lateral extracavitary approach all through posterior

The Lateral extra cavitary approach [LECA] is a one stage approach allowing simultaneous ventral and dorsal exposure in the more familiar prone position without repositioning of the patients. It provides the ability to re-attack the ventral graft site after application of dorsal instrumentation. The neural elements are visualized early in the procedure allowing safe decompression. The aim of this work was to study the safety and technical difficulties of the LECA in different spinal pathology and the value of using a midline skin incision. 40 patients with different spinal pathology including trauma, tumours, infections, deformity and thoracic disc prolapse were treated via the LECA. 37 patients were operated via mid-line skin incision and only 3 patients via the hockey stick incision. All patients had decompression, anterior column reconstruction and posterior stabilization simultaneously. Mean follow up period was 21 months. Neither significant perioperative complications nor mortality were reported. The midline skin incision is more cosmetic and offers good exposure. The LECA is a safe approach better than combined anterior and posterior approaches

study of HLA type II [DRB] by PCR in Egyptian rheumatoid arthritis patients

To assess the relationship between HLA-DRB1 and rheumatoid arthritis in Egyptian patients, 40 subjects ere examined; 26 were rheumatoid arthritis patients and 14 were normal persons. The patients were further subdivided into groups according to the Mean Grades of the Disease Activity. All patients and the controls were subjected to ESR estimation by Westgren's method, Rheumatoid factor testing and HLA-DRB1 typing by PCR. The DNA was extracted from whole blood. Exon 2 was amplified and checked by gel electrophoresis. For HLA-DRB1 allele detection, amplification products were subsequently hybridized using typing strips in which 37 sequence specific DNA probe lines and 2 control lines were fixed. There was a significant association between rheumatoid factor and the grade of disease activity. There was a significant association between HLA-DRB1 broad types *4 and *1 and the susceptibility to rheumatoid arthritis. HLA-DRB1 broad types *4 and *1 had significant higher frequencies in patients than controls. They were 40.4% and 21.2% in patients while were 10.7% and 3.6% in controls. P values were 0.04 and 0.003 respectively for them. HLA-DRB1 *0102 allele had shown a significant increase in group IV rheumatoid arthritis patients with a frequency of 50%. high relative risk, and a P value of 0.014

Computed tomography for evaluation of adrenal dysfunction A/C- year follow-up

To evaluate the computed tomography [CT] morphology of the adrenal glands of patients with adrenal dysfunction. CT examination of adrenal glands was performed in 331 consecutive patients with symptoms suggestive of adrenal dysfunction. CT was performed using 4-mm contiguous sections for the adrenal area. Intravenous contrast was injected in 78 cases of the adrenal mass lesions. We analyzed 331 consecutive CT scans performed over a 10-year period. One hundred and twenty-seven patients had hypercortisolism, 23 had unilateral adrenal tumor, 18 had bilateral adrenal hyperplasia and 86 had normal adrenals. The CT diagnosis was confirmed at surgery in all 23 unilateral adrenal tumors except in 1 case [tuberculosis in a hyperplastic adrenal gland]. Among the 91 cases of hypertension, 86 were being evaluated for pheochromocytoma and 5 for Conn's syndrome. Forty-three had adrenal pheochromocytoma [1 bilateral] and 10 had extra-adrenal pheochromocytoma detectable on CT. Two of the 5 cases of hyperaldosteronism [Conn's syndrome] had adrenal tumor. Adrenal enlargement was observed in 17 of the 33 cases of Addison's disease. Four of them were cases of histoplasmosis. CT scanning is a sensitive tool for the imaging of adrenal glands. Both neoplastic and inflammatory lesions can alter adrenal gland morphology. Our results highlight the importance of studying adrenal morphology. CT morphology is helpful to decide the modality of treatment

Bacteriological and immunological study of childhood otitis media especially H.influenzae infection and role of cytokines

Middle ear fluids [MEFs] from 500 children of whom 150 children aged 3 months to 2 years presented with acute suppurative otitis media [ASOM] and 350 children aged 2-8 year diagnosed as chronic suppurative otitis media [CSOM] with perforated drum membrane were examined bacteriologically for the causative bacteria. Gram- positive cocci; including S. pneumoniae, S. viridans were the most common causes of ASOM. Whereas in CSOM, both Gram- negative bacilli, including P. aeruginosa, P. mirabilis, E. coli, H. influenzae and Gram- positive cocci were equally affecting he middle ear [42% and 42.6% respectively] H. influnzae was isolated from cases of ASOM and CSOM with a percentagte of 10 and 2.6 respectively. Biotype [IV] was the commonest biotype isolated from ASOM and CSOM with a percentage of 60 and 77.8 respectively. Serotype [b] seems to be more frequently associateed with biotype [IV] which was the commonest biotype in non capsulated strains. Using the Enzyme Linked Immunosorbent Assay [ELISA] system, the number of positive cases for interlukin-1 [IL-[1]], in cases of ASOM was of high statistical significant value [P<0.001] compared with that of CSOM and the number of positive cases for tumour necrosis factor [TNF] in cases of CS OM was of high statistical significant value [P<0.001] Compared with that of ASOM. The level of [IL-[1]] in cases of ASOM was of high statistical significant value [P<0.001] compared with that in cases of CSOM but the level of IL-[6] in cases of ASOM was of statistical significant value compared with that in cases of CSOM [P<0.05]. TNF levels in cases of CSOM was of high statistical significant value compared with that in cases of ASOM [P<0.001]. This may explain, on immunological basis, the frequent recurrences of ASOM and the more destructive pathologly in CSOM