study on cryptorchidism a comparison of histological finding in the germinative epithelium before and after the age of 2 years

Undescended testis is a common problem with high risk of infertility and cancer. Early surgical correction is important for prevention of those risks. In the last year 1999, multi-disciplinary projects were done between surgical, dermatological and pediatric departments aiming to re-explore the histological and morphological changes in cryptorchid testis and its relation to age. Twenty four [24] male patients were recruited from El-Minia University Hospital and were divided into 4 main groups. Group A included 6 infants under the age of 2 years; group B included 4 patients aged from 2-9 years [pre-pubertal]; group C included 6 patients aged from 9 to 14 years [pubertal]; and group D included 8 patients aged from 14 to 21 years [post-pubertal]. Orchiopexy was done for all patients in one stage and bilateral testicular biopsy was taken and fixed immediately in Baun's solution and then stained by H and E for histopathological preparations. Our results showed that, for boys under the age of 2 years, there was no change from the normal spermatogonia and Sertoli cells with no thickening of their basement membrane. In pre-pubertal children, we found that changes were evident by the age of 7 and 8 years in the form of decreased number of spermatogonia, delayed maturation of Sertoli cells, widening of interstitial spaces and increased number of fibroblasts in the interstitium. In pubertal patients, the spermatogonia became rare and Sertoli cells were immature. Biopsy specimens from post-pubertal patients showed marked reduction of spermatogonia and arrest of spermatogenesis at primary spermatocyte stage. We concluded that early correction of cryptorchidism is vital for preservation of testicular integrity and maintenance of fertility

Value of motor and somatosensory evoked potentials in assessment of motor function in cerebral palsy

Cerebral palsy is a static non progressive motor disability that occurs at birth or early childhood. It results from injury to the neuromotor components of the central nervous system. Evoked potentials [EPs] are neurophysiological investigations used to demonstrate the existence of central nervous system lesions and were used as a screening method for neuropediatric diseases. Motor and somatosensory evoked potential [SEP] are the most sensitive methods of evoked potentials. They can provide a non-invasive objective method of evaluating the central and peripheral nervous system. The present study included 20 Egyptian children, 11 males and 9 females ranging in age from 3 to 6 years with a mean age of 3.9 years, presenting with spastic diplegia. All patients had mild to moderate motor disability and I.Q. above 50. Control group included 20 children, age and sex-matched with patients group. We studied motor and somatosensory evoked potentials in those patients and their correlation with motor functions. Transcranial magnetic stimulation [TMS] to the right upper limb [abductor pollicis brevis muscle] and somatosensory evoked potentials testing from the right median nerve and the left posterior tibial nerve were used to assess function of the corresponding systems. Motor evoked potentials from the right upper limb showed significant delay in cortical latencies and significant prolongation of central motor conduction time in CP patients compared to control group. However, the amplitude of cortical response showed no significant changes. Somato-sensory evoked potentials of right median nerve showed significantly prolonged cortical N19 / P22 absolute latency, N13 - N20, Erb's - N20, N13 - N20 inter peak latencies respectively. However, Erb's, N13, Erb's - N13 absolute latencies and inter peak latency showed non significant changes but N20 amplitude was significantly decreased. Somatosensory evoked potentials of the left posterior tibial nerve showed significant prolonged cortical and lumbar absolute latencies and inter peak latency as well as a significant decrease of amplitude of cortical wave. A statistically highly significant positive correlation was observed between the hand function and N20 amplitude [P < 0.01] of SEPs of the right median nerve while all other variables showed no statistically significant correlation with each other. Also, a statistically significant positive correlation was observed between the foot function and cortical amplitude [P < 0.05] of SEPs of the left posterior tibial nerve while all other variables showed no statistically significant correlation with each other. A tendency towards positive correlation was observed between hand functions and cortical latency [P < 0.09] of motor evoked potentials to the right abductor pollicis brevis muscle. We concluded that somatosensory evoked potentials are sensitive, non-invasive techniques for detection of the severity of motor impairment. We recommend MEPs and SSEPs as a relatively fast and effective means of assessing the functional integrity of the central nervous system in cerebral palsy patients

