subset of patients who are not likely to respond to systemic lytic therapy. The introduction of direct catheter instillation of thrombolytic enzymes has not only improved the efficacy of thrombolytic therapy but has also reduced the risk of serious bleeding. This study included 80 patients that were divided into two groups. The first group: 40 patients with iliofemoral DVT treated with regional catheter directed thrombolysis. The second group: 40 patients with iliofemoral DVT treated with heparin followed by oral anticoagulation. In the first group complete lysis was achieved in 55% of patients and partial lysis in 40% of patients while in the second group neither complete nor partial lysis was achieved which was statistically significant P< 0.05. After 12 months, the first group showed complete patency in 70% of patients and partial patency in 30% of patients, while the second group showed complete patency in 5% and partial patency in 60% of patients which was also statistically significant P < 0.001. Catheter directed thrombolysis [CDT] was superior than anticoagulants in the management of iliofemoral [DVT], the results were promising as regards -Good and rapid degree of lysis.-High percentage of patency after 12 months -Lesser occurrence of venous reflux and post phlebitic symptoms, so the quality of life was improved by using CDT, with no recurrence of deep venous thrombosis after a follow up of 12 months

Dynamic external fixator in treatment of distal radial fractures

In this study the results of operative treatment of twenty two patients with fractures of the distal radius by dynamic external fixator. Many of the fractures were due to fall onto the outstretched hand [13 patients or 59% of the cases]. Fourteen patients were males [63.6%]. The average age at the time of operation was 43.9 years; the age varies between 22 years to 63 years old. All our patients except one were operated upon within the first week of trauma with a mean time of 4.5 days. Evaluation of the patients was according to the comprehensive classification of fractures of long bones [Muller et al 1990][1], their were three patients type A 2-2, two patients type A 2-3, four patients type A 3-3, five patients type B 3-2, three patients type B 3-3, three patients type C 1-2 and the last two patients were type C 3-2. After an average follow-up of 13.32 months [range between 9 to 24 months]. The final results were assessed both clinical and radiological. Nine cases were excellent, nine good, two fair and the last two patients were poor according to the modified system of green and O'Brien 1978[2]. The fair and poor results occurred mainly in type C fractures which characterized by involvement of the articular cartilage

ABG II cementless HIP system in management of adults hip arthritis

The ABG Hip was conceived to improve the osteointegration of cementless prostheses, to eliminate thigh pain. This achieved by an anatomic shape which would conserve bone stock and transmit stresses as close to the physiological stresses as possible. 1. The ABG II was applied after improvement of acetabular cup design where a hemispherical shape to preserves bone stock and encourages even transfer of load to the supporting bone with circular grooving that promotes bone ingrowth, the ABG II cup has 5 clustered screw holes. Fixation achieved by spikes. Any vacant holes in the cup can be sealed by the surgeon, the ABG II obturator screw provides a water seal to reduce migration of any wear debris that may excist[2]. A consecutive series of eighteen patients with destruction of the hip joint. The common cause for this problem was rheumatic arthritis which lead to early massive arthritis of the hip. Avascular necrosis was the second cause in this series while old neglected fractures and dislocations of the hip joint were the third cause. Finally we have one patient with neglected DDH. In this work eleven patients were males while seven were females. Eight patients had their right side affected while ten patients had their left side affected. The age of the patients ranged between 29 years and 56 years. The follow up period ranged between 13 and 40 months. The antero-lateral approach was used in ten patients while the postero-Iateral approach was used in eight patients. ABG II can easily be applied both anteriorly and posteriorly. The assessment of the results of the hip was performed in every visit for the patient using the modified Harris hip score protocol 3. The data collected from the final follow up visit for each patient used to assist the final results of the prosthesis. The results of eighteen ABG II hip replacement had an improvement in all cases [100%]. Radiologically, none of the hips in our series develops loosing or osteoprosis of the diaphysis without any manifestation of stress shielding in the cortex, no heterotrophic bone formation, and no change in the implant position

