External Auditory Canal: Computed Tomography Analysis and Classification

Abstract Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CTscans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ±0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ±1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ±0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.

Transarterial Embolization of Intracranial Arteriovenous Fistulas with Large Venous Pouches in the Form of Venous Outlet Ectasia and Large Venous Varix or Aneurysm : Two Centers Experience

Objective@#: There are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers’ experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome. @*Methods@#: The authors’ two institutions’ databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included. @*Results@#: Fifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0–2). @*Conclusions@#: TAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.

The Role of Dopamine in Associative Learning in Drosophila: An Updated Unified Model / 神经科学通报·英文版

Learning to associate a positive or negative experience with an unrelated cue after the presentation of a reward or a punishment defines associative learning. The ability to form associative memories has been reported in animal species as complex as humans and as simple as insects and sea slugs. Associative memory has even been reported in tardigrades [1], species that diverged from other animal phyla 500 million years ago. Understanding the mechanisms of memory formation is a fundamental goal of neuroscience research. In this article, we work on resolving the current contradictions between different Drosophila associative memory circuit models and propose an updated version of the circuit model that predicts known memory behaviors that current models do not. Finally, we propose a model for how dopamine may function as a reward prediction error signal in Drosophila, a dopamine function that is well-established in mammals but not in insects [2, 3].

Role of Chymotrypsin in Management of Moderate Parapneumonic Pleural Effusion in Children

Aims:To show the benefit of chymotrypsin as an adjuvant therapy in cases of moderate parapneumonic pleural effusion in children.Study Design: Randomized controlled trial.Place and Duration of Study:Pulmonology Unit, Pediatric Department and Radiology Department, Tanta University Hospital, Egypt between Februray, 2019 to Februray, 2020.Methodology:Subjects comprised of 60 children randomized into three groups 20 children each (41 males, 19 females; age range 1-14 years) with moderate parapneumonic pleural effusion by chest ultrasound. Clinical as well as complete blood count, C-reactive protein and chest ultrasonography at time of presentation, after one week (first end point) and after two weeks (second end point). Management with antibiotics, analgesics, antipyretics, chest tube insertion and oral chymotrypsin in group 2 and intramuscular chymotrypsin in group 3.Results:There was statistically significant decrease in fluid thickness by chest u/s (mm) in group 2 (Mean ±SD= 6.400±3.872) and group 3 (Mean ±SD= 6.150±2.720) after one week and after two weeks group 2 (Mean ±SD= 15.3±4.658) while group 3 (Mean ±SD= 3.3±1.559) in comparsion to group 1 after one week (Mean ±SD= 16.100±10.351) and after two weeks (Mean ±SD= 11.35±7.066) ( P < 0.001), duration of hospitalization (days) and chest tube (days) were statistically significant lower in group 2 (Mean±SD= 15.200±4.112 ), (Mean±SD= 9.100±2.808) respectively and group 3 (Mean±SD= 14.050±3.300), (Mean±SD= 7.400±1.698 ), in relative to group 1 (Mean±SD= 18.65±3.329 ),(Mean±SD= 9.85±3.265 ), (P <0.001, P=0.017 respectively) and percentage of decortication wasstatistically significant lower in group 2 and 3 in relative to group 1. (P =0.017). Conclusion:Chymotrypsin has an adjuvant role in management of moderate parapneumonic pleural effusion evidenced by earlier recovery less hospital stay, derease in chesttube insertion and need for decortication and intramuscular chymotrypsin injection has better effect than oral chymotrypsin in moderate parapneumonic pleural effusion

Width-to-length ratio comparison between ameloblastomas and odontogenic keratocysts in the body of the mandible: A preliminary study

Purpose@#The purpose of this study was to investigate the utility of the width-to-length ratio for the differentiation of ameloblastomas and odontogenic keratocysts in the body of the mandible. @*Materials and Methods@#This study retrospectively reviewed 9 patients with ameloblastomas and 9 patients with odontogenic keratocysts using cone-beam computed tomography. The width-to-length ratio was determined by measuring the ratio between the greatest buccolingual dimension and the greatest perpendicular anteroposterior dimension of the lesion on the axial view. One-way analysis of variance was used to examine the difference in the width-to-length ratio between the 2 types of lesions. Statistical significance was tested at P<0.05. @*Results@#Ameloblastomas showed a mean width-to-length ratio of 0.64, whereas odontogenic keratocysts showed a mean width-to-length ratio of 0.41. The cut-off value with which the 2 types of lesions were differentiated was 0.5. The width-to-length ratios of ameloblastomas were significantly higher than those of odontogenic keratocysts (P<0.05). @*Conclusion@#The width-to-length ratio might be used to differentiate between ameloblastomas and odontogenic keratocysts.

