role of arthroscopy in the treatment of ankle fractures

Anatomic surgical realignment of ankle fractures may still be associated with poor clinical outcomes, possibly as a result of occult intra-articular injury. Malleolar fractures have been reported to be associated with a poor prognosis even when the anatomic reduction is complete. Soft tissue injuries such as damage to the cartilage and ligaments, soft tissue impingement, and the existence of free bodies within the intra-articular space account for this poor outcome. In treating acute malleolar fractures, an arthroscope is used to confirm anatomic reduction on the articular surface and treat intra-articular injuries [Leontaritis et al, 2009]. The aim of this study was to evaluate the arthroscopic findings and the surgical outcome for arthroscopy-assisted minimally invasive internal fixation of acute medial malleolar fractures. From January 2005 to December 2008, thirty two patients who had experienced medial malleolar fractures [17 males, 15 females; mean age, 35 years; range, 11-54 years] were operated on using minimally invasive surgical fixation assisted with arthroscope in the Department of Orthopedics Surgery, Al-Azhar University. Arthroscope was used to confirm the fracture line, cartilaginous damage, presence of detached cartilaginous fragments in the articular space, ligament damage, and diastasis of the distal tibiofibular joint. The cartilaginous damage was treated using shaving, and the free cartilaginous fragments were excised. Diastasis of the distal tibiofibular joint was treated using distal tibiofibular joint fixation, using a cortical screw 3.5mm Phi. Fracture fixation was conducted after anatomic reduction had been confirmed using fluoroscopy and arthroscopy. Cartilaginous damage was noted in 15 [46.8%] patients, among whoml0 patients were treated by shaving and 5 underwent cartilaginous fragment removal. From a postoperative radiographic evaluation, a good result in 28 [87.5%] patients and a fair outcome in 4 [12.5%] were confirmed. The clinical results were good in all and no postoperative complications or pseudoarthrosis was noted. The results were scored according to Freiburg Ankle Scoring System [BULGUN et al, 2004] containing the criteria pain, function, swelling, range of motion and athletic activity. The overall score significantly increased from 52.1 preoperatively to 74.8 postoperatively. Comparing the different criteria, the score parameters pain and function improved significantly, whereas the other parameters did not show significant improvements. We concluded that the arthroscopy of the ankle joint can be used in case of arthroscopic guided percutaneous fracture reduction and fixation, the procedure that shorten the recovery time, minimize the postoperative discomfort, and producing and early mobilization of the joint

Synthesis and antidepressant activity of some novel fluoxetine derivatives

The present work involves the synthesis of three series of novel fluoxetine derivatives in order to evaluate their potential as antidepr ess ants. The first series consists of 1 -methyl- 1-[3-phenyl-3-[4-trifluoromethylphenoxy]propyl]-3-substituted ureas 2a-c and thioureas as their bioisosters 3a-m which were prepared by reacting fluoxetine 1a with different isocyanates and isothiocyanates respectively. The second series N-acyl/aroyl-N-methyl-3-phenyl-3-[4-trifluoromethylphenoxy]-propylamines 4a-d were synthesized by refluxing 1a with acyl/aroyl chloride and trifluoroacetic anhydride. The third one, N-chloroacyl-fluoxetine 5a-c was obtained via the reaction of la with chloroacyl chloride. In addition to a propionitrile derivative 8 which was achieved by refluxing 1a with acrylonitrile. The twenty four final compounds were biologically screened throughout the work for their potential as serotonin reuptake inhibitors by measuring potentiation of 5-HTP induced neurotoxity and some as norepinephrine reuptake inhibitor by measuring yohimbine-induced mortality in mice to calculates-HTP/NE ratio as a parameter for selectivity to inhibit serotonin reuptake. Four compounds [3e, 3h, 3i, 5b] were found to be as potent as fluoxetine

Impact of A nursing care guidelines on biopsychosocial adaptation of patients with renal transplantation

