Morphometric study of sacral hiatus in adult human Egyptian sacra: their significance in caudal epidural anesthesia

The reliability and success of caudal epidural anesthesia depends on anatomic variations of sacral hiatus [SH] as observed by various authors. SH is an important landmark during caudal epidural block [CEB]. The purpose of the present study was to clarify the morphometric characteristics of the SH in human Egyptian dry sacra and pelvic radiographs and identification of nearest ony landmarks to permit correct and uncomplicated caudal epidural accesses. The present study was done on 46 human adult Egyptian dry sacra. The maximum height, midventral curved length, and maximum breadth of each sacrum were measured and sacral and curvature indices were calculated. According to sacral indices, sacra were divided into 2 groups [22 male and 24 female sacra]. SH was evaluated in each sacrum according to its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior [AP] diameter at its apex, and transverse width at its base. Linear distances were measured between the apex of SH and second sacral foramina, right and left superolateral sacral crests. The distance between the 2 superolateral sacral crests also was measured. The most common types of SH were the inverted U and inverted V [in male] and inverted V and dumbbell shaped [in female]. Absent SH was observed in male group only. The most common location of SH apex was at the level of S4 in all groups of dry sacra and S3 in all groups of lumbosacral spine radiographs, whereas S5 was the common level of its base. The mean SH length, transverse width of its base, and AP diameter of its apex were 2.1 +/- 0.80, 1.7 +/- 0.26, and 0.48 +/- 0.19 cm. Female sacra showed narrower SH apex than male. The distance between the S2 foramen and the apex of the SH was 4.1 +/- 1.14, 3.67 +/- 1.21, and 4.48 +/- 1.01 cm in total, female and male sacra, respectively. Sacrum and SH showed morphometric variations in adult Egyptians. The equilateral triangle is an important guide to detect SH easily and increases the success rate of CEB. Insertion of a needle into the SH for caudal block is suggested to be done at its base to avoid the anatomic variations of its apex

[ assessment of pain following the harvesting of autogenous bone from the symphysis]

The pain following oral grating surgery is varied from patient to another. This matter takes a great attention from the patient during the distinguishing the operation with him. So, the aim of this study is to assess the pain following the harvesting of autogenous bone from the symphysis. 9 patients received alveolar ridge grafting. Two scales were used; the first had a list of four degrees:1]no pain,2]slight pain,3] moderate pain, 4]severe pain. The second scale was ranged from 0 to 100, and the patient defined the number that conform with his pain. In the first scale and after 3 hours: 3 patients felt no pain, 4 patients felt slight pain, 2 moderate pain and any did not felt sever pain. While in the second scale and after 3 hours: The pain severity average was 31,78%, and after 48 hours was 15,11%, and after one week was 3,33%. The operation of alveolar ridge augmentation using bone grafts harvested from chin symphisis is followed by a slight and moderate pain similar to other routine oral surgeries.

Evaluation of the surgical factor in postoperative pain control

Postoperative pain control has been studied extensively, including many perioperative pain control procedures. Unfortunately, the impact of the surgical technique was not objectively studied. The aim of this study is to evaluate if the type of surgical dissection needed for extensive abdominal wall dissection actually has an effect in the reduction of postoperative pain or not. Forty adult patients, 19 males and 21 females, were randomly divided into two groups with each group containing 20 patients having different varieties of anterior abdominal wall ventral hernia. Patients in group I had their hernias and abdominal wall flaps dissected by only sharp dissection using scalpel. Patients in group II had their hernias and abdominal wall flaps dissected using mainly blunt dissection assisted by sharp dissection where blunt dissection could not do the job. All the patients had general anesthesia. No preemptive analgesia was used. Nalbufen was used as the only postoperative pain killer and the total amount used of it was treated as the indicator for the intensity of postoperative pain. The results of the present study showed that the total amount of Nalbufen used for the control of postoperative pain is significantly less in group I throughout the postoperative follow-up period. This study concludes that use of sharp dissection in cases of extensive abdominal wall dissection is statistically better than other methods of dissection in terms of postoperative pain control

Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients

To compare two different supraglottic airway devices, the laryngeal mask airway [LMA] and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO[2], oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO[2], end-tidal CO[2], number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. No statistically significant difference was reported between both the groups, regarding heart rate, arterial BP, SPO[2] and end-tidal CO[2]. The mean duration of insertion attempts was 15.6 +/- 4.9 seconds in the I-gel group, while it was 26.2 +/- 17.7 seconds in the LMA group. The difference between both the groups regarding duration of insertion attempts was statistically significant [P=0.0023*], while the number of insertion attempts was statistically insignificant between both the study groups [P>0.05]. Leak pressure was [25.6 +/- 4.9 vs. 21.2 +/- 7.7 cm H 2 O] significantly higher among studied patients of the I-gel group [P=0.016*] and the incidence of gastric insufflation was significantly more with LMA group 9 [22.5%] vs. I-gel group [5%] [P=0.016]. Both LMA and I-gel do not cause any significant alteration in the hemodynamic status of the patients, end tidal CO[2], and SPO[2]. The postoperative complications were not significantly different except nusea and vomiting was statistically significant higher in LMA group [P=0.032]. among both LMA and I-gel patients. Insertion of I-gel was significantly easier and more rapid than insertion of LMA. Leak pressure was significantly higher with I-gel than LMA and thus incidence of gastric insufflation was significantly lower with I-gel

Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery

Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED[95] doses of cisatracurium [100 microg/kg] do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED[95]. To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium. The study designed as randomized controlled clinical trial to compare between atracurium [2?ED[95]] and different doses of cisatracurium [2?ED[95], 4?ED[95], 6?ED[95]] regarding onset time, duration of action, condition of intubation, hemodynamic effects, and sings of histamine release clinically. Sixty four patients were randomly assigned to one of four groups, the first group [group 1] received 2?ED[95] dose of atracurium, group 2 received 2?ED[95] dose of cisatracurium, group 3 received 4?ED[95] dose of cisatracurium, while group 4 received 6?ED[95] dose of cisatracurium. The Datex relaxograph [Type NMT-100-23-01, S/N: 37541] for neuromuscular monitoring was used. HR, MABP was statistically significant increased post-intubation with administration of 2?ED[95] dose of atracurium in group 1 and the same dose of cisatracurium in group 2 but 5-20 min later was not statistically significant with administration of 4?ED[95] and 6?ED[95] doses of cisatracurium in groups 3 and 4, respectively. Onset time was found to be significantly lower with 2?ED[95] dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium [4?ED[95] and 6?ED[95]] showed onset time and longer duration of action that was significantly lower than with atracurium and with lower dose of cisatracurium [2?ED[95]]. Only 6?ED[95] dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent condition of intubation. 4?ED[95] and 6?ED[95] doses of cisatracurium were significantly better than 2?ED[95] dose of cisatracurium. 2?ED[95] dose of atracurium and 2?ED[95] dose of cisatracurium were similar, while 4?ED[95] and 6?ED[95] doses of cisatracurium were significantly better than atracurium and 2?ED[95] dose of cisatracurium. The same dose [2?ED[95] dose] atracurium is more effective neuromuscular blocking agent than cisatracurium, while higher doses of cisatracurium 4?ED[95] and 6?ED[95] provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, and no associated signs of histamine release clinically

Role of multidetector computed tomography prostatic perfusion in diagnosis of prostate cancer

To evaluate the role of multidetector computed tomography prostatic perfusion in diagnosis of prostate cancer. From November 2007 to December 2009, 112 patients with suspected prostate cancer [with no previous histologic proof of prostate cancer] performed multidetector computed tomography prostatic perfusion followed by TRUS examination results were correlated with histopathological results from TRUS guided biopsy of the prostate were included in this thesis study. Our results are yielding multidetector computed tomography [functional ct "fct"] evaluation for detection of malignancy with sensitivity 90.54%, specificity 86.8%, positive predictive value 93.056%, negative predictive value 82.5%, accuracy 89.3% and pre-test probability = 64.3%. Multidetector computed tomography prostatic perfusion is a sensitive imaging modality the diagnosis of prostate cancer and should be routinely employed for raising the positive predictive value of prostatic biopsy