Bilateral tripartite insertion of the fibularis (peroneus) brevis muscle: a case report / Inserción tripartita bilateral del músculo fibular corto: reporte de caso

SUMMARY: The fibularis brevis muscle typically inserts by a single long, robust, flat tendon upon the base of the fifth metatarsal. In this case report, we demonstrate two comparatively small accessory tendons of insertion in both the right and left limbs of an elderly cadaver. In each limb, the superior and inferior accessory tendons arose from the distal end of the main tendon of insertion to attach to, respectively, the shaft and neck of the fifth metatarsal. The bilateral presence of this comparatively rare condition is a new finding. Review of the literature reveals that these accessory tendons are most probably remnants of the inserting tendons of the atavistic muscle peroneus digiti minimi. The presence of this anomaly could affect reconstruction surgeries that utilize the inserting tendon of fibularis brevis, and treatment of avulsion fractures of the base of the fifth metatarsal.

RESUMEN: El músculo fibularis corto generalmente se inserta por un solo tendón largo, robusto y plano en la base del quinto metatarsiano. En este trabajo demostramos dos tendones accesorios de inserción comparativamente pequeños en ambos miembros inferiores de un cadáver de edad avanzada. En cada miembro inferior, los tendones accesorios superiores e inferiores surgieron de la porción distal del tendón principal de inserción para adherirse, respectivamente, al eje y al cuello del quinto metatarsiano. La presencia bilateral de éste músculo, comparativamente raro, es un nuevo hallazgo. La revisión de la literatura revela que estos tendones accesorios son probablemente remanentes de los tendones de inserción del músculo peroneus digiti minimi. La presencia de esta anomalía podría afectar las cirugías de reconstrucción que utilizan el tendón de inserción del músculo fibular corto, y el tratamiento de las fracturas por avulsión de la base del quinto hueso metatarsiano.

Vascular endothelial growth factor correlation with clinicopathological parameters in ovarian cancer

Epithelial ovarian cancer (EOC) is one of the most lethal gynaecologic malignancies with an increasing incidence worldwide; there is an increasing need for the identification of novel prognostic biomarkers in EOC patients. Given the key role of angiogenesis and growth factors in the biology of tumorigenesis, vascular endothelial growth factor (VEGF) is considered a milestone in the process of ovarian cancer progression and invasiveness. Authors aimed in the present study to evaluate the relevance of serum level of VEGF with clinicopathological parameters in patients with EOC. VEGF is reported to be correlated with variable parameters in EOC patients including International Federation of Gynecology and Obstetrics (FIGO) classification, lymph nodal involvement and ascites formation. In the following review, authors discussed these correlations and distinguished the possible future role of VEGF as a promising prognostic biomarker for EOC patients.

Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery: A randomized blinded study.

To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups. After induction of general anesthesia, thoracic epidural catheter was inserted in group E (epidural) patients and thoracic paravertebral catheter was inserted in group P (paravertebral) patients. Post operative pain score was recorded hourly for 24 hours. Plasma cortisol level was recorded at three time points. Tidal breathing analysis was done preoperatively and 6 hours postoperatively. Analgesia, serum cortisol level, and pulmonary function parameters were comparable in the two groups. However, failure rate (incorrect placement of catheter) was significantly higher in epidural group than in paravertebral group (7% versus 0%, respectively). The complications were also significantly higher in epidural group (vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that both thoracic paravertebral block and thoracic epidural block results in comparable pain score and pulmonary function after thoracotomy in pediatric patients; the paravertebral block is associated with significantly less failure rate and side effects.

