Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain / 대한해부학회지

Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that inf luences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibrofascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by –17.2%±11.0% at lower end of shaft of femur, –21.1%±6.0% at upper border of patella, –36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.

Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain / 대한해부학회지

Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that inf luences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibrofascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by –17.2%±11.0% at lower end of shaft of femur, –21.1%±6.0% at upper border of patella, –36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.

Laryngeal cancer: sociodemographic, life style and clinical risk factors among patients underwent total laryngectomy

Laryngeal cancer [LC] is an important health problem. It is one of the most common respiratory cancers. The prevalence of this cancer is increasing all over the world. The aim of the present study is to determine the clinical features of the laryngeal cancer patients underwent total laryngectomty [TL]; to define the characteristic features of surgery in these patients; and to define the life style, health behavioral, sociodemographic and clinical risk factors of the patients. A total of 90 laryngeal cancer patients and a control group of the same number were enrolled in the study. A case-control, hospital based study design was used. The most important clinical features of the studied laryngeal cancer cases underwent TL were; most lesions site was glottis [56.7%], presented with hoarseness of voice [85.6%] and most of the patients were in stage III [63.3%]. Also, the most important characteristics of the surgery in these cases were 64.4% had TL and primary tracheoesophageal puncture, 88.9% underwent thyroidectomy and 25.6% had preoperative tracheostomy. The +ve reflux symptoms index was significant clinical risk factor [OR=6.77]. Factory worker occupation was significant risk factor [OR=4.65]. The most important sociodemographic risk factors for laryngeal cancer were male sex, urban residence, old age, low social level and low occupational level [ORs= 52.59, 2.43, 2.43, 1.99 and 1.97; respectively]. Further, the most important significant health behavioral risk factors were cigarette smoking, goza smoking and no healthy food intake [ORs= 4.44, 4.25 and 2.74; respectively]. Population based studies are needed in different areas in Egypt and on large numbers of patients to understand the full epidemiology of the laryngeal cancer and quality of life of these patients

Study of the relationship between serum cortisol and dehydroepiandrosterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged with Alzheimer's disease and vascular dementia

Dementia is the general term that refers to the decline of mental abilities including memory and other thinking skills while a person is alert and awake. Dementia is considered a late-life disease because it tends to develop mostly in elderly people. The two most common forms of dementia in older people are Alzheimer's disease and multi-infarct dementia [vascular dementia]. Alzheimer's disease accounts for around 60% of all cases of dementia, while vascular dementia accounts for up to 20% of all cases of dementia. Cortisol and dehydroepiandrosterone [DHEA] and its sulfate ester [DHEAS] are adrenal steroid hormones. These hormones have been suggested to have a role in many aging related diseases and perhaps in aging itself. These hormones have been shown to multiple effects on the function of the hippocampus, which is involved in learning and memory processes. These adrenal steroids may thus be associated with cognitive impairment, which is a major symptom of dementia. To study the relationship between serum cortisol and dehydroepiandroesterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged persons with Alzheimer's disease and vascular dementia. Study was conducted on 30 elderly demented patients selected randomly from the general population. Their ages ranged from 52 to 85 years with a mean of 68.5 years and they were 13 males and 17 females, they were divided into two groups; group I: 15 patients [7 males and 8 females] with probable Alzheimer's disease diagnosed according to diagnostic and statistical manual of mental disorder [DSM- IV criteria], group II: 15 patients [6 males and 9 females] with vascular dementia, group III consisted of 15 elderly healthy volunteers, matched for age and sex with no evidence of dementia have been served as control group. All were submitted to morning collection of blood for determination of the plasma cortisol and DHEAS measured by chemiilluminescence. The 30 points Mini Mental State Examination [MMSE] was used to assess cognition. The present study firstly showed that mean serum cortisol level increase while mean serum DHEAS level decrease with age and mean serum cortisol levels was higher in both AD and VD than normal controls while mean serum DHEAS levels in both AD and VD] was lower than normal controls. Gender did not play a significant role in variability of cortisol and DHEAS. Also, most of Alzheimer's disease patients were none educated in comparison to vascular dementia patients and this indicates that a low level of education has been associated with a greater risk of developing AD. There is an association between serum cortisol and DHEAS levels and severity and duration of dementia and cognitive decline in demented patients. There is a strong association between cortisol and DHEAS and prevalence of dementia in the elderly. There was a trend of high serum cortisol level in males and high serum DHEAS level in females but, gender did not play a significant role in variability of cortisol and DHEAS. Low level of education has been associated with a greater risk of developing dementia and there is association between serum cortisol and serum DHEAS levels and duration and severity of dementia

