[Contact dermatitis in CHU of Mahdia]

Purpose of the study: Contact dermatitis appears among the most frequent occupational diseases particularly in hospital environment. Objectives of the study are to determine frequency of contact dermatitis in the university hospital of Mahdia, to emphasize the clinical profile of and find the causal allergens. We have carried out a transversal study concerning a representative sample of 225 hospital personals working in the university hospital of Mahdia. The study contained a questionnaire searching the dermatological risk, a clinical examination by a dermatologist for a diagnostic orientation and patch tests with European standard and additional series. Contact Dermatitis prevalence was 19, 1% [13.86 - 24.34]. Irritation was the most frequent [11.1%], followed by eczema [5.8%] and urticaria [2.2%]. The profile of the symptomatic staff is a worker or a nurse, from 30 to 40 years old and exercising in paediatrics or obstetrics services. Substances incriminated were gloves [34.9%], disinfectants and antiseptic [30.2%], medicines [16.3%], cleaners [16.3%] and colophony [4.6%]. Prevenvon is based on the replacement of incriminated products by others less aggressive, on the sensitization of the hospital staff towards the cutaneous risk inherent to their professional activity

Coil embolization of splenic artery as an adjunctive therapeutic technique before splenectomy in patients with massive splenomegaly and secondary hypersplenism

Splenectomy for massive splenomegaly, [splenic weight 10 times usual weight of 150-200 gm], with secondary hypersplenism, has uncommonly high morbidity and mortality because of technical challenges and problems of hemostasis due to severe thrombocytopenia refractory to platelet transfusion. In an attempt to decrease intraoperative blood loss and to improve the preoperative general condition of the patients, preoperative splenic artery embolization is advised. To study the effects of preoperative coil embolization of the splenic artery in patients with massive splenomegaly and secondary hypersplenism and its impact on improvement of hypersplenism specially thrombocytopenia and subsequent Splenectomy. This study included 15 patients with massive splenomegaly and secondary hypersplenism. The causes of splenomegaly were liver cirrhosis with portal hypertension [5 patients], spherocytosis [5 patients], isolated splenic lymphoma [3 patients] and sickle cell-beta thalassemia [one patient] and one patient with unknown cause. All patients with liver cirrhosis were selected to be Child-Pough grade A. All patients were subjected to coil embolization of the splenic artery after infusion of one unit of fresh blood and another unit of platelet concentrates in some patients. Then subsequent splenectomy was done within 2 to 5 days. In patients with liver cirrhosis and portal hypertension, ligation of the left gastric vein was also done in conjunction to splenectomy. This study was done in Assiut University Hospital during the period between February 2001 to October 2006. This study was done on 15 patients with massive splenomegaly, 9 males [60%] and 6 females [40%] with their ages ranged between 15-48 years with the mean age of 29.2 years. The preembolization platelet count ranged between 19x10[9]/L to 78 x10[9]/L with a mean value 45x10[9]/L. One of the patients, known to have heterozygos sickle cell disease presented by acute splenic sequestration crisis. Splenic artery occlusion aided normalization of the thrombocytopenia within 2 to 5 days in all patients by fresh blood transfusion. The postembolization platelet count ranged from 143 to 210 x10[9]/L with a mean 168x10[9]/L. Successful splenectomy was subsequently done with no intraoperative significant blood loss and additional transfusion. No serious complications resulted from both procedures. Preoperative proximal coil embolization of the splenic artery is a safe technique and allows safe splenectomy in patients with massive splenomegaly with secondary hypersplenism that carries high risk splenectomy. It is a life saving technique in patients with acute splenic sequestration crisis. After proximal coil embolization, it is advisable to perform splenectomy before dilatation of the collateral and recurrence of hypersplenism

[MRI contribution in diagnosis of acute bone infarcts in children with sickle cell disease]

