Anorectal dysfunction in diabetic autonomic neuropathy and microangiopathy

Diabetic autonomic neuropathy affects many physiological systems, producing a variety of important clinical manifestations. Diabetic motility disturbances are frequent and may be found within esophagus, stomach, small bowel, colon and anal sphincter. Disturbed motility may explain gastrointestinal symptoms of patients with diabetic enteropathy. The aim of this study was to investigate any possible relation between the severity of anorectal dysfunctions in diabetes mellitus and the duration of the disease and the presence of microangiopathy or neuropathy. The present study comprised 47 diabetic male patients and ten healthy male volunteers as control group. The patients and control were subjected to history taking, clinical examination [including autonomic function tests and occular fundoscopy], and a series of investigations including laboratory, sigmoidoscopy with mucosal biopsy and lastly anorectal manometry. The majority of diabetic noncomplicated patients were found to be asymptomatic [73%]. While, conistipation was the most common among symptomatic diabetic patients whether complicated [41%] or noncomplicated [20%], incontinence was frequent in autonomic neuropathy [28%]. Complicated diabetic patients exhibited decreased resting anal pressure [P=0.027], squeeze pressure [P=0.017], and higher thresholds of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to diabetic non complicated cases. Diabetic patients with long history of the disease [>5years] had more worsening of the resting anal pressure [P=0.001], anal squeeze pressure [P=0.001] and more impairment of minimal rectal sensation [P=0.001], sense of desire for defecation [P=0.001] and maximum tolerable volume [P=0.001] when compared to those with short history. In patients with long history of diabetes mellitus, anorectal motility disorders were observed frequently and could be attributed to the increased incidence of microangiopathy, autonomic and peripheral neuropathy observed in this subset of patients. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea and sometimes incontinence. Anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful in early recognition of gastrointestinal motility disorders and subsequently better long-term management of patients with diabetes mellitus

Computed tomography and normal cross sectional anatomy of the head of the sheep

The objective of the present study was to define the detailed description of the anatomy of the head in the native sheep breed in Egypt by computerized tomography [CT] for use by radiologists and veterinary clinicians. Normal five heads of adult sheep of different ages [2-4 years] and sexes [three females and two males] were used in this study. Sheep were killed and the heads were sectioned at the level of atlantoaxial joint. 10-mm contiguous transverse CT images were acquired with a third-generation CT scanner. Frozen cross-sectional slices of sheep head were photographed and compared with the CT images. The important anatomic structures were revealed, seen clearly and labeled in two corresponding photographs of cross-sections and CT scans of the sheep head. The various dimensions of the nasal, cranial and tympanic cavities were recorded

Magnetic resonance imaging and cross-sectional anatomy of the brain of the red fox [Vulpes vulpes]

This article presents the detailed anatomy of the red fox brain and associated structures using magnetic resonance imaging [MRI]. The heads of five clinically normal adult foxes were used for this study. Contiguous T2-weighted transverse magnetic resonance images were acquired from just caudal to the level of cribriform plate to the caudal aspect of cerebellum, using 1.5-T Philips NT scanner. MR images were compared with corresponding frozen and formalinized cross sections of the heads of foxes at different levels. Most features of the brain that were identified on anatomic sections could be identified on the corresponding MR scans despite the low contrast between structures, particularly if adjacent bony and soft tissue structures were used as landmarks. Different anatomic and neuroanatomic structures were identified and labeled on the images as reference for MR morphology of the fox brain and related structures

Some anatomical studies on the abdominal aorta in the male red fox [Vulpes vulpes]

The present study was carried out on three adult male red foxes to clarify the obscure abdominal aorta in this animal. A suspension of 5% Barium sulphate was tested in the present work as both radio-opaque and vessel filler material to overcome specimens shortage of the wild animals. Hence the same specimens were radiographed, then photographed in the fresh state after opening the abdominal wall, then kept in formalin in a chilling room then carefully dissected and described, then re-photographed. The results showed that barium sulphate was an excellent vessel filler in the small vessels, while in the large vessels it was poorly hardened and may ooze if vessel leakage occurs during dissection. The abdominal aorta extended from the level of the first lumbar vertebra cranially, as a continuation of the thoracic aorta, to the level of the iliac crest caudally, slightly cranial to the promontory of the sacrum where it divided into a median sacral and a paired internal iliac arteries. All the parietal branches of the aorta were paired, they included the caudal phrenic, cranial abdominal, 7 lumbar, deep circumflex iliac and the external iliac arteries. The visceral branches were either single [celiac, cranial mesenteric and caudal mesenteric arteries] or paired [renal, middle adrenal and testicular arteries]. The level of origin of the right paired visceral arteries was cranial to that of the left ones. The adrenal gland received a cranial adrenal branch from the caudal phrenic artery, a middle adrenal artery from the abdominal aorta and a caudal adrenal branch from the renal artery. Several photographs and radiographs were prepared. The obtained results were compared with their correspondings in the domestic animals, especially the domestic carnivores