Using of lactobacillus acidophilus and lactobacillus plantarum cultures as trials for improvement of yoghurt characteristics

Yoghurt was manufactured from 6Kg of heat treated mixed cow's and buffalo's milk [1:1] with 2% Lactobacillus delbrueckil subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus [1:1] as normal starter cultures of the 1[st] group. However, another two groups of yoghurt were inoculated with 1% normal starter culture with 1% Lb acidophilus culture for 2[nd] group and 1% Lb plantarum for the 3[rd] group. Yoghurt samples were analyzed for organoleptic scores, titratable acidity and microbiological quality during refrigerated storage till the signs of spoilage appeared. The trials repeated for processing and analysis for 3 times. The obtained results indicated that acidophilus yoghurt had the best organoleptic properties as compared with control and plantarum yoghurt samples and have better acidity and microbiological quality. Accordingly, the using of Lb acidophilus and Lb plantarum is very effective in prolonging the yoghurt shelf life up to 21 days of refrigerated storage with better properties than control yoghurt. As well as, they promote the consumer health as they are probiotic bacteria

Transformational and transactional leadership behaviors adoption and its relation to nursing services quality management as perceived by first- level nurse managers in a military hospital

First-level nurse managers are important front-level administrators in the hospital. They are positioned in close proximity to .the work itself and to the nursing staff engaged in patient care. They should be able to improve service quality management to ever- changing situations. To measure transformational and transactional leadership behaviors' adoption and its relation to nursing services quality management as perceived by first- level nurse managers in a military. Descriptive Co- relational design.was used in carrying out this study. The study was conducted in a Military hospital. The study subjects were [no.50] who accepted to participate in the study and met the inclusion criteria. Tools: Data of the present study was collected through utilizing two questionnaires. First questionnaire was modified Multifactor Leadership Form 5X which contain [50 items]. Second questionnaire was modified service quality management [65 items]. The finding indicated that a first level nurse managers who adopting transformational or transactional leadership behavior was practiced in moderate level. Moreover, first level nurse managers had moderate level of activities related to nursing service quality management. Also, transformational and transactional leadership was positively related to service quality management of first-level nurse managers' .Furthermore, leadership behaviors, service quality management were related to first level nurse managers' age, years of experience, educational. leadership behaviors should be sharpened by continuous training with updated date knowledge. And this type of study should be replicated to allow for future comparisons of leadership behaviors of nurses managers levels and service quality management between hospitals in Military sector

Spinal compression by brown tumor in two patients with chronic kidney allograft failure on maintenance hemodialysis

Brown tumors with non-neoplastic process are noticed in patients with end-stage renal disease suffering from a severe form of secondary hyperparathyroidism. Herein, we report a patient with chronic kidney allograft failure returned back to hemodialysis who experienced manifestations of cauda equina compression secondary to a lumbar brown tumor. Also, we had another patient on hemodialysis with a demineralized lesion affecting the cervical vertebrae. Although brown tumor is a rare complication, these two cases highlighted the importance of neurological symptoms in uremic patients. Spinal decompression surgery, in order to alleviate pressure on neurological structures, together with subtotal parathyroidectomy, were highly indicated

Endoscopic versus open lumbar sympathectomy

There have been increasing reports of early experiences with endoscopic lumbar sympathectomy. Most of these reports mentioned a small number of cases and non compared this minimal invasive procedure to the standard open approach. Thirty-one patients with inoperable critical limb ischemia attended our hospital over 32 months, were randomized to either open or endoscopic approach for lumbar sympathectomy. We used the standard technique for the open approach and used the aid of two different purpose balloons for the endoscopic approach. Data regarding operative time, complications, operative success, operative wound pain control and hospital stay were compared in both groups. Operative time was initially longer in the endoscopic approach, but toward the end of the study, it was nearly the same in both groups. The aid of the dissecting and retracting balloons helps to have a safe endoscopic approach with no intraoperative complications. Patients who had endoscopic approach significantly required fewer painkillers for the operative wound and had shorter hospital stay than those who had the open approach. Endoscopic lumbar sympathectomy is a safe and feasible procedure. It has a better outcome when compared to the open approach

