Early Appendectomy for Acute Appendicitis in Adults: Is it Valuable?

Objectives: Despite much progress in surgery, controversy still exists as regard the timing of appendectomy. This study aims at determining the relationship between pathological severity, complications, hospital stay and timing of appendectomy. Patients and methods: All patients diagnosed as acute appendicitis at Surgery Department in Minia University Hospital over the year 2018 were included. Patients<18 years, patients not recognizing the exact time of symptom onset and patients with negative appendicitis in pathology examination were excluded. The diagnosis was confirmed by ultrasound or CT prior to surgery. Pre-hospital, in-hospital and whole elapsed times were recorded. Macroscopic appearance and stage was described at surgery. Postoperative complications and hospital stay were recorded. Results: The number of included patients was 182; 119 males and 63 females. The mean age was 30.5 ± 6.19 years. Advanced age was significantly associated with advanced pathology (p<0.001). The mean temperature was 37.8 ± 0.75°C with significant associated between high temperature and advanced pathology (p<0.001). Mean WBC count was 12,380 ± 0.98 cells/µL with significant correlation between leukocytosis and advanced pathology (p<0.001). Advanced pathology was significantly correlated to pre-hospital elapsed time (Range 31.26 ± 3.74 to 52.30 ± 2.92 h) and to whole elapsed time (Range 43.43 ± 3.75 to 66.62 ± 2.82 h). Hospital stay (1.66 ± 0.30 days for stage 1 up to 7.50 ± 0.51 days for stage 4) and complication rate (4% for stage 1 up to 100% for stage 4) significantly correlated to advanced pathology (p<0.001). Conclusion: Early appendectomy may stop the pathological progress with subsequent reduction in complication rate and hospital stay. So, early appendectomy is recommended.

The Combination of Sonography and Physical Examination Improves the Patency and Suitability of Hemodialysis Arteriovenous Fistula in Vascular Access

Purpose: We compared the patency and the suitability of arteriovenous fistula (AVF) created for vascular access by two approaches: (a) physical examination with preoperative vascular mapping and (b) physical examination alone. Methods: We compared the patency and the suitability of AVF created in patients for dialysis. There were two cohorts of patients of 79 patients each: (a) patients with AVF created based on the combination of physical examination and preoperative vascular mapping (PE+VM) and (b) patients with AVF created based on physical examination (PE) alone. Fistula patency is defined as clinical detection of thrill (or auscultation) of murmur over the fistula and coded as having thrills (patent) versus not having thrills (not patent). Suitability of fistula is defined as functioning AVF (AVF can be adequately used via 2-needle cannulation for dialysis) and coded as suitable versus not suitable. Results: AVF created after the preoperative vascular mapping (PE+VM) has 5.70 (at six weeks) and 3.76 (at three months) times higher chance for patency, and 3.08 times higher chance for suitable AVF for dialysis than AVF created after the physical examination (PE) alone. Conclusion: Physical examination with preoperative ultrasound mapping (PE+VM) significantly improves the short term patency and the suitability of AVF for dialysis.

Comparative study of vitamin [D] Status in Full Term and Preterm Infants and Their Respective Mothers

Background: Vitamin D Is important for maintenance of calcium and phosphorus homeostasis and bone mineralization. Vitamin D deficiency in the mothers has possible adverse effects on the fetus and contributes to low vitamin D in infancy

Objectives: To assess vitamin D status, calcium, phosphorus and alkaline phosphate in preterm infants and their mothers

Patients and Methods: A cross sectional study was conducted on 46 neonates, and their mothers

The study was conducted between July and December 2013. The following had been done for all patients: Full medical history and clinical examination for mothers and their neonates, Laboratory investigation: Maternal blood And cord blood samples were collected at Delivery to measure vitamin D [vit. D], Calcium [Ca], phosphorus [P] and alkaline phosphate [ALP]

Results: Maternal hypovitaminosis D [vitamin D [25 [OH] D] <10 ng//ML was found in 89.% of pregnant women at the time of delivery and neonatal hypovitaminosis D [vitamin D <10 ng//mL] was found in 93.5% of studied neonates

Maternal vit D did not correlate to maternal dietary vit D, but it correlated to cord blood vit D was correlated to cord blood vit D but not cord blood Ca, Phosphorus, or alkaline phosphates