Anterior ethmoidal artery, a surgical and radiological study

Anterior ethmoidal artery [AEA] has a great clinical and surgical importance. It is a particularly important landmark for the fovea ethmoidalis and the base of the anterior cranial fossa. It is a possible sight of traumatic or intraoperative bleeding. Accurate localization of the anterior ethmoidal canal [AEC] and anterior ethmoidal artery [AEA] both radiologically and surgically and their relation to nasal lamellas and skull base in order to avoid the serious complications that might happen after violation of the canal or the artery. 50 patients diagnosed to have chronic rhinosinusitis [CRS] with or without sinonasal polyposis were selected. All the cases were subjected to: a] preoperative computerized tomography. b] operative intervension in the form of endoscopic sinus surgery [ESS], with dissection of the roof of the ethmoid sinuses for indentification of the anterior ethmoidal canal [AEC]. Radiological evaluation was done by axial, helical thin cuts and reconstructed saggital views, while assessment during surgery was encountered after direct endoscopic visualisation, using palpation with a probe and simple ruler measurements. Twelve patients had ESS performed on one side and 38 patients ESS on both sides. Thereby, a total of 88 AEC identifications were performed. In all dissections the AEC and AEA were successfully identified surgically and radiologically. On comparing surgical and radiological localization of the AEC in relation to the lamellas, it was found that the location of the AEC was the same in 86 dissections, while not in 2 dissections. AEC was positioned inside the skull base without bony defects in 82 dissections, and in 6 dissections, 2mm below the skull base, connected to it by a mesentry. Endoscopic localization of the AEC during surgery and the results of CT imaging were comparable. It was found that the AEA, the anterior turbinate axilla and the superomedial edge of the nostril were in a straight line. This finding was extremely helpful in the endoscopic search for the AEA

Parasitic infections and woman health

The present study was carried out on 400 Egyptian women ranging in age from 15 to 49 years. Full history, complete clinical, parasitological and hematological examination was done; also, rectal biopsy and indirect detection of schistosomiasis in urine by using Schisto-Fast kit was done. The results showed that the prevalence rate of parasitic infection was 15.2%, 8.2% of them were mixed infected cases. The most frequent parasite was S. mansoni. The highest prevalence rate of infection was 68.4% among the reproductive age group of 15-20 years. The prevalence of anemia was 76.7% in the infected group versus 69.7% in the noninfected one. The highest prevalence of anemia was in the age group of 20-35 years; also, 76.8% of the infected group had microcytic anemia, which is the commonest type in all anemic cases [57.4%]. Schistosomiasis was found to be the most important cause of anemia

Female genital schistosomiasis: prevalence disease associated morbidity and intensity of infection as detected by soluble egg antigen in urine