Renovascular disease and cognitive impairment in elderly: a novel risk maker

Renal artery stenosis is most commonly due to either fibromuscular dysplasia or atherosclerosis. Atherosclerosis accounts for 90 percent of cases of renal-artery stenosis. Renal-artery stenosis may occur alone [isolated anatomical renal-artery stenosis] or in association with hypertension, renal insufficiency [ischemic nephropathy], or both. The aim of the present work was to study the role of renovascular disease as a novel risk marker of cognitive impairment in elderly. The study included 80 patients divided into 4 groups: Group 1: 20 cases of elderly patients above 65 years and suffering from grade 2 or 3 CKD. Group II: 20 cases aged 20-40 years and suffering from grade 2 or 3 CKD. Group III: 20 healthy controls aged above 65 years. Group IV: 20 healthy controls aged 20-40. They had been evaluated for their: Clinical condition, including physical examination and history taking, ECG, BMI estimation, MMMS examination, Routine investigation including: complete blood picture with differential counting, bleeding and coagulation time, liver functions tests, lipid profile, fasting and post-prandial plasma glucose, renal function tests, complete urine analysis, 24-hours proteins in urine, assessment of glomerular filtration rate [GFR] by MDRD and creatinine clearance and in addition specific laboratory investigations were done including: Serum CRP using turbidimetry, Microalbuminurea using turbidimetry, v-WF Ag by ELISA, s-ICAM. By ELISA and Duplex study was performed on carotid and renal arteries. The results of the present study showed that there was a significant increase in the BMI in groups land II in comparison to group III which was higher than group IV. The MMMS test was significantly lower in group I in comparison to groups II and III which were in turn significantly lower than group IV. Hemoglobin was significantly lower in groups I and II than group III and IV. Platelets count was significantly lower in groups I and II than group III which was also significantly lower than group IV. Creatinine clearance was significantly lower in groups I and II than in groups III and IV vWF levels were significantly lower in groups land II than in groups III and IV s.ICAM I was significantly higher in groups I and II compared to groups Ill and IV. CRP was significantly increased in groups I and II in comparison to groups III and IV Carotid plaque score was significantly higher in group I than group II which was higher than groups III. Resistive index was significantly lower in groups land II than in groups III and IV Acceleration index was significantly lower in groups I and II than in groups III and IV. A significant positive correlation was found between age and urinary albumin, CRP, and s.ICAM. A significant negative correlation between age and cereatinine clearance and MDRD in groups I, II and III. Reno vascular disease is common in elderly and the most important cause is atherosclerosis in this group of patients. There are many risk factors for cognitive impairment in patients suffering from renovascular disease and most of them are correctable. Renovascular disease can be considered as a novel risk factor of cognitive impairment through many interacting mechanisms

Study of the correlation between; nitric oxide profile, degree of liver injury and structural vascular changes of the gastric mucosa in chronic hepatitis C virus related liver diseases