Study of brainstem auditory evoked response in asphyxiated neonates

The present study was undertaken to evaluate the effect of neonatal asphyxia on brainstem auditory evoked response [B A E R] and the possible reversibility of abnormal BAER on follow up after 3 months of age. Prospective case control study was done in the neonatal special care unit and neurology department, at EL-Minia university hospital. Twenty five term neonates with 5-minute Apgar score< 6, who had hypoxic ischemic encephalopathy [HIE] or asphyxia underwent BAER testing with follow up at 3 months. Twenty age and sex-matched normal neonates served as control. Denever development screening test [Denever II] was performed at 3 months of age. Twelve out of twenty five [48 percent] neonates with birth asphyxia showed abnormalities on initial BAER. The commonest abnormalities seen were raised threshold of interside latency difference in 8/12 neonates [66.7 percent], followed by prolongation of latencies of various waves in 6/12 neonates [50 percent]. Other abnormalities observed were prolonged intervene interval [16.7 percent] and prolonged interside interval difference [8.3 percent]. There were a significant association of BAER abnormalities with duration of neurological findings more than 5 days and stages of HIE. On follow up of 12 cases at 3 months of age, abnormalities in BAER reverted back to normal in 11 cases [91.6 percent]. The Denever Developmental screening test [Denever II] was suspect in 3 cases only. It was concluded that BAER abnormalities in neonatal asphyxia are transient and revert back to normal in most cases on follow up at 3 months of age and BAER is simple non invasive tool but does not appear to be a useful one for early detection of neurological handicaps

Value of motor and somatosensory evoked potentials in assessment of motor function in cerebral palsy

Cerebral palsy is a static non progressive motor disability that occurs at birth or early childhood. It results of injury to the neuromotor components of the central nervous system. Evoked potentials [EPs] are neurophysiological investigations used to demonstrate the existence of central nervous system lesions and were used as a screening method for neuropediatric diseases. Motor and somatosensory evoked potential [SEP] are the most sensitive methods of evoked potentials. They can provide a noninvasive objective method of evaluating the central and peripheral nervous system. The present study included 20 Egyptian children, 11 males and 9 females ranging in age from 3 to 6 years with a mean age of 3.9 years, presenting with spastic diplegia. All patients had mild to moderate motor disability and I.Q. above 50. Control group included 20 children, age and sex-matched with patients group. We studied motor and somatosensory evoked potentials in those patients and their correlation with motor functions. Transcranial magnetic stimulation [TMS] to the right upper limb [abductor pollicis brevis muscle] and somatosensory evoked potentials testing from the right median nerve and the left posterior tibial nerve were used to assess function of the corresponding systems. Motor evoked potentials from the right upper limb showed significant delay in cortical latencies and significant prolongation of central motor conduction time in CP patients compared to control group. However, the amplitude of cortical response showed no significant changes. Somato-sensory evoked potentials of right median nerve showed significantly prolonged cortical N[19]/ P[22] absolute latency, N[13] - N[20], Erb's - N[20], N[13] - N[20] inter peak latencies respectively, however, Erb's, N[13], Erb's - N[13] absolute latencies and inter peak latency showed non significant changes but N[20] amplitude was significantly decreased. Somatosensory evoked potentials of the left posterior tibial nerve showed significant prolonged cortical and lumber absolute latencies and inter peak latency. Also, significant decrease of amplitude of cortical wave. A statistically highly significant positive correlation was observed between the hand function and N[20] amplitude [P < 0.01] of SEPs of the right median nerve while all other variables showed no statistically significant correlation with each other. Also, a statistically significant positive correlation was observed between the foot function and cortical amplitude [P < 0.05] of SEPs of the left posterior tibial nerve while all other variables showed no statistically significant correlation with each other. A tendency towards positive correlation was observed between hand functions and cortical latency [P < 0.09] of motor evoked potentials to the right abductor pollicis brevis muscle. We concluded that somatosensory evoked potentials are sensitive, non-invasive techniques for detection of the severity of motor impairment. We recommend MEPs and SSEPs as a relatively fast and effective means of assessing the functional integrity of the central nervous system in cerebral palsy patients

Bone mineral measurements in the lumbar spine of Egyptian children using quantitative computed tomography