Conclusion: Vitamin D levels in Egyptian mothers delivery is deficient and it correlates well to cord blood Vitamin D levels

Deterioration of testicular functions in adult male rabbit after exposure to mobile phone radiation with impending recovery

The accumulate effects of electromagnetic field [EMF] release from mobile phones have many effects on multiple organs. Nevertheless, its effect on testicular function is still debated. The objective of the study is to clarify the alterations in testicular functions after exposure to electromagnetic radiation of mobile phone and to investigate the possibility of recovery. Eighteen adult male rabbits are enrolled into 3 groups: control, exposed and recovery group. Tine exposed and recovery groups are exposed to mobile phones in standby position for 18 hours /day and six day/week for 14 weeks. After that, the recovery group was monitored for another 14 weeks. exposure to EMR induced a significant drop in sperm count, sperm motility and sperm fast forward motility at the 6[th], 12[th] and 9[th] week respectively and get maximum inhibition at the 14[th] week. These finding were concomitant with degenerative changes in seminiferous tubules and interstitial cells of Leydig. These negative effects may be attributed to the detectable decrease in the serum level of testosterone, gonadotophic hormones, increase the level of oxidative stress and direct deterioration of testicular tissue. The other study points [body and testicular weight, body temperature and percentage of sperm morphology and live sperm] did not show any alteration. Recovery period significantly ameliorated the suppressed testicular functions and also, restored the hormonal and oxidative biomarkers within the 14 weeks. the longitudinal exposure to EMR causes testicular dysfunction that may be mediated by hormonal disturbances, oxidative stress or direct damage on testicular tissue that could reverse and improve within the recovery period

Cord soluble intercellular adhesion molecule-1 in infants of diabetic mothers

To assess cord blood serum sICAM-1 level in IDMS and whether it is related to birth weight and fetal insulinemia. 30 full term neonates to pregestational diabetic mothers [Patient group] and 20 healthy full term neonates to non diabetic mothers [Control group] recruited from neonates delivered in Obstetrics and Gynecology Hospital, Ain Shams University were enrolled. Infants of diabetic mothers [IDMs] were divided into 2 groups, macrosomic [n:15] and non macrosomic neonates [n:15]. Infants' anthropometric indices were recorded. Cord blood samples for glucose, insulin sICAM assay, together with maternal glycosylated haemoglobin were obtained and analyzed. Serum insulin and sICAM were significantly increased in IDMs compared to the control group. Serum glucose, insulin and sICAM were comparable in macrosomic and non macrosomic IDMs. sICAM-1 level was not correlated to gestational age, birth weight, crown heel length and head circumference in infants of diabetic mothers [both macrosomic and non macrosomic] or control groups. sICAM was not correlated to maternal HbA1C in IDMs. sICAM was not correlated to glucose and insulin in all studied groups. Infants of diabetic mothers had elevated levels of cord serum insulin and sICAM, which were comparable in both macrosomic and non-macrosomic neonates. Whether the subclinical inflammation is associated with long term effects on the increasing prevalence of obesity and glucose intolerance later in life remains to be investigated

Evaluation of liver hepcidin mRNA expression in patients with chronic hepatitis C virus infection [HCV] and liver cirrhosis

Elevated serum ferritin and iron accumulation in the liver are common in patients with chronic hepatitis C virus infection and have been associated with more aggressive disease and decreased response to interferon therapy, but the mechanism is unknown. Recently identified hepcidin, which is a small cysteine-rich cationic peptide produced by hepatocytes, secreted into plasma and excreted in urine, acts as regulator of intestinal iron absorption and iron recycling by the macrophage. This study was conducted to evaluate hepatic hepcidin mRNA expression in patients with chronic HCV infection and correlate its expression level with serum iron, serum ferritin and the grading and staging of liver disease. Fifty patients [40 males and 10 females] with chronic HCV infection were classified into two groups, chronic hepatitis [CH, n = 35, 28 males and 7 females] and liver cirrhosis [LC, n = 15, 12 males and 3 females]. In addition, 18 apparently healthy subjects [donors for partial liver transplantation] served as the control group. All patients were both anti-HCV and HCV RNA positive. Serum iron and serum ferritin were measured for all studied groups. Hepatic hepcidin mRNA expression level was determined by SYBR-green real-time PCR. Serum iron and ferritin were significantly higher in the patient groups compared to control group [p <0.001]. Hepatic hepcidin mRNA expression was significantly decreased in the patient groups than in the control group [p <0.001]. Also its expression was decreased in patients with liver cirrhosis than in patients with chronic hepatitis. There was a negative correlation between hepatic hepcidin mRNA and serum iron and ferritin in the patient groups. On the other hand no correlation was detected between it and histological grading of activity [r = -0.001, p >0.05]. Meanwhile there was a strong negative correlation between hepatic hepcidin mRNA and the histological stage of fibrosis [r = -0.51, p <0.001]. In conclusion failure of homeostatic regulation of hepatic hepcidin expression may be induced by HCV infection and this may cause elevation of serum iron and ferritin levels in patients with HCV infection. Therefore, understanding the role of the liver in hepcidin regulation and iron homeostasis may be helpful in the management of HCV hepatitis