Nitric oxide [NO] plays an important role in HCV associated hepatic dysfunction and in the pathogenesis of portal hypertension. This study was designed to correlate serum nitrite and nitrate levels with the degree of liver injury and gastric mucosal changes in HCV patients at different stages of the disease. 80 HCV infected patients were classified equally into 4 groups; chronic hepatitis C, Child A, B and C cirrhosis groups. 20 healthy subjects were allocated as a control group. For all patients, serum nitrite and nitrate levels, HCV RNA and liver test profile were evaluated. Liver biopsies for chronic hepatitis C and Child-A cirrhotic patients were obtained for grading, staging and expression of interferon gamma [INF- gamma] and pentosidine. Esophagogastrodudenoscopy to evaluate the degree of portal hypertensive gastropathy [PHG] and expression of vascular endothelial growth [VEGF] by histopathology. Serum NO profile was significantly higher in all HCV infected patients than healthy subjects. A significant correlation between IFN-gamma expression and both of serum NO and viral load. Also, hepatic pentosidine expression was correlating with staging and fibrosis. Also both of serum NO and gastric VEGF were over expressed and correlating with the degree of PHG. In HCV infected patients, serum NO was significantly overexpressed and correlating with the severity of chronic liver disease. Our study supports the role of direct viral cytopathic effect in HCV patients because of the significant correlation of viral load with both of serum NO and hepatic IFN-gamma expression. Pentosidine might be considered a marker of oxidative stress and fibrosis in chronic HCV liver disease

Helicobacter pylori infection and hyperemesis gravidarum is there a relationship?

To investigate any possible association between Helicobacter pylori infection [H. pylori] and hyperemesis gravidarum [HG] by using both H. pylori Stool Antigen [HpSA] test and H. pylori IgG Antibody [HpIgG Ab] serologic test. Prospective randomized study. One hundred thirty pregnant women in the first 16 weeks of pregnancy divided into two groups: 65 patients with HG [HG group] and 65 randomly selected asymptomatic pregnant women matched for age, parity, gravidity and gestational age with patients in HG group and formed the control group. Serum samples collected from cases were examined for HpIgG Ab by Chemiilluminescence on Immulite and feces samples were examined for HpSA by Helicobacter Antigen Quick test. Chi square [x[2]] test was used accordingly for statistical analysis. Positive HpSA test was detected in 47.7% of patients with HG and in 13.9% of asymptomatic cases, the difference was statistically significant [x[2] = 7.25, P=0.001]. Positive HpIgG Ab was found in 81.5% of patients with HG and in 69.2% of control women. The difference was not statistically significant [x[2]= 3.23, P= 0.07]. This study suggests an association between H. pylori infection and HG. HpSA test provides a more accurate tool for detection of active H. pylori infection than IgG Ab serologic test that recommends its routine use in patients with HG as well as in women who desire to become pregnant in the near future

Evaluation of haemostatic mechanisms in the elderly

Aging is associated with changes in the haemostatic balance including coagulation, flbrinolytic and/or platelet activity. Adverse changes in coagulation and flbrinolytic factors are thought to contribute to the increased risk of cardio-vascular disease and atherothrombosis with age. In this study the aim was to determine how the biological factor of age affected coagulation, flbrinolytic factors and platelet glycoprotein receptors levels. In so doing the effect of age on the two important systems in the body involved in haemostasis namely, the coagulation and flbrinolytic systems was studied. The population studied consisted of ten young healthy controls aged 20 - 30 years representing [group I], twenty subjects aged 60 - 70 years [group II], twenty subjects aged 70 - 80 years [group III] and ten subjects above 80 years [group IV]. All groups were subjected to thorough history taking, complete clinical examination and routine investigations excluding obeses, hypertensives, diabetics, patients with chronic obstructive pulmonary disease [COPD] or ischemic heart disease and patients with peripheral vascular disease. Investigations of coagulation parameters [procoagulant markers] included prothrombin activity, estimation of flbrinogen level, Factor VII assay, Thrombin antithrombin [TAT] complex, Prothrombin fragment 1+2 [PF1+2]. Investigations of flbrinolytic system [flbrinolytic markers] included Tissue plasminogen activator [TPA] and tissue plasminogen activator- inhibitor [TPA-I], Flow cytometric investigation of platelet receptors, including platelet membrane glycoprotein GPIIb, Ilia, and GPIb. Prothrombin activity and TAT complex were found to increase with age but their differences between the aged groups and group I did not attain a statistical significance. Serum flbrinogen, factor VII and PF 1+2 were rising with the advancement of age and their means were significantly higher in all aged group in comparison with the young group.Serum TPA and TPA-I showed a progressive increase with age and their means were significantly higher in all aged group in comparison to the young group. Platelet glycoprotein receptors IIb, IIIa and Ib levels were found statistically significant higher in all aged groups in relation to group I. The maximum increase was found in group IV. The age-dependency of these markers has to be taken into account in respect to their clinical use in order to characterize patients with suspected risk of atherosclerotic events. In future, one should consider routinely screening for these markers in those above the age of 60 years and, if found to be high consider giving flbrinolytic and antithrombotic agents prophylactically