Recipients of living donor kidney transplantation hope for an improved physical well-being after transplant. Furthermore the patients and their relatives frequently expect an improvement in their psychological findings in consequence of the living related transplantation. Thus the aim of this study is to evaluate the impact of utilizing a modified nursing care guidelines on biopsychosocial adaptation of patients with renal transplantation, as well as on daily living activities. A convenience sample of 60 outpatient renal transplant patients were selected from the follow-up clinic at the National kidney Institute, [MOHP] in Cairo. Three tools were utilizing for data collection; Sociodemographic and medical data sheet, Pre/Post- test Questionnaire sheet, and Sickness Impact Profile Tool, and patients were exposed to the modified nursing care guidelines [NCG], then assessed three times, pre, 3, and 6 months later. The results of this study showed highly statistically significant improvement regarding the effect of immunosuppressive drugs on physical condition [p<0.001] .There was also statistically significant improvement among patients as regards physical, and psychosocial status as well as activities of daily living. The pre-post changes in knowledge scores were also statistically significant improvement in the study group p<0.00. These results imply that Implementation a transplant rehabilitation program for renal transplant patients through the collaboration of various rehabilitation transplant team

Injectable bioactive cement in treating selected distal radial fractures

Between 2003 to 2006, twenty eight selected distal radial fractures in 27 patients operated in the division of emergency surgery, department of orthopedics and traumatology, Al Azhar university and other specialized centers were followed clinically and radiologically. Injectable bioactive calcium phosphate cement was used in conjunction with osteosynthesis or external fixation to correct metaphyseal bone defects experienced after reduction due to comminution. Fracture fixation/fragment stabilization was individualized according to every case. Percutaneous pins were used in 10 [35.7%] fractures, small fragment plate and screws in 3[10.7%] supplemental removable external splint immobilization for 4-6 weeks was used when indicated. External fixator helped with K-wires if necessary was used in 12[42.9%] fractures and Plaster-of-Paris splint or cast support in the remaining 3[10.7%]. Of the 27 patients, 23 [85.2%] were males and 4[14.8%] were females. Mean age at surgery was 33 years [range 21 to 59 years]. There were 17 [63%] right, 9[33.3%] left and 1 [3.7%] bilateral cases. Fractures were classified into three AO groups, accordingly, cases were graded; A [21.4%], B[17.9%] and C[60.6%]. Standard X-rays were used for radiological evaluation in all patients. Wrist scoring system developed by Cooney, et al., was employed for clinical assessment [9]. At a mean follow up 9.6 months [range 11-29 months], the overall results were: 17[60.7%] excellent,6 [21.4%] good, 2 [7.1%] fair and 3[10.7%] poor. In conclusion, calcium phosphate cement represent a good spacer biologically and biomcchanically, resulted in improved treatment outcomes for patients with comminuted fractures of the distal radius

Preoperative evaluation of upper airway during pregnancy by clinical observation and acoustic pharyngometry

The present study from the period of January 2005 to June 2005 aimed to compare upper airway dimensions in pregnant and non-pregnant women. A total of 30 women in the third trimester of pregnancy were recruited from the antenatal service and matched with 30 non-pregnant. Upper airway dimensions were measured using acoustic reflection. Of those who reported whether or not they snored, 9% of control women, and 23% of pregnant women reported that they snored on at least one night per week. Snoring frequency increased during pregnancy [p < 0.001]. Of the thirty pregnant, 5% stated that they started to snore or markedly increased their snoring frequency during the first trimester, 6% during the second trimester, and 23% during the third trimester. When seated, pregnant had wider upper airways than non- pregnant [p < 0.02], but there was no difference when supine. Oropharyngeal junction area in the seated position was the same in non-pregnant and pregnant women. Supine oropharyngeal junction area was less in the pregnant women than in the non-pregnant women. The study showed that pregnant women have upper airway narrowing and high incidence of snoring

Synthesis of some potential antiestrogenic agents

Some novel steroidal arylidene derivatives were synthesized and representative examples were tested for their antiestrogenic activity. The active compounds were subjected for antitumor activity screening. The compounds tested displayed aromatase inhibitory activity as shown by decrease in estradiol and increase in testosterone levels. Further, some compounds were tested for androgenic/anabolic activity. The steroids used for preparation of these arylidene derivatives are the clinically applied: levo-Norgestrel, Testosterone, Mesterolone and Norethisterone