Epstein barr virus DNA in hepatocelullar carcinoma tissues from hepatitis C positive Egyptian patients

Hepatocellular carcinoma [HCC] is one of the most frequent malignant tumors. It possesses the characteristics of high malignancy, rapid progress and poor prognosis. In recent years, studies have suggested that Epstein-Barr virus [EBV] is associated with HCC although opposite results have been subsequently reported. The present study was to determine the prevalence of EBV in HCC Egyptian patients, and whether EBV acts synergistically with hepatitis viruses in HCC carcinogenesis. The study included 61 patients, 20 HCV positive patients without HCC [16 males and 4 females] and 41 patients with proved HCC. They were subclassified into 3 groups [21 HCV positive [18 males and 3 female], 10 HBV positive [8 males and 2 females] and 10 HCC patients negative for both HCV and HBV [7 males and 3 females]]. Thorough clinical examination, abdominal ultrasonography and liver spiral CT were done. Liver function tests and serum alpha-fetoprotein [AFP], viral hepatitis markers for B and C, anti-EBV early antigen [EA-IgM], virus capsular antigen [VCA-IgMl and HCV RNA by reverse transcription PCR [RT-PCR] were measured. EBV-BamHI W DNA, and EBV-LMP1 DNA were performed by conventional PCR in the tumorus liver tissue of 41 HCC patients and the 20 noncarcinoma patients [HCV without HCC]. The positive ratios were compared between HCC subgroups and non tumorus HCV group. Our results revealed that, EBV-BamHI W DNA and/or EBV-LMP1 DNA were positive in 25 [40.9%] among overall 61 studied cases. In HCC patients, EBV-BamHI W DNA and/or EBV-LMP1 DNA were positive in 13 [61.9%] out of 21 HCV positive, 2 [20%] out of 10 HBV positive cases, 3 [30%] out of 10 cases negative for both HCV and HBV. However, it was positive in 7 [3 5%] out of 20 HCV cases without HCC [non tumotus cases]. The rate of EBV infection in HCC with HCV positive cases was significantly higher [Fisher exact=4.6 1; p<0.05] than HCC with HBV positive ones, HCC cases negative for both B and C virus [Fisher exact-4.28; p<0.05] and chronic HCV [non tumours] cases [Fisher exact=4. 19; p<0.05]. In addition, HCC in EBV DNA positive cases was associated with high HCV viral load, AST, ALT, low serum albumin, while there was no relation to AFP serum levels. In conclusion: the existence of EBV infection in HCC tissues suggests that EBV may be involved in the hepatocellular carcinogenesis in Egypt

A survey on lower urinary tract symptoms (LUTS) among patients with Benign Prostatic Hyperplasia (BPH) in Hospital Universiti Sains Malaysia (HUSM)

Patients with Benign Prostatic Hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can be of obstructive symptoms such as hesitancy, incomplete voiding, post void dribbling or of irritative symptoms such as urgency, frequency and nocturia. Various recent studies indicate that nocturia is a very important and bothersome lower urinary tract symptom especially among patients with Benign Prostatic Hyperplasia (BPH). The aim of the study was to determine the frequency of common urinary symptoms among patients with BPH in HUSM as well as to evaluate the extent of bothersomeness of each and every symptom to these patients. This study too was aimed at evaluating the success of TURP in resolving pre operative LUTS. This was a questionnaire-based survey using a validated ICSBPH model whereby patients with BPH were selected and quizzed personally by an investigator. A subset of patients who had undergone TURP was further questioned regarding their satisfaction with the procedure. When nocturia is defined as waking up at night once or more to pass urine, the prevalence of nocturia was about 90%, but only 1 in 6 patients considered this is a very serious symptom. Even if the definition was changed to waking up twice or more, the prevalence is still quite high at over 80%. Urgency was noted in half of the patients, but only a quarter of them consider it a serious problem. 1 in 5 patients experienced significant leak and almost all consider it serious. About one third of the studied population had to be catheterized due to urinary obstruction and interestingly only about half of them considered it as a very serious event. Overall, a great majority of these patients considered suffering from these urinary symptoms for the rest of their life as very devastating. This study concludes that although the prevalence of nocturia was high among BPH patients, but it was not considered serious by majority of them. In fact, LUTS in our BPH patients did not differ much from BPH patients elsewhere. On the whole, TURP resolved most of the LUTS effectively.

