Anesthesitic management for insulinoma resection in a patient having chronic inflammatory demyelinating neuropathy / Manejo anestésico para resección de insulinoma en un paciente portador de neuropatía desmielinizante crónica

Chronic Inflammatory Demyelinating Polyneuropathy associated with hypoglycemia 2 to insulinoma is unusual, and to our knowledge, very few patients have been reported in literature. Despite varying presentations in these patients, the clinical characteristics are usually the same. The syndrome usually occurs after several episodes of protracted hypoglycemia. The neuropathy is nearly always symmetrical. We report anesthetic management for a young female patient presenting with CIDP & repeated hypoglycemic episodes during a 2-year period scheduled for insulinoma enucleation.

La polineuropatía desmielinizante inflamatoria crónica asociada con hipoglicemia secundaria a insulinoma es inusual y, hasta donde sabemos, muy pocos pacientes han sido reportados en la literatura. A pesar de las diferentes presentaciones en estos pacientes, las características clínicas suelen ser las mismas. El síndrome generalmente ocurre después de varios episodios de hipoglicemia prolongada. La neuropatía es casi siempre simétrica. Presentamos el manejo anestésico para una paciente joven que se presenta con polineuropatía desmielinizante inflamatoria crónica y episodios repetidos de hipoglicemia durante un período de 2 años programado para la enucleación de insulinoma.

Psychiatric and functional neuroimaging abnormalities in chronic hepatitis C virus patients: Is vasculitis a contributing factor?

Background and study aims: Central nervous system [CNS] involvement in hepatitis C virus [HCV] infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis

Patients and methods: Nineteen patients [15 females and 4 males] with chronic HCV infection [mean age 46.5 +/- 7 and mean duration since diagnosis of HCV infection 4.7 +/- 4 years, including 6 [32%] Child-Pugh class A cirrhotic patients] and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale [WMS], Beck Anxiety Inventory [BAI] and Beck Depression Inventory [BDI]. Brain HMPAO Single Photon Emission Computed Tomography [SPECT] was performed for HCV patients

Results: Patients with HCV had lower scores on the block design test compared to control subjects [8.37 +/- 1.89 versus 10.37 +/- 1.47, p < 0.001], lower total WMS scores [43.15 +/- 10.49 versus 60.27 +/- 8.08, p < 0.001] and higher anxiety and depression scores [16.94 +/- 10.46 and 37.17 +/- 10.38 versus 10.3 +/- 4.67 and 28.9 +/- 5.99, p = 0.004 and 0.001, respectively]. Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis [39.14 +/- 9.3 versus 51.17 +/- 8.3, p = 0.019] while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores [35.87 +/- 10.8 versus 46.79 +/- 8.6 in those with normal SPECT, p = 0.049]

Conclusions: Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients

Does fluid restriction affect the image quality of skeletal scintigraphy?

In Islamic countries in the month of Holy Ramadan many Muslims based on their religious Legislation refuse fluid intake during the fasting time though instructed to drink after injection of Tc-99m Methylene-diphosphonates [Tc-99m MDP] used for skeletal scintigraphy. We aimed to establish whether fluid restriction in Tc-99m MDP skeletal scintigraphy has an impact on its quality. One hundred forty-four patients referred for skeletal scintigraphy were studied. Group 1 was well hydrated while group 2 was instructed not to drink till imaging. Image quality was assessed using quantitive measures where by the end of imaging, equal regions of interest [ROI] were drawn over the femoral diaphysis, and the contralateral adductor area. The total number of counts from the bone [B] ROI and soft tissue [ST] ROI was expressed as a ratio [B: ST ratio], and a mean value for each group was established. The image quality was also assessed without knowledge of individual's water intake by a semiquantitative score. No statistically significant difference was found between the B:ST ratio means [P=0.46] and the semiquantitative scores [P=0.42] in both groups. Fluid restriction had no impact on the image quality in Tc-99m MDP skeletal scintigraphy though a higher radiation dose to the urinary bladder wall is anticipated

Tc-99m diethylenetriamine pentaacetic acid [DTPA]: is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate [MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis [RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1 [G1] included 30 patients [mean age 40.4 +/- 4.4 years] on MTX and NSAIDS, while 22 RA patients [mean age 38.5 +/- 8.2 years] who received NSAIDs only served as the control group [G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid [Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30 [70%] in G1 showed reduced GFR compared to 6/22 [27.3%] in G2 [P0.007] with 3.3 +/- 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age [r = -0.396, P = 0.005], MTX-cumulative dose [r = -0.263, P = 0.049], MTX-intake duration [r = -0.293, P = 0.031] and NSAID-intake duration [r = -0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA

Estimation of glomerular filtration rate as a predictor of renal impairment in egyptian systemic sclerosis patients, a comparative study between the classic gates method using TC99M DTPA and the cockcroft and gault formula: correlation with disease severity