Insulin Like Growth Factors [IGF] and early detection of HCC in HBV/HCV patients

The role of IGF signaling in controlling rates of cell renewal has led to interest in the relevance of this regulatory system to both ageing and neoplasia [1, 2, 3, 4] IGFI signaling stimulates proliferation prolongs survival of cells propagated in tissue cultures [4] The insulin like growth factor 1 signaling pathway arose early in evolution, possibly as regulator of cellular proliferation in relation to nutrient availability

Comparison of stenting with minimally invasive bypass surgery for high grade stenosis of the proximal left anterior descending coronary artery: six months follow up of randomized study

High grade stenosis of the proximal left anterior descending coronary artery [LAD] in patients with single-vessel disease is associated with a significantly worse prognosis than lesions at any other location. To compare the merits of stenting with minimally invasive coronary artery bypass [MICAB] surgery for high grade stenosis of isolated proximal LAD. One hundred patients with isolated high grade lesion [stenosis] >75% of laminal diameter in the proximal LAD were included. The patients were classified into two groups: Group A included 50 patients in whom successful stenting was performed. Group B included 50 patients in whom successful MICAB was performed. In group A the mean percentage of stenosis was significantly reduced to 10.48 +/- 4.112. After stenting, non of the patients died, 2Q wave infarction, 2 non Q wave infarction and 1 required coronary bypass surgery, 1 stroke, 3 LAD dissection, 5 angina pectoris, 3 needed revascu-larization, 4 vascular complications and 4 needed blood transfusion. In group B, after surgery 1 patient had Q wave infarction, 1 non Q wave infarction, 2 patients needed necessary sternotomy because of an intramyocardial segment of the LAD, 3 angina pectoris, 2 needed revascularization, 2 vascular complications, 2 needed blood transfusion, 2 developed AF and 2 chest wall hernias. The mean duration of lCU stay after surgery was 2.62 +/- 1.086 days as compared to 1.8 +/- 1.591 days after stenting [p < 0.05], the mean duration of hospitalization after surgery was 8.64 +/- 3.186 days as compared to 2.34 +/- 2.471 days after stenting [p < 0.01], Follow-up was complete for all patients except two patients in each group [2 patients died in group B while in group A one patients traveled and other was excluded, eleven asymptomatic patients refused repeated cardiac catheterization after stenting, as did 13 patients after surgery. No statistically significant difference was found between both groups as regard to positive exercise stress test [p > 0.05]. After stenting, the angina class improved 79.2% were free of angina. After surgery, the mean angina class improved, 91.6% of patients were free of angina. After six months of follow up, in-stent restenosis was detected in 11 patients [29.7%] and subgroup analysis showed a restenosis rate 15.4 for type B lesion and 46.2% for type C lesion. The recurrence of stenosis was more in type C and B than type A in stenting group. In surgical group, 3 patients [8.6%] had stenosis > 50% of the luminal diameter at the anatomic region, and subgroup analysis showed a restenosis rate of 3.6% for type B lesions and 21.4% for type C lesions. The recurrence of stenosis was more in type C and B than type A in surgical group. Secondary end points were 56% in group A vs 26% in group B. Stenting and minimally invasive bypass surgery are safe and effective treatment options for high grade lesions in the proximal LAD; MICAB requires longer hospitalization, more cost but has better an-giographic outcome while stenting has higher target vessel revascularization and secondary adverse cardiac event than MICAB

value of recurrent laryngeal nerve identification and stimulation by usig intraoperative disposable nerve stimulator during thyoid operation