ACE gene polymorphism: a predictor of instent restenosis

Restenosis is the maladaptive response of the coronary artery to Restenosis occurs in 20-50% of patients [Pts] after balloon angioplasty and in 10-30% of patients receiving a stent. Neointimal proliferation is one distinct processes involved and the rennin-angiotensin system has been implicated in its pathogenesis. The level of plasma has been implicated in its pathogenesis. The level of plasma ACE is party under genetic control and the plasma and cellular levels pf ACE are associated with the insertion/deletion [I/D] polymorphism in the ACE gene where DD genotype bearers have higher levels of ACE than either ID or II genotype bearers. Aim: To assess the possible role of ACE gene polymorphism in the pathogenesis of instent restenosis [ISR]. We studies 136 patients having elective or emergency successful angioplasty and of a previously untreated native single coronary artery, including 117 males and 19 females, with a mean age of 52.5 +/- 9.8 years. Besides clinical evaluation, all pts were subjected to routine laboratory measurements, followed by DNA extraction for a peripheral venous sample using the QUIAmp Blood Kit. ACE gene was amplified by PCR-technique [30cycles], then were electrophoresed in agars gel and visualized directly with ethidium bromide staining under an ultraviolet light source to determine the ACE I/D genotypes. Clinical follow-up was performed on monthly basis up to six months for the occurrence of major adverse cardiac events. Angiographic follow-up was done in 93 patients at a mean of 6.17 +/- 2.3 months after PCI using edge detection and segment analysis by the Xcelera catch Philips Intruris QCA program to detect the minimal lumen diameter, reference vessel diameter and segment length before and after PCI and after 6 months follow up in the same views at baseline, to detect acute gain, late lumen loss and binary restenosis rate. ISR was expressed as >/= 50% diameter loss. Out of 136 pts, 93 were available for angiographic follow- up. Those were divided into two groups: 41 pts with angiographic evidence of restenosis [ISR], and 52pts without angiographic evidence of restenosis [NO-ISR]. The homozygous DD genotype was significantly more frequent in the ISR group compared to the NO-ISR group [51.2% vs 11.5%, p=0.005]. The heterozygous ID genotype was significantly more frequent in the NO-ISR group compared to the ISR group [76.9% vs 39%, p=0.005]. The homozygous II genotype was equal in both group [11.5% in ISR vs 9.8% in No ISR, p=0.79]. Compared to the heterozygous ID and the homozygous II, genotypes the homozygous DD genotype, of the ACE gene was more significantly associated with in-stent restenosis. This knowledge may help in the selection of subgroups of patients who will benefit form alternative therapeutic strategies such as CABG surgery or intensive preventive treatment or drug-eluting stent

Treatment of recalcitrant lateral epicondylitis of the elbow by surgical release of the common extensor origin

A prospective non-randomized study of 21 patients with recalcitrant lateral epicondylitis of the elbow was carried out to evaluate the results of the surgical release of the common extensor origin. The dominant arm was involved in 76.2% of the patients. The average duration of symptoms before the operation was 19 months [range, 9-38 months]. The average duration of follow up was 24 months [range of 10-42 months]. The results of the current study suggested that the release of the common extensor origin is an acceptable surgical modality to provide an effective treatment for the resistant lateral epicondylitis when nonoperative management fails

Percutaneous pinning of open or unstable diaphyseal forearm fractures in children