comparative study on the quality of plain and probiotic yoghurt

A total of 40 random samples of plain and probiotic yoghurt [20 of each] were collected from different markets in Kaliobia governorate to evaluate their quality. The sensory characteristic score of probiotic yoghurt [91.69 +/- 7.86] was significantly better than plain one [77.91 +/- 8.16]. The chemical examination indicated that the average values of pH and titratable acidity were 3.63 +/- 0.07 and 0.91 +/- 0.07 for plain yoghurt and 4.29 +/- 0.05 and 0.72 +/- 0.06 for probiotic yoghurt. On the other hand, the bacterial counts in the examined plain and probiotic yoghurt samples were 1.35 x 10[4] +/- 0.22 x 10[4] and 2.12 x 10[3] +/- 0.39 x 10[3]/g for aerobic spore formers count, 4.78 x 10[2] +/- 0.61 x 10[2] and 1.31 x 10[2] +/- 0.17 x 10[2] /g for B.cereus count, 2.01 x 10[3] +/- 0.34 x 10[3] and 4.73 x 10[2] +/- 0.52 x 10[2] /g for staphylococci count and 7.24 x 10[2] +/- 1.83 x 10[2] and 2.58 x 10[2] +/- 0.41 x 10[2] /g for coliform, respectively. Furthermore, B.cereus, B.circulans, B.coagulans, B.licheniformis, B.macerans, B.stearothermophilus and B.subtilis, S.aureus and S.epidermidis as well as micrococci were isolated from both plain and probiotic yoghurt with varying percentages. However, Enteropathogenic Escherichia coli [EEC] were isolated from 5% of plain yoghurt samples and serologically identified as O26: K60 [B6] and O128: K67 [B12]. In contrast, all examined samples of probiotic yoghurt were free from E.E. coli. According to sensory, chemical and bacteriological results, probiotic yoghurt appeared to be better and more safe for human consumption as compared with plain one

Routine intraoperative transesophageal echocardiography for pediatric open heart surgery: is it justifiable?

The routine use of intraoperative transesophageal echocardiography [IO TEE] in children is still debatable. The aim of this study was to determine the safety, benefit, and the possible risk of the routine use of IO TEE. IO TEE was performed in all children under the age of 14 years with complex congenital heart defects undergoing open heart surgery, from July 2001 to December 2002. Simple lesions such as secundum atrial septal defects or simple perimembranous ventricular septal defects [VSD], and neonates less than 2.7 kg were excluded. All children underwent a pre-repair and post-repair complete IO TEE study. There were 112 children, 65 males and 47 females. Ages ranged from 4 days to 156 month, a median of 9 months. A full study was not done in three neonates [3%] because the probe could not be inserted in one, and because of airway compression resulting in desaturation in another two. A pre-repair study confirmed the preoperative transthoracic echocardiographic findings in 105 children [95%]. Diagnostic discrepancy or unexpected lesions not reported preoperatively were found in 6 children [5%]. Of the 109 children who had full post-repair studies, 67 [60%] showed optimum repair with no residual lesions, and 26 [23%] showed trivial or mild residual lesions accepted by the team. Going back on pump to fix moderate or severe residual lesions occurred in 16 [14%] children. In all of these children, the decision for going back on pump was prompted by the IO TEE examination alone. Mild complications occurred in two children [2%]. Based on our results, we recommend the routine use of IO TEE. It is safe, has a low complication rate, adds additional information and has a high impact on the diagnosis of residual lesions required in the operating room. However, careful monitoring of the ventilation and airway pressure, particularly during probe insertion and manipulation in small children, is very essential