This study was done to assess the prevalence and morbidity pattern of S. haematobium infection in women of reproductive age [15 - 45 years] in schistosomiasis endemic area. One hundered and eighty women involved in this study and grouped as follows: group I: women with proven femal genital schistosomiasis [FGS] [n = 80], group II: endemic referents [n = 80] and group III: women living in schistosomiasis-free area [n= 20] serve as controls. Full history, general gynaecological and parasitological examinations were done to every women, a s and wich ELISA was carried to detect soluble egg antigen [SEA] in urine of all cases.Evaluation of the applicability of this assay as a diagnostic and morbidity indicator was done. revealed that significantly more FGS reported a history of spontaneous abortion [P < 0.01], complaints of irregular menstruation [P < 0.001], pelvic pain [P < 0.01] vaginal discharge [P < 0.0001], dysuria [P < 0.01] and haematuria [P < 0.0001] than in the referents. Biopsies were taken from the cervix of 80 women with macroscopical lesions and from them 24 cases, S. haematobium eggs were found by histological sectioning [30%]. In the control group [referents] no eggs were detected in the cervical biopsies of 10 of them [50%]. Infections with C and ida albicans, Trichomonas vaginalis were found in similar frequencies in all groups. Ecographic abnormalities of the urinary tract were present in 24% and 0% of the infected women and referents respectively. These findings were accompanied by an elevated frequency of haematuria [55.6% versus 10%] and proteinuria [70% versus 20%] in the FGS and referent groups. Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract but also frequently in the lower reproductive tract [LRT]. SEA levels in urine of S haematobium infected women significantly correlated with egg counts and with clinical findings [P < 0.001]. In addition lower genital tract pathology as determined by cervical smear and biopsy significantly correlated with the SEA levels in urine

Importance of cytokines production during Hymenolepis nana primary and challenge infection

The function of cytokines produced during Hymenolepis nana infection in mice in protective immunity against reinfection was studied. IFN-gamma, TNF-alpha and IL-4 in aqueous intestinal extracts were assayed during primary and challenge infection. The results showed that, after primary infection with H.nana eggs, the levels of all cytokines [IFN-gamma, TNF-alpha and IL-4] started to increase from days 3-5 post - infection when the parasites are thought to begin their luminal phase, while challenge infection, stimulates a significant increase in their levels. All the parasites derived from the primary infection were markedly decreased and the cysticercoids can't be observed after challenge infection

Lymphocytic immuno-phenotype and expression of epidermal growth factor receptor in intestinal schistosomiasis

Schistosomiasis is an endemic disease in Egypt performing major health and subsequently economic problems. Schistosomiasis generates a range of host immune responses that may contribute to the pathogenesis of this disease. In this study immunologic response and reparative potentiality of intestinal mucosa following infection have been evaluated Fortey patients with manifestations of active intestinal schistosomiasis were selected by positive rectal snip for this study and compared to 10 negative control patients. sigmoidoscopic biopsies were obtained and conducted for histopathologic examination, immunohistochemistry study of CD4+, CD8+ and epidermal growth factor receptor [EGFr], and feulgen stain to evaluate DNA content of glandular epithelium, using CAS200 image analyzer system. All bilharzial biopsies demonstrated lymphocytic infiltration intermixed with eosinophils and bilharzial ovae were detected in 12 biopsies. Positive CD4+ lymphocytes were observed in 35 cases [88.2%] with focal or diffuse distribution [25 and 10 cases respectively]. Seven cases were CD8+ positive [17.5%]. In 18 biopsies [47%], epidermal growth factor receptor was expressed by glandular and brush border epithelium. These cases demonstrated proliferative diploid histogram represented S-phase pattern of DNA distribution. The EGFr expression was conelated well with presence of bilharzial ovae, ulcerated epithehum and positive CD4+ lymphocytes. In conclusion, the expression of EGEr is stimulated by antigenisity released from ovae and cytokines of the activated T cells, to participate in mucosal healing process through DNA synthesis and adaptation to the presence of infection

Residue-concentration of malathion and its metabolites in blood, urine, milk and tissues of lactating goats after multiple oral administration

Determination of Residues of Malathion [M] and its metabolic fractions Malaoxon [MO], 0, O-dimethyl-phosphoro dithionate [DPDT], Malathion mono acid [MCA], Dicarboxylic acid [DCA] and desmethylmalathion [DMM], in serum, urine and tissues of lactating goats received a daily dose [10mg-1 kg] body weight of [M] for 5 successive days was investigated. Daily samples of blood and urine were collected during the period of administration as well as 7 and 14 days after withholding of [M]. Tissue samples were taken from slaughtered goats at 7 and 14 days after cessation of the insecticide. Gas chromatographic technique [GC] was adopted for determination of [M] and its metabolites. [M] was not detected in any serum samples collected during administration and/or after cessation of insecticide, while it was excreted unchanged in urine and milk till one week after cessation of treatment with neurotoxic concentration over 20 ng/ml. The active metabolites [MO] and [DPDT] were not detected in any milk samples collected during application or after stoppage of [M] administration, while both metabolites were detected in serum and urine with neurotoxic concentrations during period of administration and still detected in serum for 7 days [400 ng/ml] and DPDT for 14 days [241 ng/ml] after stopping of [M] administration. The major excretory detoxified metabolites was found in milk on the days 7 and 14 after cessation of Malathion. Tissue residue-analysis