This is a retrospective review 58 children with both-bone forearm fractures who were treated by percutaneous intramedullary K-wire fixation after closed reduction in 43 cases and open reduction in 15 cases. All fractures were diaphyseal, displaced, and unstable. The factures were closed in 51 cases and open in 7 cases. The mean age was 12.3 years [range, 7-15 years]. There were 44 boys and 14 girls. The average follow-up was 18.4 months [range, 8-29 months]. At the last follow-up, the results were graded according to the system described by Price et al. Fifty-two cases showed excellent results, 5 cases showed good results, while only one case showed fair result. There were no poor results. Of the 51 closed fractures, closed reduction failed in 8 cases; and at open reduction soft tissue interposition was always the cause of failure of closed reduction in these cases. Forty-nine fractures united within 2 months, 7 fractures united within 3 months, while union was delayed for more than 3 months in 2 cases. Complications were encountered in 11 cases [5 cases of transient radial nerve affection, 3 cases of superficial pin site infection, and 3 cases of refracture after K-wires removal]. No cases were complicated by deep infection, physeal growth arrest, cross-union or non union. Six patients lacked full pronation and supination. Statistical correlation between the overall results and each of the type of fracture, level of fracture and type of reduction was found to be significant only for the type of fracture. The results of the current study suggest that intramedullary fixation by using standard K-wires plus cast immobilization provides effective treatment for the problematic open or unstable diaphyseal forearm fractures in children when closed management has failed

ACL reconstruction using mid-third patellar tendon autograft: modified technique, subjective and objective evaluation

Between February 1998 and January 2002, 119 patients suffering from chronic knee instability due to ACL injury were operated upon. The average follow up period was 28 months [range 14-47 months]. At the final follow up, the overall International Knee Documentation Committee [IKDC] evaluation results showed that 93.3% of the patients were graded as normal or nearly normal [grade A or B], 5% as abnormal [grade C], whereas 1.7% as severely abnormal [grade D]. According to Tegner activity level, the median score was 7. Applying the Lysholm score, 44.5% of the patients were scored as excellent, 51.3% were scored as good, 4.2% were scored as fair, while no patients were scored as poor. 96% of the patients showed a full range of knee motion. 18.5% of the patients complained of mild donor site morbidity, which was not significantly disabling. The rate of associated meniscal injury was 46.3%

Lisfranc joint injuries: surgical treatment, outcome and complications

In this study, 31 adult patients with a Lisfranc joint injury treated surgically between 1998 and 2002 were reviewed, where both closed reduction with percutaneous pinning and open reduction and internal fixation with screws were adopted. The study detected 26 closed injuries and 5 open injuries. Nineteen patients had combined ligamentous and osseous injuries and 12 patients had ligamentous injury only. The average duration of follow up was 28 months [range 14-54 months]. At the final follow up, the results were graded using the American Orthopedic Foot and Ankle Society [AOFAS] midfoot Score and the grading system suggested by Arntz et al. Closed reduction was successful in 61.5% of the closed injuries, followed by stable fixation by percutaneous pinning. Open reduction and internal fixation with 3.5 mm cortical injuries were needed for the remaining closed injuries, in addition to the open injuries. The average AOFAS midfoot score was 79 points [range 45-100 points]. As regards the Arntz et al. grading system, 32.2% showed excellent results, 45.2% showed good results, 16.1% showed fair results and 6.5% showed poor results. 29% of the patients showed an evidence of tarsometatarsal osteoarthritis. Complications were encountered in 29% of the patients. A secondary tarsometatarsal arthrodesis was performed in three patients, due to persistent pain. No primary arthrodesis was undertaken

Soft tissue profile, of young adult Egyptians cephalometric study

Assessment of soft tissue profile is an essential step in planning the correction of maxillofacial deformities. In this study 50 lateral cepholograms of young adult Egyptians with normal occlusion were analyzed to get the nor mal soft tissue measurements of anteroposterior relation and vertical proportions. This study has proved the presence of some difference in the anteroposterior relations and vertical proportions between the Egyptians and American Caucasians. Egyptians have a soft tissue chin that is less prominent than the Americans, but the soft tissue chin thickness is larger in Egyptians than the Americans. Upper and lower lips are more protrusive in Egyptians than the Americans. Both upper and lower lips at vermilion are thicker in Egyptians than the Americans. In the vertical proportions, Ricketts-Devine proportions could be applied in the Egyptians faces with one difference The subnasal point [Sn.] should be used in Egyptians instead of the Alar rim point [Ar.] that was used by Ricketts in Americans