We analyse MRI findings of nine children with sickle cell disease having painful osseous attacks. The diagnosis of vaso-occlusive crisis was confirmed by negative bacteriology. MRI is useful for determining the anatomic site and the extent of acute infarcts. It gives a global view of osseous abnormalities, and contributes to differentiating acute infarcts from acute osteomyelitis

Role of MR chlangiopancreatography in biliary obstruction- A clinico-radiologic and opreative study

Thirty-five patients with obstructive jaundice suspected clinically [19 males and 16 females, their ages ranged from 5 to 81 years] were included in this study. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and magnetic resonance cholangiopancreatography [MRCP]. Twenty-three patients were operated upon. ERCP was done in nine patients as well as percutaneous transhepatic cholangiography [PTC] and drainage transhepatic cholangiography [PTD] in two patients. One patient was diagnosed by ultrasound [US] and MRCP to have primary sclerosing cholangitis. MRCP images revealed extrahepatic biliary obstruction in 34 cases with good quality images. It demonstrated the levels of obstruction in all patients but diagnosed their causes in 33 only [16 were malignant, 11 calcular, one primary sclerosing cholangitis, 3 post-cholecystectomy stricture of CBD, one papillary stenosis and one chronic pancreatitis]. In two patients, there was a distal obstruction of undetermined origin by MRCP and one patient had calcular obstruction by ERCP [false -ve]

Modified wide base diamond flap anoplasty and anorectal manometric study and their impact on the outcome of management of cictatricial anal stenosis

Twenty patients were included in this study [17 men and 3 women with a mean age of 37.2 years]. Severe anal stenosis [AS] was found in 17 patients and moderate AS in 3 patients. Low AS was present in 4 cases, mid AS in 5 cases and diffuse AS in 11 patients. Hemorrhoidectomy was the cause of AS in 65% of the patients. The preoperative manometric study revealed hypertonia of the internal anal sphincter in 18 patients [16 with severe and 2 with moderate AS] and hidden posterior external sphincteric injury in one patient having pelvic colostomy. Diamond flap anoplasty with wide base was done bilaterally in patients with severe AS and unilaterally in those with moderate AS. Lateral partial internal sphincterotomy was done in all patients with preoperative hypertonia. Closed suction drainage of the dead subcutaneous space at the donor site was done only in 15 patients. In patients with sphincteric defect, posterior overlap repair was done one month after anoplasty. The study concluded that anoplasty using diamond flap with wide base technique is a safe method to correct cicatricial AS with good long-term results. Anorectal manometric study plays a role in the selection of patients for lateral partial internal sphincterotomy, detection of hidden external sphincteric injury and postoperative follow up of patients

Use of autologous vein graft in reconstruction of common bile duct defect: an experimental study

This study was done on 10 healthy dogs to evaluate the possible use of autologous venous graft and stent to repair a segmental common bile defect [CBD]. The preoperative liver function tests were normal in all dogs. A 1.5-2 cm segment of supraduodenal CBD was excised and replaced by 3 cm segment of vena cephalica antibrachii on a stent. One end of the stent was introduced into the CBD proximally and the other distally; then the graft was sutured into the CBD using vicryl 5/0 suture. Liver function tests were done on days 7, 14 and 20 postoperatively and re-laparotomy was done after 3 weeks. One dog died intra-operatively and was excluded. The defect was repaired successfully in nine dogs. The postoperative follow up liver function tests on days 7, 14 and 20 were normal in 8 dogs. In one dog, the tests indicated biliary obstruction. At re-laparotomy after three week, the grafts were perfectly healed in all dogs without any evidence of bile leakage. In the dog with obstructive liver function tests, the gallbladder and the graft was strictured and the stent displaced into the duodenum

Functional preperitoneal mesh repair of inguinoscrotal indirect hernia through inguinal approach