Skin - sparing mastectomy with TRAM Reconstruction: a valuable option

In this study, 22 patients with stage I-II breast cancer underwent skin-spring mastectomy with unipedicled transverse rectus abdominis myocutaneous flap. Fifteen cases had T2 and seven had T1 lesions. Twelve cases were clinically N0 and ten were N1. The pathology was an infiltrating duct carcinoma in twenty cases, infiltrating lobular carcinoma in one case and medullary in one case. Seventeen patients had grade II and five had grade 1 tumors. The operative time ranged from 5-7 with a mean of 6 hours with an estimated blood loss of 1 liter. Nineteen patients were satisfied with the final outcome and three were not satisfied. Objectively, eight cases h ad an excellent result, eleven had average results and three had fair results. Two cases had a partial necrosis of the breast skin, two had partial flap loss and one case had flap hematoma, wound infection, hernia and hypertrophic scar. Moreover, three cases had fat necrosis, one case of hypertrophic abdominal scar and one case had incisional hernia

Depressive symptoms and quality of life in cancer patients in comparison with depressed psychotic patients

This cross-sectional study aims to assess the nature and severity of depressive symptoms and quality of life in cancer patients, compared to psychotic depressed patients. The study sample consisted of 40 cancer patients recruited from outpatient clinics of chemotherapy and radiotherapy at Ain Shams University hospital. The control group included 40 consecutive patients with diagnosis of depression taken from outpatient clinic of the Institute of Psychiatry of Ain Shams University. The ressearchers applied interview sheet for patients, Beck depression rating scale and quality of life depression rating scale. The results revealed statistically significantly higher prevalence and severity of depressive symptoms in the study group, compared to control, p=0.003. The two groups were also different as regards nature of depression. The quality of life domains were also statistically significantly different between them. However, no statistically significant difference could be revealed in overall quality of life score. It was recommend to develop protocols and individualized interventions that respond to psychological and physical needs of cancer patients to promote their quality of life. Nurses must increase Their efforts to identify those who are most psychologically vulnerable and those who perceive that obstacles exist to seek emotional help through counseling and psychological services

Arthroscopic anterior cruciate ligament reconstruction, with autogenous Patellar tendon

Twenty-eight patients with chronic anterior cruciate ligament [ACL] insufficiency were evaluated after arthroscopic bone-tendon-bone [BTB] patellar ligament reconstruction. All patients had operated for ACL insufficiency after more than three months, but less than one year of the injury. The average follow up was 20 months. Twenty-two patients had normal or near normal stability in the operated knees when compared with the contralateral joints and the Lysholm knee score showed satisfactory results [>82 points]. There was one traumatic and one spontaneous rupture. It was found that arthroscopic reconstruction of ACL insufficient knee with a bone-patellar ligament- bone [BTB] graft lead to good stability and improved function often allowed the patient to resume the ordinary activities

Developing and validating a job description for the staff nurse working in the emergency departments at Ain Shams University Hospitals

This study aimed to develop a job description for the staff nurse working in the Emergency Departments at Ain-Shams University Hospitals. The study included 20 staff nurses and their supervisors [19] as well as physicians [20] who are working in the Emergency Department in addition to Nursing Jury including 17 nursing faculties from Nursing Administration Departments at three different universities [Ain-Shams, Zagazig and Mansoura] and 15 nursing faculties from Medical Surgical Nursing Department at Ain-Shams University. A standard questionnaire, an observation checklist, job analysis questionnaire and job description questionnaire were used for data collection. The study was conducted through two phases: The first phase concerned with the development of the standard of nursing emergency practice; based on this phase and on job analysis, the proposed job description was figured out [the second phase]. The findings indicated that the proposed job description is valid to be used in the Emergency Departments at Ain-Shams University Hospitals, so it was recommended to be used and to be periodically updated

Progesterone and estrogen serum level, and menstrual disorders in epileptic women

This work aimed to evaluate progesterone and estrogen in some epileptic women during childbearing period with reference to menstrual irregularities. The study was conducted on three groups: Group I consisted of 20 women with temporal lobe epilepsy [TLE], Group II consisted of 20 women with generalized tonic clonic epilepsy [GTCE] and Group III included 20 women with normal menstrual cycles and normal EEGs and no manifestations of epilepsy [control group]. The study revealed that ten women with TLE and five women with GTCE had menstrual disturbances. The mean level of progesterone was significantly low in women with TLE and GTCE in comparison with the control group, while estrogen level showed no significant difference between women in all groups