Role of pectoral fascia removal in modified radical mastectomy

Pectoral fascia may act as a protective layer against harmful effects of radiotherapy [fibrosis]. Moreover, dissection of pectoral fascia from its muscle may contribute to much seroma formation. So, this study comes to evaluate the relation between pathological parameters of primary tumour and pectoral fascia1 invasion. Fifty patients submitted to this study where the primary tumour, axillary lymph nodes and pectoral fascia were histopathologically studied. The results showed presence of a good relation between the distance of the primary tumour and pectoral fascia invasion. There was also a good relation between pectoral fascia invasion and axillary lymph nodes infiltration. So, it was advised to remove pectoral fascia when the distance between it and primary tumour is less than 1 cm. Also, it should be removed when there is an axillary lymph node invasion irrespective of their numbers. Otherwise, preservation of pectoral fascia is advised

Intestinal absorptive status and gut contamination among Egyptian thalassemic children

In this study, the intestinal absorptive status and the prevalence of small bowel bacterial overgrowth were assessed in 72 thalassemic children. They were classified according to the onset of the disease, the splenic status and type of chelation therapy into three groups. Group I included 15 newly diagnosed cases. Group II included 30 thalassemic children receiving subcutaneous desferrioxamine [DF] as a chelation therapy [15 of them had intact spleen and 15 were splenectomized]. Group III included 27 patients receiving oral salicylhydroxamic acid [SHAM] as a chelation therapy [12 of them had intact spleen and 15 were splenectomized]. Fifteen healthy age and sex matched children served as controls. The results revealed that the levels of fecal alpha-1 antitrypsin [a marker of enteric protein loss] were significantly higher in all studied groups as compared with the control group. In conclusion, malabsorption was a common finding in thalassemic patients regardless of the duration, type of chelation therapy and whether splenectomized or not. Furthermore, small bowel bacterial overgrowth was also common in thalassemic cases, especially the splenectomized ones due to the profound immune disturbances occurring after splenectomy

Modification of plating in fractures of proximal shaft femur in adolescents

17 patients with fracture upper third femur in adolescents treated surgically by cloverleaf plate in King Fahad Hospital madina and Ain Shams University Hospitals between 1992 and 1995. Their age was 12.3 to 17.8 years old, mean age was 15.4, 11 patients were males while 6 patients were females. The patients were treated with open reduction and internal fixation by cloverleaf plate. The wings of the plate bent to hold the proximal fragment and the greater trochanter. Ten patients were operated within 6 hours while the rest operated upon within 5 to 11 days after trauma. The follow up range between 9 to 14 months, average 12.5 months. Healing takes 12 weeks average, ranges between 9 to 18 weeks. Final follow up, all patients united with full range of motion at the hip and knee, with only one patient with leg discrepancies above 1 cm [1.8 cm]. One patient suffer from superficial wound infection that resolved after I.V. antibiotics

utility of real-time ultrasonography vs alpha-fetoprotein estimation and computed tomography in the diagnosis of focal hepatocellular carcinoma associated with liver cirrhosis

A total of 146 cirrhotic patients were examined by ultrasonography. In 26 patients [17.8%], a space occupying lesion was detected, while the serum AFP level was higher than 200 ng/ml in only 10 of them [38.5%]. Abdominal CT scanning was successful in displaying the focal hepatic lesion in 22 out of the 26 patients [84.6%]. To verify the diagnosis of these lesion, CT-guided biopsy was performed in only 18 patients out of the 22 patients, 4 patients were excluded [liver bathed in ascites in 3 patients and prothrombin concentration below 40% in one patient

utility of real-time ultrasonography vs alpha-fetoprotein estimation and computed tomography in the diagnosis of focal hepatocellular carcinoma associated with liver cirrhosis

A total of 146 cirrhotic patients were examined by ultrasonography. In 26 patients [17.8%], a space occupying lesion was detected, while the serum AFP level was higher than 200 ng/ml in only 10 of them [38.5%]. Abdominal CT scanning was successful in displaying the focal hepatic lesion in 22 out of the 26 patients [84.6%]. To verify the diagnosis of these lesion, CT-guided biopsy was performed in only 18 patients out of the 22 patients, 4 patients were excluded [liver bathed in ascites in 3 patients and prothrombin concentration below 40% in one patient

Value of CT in critical facio-maxillary injuries

The CT scans for 18 cases of faciomaxillary injuries due to RTA were reviewed. The fractures encountered in different facial components was described and classified. The value of CT scans versus conventional X-rays for patients with facial trauma was discussed