Recurrent laryngeal nerve [RLN] iatrogenic injury is one of the most serious complications in thyroid surgery. Paralysis of vocal cords can repesents a srious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. This work is to study the importance of searching, identification and exposure of the RLN surgically and confirming this by using a disposable nerve stimulator to avoid its injury.Design: prospective study. Patients and Records of forty patients who underwent thyroidectomy by the authers at several Hospitals were reviewed for RLN paralysis between January2001 and December 2003. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator [Xomed, Jacksonville, Florida] set at 0.5 milliamper [mA]. Without the use of neuromuscular blockade during anesthesia, RLN function was assessed by palpating of the cricoarytenoid joint and posterior cricoaryteniod muscle while the stimulus was applied directly to nerve after identificantion. Postoperative, assessment of RLN integrity was determined by using flexible nasolaryngoscopy 7 days after the procedure to visualize the vocal cord mobility. RLNs were identified and stimulated intraoperatively in all patients. Concerning the postoperative results, flexible nasolaryngoscopy was utilized in all patients one week after the procedure. All patients had bilateral mobile vocal cords after the first week postoperatively. Conclusions: The authors concluded that iatrogenic injury to the RLN or to its branches could be avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In addition, using intraoperative disposable nerve stimulator is very helpful in confirming the location and function of the RLN

Study of some coagulation and fibrinolytic parameters in schistosomal cases

Schistosomiasis is a major health problem in various parts of the world and Egypt. The disease is well known for the bleeding tendency that may result from diminished synthesis of coagulation factors, fibrinolytic system activation and consumption coagulopathy. This work attempted to evaluate the role of the ascitic fluid milieu in the hypercoagulability that may be observed in schistosomal hepatic fibrosis. Three parameters were assayed; prothrombin fragment 1+2[PF 1 + 2], thrombin-antithrombin complex [TAT] and fibrin monomers [FM]. These parameters were assayed both in the plasma and ascitic fluid simultaneously. The study was carried out on 18 schistosomal patients with hepatic fibrosis and tense ascites. The values of PF 1+2, TAT were significantly correlated both in plasma and ascitic fluid, while FM although was higher than the expected values yet was not significantly associated to either of the two other parameters. We concluded from this study that the ascitic fluid can be an important source of pro-coagulant material to the plasma in ascitic patients with schistosomal hepatic fibrosis

Electromyographic study of some cases of anorectal intercourse

In this work, 20 anorecetive intercourse [ARI] cases of both sexes, referred to Cairo Medicolegal Department, ministry of Justice, were examined. They were compared with 10 healthy non-anorecetive subjects. Regarding the characteristics of the studied cases, 30% of males were married compared to 60% of females. Anal penetration was complete in all married cases [males and females], while it was 70% and 60% in unmarried ARI males and females respectively. There were no signs of violence in all married cases as they were cooperative with the other partner. Regarding local examination, in 80% of married female cases the anus was deeply seated compared to 70% in married males. In unmarried female cases, 670% had deeply seated anus compared to 80% form males. Funnel shaped anus was detected in 70% of ARI married female cases and 60% of ARI married male cases. It was 40% in ARI unmarried females and 80% in ARI unmarried males. The analysis of needle electromyography [EMG] mapping of the external anal sphincter of ARI subjects revealed weakness, which ranged from mild to marked at localized sites and sometimes there was generalized weakness at all sites compared to the control healthy cases

Study of DNA flowcytometry, serum CEA, CA 19-9 in correlation with histopathological staging and grading of colorectal carcinoma