This study was designed to determine age and gender based normative values for spinal bone mineral density [BMD] in Egyptian children. Five hundred and twenty two healthy Egyptian subjects aged 2 months to 12 years [292 males, mean age 5.6 years; 230 females, mean age 6.2 years] were recruited for BMD assessment. BMD was measured by quantitative computed tomography [QCT] using General Electric Scanner Prospeed Plus with 512 x 512 matrix. The study population were grouped according to age into Group-I that included 141 cases [86 boys and 55 girls, aged 2 months to less than 2 years, mean 1.3 years], Group-II included 218 cases [123 boys and 95 girls, aged 2 to less than 6 years, mean 3.6 years] and Group-III that included 163 cases [83 boys and 80 girls, aged 6 -12 years, mean 8.2 years]. Bone mineral density for each group was calculated in addition to the mean and standard deviation. Drawings representing the mean of bone mineral content in different age groups were also made. Finally we compared our data with those in the literature

role of ultrafast CT in the diagnosis of atrial septal defects and partial anomalous pulmonary venous return

Atrial Septal Defects [ASDs] and Partial Anomalous Pulmonary Venous Return [PAPVR] are relatively two of the most frequent congenital heart lesions producing right heart volume overload. Although generally well tolerated during childhood, exercise intolerance, arrhythmia, pulmonary hypertension, paradoxical embolism, and congestive heart failure appear later in adulthood. Transthoracic echocardiography [TTE] is usually effective for their diagnosis in children, however; its accuracy may be limited in large or older subjects and cardiac catheterization [CC] is then required. The purpose of this study is to assess the value of ultrafast cine computed tomography [UFCT] to diagnose ASDs and PAPVR in a wide spectrum of patients age and size as compared to other non-invasive imaging systems, namely transthoracic and transesophageal echocardiography. The study population included 36 patients, 21 children and 15 adults, age 4/12 to 45 years, and weight 4.8 to 83 kgs. Diagnosis included: secundum ASD [SASD] in 21, sinus venosus ASD [VASD] in 7, and PAPVR in 8. Patients with primum ASD were excluded. All patients had TTE, 14 had intraoperative transesophageal echocardiography, 20 had CC, and all had a surgical repair. UFCT flow studies using time-density curves from single contrast bolus injections and high resolution imaging during constant infusion, were obtained. These provided the anatomy of pulmonary veins and atrial septum, size/thickness/function of right ventricle and identified the direction/magnitude/localization of shunting. UFCT diagnosed all 21 patients with [SASD], all 7 patients with [VASD], and failed to diagnose PAPVR in one patient where only a flow study was done, i.e. without high resolution imaging. In contrast, TTE failed to demonstrate [SASD] in 5 patient and [VASD] in 4 patients, all of whom were adult subjects. It also failed to identify the PAPVR in 5 out of 8 patients, two of whom were children. TEE showed all 10 patients with SASD and failed to show 1 out of 4 patients with VASD. Non of the partial veins were imaged with TEE. TTE is of limited value in large subjects with ASD or PAPVR. UFCT is the diagnostic procedure of choice short of invasive cardiac catheterization

Growth hormone improves immune function in GH-deficient young adolescents

To delineate the role of growth hormone [GH] in the development and function of the immune system, sixteen GH-deficient young adolescents were studied for evaluation of the immune status before and after treatment with recombinant human growth hormone [rhGH]. Ten apparently healthy young adolescents age and sex-matched with the study group were included in the study as control group. Blood samples were obtained for immune studies before treatment and at 2, 6 and 9 months after. Immune studies included; enumeration of total T and B lymphocyte number, CD3+, CD4+, CD8+ and CD4+/ D8+ ratio, serum immunoglobulin concentrations [IgG, IgM], assessment of Iympho-proliferative response to phytohemagglutinin and testing for intracellular killing by Nitro blue tetrazolium test [NBT]. Results showed significant impairment in mitogen stimulation and phagocytic function in GH-deficient young adolescents when compared to control group [73.18 +/- 5.2 versus 146.2 +/- 7.6, P < 0.0001 and 50.13 +/- 5.8 versus 82.2 +/- 4.49, P < 0.0001 respectively]. This impairment improved significantly after treatment with rhGH [p < 0.0001]. However, there were no significant differences in the total B-Iymphocytes numbers, CD3+, CD4+, CD8+, CD4+ / CD8+ ratio, and serum immunoglobulin levels between GH-deficient group and control group, as well as between values obtained before and after rhGH treatment. These results indicate that growth hormone administration has profound immune-enhancing effects in GH-deficient young adolescents and may be of therapeutic effect in states of compromised immune function