Short term prognostec value of interleukin-10

A role for inflammation has become well established over the past decade or more in theories describing the atherosclerotic disease process. From a pathological viewpoint, all stages, of the atherosclerotic plaque might be considered to be an inflammatory response to injury. Indeed patients with acute coronary syndromes demonstrate elevated levels of systemic markers of inflammation. Yet little is known about the role of anti-inflammatory cytokines in this setting. The aim of this work was to study the serum level of interleukin-10, which is produced by various inflammatory cells and identified as a cytokine synthesis inhibitory factor, in patients of unstable angins using stable angina patients as a control group and its prognostic value during in hospital stay. This study included 60 patients who were admitted for the assessment of angina chest pain. They were classified into 2 groups. Of the 60 patients, 30 had unstable angina [Group I] and 30 had chronic stable angina [Group II]. Samples from those patients were taken under aspirin cover at the time of admission and another ones were collected in the first 48 hours after admission to assess serum interleukin-10 level. According to the serum level of IL- 10, patients of group I [Unstable angina] was arranged into two equal subgroups. Each subgroup includes 15 patients. Group [IA] included patients with low serum IL-b and Group [IB] included patients with high serum IL- 10. We have compared the two subgroups regarding cardiovascular events during in hospital stay and regarding baseline characteristics. Also coronary angiography was carried out and analyzed. We found that, no significant differences between the two groups regarding baseline characteristics. Interleukin-10 was significantly lower in patients of group I compared with patients with group II [t = 8.6, p < 0.05]. Also, Interleukin- 10 was significantly negatively correlated with different types of lesions [P = 0.0004]. IL- 10 was not significantly correlated with the morphology of the lesions in group I [P = 0.065]. Angiographic findings were similar in the two groups except for the number of vessels affected which was significantly higher in the unstable group [P = 0.01]. IL-b was not significantly correlated with type or morphology of the lesions in patients of group II. During hospital stay, there was more poor prognosis among patients of group IA compared to those in group IB

Acute effects of lobectomy on right ventricular ejection fraction and mixed venous oxygen saturation

Traditional methods of assessing the operative risk for lung resection provide only a modest ability to predict postoperative morbidity and mortality. The aim of this study was to evaluate the effect of lobectomy on pulmonary hemodynamic and gas exchange variables using the RV thermodilution ejection fraction/oximetric catheter. We evaluated the acute postoperative effects of lung resection on hemodynamic and gas exchange parameters in 30 patients. Anesthesia was induced with thiopentone sodium and maintained with midazolam, fentanyl and pipecuronium. Intubation was performed with a double-lumen, left-sided endobronchial tube for one lung ventilation. The hemodynamic and gas exchange parameters were recorded before and after induction of anesthesia, and two hours after lung resection. These parameters were also recorded after the classification of the patients according to the underlying lung pathology. Lobectomy was associated with significant hemodynamic changes and good maintenance of gas exchange variables. SVI, LVSWI and RVEF were significantly decreased in the early postoperative period after lung resection. MPAP, COP, CI, SVRI, PVRI, RVSWI, and RVEDVI showed no significant changes during the perioperative period. SVO2 showed a significant increase after lung resection when compared with preinduction values, while VO2 significantly decreased. SaO2, a-A PO2, QS-QT, DO2, and O2ER showed no significant changes during the perioperative period. We conclude that in the acute post-resection period [up to 2 hours postoperatively] there is right and left ventricular dysfunction with good maintenance of gas exchange

Ornithonyssus [Acari: Macronyssidae] mite dermatitis in poultry field-workers in Almarg, Qalyobiya governorate

Cutaneous manifestations of bird and rat mite infestation in man are not easily recognized by physicians or patients. Clinical signs and symptoms are developed secondary to bites of mites that have infested rats, domestic poultry or birds nesting in or near human habitation and comes into contact with man. This study details 4 cases of pruritic dermatitis developed in four field workers in poultry farms in El-Marg district, Qalyoubia governorate, Egypt. The zoonotic species of Ornithonyssus sp., [Family Macronyssidae] was isolated from all samples collected from patients' habitat and the role played by Ornithonyssus mites in causing dermatitis in man was discussed

Outpatient treatment of non-complicated deep venous thrombosis:is it still questionable?

At our medical community, we persist on treating all cases of acute deep venous throm boris in the hospital for fear of pulmonary embolism [PE] antobe-able to give unfractionated hearin [UFH] infusion, misguided by the apparent high cost of the low molecular weight heparin [LMWH]. The purpose of this study was to prove that out patient treatment [OPT] is not only safe and effective, but also more reasonable and economic in treating non complicated DVT. Out patient treatment [OPT] was given for patients with proven non-complicated DVT in the period between January 2004 and January 2005. Data regarding complications, vein clearance and recurrence were collected at: one week, 4 weeks, 3 and 6 months. The cost of this regimen was compared to the cost of receiving UFH infusion at a general and private hospitals. Patient compliance was also assessed. Fifty-three patients received OPT for DVT between January 2004 and 2005. Only one patient [1.8%] had minor PE. Two patients [3.7%] had remnant of the clot at the end of follow up period. Three patients [5.6%] had deep venous reflux and no one had recurrence during the follow up period. This type of treatment costs the same price when compared to the in-patient treatment using the UFH at a general hospital and less than half the price for treatment at a private one. All patients were compliant to the injections and 37 of them [70%] were compliant to the elastic stockings [ES] This study confirmed that OPT of non-ocomplioance is high and the treatment is presumably satisfying. Admitting patients with non-complicated DVT is no more justified or accepted