Study on parasitic cysts in muscles of cattle and pigs and their relation to the human

This study was done on the muscles of slaughtered cattle and pigs under the supervision of veterinary doctors. A total of 110098 slaughtered pigs showed Cysticercosis cellulosae [0.028%], Trichinellosis [1.66%] and mixed infection of Cysticercosis cellulosae and Trichinellosis [0.099%]. A total of 254521 slaughtered cattle showed Cysticercosis bovis infection [2.8%]. Some interesting cases of Toxoplasmosis and Sarcocystosis were inspected during the microscopical examination. A general discussion on different parasitic muscle cysts and their relation to the human was given

Isolation of halophilic bacteria from a brine near Suez Canal area, Egypt

Moderate and extreme halophilic bacteria were isolated from different soil samples collected from a brine near Manzala Lake, Egypt. The first soil sample was taken from the border of the brine, while the second was gathered 2 m far. In spite of the slight distance between the two sites; the isolated bacteria from the first soil sample included only moderate halophilic organisms, while the second soil contained extreme and moderate halophilic isolates. The bacterial isolates in the two soils were cocci and the biochemical analysis indicated that the extreme halophilic forms were different strains of Halococcus spp

Pharmacokinetic profile of pipemidic acid in normal and nephritic rats

The pharmacokinetic profile, tissue distribution and residual content of pipemidic acid were studied in normal and nephritic rats. The maximum serum concentration was reached after 1 hour in both normal and nephritic rats following oral administration of 50 mg/kg b. wt. Lower serum concentration were detected in nephritic rats at corresponding time intervals as compared with healthy ones. Following the intravenous injection of pipemidic acid, the resulting curves were best fitted to follow two compartment open model. The drug was highly distributed in all tested tissues and completely disappeared from all tissues after 9 and 15 days in healthy and nephritic rats following its oral administration in a dose of 50 mg/kg b. wt. twice daily for 5 successive days

Some pharmacological aspects of ultra-short acting B-blocker [Esmolol]

Some pharmacological actions of esmolol, a new ultrashort acting cardioselective beta adrenergic blocker, were studied on guinea pig's auricles, rabbit's heart, rat's phrenic nerve diaphragm, rabbit's duodenum, rat's uterus as well as dogs blood pressure, ECG pattern and their protective action when administered intravenously before and after induced tachyarrhythmias with adrenaline in pentobarbital anaesthetized dogs was demonstrated. Esmolol induced a marked negative inotropic activity on guinea pig's auricles. On isolated rabbit's heart, the negative inotropic and chronotropic effects were induced by esmolol in concentrations up to 7.5 x10[-7] M/m1. The inhibitory effect of esmolol potency is 1/36.36 as potent of propranolol on rabbit's heart. In anaesthetized dogs. i.v. injection of esmolol at dosage ranged from 7.5 x10[-5] -6X10[-3] M/kg b.wt. produced a significant decrease in systolic and diastolic pressure, while lower doses induced insignificant changes. The electrocardiographic pattern induced by esmolol in dogs were mainly characterized by an increase in the amplitudes of P-wave and T-wave, prolongation of P-R, T-wave, P-wave and P-T intervals. Esmolol in a dose of 6 x 10[-4] M/kg b.wt. produced a good curative effect when injected intravenously after induced arrhythmias with adrenaline than before injection. Esmolol inhibited the indirect muscle twitches of rat's phrenic nerve-diaphragm. Furthermore, esmolol induced a marked inhibition of both amplitudes and frequency of isolated rabbit's duodenum and uterus of rats in concentrations more than 3.86 x 10[-5] and 3.6 x 10[-5] M/m1, respectively

