Doppler ultrasonogragshic evaluation of portal circulation in patients of portal hypertension treated by splenectomy, devascularization and oesophageal transection

The portal hypertension with bleeding oesophageal varicose is a major medical problem in Egypt, the risk of death from 10% to 40% in these patients due to massive secondary heamorrhage. Splenectomy, Devascularization and Oesophageal Transection is one of the most important lines was used to treatment of bleeding oesophageal varices in patients suffering from portal hypertension particularly after failure of upper gastrointestinal tract endoscopy. The doppler Ultrasonography is simple,non invasive investigation to determine the blood vessels diameter, direction of blood flow, blood volume and degree of vascular congestion. The portal circulation evaluated pre and post operative by doppler Ultrasonography in 50 patients [41 males and 9 females] suffering from portal hypertension and oesophageal varices [Child A or Child B] and treated by Splenectomy, Devascularization and Oesophageal Transection to determine the degree of correction of the hemodynamic state. The portal vein diameter decreased after the operation by 1.5 mm, cross sectional area by 0.42 cm while its flow velocity increased after the operation by 3.22 ' cm/sec Its flow volume increased after the operation by 49.2ml/min and its congestive index decreased after the operation by 0.07cm/sec.So the operation is effective in the treatment of portal hypertension and oesophageal varices as it improves liver blood flow and liver perfusion. It also eradicated oesophageal varices

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated

Etiology of chronic dysphonia in children that attend E.N.T. clinic in Minia University Hospital

Our study was done to study the etiology of chronic hoarseness of voice in children. The study was done at E.N.T. clinic at Minia University hospital, 50 children, were included in the study, they complained of chronic hoarseness of voice and didn't have any medical diseases. The age range from 3 to 12 years, with, 40 boys and 10 girls. Complete E.N.T. examination was done with indirect laryrgoscopy, rigid laryngoscopy and vediostroboscopy. The pathological lesions that encountered are: Vocal nodules 68%, Laryngeal web 8% multiple papilloma 8%, chronic laryngitis [hypertrophied vocal cords] 6%, vocal cord paralysis 4%, vocal fold cyst 4%, and Laryrgoscleroma 2%. The common cause of chronic hoarseness of voice in children is vocal nodule that can be treated by voice therapy efficiently

Diclofenac sodium versus paracetamol preoperatively for tonsillectomy: effects on pain and haemostasis

Sixty children and adolescents [6-16 y] were randomized in this study to receive rectal paracetamol 13-20 mg kg-1 [group I] or diclofenac sodium 0.65-1.0 mg kg-1 [group II] preoperatively. Pain was evaluated postoperatively by means of the visual analogue scale and by recording the use of pethidine for rescue analgesia. Perioperative blood loss was estimated from The measured intraoperative blood loss, bleeding time, use of drugs to achieve haemostasis and the incidence of reoperations. Surgical duration was prolonged and blood loss was more in group II than those in group I, but nonsignificant. Bleeding time was prolonged [but within the normal range] in group II than group I. The postoperative pain was significantly less with diclofenac [group II] than paracetamol [group I]. This was clear from time from extubation to 1st pethidine dose [34 + 15 in group II vs. 25 + 11 in group I]. Pethidine consumption was 21.7 +/- 7.4 in group III vs. 29.5 +/- 8.1 group I. Desmopressine use was more with diclofenac and vomiting was more in group II

Correlation between permeability glycoprotein expression and tumor grade in squamous cell carcinoma of the head and neck

One established mechanism of multidrug resistance [MDR] in cancer chemotherapy is elevated expression of permeability-glycoprotein [Pgp], that functions as an efflux pump which excretes lipophilic chemotherapeutic drugs from cancer cells. The expression of Pgp by immunohistochemistry was examined in tissue specimens taken from 60 patients with head and neck squamous cell carcinomas using a monoclonal antibody, which is specific to human MDR1 gene product. The results showed that 80% of the tumors were stained by Pgp antibody with a statistically significant correlation between the degree of expression of Pgp and the degree of differentiation. The results showed also a wide variation in Pgp expression and high expression of Pgp in more undifferentiated tumors. So, Pgp can be used as a marker for diagnostic and prognostic value in the head and neck cancer

Transtympanic iontophoresis for treatment of secretary otitis media in children

This study was designed to compare the results of transtympanic iontophoresis of two different concentrations of dexamethasone into the middle ear to evaluate iontophoresis as a new method in management of SOM. The study group consisted of 70 patients [140 ears]. The mean age was 4.8 years + 1.39. All the patients had bilateral tympanogram type B, and MHL >20 dB at the start of the study. The patients were classified into the following groups: Group 1 [10 patients received saline solution iontophoresis in one ear/6 trials], group 2 [a- 30 patients received 0.4% dexamethasone in one ear/6 trials and b- 10 out of the 30 patients who continued iontophoresis for 10 trials], and group 3 [a- 30 patients received 0.8% dexamethasone in one ear/6 trials and b- 10 out of the 30 patients who continued iontophoresis for 10 trials]. All the patients received oral amoxicillin 40 g/kg/day/10 days. It started at the first day of iontophoresis. All received iontophoresis in one ear for 6 trials. Patients of groups 2b and 3b continued 10 trials. Each iontophoresis trials lasted 16 minutes. The iontophoresis was performed 3 times/week. The diagnosis was confirmed before and after iontophoresis by otoscopic examination and Siegle's pneumatic otoscopy, examination with operating microscope, hearing tests [pure tone audiometry, speech reception threshold [SRT] and tympanometry]. The tympanoaudiometric criteria for improvement were a gain in MHL of >15 db, or a change in tympanogram type from B to either A or Cl. The study showed a statistically significant gain in the iontophoresis ears when compared to the ears on the other side or those received saline [control group]. The mean gain in MHL was 11.43 dB in group 2A [0.4% dexamethasone] and 13.97 dB in group 3A [0.8% dexamethasone], compared to 6.5 dB and 6.6 dB on the other ears, respectively, or to 6 dB gain of saline iontophoresis ears. The study showed also a high correlation between SRT and MHL, which means that SRT can be used to monitor the progress of hearing instead of pure tone audiometry in young and uncooperative children. Iontophoresis of dexamethasone improved the tympanometric values of the treated ears. 26.7% of ears treated with 0.4% dexamethasone and 53.3% of ears treated with 0.8% dexamethasone have changed from type B to either A or Cl, in comparison to 10% and 13.3% in the other ears, respectively. The study showed also that increasing the concentration of dexamethasone from 0.4% to 0.8% has improved the audiometric and tympanometric results. The mean MHL gain was 13.97 dB in 0.8% group have changed to A or Cl, in comparison to 26.7% in 0.4% group. This effect is obvious when the tympanoaudiometric results of both groups were compared. While, the tympanoaudiometric results of group 0.4% were statistically insignificant, those of 0.8% group were found to be statistically significant. This showed clearly that increasing the concentration increases the improvement tympanoaudiometric results of SOM. Increasing the number of iontophoresis trials was shown to increase the improvement in the mean MFIL gain. In group 2B [10 trials 0.4% dexamethasone], the overall mean MHL gain alter the 10 trials was 17.3 dB compared to 9.4 dB after the initial six trials. In group 3B [10 trials 0.8% dexamethasone], the results were 21 dB and 14.5 dB, respectively. This increase in the mean MHL gain was statistically significant in both the group 2B and 3B. While, these patients had a statistically significant gain in the mean MHL, yet the improvement in their tympanometric results was lower than that of the patients who got 6 trials only