Evaluation of growth hormone [GH] and insulin-like growth factor 1 [IGF-1] in children with protein energy malnutrition

Protein energy malnutrition is a range of pathological conditions arising from coincident lack, in varying proportions, of protein and calories, occurring most frequently in infants and young children and commonly associated with infections. Protein-energy malnutrition [PEM] may range in severity from mild, through moderate to severe degree. Two distinct syndromes occur, at either end of the spectrum, marasmus and kwashiorkor, and in between, varying degrees of signs of each are found mixed together in what is sometimes termed "marasmic kwashiorkor". To clarify the influence of nutrition on the Growth hormone - Insulin-like growth factor-1 axis [GH-IGF1 axis] in protein-energy malnutrition, fifty children suffering from different degrees of protein-energy malnutrition and twenty normal children were recruited from outpatient clinic and inpatient pediatric wards of EI- Minia university Hospital, Egypt. Blood samples were collected from all patients for determination of CBC, total protein, serum albumin, growth hormone and insulin-like growth factor-1. Patients were classified on the basis of Welcome classification of PEM into three groups. Marasmic group included 28 children [16 of them were boys] ranging in age from 4 months to 2 years, kwashiorkor group included 14 children [6 of them were boys], ranging in age from 4 months to 2 years and marasmic-kwashiorkor group included 8 children [3 of them were boys] ranging in age from 4 months to 1.5 years. The results of the study showed that the mean GH serum levels were significantly higher in the three malnourished groups than in controls [p = 0.0001]. In contrast, IGF-1 serum concentration was lower and seemed to be related to high GH and to a reduction of GH receptors. Serum total protein and serum albumin were significantly lower in kwashiorkor than in marasmus and marasmic-kwo groups [p < 0.05], but in all groups they were lower than in controls. We concluded that the combination of low level of IGF-1 together with either normal or elevated level of basal growth hormone is very suggestive of protein - energy malnutrition and can help to distinguish growth failure due to growth hormone deficiency from that of PEM

Cytokines and zinc levels in serum and cerebrospinal fluid of children with febrile seizures and encephalitis

The present study was proposed in an attempt to understand the role of serum and cerebrospinal fluid [CSF] levels of proinflammatory cytokines [TNF-alpha, IL-1beta and IL-6] and zinc in children with febrile convulsions and cases with encephalitis in comparison with normal ranges. Fifty patients were enrolled in the study, 15 with febrile convulsions, 15 patients with acute encephalitis and a control group of 20 patients with febrile illness but no convulsions. Serum and CSF levels of TNF-alpha, IL1-Beta and IL-6 were significantly higher in cases with encephalitis than in cases with febrile convulsions and control. There were no significant differences between cases with febrile convulsions and controls. On comparing cases with febrile convulsions and cases with encephalitis, serum and CSF levels of pro-inflammatory cytokines were significantly higher in cases with encephalitis. It was also found that children with febrile convulsions had decreased serum and CSF levels of zinc much less than in both cases with encephalitis and control groups. The correlation between serum and CSF levels of pro-inflammatory cytokines was significantly positive for cases with febrile convulsions and encephalitis, while there was no correlation between serum and CSF zinc levels in both groups

study on the effect of prostaglandin F2 alpha on blood glucose in normal, diabetic and stressed rats

The aim of the present work was to study the effect of prostaglandin F2 alpha on blood glucose level in normal and diabetic rats and to study its protective effect against stress-induced hyperglycemia and alloxan-induced diabetes. The results obtained showed that injection of prostaglandin F2 alpha reduced the ether stress-induced hyperglycemia, while it has no significant effect on plasma glucose level in normal and diabetic rats. The results showed that it has no protective effect against alloxan-induced diabetes. Interpretation of these results suggested that prostaglandin F2 alpha might act through stimulation of insulin release

EEG and ECG observation in acute uremia

Acute uremia was induced in rats by glycerol injection. After 10 hours, EEG and ECG tracings were recorded and serum creatinine, Na[+] and K[+] in both normal and uremic rats were measured. With uremia, EEG become abnormally slow i.e percentage frequency of slow waves [<5 H[2]] was increased with simultaneous decrease in% frequency of fast waves [>9 H[2]]. In addition, charateristic slow delta waves were recorded. ECG recording showed less characteristic change with prolonged P-R interval, decreased QRS voltage and increased amplitude of T wave