Prognosis of Systemic sclerosis largely depends on involvement of internal organs. Kidney affection has the worst prognosis and highest mortality rate. Aim was to evaluate renal impairment in patients with systemic sclerosis by measuring the Glomerular filtration rate and then calculating the GFR using the Cockcroft and Gault formula and the Modification of Diet in Renal Disease equation [MDRD] formula and test the accuracy of these formulae. The study included 31 scleroderma patients [27 females, 4 males] recruited from the Rheumatology and Rehabilitation Department, Cairo University hospitals, mean age 43.25 +/- 11.28 years, 16 had limited systemic sclerosis, 12 diffuse systemic sclerosis and 3 had overlap syndrome. Therty-one age and sex matched healthy controls were included. Estimation of disease severity was done using disease severity index. GFR was measured using TC99mDTPA. The modified Cockcroft and Gault formula and equation 7 from the Modification of Diet in Renal Disease [MDRD] were used. A measured GFR within normal [>89ml/min] was found in 14 patients [45.1%] with normal kidney function and serum creatinine. Reduced GFR was reported in 17 patients [54.9%], it ranged from 60-89ml/min with mild renal impairment in 10 patients [32.3%], and ranged from 30-59ml/min showing moderate functional impairment in 7 patients [22.6%], none of our patients had severe renal impairment according to the Gates method for measuring the GFR. The formulae used succeeded to detect reduction of GFR in 35.29% of those affected using the Cockcroft-Gault and in 41.17% of those affected using the MDRD. A positive correlation was found between MDRD and measured GFR, furthermore, the decline in the GFR didn't show any correlation with disease severity. A positive correlation was also reported between the presence of renal involvement and pulmonary vascular involvement in the group under study p=0.04. Measurement of the GFR using Gates method showed reduction of the GFR in 54.9% of the SSc patients under study. Serum creatinine was an insensitive tool for evaluating renal functional impairment. The formulae used weren't as precise as the measured GFR in diagnosing all cases with subclinical renal involvement in the studied population. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration

Herbal extracts counteract cisplatin-mediated cell death in rat testis / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the protective effects of ginger (Gin) and roselle (Ros) against testicular damage and oxidative stress in a cisplatin (CIS)-induced rodent model. Their protective effects against CIS-induced apoptosis in testicular and epididymal sperms is also investigated.</p><p><b>METHODS</b>Ethanol extracts of Gin or Ros (1 g/kg.day) were given orally to male albino rats for 26 days. This period began 21 days before a single CIS intraperitoneal injection (10 mg/kg body weight).</p><p><b>RESULTS</b>Gin or Ros given orally significantly restored reproductive function. Both tested extracts notably reduced the CIS-induced reproductive toxicity, as evidenced by restoring the testis normal morphology. In Gin and Ros, the attenuation of CIS-induced damage was associated with less apoptotic cell death both in the testicular tissue and in the sperms. CIS-induced alterations of testicular lipid peroxidation were markedly improved by these plant extracts.</p><p><b>CONCLUSION</b>The present results provide further insights into the mechanisms of protection against CIS-induced reproductive toxicity and confirm the essential anti-oxidant potential of both examined extracts.</p>

Effects of Roselle and Ginger on cisplatin-induced reproductive toxicity in rats / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the protective effects of Hibiscus sabdariffa (Roselle) and Zingiber officinale (Ginger) against cisplatin-induced reproductive toxicity in rats and to study the mechanisms underlying these effects.</p><p><b>METHODS</b>Ethanol extracts of H.sabdariffa or Z.officinale (1g/kg x day) were given p.o. to male albino rats for 26 days, which began 21 days before a single cisplatin i.p. injection (10 mg/kg body weight).</p><p><b>RESULTS</b>Extracts of H.sabdariffa and Z.officinale reduced the extent of cisplatin-induced sperm abnormality and enhanced sperm motility. Both extracts restored the control level of malondialdehyde (MDA) (lipid peroxidation marker) in the cisplatin-treated testis. The cisplatin injection induced decline in the levels of superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT) were significantly reversed to control levels in groups where cisplatin was preceded by the administration of either H.sabdariffa or Z.officinale.</p><p><b>CONCLUSION</b>Both H.sabdariffa and Z.officinale treatment increased the activities of testicular antioxidant enzymes and restored sperm motility of cisplatin-treated rats. The protective effects of tested plants are, therefore, suggested to be mediated by their potent antioxidant activities.</p>

Does the prolene hernia system affect testicular function?

Over a period of 16 months, 20 male patients with unilateral primary inguinal hernias were operated upon in the Kasr Al Aini Hospital, Cairo University using the Prolene Hernia System. All patients underwent pre and post-operative semen analysis and scrotal scintigraphy to assess testicular perfusion. All, but one, patients showed no change in the semen analysis and sintigraphy from the preoperative value. This patient had signs of testicular ischemia as evidenced by decreased uptake of the radiotracer 3 months postoperatively. This case was attributed to injury of the vessels during dissection rather than due to the mesh itself

Diagnostic accuracy of TC99M HIDA cholescintigraphy with fatty meal and gall bladder ejection fraction for assessment of the gall bladder motor function in patuents with chronic acalculous cholecystitis

In this study, 46 patients [36 females and 10 males] presenting with variable degrees of long-standing upper right quadrant abdominal pain were included. All patients underwent clinical evaluation, abdominal ultrasonography and Tc99m hepatic iminodiacetic acid [HIDA] scanning with gallbladder ejection fraction [GBEF] calculation. Clinically, 26 patients had a mild degree of biliary pain, while 20 patients had a moderate degree. Ultrasonography was free in 26 patients, while 20 patients showed an evidence of GB abnormalities ranging from mild to severe changes. A confirmatory test was used in these cases by adding the sonographic and clinical findings for each patient to aid in the decision to operate or not. HIDA scanning was carried out in all patients with GBEF calculation. A 35% value was taken as a cutoff measurement, where patients with values <35% were considered abnormal and positive for acalculous GB disease. In patients with a proper GBEF [>35%], no operation was done and they were placed on the follow up and represent [18 patients]; while patients with abnormal GBEF [<35%], even with a negative confirmatory test, were operated by cholecystectomy [28 patients]. The mean GBEF value in the non- operated group was 55.9%, while that of the operated patients was 23.3%. All the operated patients proved positive to histopathology for acalculous cholecystitis. A remarkably highly positive P-value was found between the operated and non-operated groups as regards the GBEF value