Arthroscopic repair of meniscal tears by the inside out technique

Twenty patients having longitudinal meniscal tear in the middle of the meniscal arc were included in the study. The aim was to present our experience and to report the results and follow up. We had used the inside out technique. The follow up evaluation, for a period of two years, of the results was done by a comprehensive examination for the affected knee. The overall results showed that up to 75% is considered satisfactory and that 85% of them were self-satisfied. In conclusion, this study demonstrates that arthroscopic meniscal repair in knees with isolated meniscal tears has a potential clinical successful outcome

Gall bladder sludge and stones in multitransfused Egyptian thalassaemic patients

One hundred Egyptian beta-thalassaemic patients on a long-term transfusion/chelation programme were evaluated for the prevalence of all bladder sludge and stones and the associated risk factors. Fifty healthy individuals served as controls. Abdominal ultrasonography revealed that 14% of the thalassaemic patients had gall bladder sludge or stones [6% stones and 8% sludge]. The thalassaemic patients with this complication were older, had a higher prevalence of gall bladder symptoms, higher levels of pretransfusion haemoglobin, larger amounts of transfused red cells, and more were regularly transfused. Multiple logistic regression analysis revealed that the presence that gall bladder symptoms and the amount of transfused red cells were the only significant predictors of the occurrence of gall bladder sludge or stones

Displaced articular fractures of the distal radius open reduction and internal fixation with plate and screws

In this study, open reduction and internal fixation with a T-plate were used in a series of 18 displaced intra-articular distal radius fractures in 18 young adult patients [12 males and 6 females] with a mean age of 27 years [range 19-40 years]. Eight fractures were AO type C2 and 10 were type C3. A dorsal plate was used in 7 patients and a volar plate was used in 11 patients, with cancellous bone grafting in 6 and supplemental K-wires in 8 cases. The mean follow-up period was 25.4 months [range 18-34 months]. By the criteria of Gartland and Werley, 15 patients had an excellent or good end-result. The mean grip strength was 70% of the contralateral normal side. Postoperatively, satisfactory open reduction was obtained in 17 cases and an excellent or good articular congruency was achieved in 14 cases. At the end of the follow-up, two wrists had substantial change in position of reduction achieved at surgery and there was a mean of 8.7 mm of radial length, 16.9 degrees of radial inclination, 5.2 degrees of volar tilt and 1.2 mm of radio-ulnar index. Post-traumatic arthritis of grade 2 or 3 developed in 5 cases. Sixteen patients were able to return to pre-injury occupation or level of activities. The study indicated that open reduction and internal fixation with plate and screws can be recommended for displaced articular distal radius fractures, particularly in young adults, after failure of closed reduction in restoring articular congruency

Isthmic spondylolisthesis posterolateral fusion with transpedicular fixation in adults

Twenty adult patients with symptomatic isthmic spondylolisthesis under-went in situ posterolaleral fusion with transpedicular Cotrel-Dubousset instrumentation [CD]. Decompression was done in 14 patients [70%] with sciatica. There were 12 women and 8 men. with a mean age of 38 years [range, 20-52 years]. All patients were recommended for surgery after a failed trial of conservative treatment. The degree of olisthesis was: Grade I in 10, Grade II in 8, and Grade III in 2. All patients had low back pain; with leg pain-bilateral in 10 and unilateral in 4. The single level fusion was done at L5 - Sl in 14, and at L4 - L5 in 6 patients. At a mean follow-up of 20 months [range, 12-36 months], successful fusion was achieved in 90% and 85% had excellent or good clinical result. Successful fusion did influence the clinical outcome in terms of pain relief and increased activity. The results justify the use of instrumented posterolateral fusion for treatment of isthmic spondylolisthesis in adults

Synthesis of some phenolic esters, anilides and ureides of 3-O-acetyl glycyrrhetic acid of biological interest