Colorectal carcinoma CRC is estimated to have a high incidence among all cancer diagnosis in both sexes. The present work aimed at studying the growth parameters of CRC by measurement of DNA content by flowcytometry and to correlate these parameters with those of adjacent mucosa and those of normal control. Also to correlate these parameters with staging, grading of the tumour and also with serum level of CEA and CA 19-9. Flowcytometric analysis yielded aneuploidy in 65% of cases. Aneuploid tumours were associated with advanced stage and poor differentiation, but the relation between ploidy and both staging and grading of the tumours was insignificant. DI correlated significantly with staging and grading of tumours. S.PF and PI correlated significantly with staging and grading of the tumour and with preoperative value of tumour markers

Management of ambiguous genitalia

Ambiguous genitalia presents a major problem and a challenge both to the surgeon and the family. 16 patients with ambiguous genitalia of different etiologic causes are presented. The basic principle of management depends mainly on phallic size and sex of rearing. All reconstructive surgery was done as one stage repair. Female genital reconstruction was done in 13 patients, while male genital reconstruction was done in 3 patients who had phallic size of more than 4 cm in length. The results in the female reconstruction were very satisfactory. Of the 3 patients with male reconstruction, 2 had satisfactory results and one reoperation for urethral fistula. The results showed that female genital reconstruction gives better and more satisfactory results than male reconstruction which needs proper selection of cases with less promising results

Complement C1q in serum and ascitic fluid in cases of hepatic schistosomiasis with ascites

C1q levels were estimated by radial immunodiffusion in sera and ascitic fluids of 15 patients suffering from advanced schistosomal hepatic fibrosis. Ten healthy individuals were also included as controls. Lower C1q values were observed in patients compared with the controls. However, the difference was statistically nonsignificant. This denotes that the classic complement pathway may not be involved in cases with advanced schistosomiasis

Myoglobin in schistosomiasis

Late cases of hepatic schistosomiasis may be associated with muscle wasting, previous reports described some neurological and enzymatic changes in such patients. Myoglobin is known to reflect changes in muscle integrity. The present report described changes in blood myoglobin in various stages of hepatic schistosomal involvement. The findings are interpreted in light of associated clinical data

Myelogram in chronic renal failure

This study was undertaken to determine the effect of chronic renal failure on bone marrow picture. It included 20 patients whose blood urea ranged between 75 and 300 mg/dl. The hemoglobin concentration varied between 4 and 11.5 g/dl. The anemia was normochromic normocytic in most of the cases [85%]. There is a rough correlation between the hemoglobin concentration and blood urea. The cellular bone marrow proliferation in response to the anemic stress in chronic renal failure is below that would be expected from the state of anemia

Study of HLA-A, -B and - C specificities in patients with diabetic retinopathy associated with insulin dependent diabetes mellitus

The controversy in relation to the presence of a possible association of some HLA specificities with the occurrence of diabetic retinopathy in patients with insulin dependent diabetes, mellitus [IDDM], together with the well established diversity of HLA antigens frequencies associated with IDDM in different populations, raised the importance of determining HLA-A,B and -C specificities in patients with diabetic retinopathy in the Egyptian population. The study has been carried out on twenty patients with IDDM with different stages of diabetic retinopathy, twenty patients with IDDM without retinopathy matched for age, sex and duration of the disease as the previous group and thirty healthy control subjects matched for age, sex and ethnic origins as patients included in the study. Histocompatibility testing by the microlymphocytotoxicity assay was done for determination of HLA-A, -B end -C specificities. The results of the present work showed that insulin dependent diabetics with retinopathy had increased frequency of HLA-B18 antigen which was statistically significant. HLA-Bw35 antigen was absent in patients with retinopathy, suggesting that this allele may confer a protective effect. The diabetics with proliferative retinopathy had significantly increased frequency of HLA-B8 and B18. These findings reinforce the view of the genetic contribution to the pathogenesis of diabetic retinopathy