A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study / 대한해부학회지

Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5–16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2–23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22–11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

Glypican 3 amino terminal marker for early detection of hepatocellular cacinoma

HCC is the 5[th] common cancer worldwide. Due to global increase of hepatitis B and C infection, the incidence of hepatocellular carcinoma [HCC] has been steadily increasing. The seroprevalence of HCV in Egypt is currently between 20 -35%. Because Alfa Feto protein [AFP] has limited sensitivity for small hepatocellular carcinoma foci, Glypican-3 [GPC-3] oncofetal protein which is over expressed in HCC could represent a hope for early detection. Evaluating the validity of Glypican-3 as an early detector of HCC. 10 healthy controls and 40 HCV positive patients distributed as follows: 10 patients with chronic hepatitis C virus infection [CH], 10 patients with compensated cirrhosis [CC], 10 patients with decompensated cirrhosis [DC] and 10 patients with HCC. Liver functions: ALT, AST, Bilirubin [T], Albumin, gamma GT. Tumor markers: AFP and GPC-3.Viral markers: HCV antibodies, HBs Ag and HBc Ab. AFP mean was126 ng/ml and GPC-3 mean was 34.63 ng/ml in HCC group which were significantly higher than the other studied groups. No significant correlation was found between AFP and GPC-3.The area under ROC of GPC-3 was higher than AFP suggesting increased GPC-3 sensitivity. AFP showed sensitivity of 70% in HCC, 30% in D.C and 20% in C.C with 100% PPV, also AFP had 100% specificity with low NPV compared to GPC-3. GPC-3 was detected in all HCC groups, DC and CH showing 100% diagnostic performance. GPC-3 in C.C revealed 70% sensitivity with 100% PPV and 100% specificity with low NPV. GPC-3 was elevated in context of patients with CH, CC and DC as it is an oncofetal protein produced by regenerating liver cells. GPC-3 and AFP improve the prediction accuracy of HCC in those seronegative to AFP

Study of the role of CD40 / CD40-L interaction in the pathogenesis of rheumatoid arthritis [RA]

CD40/CD40 ligand [CD4O/CD4O-L] interaction has pleiotropic effects in a variety of cells and biological processes including immune response. Within the immune system, these molecules represent a critical link between its humoral and cellular arms. Numerous autoimmune diseases are associated with CD40/CD40-L interaction. CD40 is a cell surface receptor that belongs to the tumor necrosis factor-receptor [TNF-R] family, and that was first identified and functionally characterized on B- lymphocytes. CD40 ligand [CD40-L] or [CD154], a member of the TNF superfamily, is a cell membrane molecule expressed on activated CD4+ T-lymphocytes. Therefore, it is now thought that CD40/CD40-L interactions play a more important role in autoimmune disease regulation. The aim of the present work was to measure the level of surface expression of CD40-L and CD40 on PB lymphocytes of rheumatoid arthritis [RA] patients and to correlate it with clinical and laboratory data and with disease activity. To achieve this goal, 30 patients with RA [Group I] who were further subdivided into group IA [15 patients with active RA] and group IB [15 patients with inactive RA], in addition to 20 healthy control volunteers [group II] were studied. All studied groups were subjected to routine laboratory investigations including, complete blood count [CBC], ESR, C-reactive protein [CRP], rheumatoid factor [RF] measured by latex test and by Rose-Waaler test. Surface CD40-L and CD40 expression on lymphocytes was measured by flowcytometry on peripheral blood [PB] of all studied groups. Statistical analysis of the results of the present study showed that surface expression of CD40-L on PB T-lymphocytes was significantly higher in RA compared to the control group. Among RA patients surface expression of CD40-L was significantly higher in active RA patients compared to inactive patients. As regards CD40 expression on PB, no statistical significance was observed among the studied groups. Therefore increased expression of CD40-L on PB T-lymphocytes could be regarded as a marker of disease activity in RA patients and to drive the activation of autoreactive beta-lymphocytes in the disease. These findings are particularly useful for clarifying the pathogenic process in RA patients and for developing a therapeutic approach that blocks pathogenic cytokine and antibody production

Serine proteases in female serum, new markers in polycystic ovary syndrome

Prostatic Specific Antigen [PSA] is present in very low concentration in female sera., but it can be measured with high sensitivity assays. Polycystic ovary syndrome [PCOS] is a disorder characterized by hyperandrogenism and chronic anovulation. Serum Testosterone is increased in PCOS patients. Women with higher levels of androgen may have higher levels of PSA compared with women with normal levels of androgen. Hirsutism represents a state of androgen excess in women. Women with PCOS usually suffer from hyperandrogenism and were selected to test the hypothesis in this study. Twenty five PCOS females were investigated for the level of PSA in their sera, using chemillurninescent technique. PSA level was found to be higher than normal, and correlated with testosterone levels. Our data suggest that measurement of this serine protease in serum may aid in the diagnosis of PCOS patients

helicobacter pylori contribute to infertility?