This study included 43 male patients with 45 inguinoscrotal indirect inguinal hernias, their ages ranged from 33 to 69 years with a mean of 48.1. The hernias were right in 24 patients, left in 17 patients and bilateral in 2 patients [4 operations]. In eight patients, the hernias were recurrent. In bilateral cases, the operations were done sequentially with two months in-between. All the primary hernias were classified as Nyhus type III [posterior wall defect] and the recurrent ones were Nyhus type IV. It was concluded that preperitoneal MeSH repair of inguinoscrotal hernia through inguinal approach has very satisfactory results and is indicated when the posterior inguinal wall is weak, so that the repair of hernia without MeSH makes it liable or recurrence

Comparative study between magnetic resonance cholangiopancreatography MRCP and surgical results in evaluation of obstructive jaundice

Thirty patients with obstructive jaundice suspected clinically, 14 males and 16 females were admitted in the surgery department, Assiut University Hospital, in the period between September 1999 to September 2000. Their ages ranging from 5 to 70 years. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and MRCP. Twenty-three patients were operated upon. ERCP was done in three patients [as diagnostic, therapeutic and palliative], PTC and PTD [as diagnostic and palliative] was done in one patient. The last three patients were diagnosed by US and MRCP to have primary sclerosing cholangitis. MRCP images revealed surgical biliary obstruction in 27 cases with good quality images. It demonstrated the level of obstruction in all patients [27 cases were extrahepatic and 3 patients were intrahepatic] and diagnosed the causes of obstruction in 27 patients [13 cases were malignant, 7 were calcular, 3 primary sclerosing cholangitis, one benign stricture of common hepatic duct [CHD], one case benign stricture of common bile duct [CBD], one case stenosis of doudenal papilla and one case chronic pancreatitis]. In three patients there was distal obstruction of undetermined origin by MRCP. One patient had calcular obstructive jaundice by ERCP [false -ve] and in two patients no cause was found by surgical exploration. In this study, MRCP was found to be a helpful technique in children and also in malignant obstruction, where it enable to diagnose four early resectable cases [three with pancreatic head cancer and one patient with ampullary carcinoma]. The specificity of MRCP in this study was found to be 100%, the sensitivity 96%, the accuracy 96.5% and the success rate in diagnosis of biliary obstruction was 100%. It was concluded that, MRCP is evolving as a rapid, easy, accurate and noninvasive tool for evaluation of the pancreaticobiliary system in patients with various obstructing biliary conditions

Nouvelle methode d'evaluation de la surface au cours du retrecissement mitral: La PLSIA correlation avec la planimetrie et le temps de demi-pression

Since preliminary reports, it has been proposed that measuring the flow convergence region proximal to an orifice by Doppler mapping can provide a means of calculating regurgitant flow rate. More recently, this method was used for estimation of mitral surface area in mitral stenosis. The goal of this study was to determine the accuracy and limitations of calculating mitral surface area using this concept comparatively with two dimensional echocardiography and pressure half time methods. 55 patients with rheumatic mitral stenosis with and without moderate mitral or aortic regurgitation were studied using imaging and Doppler echocardiography. The transmitral flow rate was calculated using the hemispheric flow convergence equation. The aliasing velocity was selected to 23cm/s by adjusting the zero baseline shift. Mitral valve area was evaluated according to the continuity equation. Mitral valve area by color flow convergence region method correlated well with that by two dimensional echocardiography [r = 0,90 p = 0,005] and by pressure half time [r = 0,81 p = 0,003]. This method provides accurate measurement of mitral valve area in patients with significant mitral stenosis and is not influenced by associated mitral or aortic regurgitations

Plasma follicle stimulating hormone [FSH] level in some psychotic disorders

This study was done on 24 female patients and 8 control volunteers. The patients included 16 schizophrenics and 8 psychotic depressives, according to PSE Catego computer program. The study was based on measuring FSH level in plasma in both groups before and after therapy. The results showed that, on comparative assessment of basal FSH levels in control subjects vs. Groups of schizophrenics and depressives, there were significant decreases of basal FSH levels in both groups. While on comparing the basal FSH level in both schizophrenics and depressives before and after antipsychotic therapy, there were no significant differences between pre and post-medication states