Effects of ciprofloxacin on renal cortex of rabbits and the role of vitamin C as a protective agent: anatomical, histological, histochemical and immunohistochemical study

Ciprofloxacin is a fluroquinolone antibiotic commonly used to treat respiratory, urinary tract, skin and soft-tissue infections. The aim of the present work was to study the effects of ciprofloxacin on renal cortex of rabbits and the possible protective role of vitamin C. Twenty four adult male rabbits were used in this study and randomly divided into three groups: control, ciprofloxacin treated and ciprofloxacin plus vitamin C-treated group. This regimen of treatment was given orally for one month. At sacrifice, blood samples were drawn for biochemical study. The kidneys were observed macroscopically and sections were prepared for histological, histochemical and immunohistochemical studies. Ciprofloxacin treated rabbits showed a highly significant increase in Blood urea nitrogen and creatinine. The kidneys of ciprofloxacin treated rabbits appeared small in size with macroscopic evidence of fibrotic capsular thickening. Renal cortex of ciprofloxacin treated rabbits showed moderate tubular dilatation in some proximal and distal convoluted tubules with marked degeneration and vacuolization of their lining cells. Some glomeruli were hypertrophied while others were atrophied. In summary, Ciprofloxacin can induce subtle renal damage which could be ameliorated by simultaneous use of vitamin C which is easily available and safe antioxidant. On the basis of our results, we advice Clinicians to use vitamin C in common with ciprofloxacin to avoid its potential complication

Some anatomical studies on the mesenteric arteries in the red fox [Vulpes vulpes]

The present study was carried out on four healthy adult red foxes to clarify the obscure mesenteric arferies which and their branches are usually involved in intestinal surgery. A suspension of 5% Barium sulphate was used in this work as both radio-opaque and vessel filler material. The results proved that the cranial mesenteric artery of the red fox arose from the abdominal aorta, at the level of the second lumbar vertebra, entered the cranial mesentery forming its root, then proceeded caudoventrally in the mesojejunum and continued as the last ileal artery. The cranial mesenteric artery gave off: 1-Caudal pancreaticoduodenal artery to the right lobe of the pancreas and the descending and ascending parts of the duodenum, 2- Eight jejunal arteries, 3- Three to four ileal arteries to the ileum, 4-Ileocolic artery to the ileum, cecum, ascending colon, transverse colon and the cranial part of the descending colon. The caudal mesenteric artery arose from the abdominal aorta at the level of the caudal border of the root of the 6[th] lumbar transverse process, passed caudoventrally in the descending mesocolon, then divided into: left colic artery to the caudal two thirds of the descending colon, and cranial rectal artery to the cranial segment of the rectum. Several photographs and radiographs were prepared. The obtained results were compared with their corresponding, especially in the domestic carnivores

role of neuropeptidey in acute exacerbation of bronchial asthma in children

Neuropeptides are chemical mediators in the sensory parasympathetic and sympathetic neurons of the airways. Numerous neuropeptides are selectively and specifically released from the lung tissues e.g., neuropeptide Y [NPY], vasoactive intestinal peptide [VIP], calcitonin gene-related peptide [CGRP], substance P [SP] and tachykinins [TK]. The imbalance between these neuropeptides is considered as one of the underlying mechanisms of bronchial asthma as some of them are potent bronchodilators whereas others are potent bronchoconstrictors. NPY is one of the important neuropeptides involved in the regulation of mechanisms of bronchial asthma. The aim of this work is to study the role of NPY in acute exacerbation of bronchial asthma in children. The study included two groups: patient group consisting of 30 children selected on clinical basis being presented with acute exacerbation of bronchial asthma and 20 apparently healthy age and sex-matched children as controls. None of the patients used oral steroids. For all patients, two plasma samples were obtained before and after treatment with bronchodilators whereas one plasma sample was collected from each member of the control group. Plasma level of NPY was determined by quantitative enzyme immunoassay after an extraction step for the tested plasma by column extraction method to separate peptides from any interfering substance. There was a significant higher plasma levels of NPY for patients in comparison to controls [10.5 +/- 4.6ng/ml versus 0.13 +/- 0.05 ng/ml P < 0.001] whereas there was no significant difference between NPY plasma levels before and after treatment [10.5 +/- 4.6ng/ml versus 10.02 +/- 4.1ng/ml; P>0.05]. The increased plasma levels of NPY during exacerbation of bronchial asthma act as a breakdown mechanism against the exacerbation of this asthma so it can be useful as a diagnostic tool for asthma but can't be employed as a predictor for responsiveness to therapy like other neuropeptides as there was no significant difference between its levels before and after treatment. Further future studies are recommended for better underst and ing of the neural mechanisms of NPY and other neuropeptides in bronchial asthma which might provide. fruitful therapeutic approach