Helicobacter Pylori is one of the important causes of chronic gastritis. It has also been implicated in extragastric disorders, such as skin diseases of autoimmune nature, vascular disorders and platelet disorders. The most acceptable hypothesis is the existence of mimicry between H Pylori antigens and cells of different host tissues. The prevalence of H Pylori infection among Egyptians is very high. The possibility of involvement of H Pylori in the pathogenesis of infertility is intriguing. H Pylori usually lasts for the patient's entire life. This may boost autoimmune reactions. Mimicry has been shown between human beta-tubulin protein [present in spermatozoa] and H Pylori flagellin, Cag A and Vac A. Antibodies to these antigens cross reacted with human spermatozoa. Our study was conducted on 30 males complaining from infertility problem, 10 healthy fertile controls were included. CASA was performed, together with H Pylori IgA antibodies in seminal fluid. There was a high prevalence of H Pylori IgA antibodies in seminal plasma of patients complaining of infertility and having asthenospermia as compared to the fertile control group

Assessment of multiple etiological and prognostic parameters in pre-eclampsia

Pre-eclampsia is an important cause of fetomaternal morbidity and mortality. It is not only unpredictable in onset and progression, but also has no effective management strategy except termination of pregnancy. There are many factors lying behind the pathogenesis of the disease. We sought at measuring different parameters as etiological and prognostic factors in pre-eclampsia. Lipoprotein [a], P-selectin, prothrombin fragment 1+2 and thrombin anti-thrombin complex were measure and correlated with the severity of the disease. We found that those parameters are increased in pre-eclamptic patients and most of them correlated with the degree of pre-eclampsia. We suggest an etiological and prognostic significance in the course of pre-eclampsia

Alpha-1-antitrypsin and Down's syndrome

Serum levels of alpha-1-antitrypsin were determined in 37 infants and children and their parents. They were 20 cases of Down's syndrome, 7 cases of mosaic trisomy 21, 10 normal children and their consecutive parents. A significant decrease in mean serum alpha-1-anti-trypsin levels was found in mosaic Down syndrome cases in comparison to control group or to regular cases [P < 0.05]. No significant difference was found between alpha-1-antitrypsin levels in serum of parents of cases and that of parents of controls. Further, no correlation was found between cases or controls and their parents regarding serum alpha-1-antitrypsin levels. We conclude that alpha-1-antitrypsin might have a role in the development of trisomy 21 through its effect on mitotic cell division by unknown mechanism. Alpha-1-antitrypsin level in parents of cases might be defiicient only in the germ cell and mitotic non disjunction could happen upon an originally euploid zygote. As mosaic chromosomal abnormalities are of postzygotic origin, positive results observed in mosaic cases suggest that mitotic non disjunction could be the result of some unknwon influence of certain protease phenotypes upon a euploid zygote

Dermatoglyphic study in cases of idiopathic epilepsy

Dermatoglyphic pattern was studied in 39 cases of idiopathic epilepsy, 20 parents known to have children with idiopathic epilepsy and 30 normal sibs of epileptic children. A control group which included 30 healthy age and sex-matched children, 25 sibs and 20 parents [10 husbands and their wives] was also studied. Our results revealed increased main line index especially on right palm, decreased total ridge count in right and left palms and more frequent existence of transverse line epileptic children as compared to their controls. No similar significant differences were found between the parents and sibs of epileptic children and their controls except for the increased main line index which was significantly increased in parents of epileptic children [P less than 0.05]. This emphasizes the existence of genetic predisposition idiopathic epilepsy

aetiologial survey of mentally retarded children who attended the genetics outpatient clinic, at Ain Shams University from January 1982 to December 1989

Medical records of children who attended the Genetics Unit of Ain Shams University Hospital in the period between January 1982 and December 1989 were reviewed. These comprised 1607 cases of mental retardation, 904 males and 703 females whose ages ranged from 1 to 12 years. Their intelligence quotients from less than 20 to less than 70. Considering the onset of mental retardation, the percentage of mentally retarded due to prenatal causes, prenatal causes and postnatal causes were 32.6%, 18.2% and 26.3% respectively, while 22.7% had undecided causes. Regarding the level of mental retardation, 17.7% of the cases had profound mental retardation, 37% had severe, 27.3% had moderate mental retardation and 18% were midly mentally retarded. The importance of complete history taking, thorough clinical examination besides properly selected investigations in diagnosis of children with mental retardation is emphasized

Mode of inheritance of idiopathic epilepsy in an Egyptian population

In this work the mode of inheritance of idiopathic epilepsy was studied in an Egyptian population in a trial to define the role of environmental and genetic factors in this disorder. Members from 32 families were studied. These included 39 cases of idiopathic epilepsy, 20 parents having children with idiopathic epilepsy. 30 normal sibs of epileptic children and 3 dizygotic twins encountered in the above families, 2 of them were normal while the third twin compared an epileptic male and a normal female. A control group including 30 healthy age and sex-matched children, 25 sibs and 20 parents were also studied. Cases and controls subjected to full history talking, thorough clinical assessment, plain X-ray skull, and E.E.G. recording. Genetic analysis included pedigree construction, segregation and consanguinity analysis, besides blood grouping and twin studied. Idiopathic epilepsy has been shown to fit a multifactor mode of inheritance. This involves interaction of both genetic and environmental factors. E.E.G. Patterns are transferred on an autonomic dominants gene with grouping revealed no significant differences between patients, their parents and sibs compared to their controls

Study of the prevalence of hepatitis [B] seromarkers among non institutionalized mentally retarded children

HB[s]Ag and HB[s]Ab were studied in non institutionalized mentally retarded children [29 due to Down's syndrome and 29 due to spastic cerebral palsy]. The prevalence of HB[s]Ag was significantly high in the group of Down's syndrome as compared with the groups of mentally retarded children due to spastic cerebral palsy and control group. This could be explained by the depression in CMI [Cell Mediated Immunity] in cases of Down's syndrome. The prevalence of HB[s]Ab was also significantly high in group of Down's syndrome. The prevalence of HB[s] Ag and HB[s]Ab in mentally retarded children due to spastic cerebral palsy were significantly higher than those in control group