Bicuspidization versus segmental annuloplasty in tricuspid valve repair

The tricuspid valve remains a challenge to the surgeons despite statements to the contrary. Although modern techniques have significantly reduced the mortality and morbidity of tricuspid repair, its indications remain controversial. Some surgeons recommend replacement, others repair, and some even suggest that the valve be ignored. This study was carried out to evaluate and compare bicuspidization repair [1st group] and segmental annuloplasty [2nd group] in repair of functional tricuspid regurgitation and to assess performance of tricuspid valve following these two techniques. During this study, fifty patients underwent tricuspid valve surgery for repair of functional tricuspid valve regurgitation secondary to rheumatic mitral with or without aortic valve pathology, in the period between November 2000 and December 2002 in The Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Cairo University. In all patients, left sided lesions [mitral with or without aortic valve lesion] were corrected during the same surgical procedure before tricuspid valve repair using mitral valve repair or replacement [for mitral valve lesions]; or aortic valve replacement for Aortic Valve Lesions. In all patients, tricuspid valve repair was performed. Patients were randomized into two groups 1st group [no. 25] included patients who underwent bicuspidization repair of their functional TR; whereas 2nd group [no: 25] included patients who underwent segmental annuloplasty for repair of their functional TR. Of the 50 patients operated upon in this study, 25 patients had bicuspidization and the other 25 had segmental annuloplasty for repair of their significant moderate to severe functional tricuspid incompetence secondary to rheumatic left sided valvular pathology. Both groups had preoperative and postoperative clinical, laboratory, electrocardiographic, radiographic and echocardiographic evaluation, 3 and 6 months after discharge from hospital. No mortality occurred in any of our patients. Tricuspid valve competence was restored in nearly 80% of all cases with only mild residual tricuspid insufficiency in about 20% of patients in the immediate postoperative period. Follow up after 3 and 6 months revealed recurrence of moderate tricuspid insufficiency in 4 patients [16%] in the l st group and 5 patients [20%] in the 2 nd group with no statistically significant difference between both groups. The simplicity of the two techniques, their efficacy and relative durability justifies their use in repair of functional tricuspid insufficiency at time of correction of left sided valvular lesions. We recommend using such simple repair techniques to correct pure functional moderate to severe tricuspid regurgitation in association with the left sided valve corrective procedures to ensure easy post operative recovery and decrease the risk of reoperation. However we recommend follow up of such patients for a longer period of time to confirm the efficacy and durability of such procedures and find out the incidence of recurrence of severe tricuspid regurge and the incidence of reoperation

Effect of angiotensin-II Receptor blockade on experimental portal hypertension in rabbits

In this study, the effect of angiotensin- II receptor antagonist [Candesartan] was evaluated on the portal venous pressure and angiotensin II plasma level in normal and experimentally induced portal venous hypertension in rabbits [PHT] [by partial ligation of portal vein for 3 weeks]. It was found that candesartan administration reduces the portal venous pressure insignificantly from 7.23 +/- 0.47 mmHg in control group to 6.96 +/- 0.32 [P > 0.05] and caused an insignificant increase of angiotensin-II plasma level from 6.98 +/- 0.63 pg/ml in control group to 7.75 +/- 0.39 pg/ml [p> 0.05]. However, after partial ligation of portal veins, the portal venous pressure rises to 13.53 +/- 0.51 mmHg, and decreased significantly by Candesartan to 8.7 +/- 0.86 mmHg [p < 0.001]. Moreover, angiotensin-Il level increased in PHT rabbits to 11. 77 +/- 0.65 pg/ml [P < 0.001] and insignificantly increased by candesartan to 12.66 +/- 0.67 pg/ml. [P > 0.05]. In conclusion, angiotensin-II receptor antagonists may be of great value in treatment of patients with portal hypertension and esophageal varices