Serum interleukin-8 levels in patients with chronic hepatitis C: correlation with histological activity index

Interleukin-8 [IL-8] is a proin Immatory chemokine that induces trafficking of neutrophils across the vascular wall Its release is triggered by inflammatory signals from a large variety of cells including monocytes, rnacrophages, Kupffer cells and hepatocytes. Our aim is to study the IL-8 levels in the serum of patients with chronic hepatitis C [HCV-CH] and whether these levels could be correlated with histological activity index [HAl]. The study included 20 patients with HCV-CH [all +ve for anti-HCV antibodies and RT-PCR] were selected from Mansoura University Hospital [Medical Outpatient Clinic]. All were subjected to thorough history taking, physical examination, routine laboratory investigations, IL-8 levels [measured with commercial ELISA systems], abdominal ultrasound and liver biopsy for HAl according to the grading and staging system of ihak et al. 1995. 10 healthy subjects with equally-matched age and sex were selected as a control group for serum IL-8 levels. IL-8 was significantly elevated in HCV-CH versus control [91.2 +/- 31.38 pg/ml versus 5.77 +/- 1.17 pg/mI]. This elevation correlates with serum bilirubin [r = 0.769, p = 0.01]. ALT [r = 0.764, p = 0.01], and AST [r = 0.620, p = 0.01], It also correlates with HAI grade [r = 0.816, p = 0.01] but not HAI stage [r = 0.108, p = 0.649]. Serum IL-B levels could be considered as a measure of the severity of HCV-CH [significant correlation with HAI grade] but -not the disease progression [insignificant correlation with HAI stage]

Susceptibility of pathogenic bacteria to augmenting in comparison to other antibiotics

A total of 6241 strains of bacteria were isolated from various clinical specimens and tested in vitro to determine the efficacy of amoxycillin calvulanic acid [Augmentin] in comparison with other commonly used antimicrobial agents. This was done by means of disc diffusion method using Muller-Hinton agar susceptibility plates. 74% of the 1994 strains of Enterobacteriaceae, 97% of 1105 Staphylococcus aureus, 62% of 300 Staphylococcus epidermiditis and all the isolates of streptococci, micrococci and enterococci were inhibited by Augmentin. All the 1289 strains of Pseudomonas species, 89% of Serratia marcescens and 79% of Enterobacter species were resistant to Augmentin. However, Augmentin showed considerably increased activity against Escherichia coli, Klebsiella, Proteus and Acinetobacter species as well as staphylococci when compared with ampicillin. Therefore, Augmentin appears to be a very active drug in empirical treatment of infections caused by Gram-positive cocci mainly as well as many of the Gram-negative Enterobacteriaceae

spectrum of meningitis in neonates and children

The medical records of 203 patients admitted with meningitis during two years were reviewed. According to the criteria of the study, cerebrospinal fluid [CSF] culture confirmed the diagnosis of bacterial meningitis in 74 patients [proved group]. Of the remaining 129 patients, where causative pathogens were not identified, 75 were partially treated bacterial, 52 were viral and 2 were tuberculous meningitis. The majority were Pakistanis and Indians representing 65% and most of them were younger than 5 years. Up to age of 2 months, Klebsiella spp. was the most common organism isolated in the neonatal period [12 cases]. Whereas, above the age of 2 months, Hemophilus influenza type B was the predominant pathogen identified particularly up to age of 2 years [14 cases]. Neisseria meningitidis was next in order [12 cases] especially during Haj. Streptococcus pneumoniae was the third organism in frequency being isolated in 8 cases. CSF culture and latex agglutination test were the most reliable in confirming diagnosis. 20% of Hemophilus influenza isolates were resistant to ampicillin and 7% were resistant to ampicillin and chloramphenicol. The addition of third generation cephalosporins to the antimicrobial therapy results in a better promising outcome with reduced incidence of mortality and neurologic deficits