Serologic study of amebiasis in diabetes

The antibody response or ameobiasis, using the indirect haemagglutination test, was studied in diabetes with [n=25] and without [n=14] active amoebiasis [positive stools for Entamoeba histolytica cysts] in relation to gastrointestinal diabetic complications. Antibody response to E. histolytica was assessed using the indirect haemagglutination test. Invasive amoebiasis [titre 1/32] was encountered in 66.6% of diabetics and in 31.3% of non diabetics [P<0.05]. Non diabetic amoebic patients and the highest antibody response [1/960 +/- 245.5] which was significantly higher than that of diabetic amoebic [1/ 258.6 +/- 109.6; P<0.01], diabetic non amoebic [1/35.4 +/- 11.2; P<0.01] and non diabetic non amoebic [1/13; P<0.01] groups. Diabetic patients with invasive amoebiasis were significantly older, having a longer duration of diabetes and a higher fasting plasma glucose compared to diabetics without invasive titres. There appears to be no influence of the type of diabetes, sex or presence of diabetic complications on the development of invasive amoebiasis in diabetics. Invasive amoebiasis was [84.6%] more than autonomic neuropathy [variation of heart rate with deep breathing] [46.6%] in diabetic patients presenting with bowl habit abnormalities [P<0.01] and in patients with tender hepatomegaly [100%] compared to those without tender hepatomegaly [77.8%, P 0.05]. It can be concluded that the antibody response ot amoebiasis is less brisk and more lasting than normal. Invasive amoebiasis may contribute to the diarrhoea and tender hepatomegaly of diabetics

Antibiotics in camels: Effect on some enzyme activities

The effect of six antibiotics [procaine benzylpenicillin, streptomycin sulphate, chloramphenicol sodium succintae, oxytetracycline hydrochloride, erythromycin ethyl succinate and tylosin] on some serum enzymes in camels following intramuscular injection of therapeutic dose one daily for 7 successive days were studied. All tested antibiotics increased the activities of alkaline phosphatase, S.G.O.T., and S.G.P.T. from the 1[st]. 14[th]. day, and the activity of arginase enzyme from 2[nd].- 10[th]. day post injection. Streptomycin sulphate, chloramphenicol sodium succinate and erythrumycin ethyl succinate decreased the ratio between S.G.O.T. and S.G.PT. activities. The other tested antibiotics have no influence on S.G.O.T/ S.G.P.T. ratio

Excretion of some sulphonamides by buffaloes

Sodium salts of sulphadiazine, sulphadimidine and sulphamerzine were infused intravenously into healthy and lactating buffaloes at a does of 100 mg/kg. So as to maintain a constant plasma concentration over 3 hours. Blood, milk and urine samples were obtained 1.2, 2.5, and 3.5 h. after the start of infusion Sulphamerazine attained the highest plasma concentration [280 ug/ml], whereas concentrations of sulphadimidine and sulphadiazine were lower [247 and 212 ug/ml, respectively]. Sulphadimidine was highly excreted into buffalo's milk [95 ug/ml] as compared to both sulphamerzine [33 ug/ml] and sulphadiazine [30 ug/ml]. The drugs tested were extensively excreted via kidneys. A relationship was observed between the rate of excretion of the sulphonamides in urine and their pKa values. The plasma protein binding showed close. Similarity [18-20%] among the three sulphonamides. On comparing the urinary clearance of sulphonamides with both creatinine and urea clearances, sulphadiazine had the highest ratio, sulphamerzine a lower and sulphadimidine the lowest one. The percentages of acetylated products of the three sulphonamides in plasma were similar [8.2-9.4%]. However, the concentrations of acetylated metabolites in the milk and urine varied distinctly