Three series of 3-O-acetyl glycyrrhetic acid derivatives were synthesized; namely, phenolic esters IIIa-e, thioester IIIf, anilides IVa-n and N-substituted ureides VIa-d derivatives. Some of these compounds were subjected to preliminary screening of their antimicrobial and antiulcerogenic activities

Results and complications of fracture neck of femur in children and adolescents

Forty-four fractures of the neck of femur in patients below 17 years of age are the subjects of this study, the mean age was 12.3 years [SD +/- 2.9] [range 5 to 16 years]. Twenty-two patients were of type Il fractures, 16 of type Ill, 4 of type IV and only two cases of type I according to Delbet's classification of fracture neck of femur in children. Four fractures were undisplaced and treated by spica cast immobilization. The other 40 fractures were displaced and treated by closed reduction and spica cast without internal fixation in 10 [22.7%] and with closed reduction with internal fixation in 30 [68.2%]. The follow-up ranged from one to five years with average of 2.5 years. The results were good in 54.6% fair in 31.8% and poor in 13.6%. The results were found to be affected by the age of the patient as well as the type of fracture and the degree of displacement. The complications met with in this study were avascular necrosis in 45.5%, coxa vara in 18.2%, non-union in 9.1% and premature physeal closure in 31.8%. Correct classification, stable anatomical reduction, with use of internal fixation for type II and III fractures with any degree of displacement are important, stress points during treatment of these fractures

Antibody mediated immune response in sickle disease variants

Sickle cell anemia, a hemoglobinopathy with serious impacts, represents a health challenge in the developing world. Patients are particularly susceptible to repeated infection that may endanger their lives. In this study, 83 adults and 30 children were included. Cross-sectionally, serum immunoglobulins [IgG, IgA, IgM] and complement factors [C3 and C4] were assessed. All subjects prospectively were immunized by hepatitis B vaccine [recombinant hepatitis B virus surface antigen]. The immune response was evaluated and followed up by antibodies to the selected antigen. IgA was significantly elevated in sickle disease patients and serum IgM was significantly lower in sickle disease children, while C3 and C4 did not show significant differences between groups. The immune response to immunization did no show difference in rate of response between various age matched groups, responders were over 80% in all groups after seven months from the first dose of vaccination in those who completed the study. However, the results denoted a quantitative difference in the level of hepatitis B surface antibody. Further studies to delineate the implicated mechanisms in the immunodeficiency are suggested. Meanwhile, chemoprophylaxis and immunoprophylaxis are recommended in sickle cell anemia

Study on abdominal pain in children

This study analyzed the commonest causes of abdominal pain. It was done on 170 children [89 males and 81 females] who suffering from abdominal pain, their ages ranged from 2 to 12 years. Every patient was subjected to detailed history, thorough general and local examination and routine investigations as stool, urine analyzes and complete blood picture. Other laboratory investigations [X- ray, ultrasound, CT scan, endoscopy and biopsy] were done, when needed. Abdominal pain in patients was either acute or recurrent, 30 patients were presenting with acute abdominal pain, 18 of them had surgical causes and 12 had medical causes

Childhood pleural diseases: diagnostic correlations

This study was done on 25 patients with pleural effusion. They were 18 males and 7 females, their ages ranged from 4 months to 12 years. 80% of the patients were below five years. All patients were examined carefully and fully investigated. Thoracocentesis with cytological and biochemical studies of pleural aspirate were made to every patient. Culture and sensitivity of pleural aspirate were also done. Radiological examination showed that the effusion was right sided in 40%, left sided in 32% and bilateral in 28% of patients. On the basis of cytological and biochemical examination of the pleural aspirate, it was empyema in 68% complicating pneumonia in most of the cases, lung abscess and immunodeficiency as well. 12% of the patients were suffering from hydrothorax as a part of generalized edema. Hemothorax was present in 8% of the cases as a result of metastatic tumor. Tuberculosis and systemic lupus erythematosus were the causes of inflammatory exudate in two patients. Chylothorax was present in one case as a result of injury of the thoracic duct during cardiac surgery. The causes of pleural effusion could be minimized by proper management of pneumonia as it is the leading cause of pleurisy in the pediatric age group. Thoracocentesis should be done to every case with pleural effusion for diagnostic and therapeutic purposes