Cardiovascular predictive value of adiponectin diabetic and non diabetic patients with end stage renal diseases

Adiponectin is a novel collagen-like protein synthesized by white adipose tissue. Its level is decreased in obesity, type 2 diabetes and insulin resistant states. It is increased in chronic renal failure. It has anti-inflammatory and antiatherogenic properties. To evaluate the levels of adiponectin in uraemic patients with and without diabetes and to correlate adiponectin level and some cardiovascular risk factors. The study included 100 subjects, 20 of them were healthy subjects and served as control group [group I], and 40 uraemic non diabetic patients [group II], 20 of them without CVC [group hA] and the other 20 patients with CVC [group JIB], and 40 uraemic diabetic patients [group III], 20 of them without CVC [group lIlA] and the other 20 patients with CVC [group IIIB]. All patients were subjected to complete clinical examination including determination of MABP, BMI, R,routine laboratory investigations,[fasting serum glucose,fasting serum insulin, lipid profile, cholesterol,TG, LDL-C, HDL-C], Insulin resistance by HOMA-IR. Serum level of adiponectin was determined by ELISA. There was significant increase in serum adiponectin level in all uraemic patients [group II and group III] when compared to control [group I] at p<0.01 Serum adiponectin level was significantly decreased in uraemic diabetic patients [group III] when compared to uraemic non-diabetic patients [group II] at p<0.01. Patients with cardiovascular complications whether uraemic non diabetic [group IIB] or uraemic diabetic [group IIIB] had a significant decrease in serum adiponectin level when compared to patients without cardiovascular complications [group IIA and group IIIA] at p<0.01. Serum adiponectin has a significant positive correlation with HDL-C and a significant negative correlation with MABP, BMI, serum insulin, HOMA-IR, LDL-C,TG and cholesterol in all patients. Adiponectin level in uraemic patients whether diabetic or non diabetic may be a good indicator of cardiovascular disease risk

Role of laparoscopy in management of the impalpable testis

The impalpable testis may be a real problem in its diagnosis as well as in its treatment. This study was done for 25 boys having 28 impalpable testes [3 bilateral] through 4 years duration. Their ages ranged from 2-18 years. Preoperative ultrasonography was accurate in 25% only. At laparoscopy; 10 testes were intra abdominal, two of which were atrophied and were excised. Of the remaining 8 testes; the vessels were short in 6; which were managed by 2 stage Fowler-Stephen procedure. The first stage was by proximal clipping and transaction of the vessels. After six months the second stage of testicular descent was done; surgically in 3 testes and laparoscopically assisted in the other 3. In two abdominal testes the vessels were long, these together with 5 peeping inguinal testes were managed by one stage laparoscopic orchiopexy. When no testis was detected abdominally, inguinal exploration was done we found 13 testes; 7 were atrophic and were excised and biopsed, in the 6 viable testes surgical orchiopexy was done. Biopsy was done from the 3 viable testes of those patients above the age of 12, no malignancy was detected. In the excised [9] atrophic testes; no parenchymatous testicular tissue was detected. Follow up for 6 months revealed normal sized testes except in one of the cases managed by surgical 2[nd] stage Fowler-Stephens orchiopexy. From this study it is concluded that, laparoscopy is a very good procedure for accurate diagnosis of the impalpable testis. It is also of great value in treatment of the intraabdominal testis. It is preferred to use it in the 2[nd] stage of Fowler-Stephens operation. Health education about the complication of the undescended testis is very important because most of our patients are older than the proper age for testicular descent

Activated protein-C resistance [APC] as a risk factor for thrombosis in cerebral and myocardial infarction

Activated protein-C. [APC] resistance is referred to poor anticoagulant response to activated protein C. It is a strong risk factor for the genesis of venous thrombosis. To evaluate its role in the pathogens is of arterial thrombosis, APC sensitivity ratio [APC-SR] was estimated in 40 healthy control subjects without history of thrombosis, and in 40 subjects with arterial thrombosis before the age of 45 years. [20 subjects with myocardial infarction and 20 with cerebral infarction]. In addition, protein C, protein S, antithrombin III activity, thrombomodulin [TM], prothrombin time [PT] and partial thromboplastin time [PTT] were also measured.The study revealed that the lower limit of normal APC-SR was 1.8, below which we found 15 positive cases for APC resistance among our patients [9 cases with myocardrial infarction and 6 cases with cerebral infarction] and non in control subjects. A statistically significant decrease in APC-SR [P < 0.01] was found in all patients with arterial thrombosis [2.18 +/- 0.22] as compared to control group [2.84 +/- 0.52] and in APC positive patients [1.69 +/- 0.44] as compared to each of APC negative patients [2.67 +/- 0.62], all patients with thrombosis [2.18 +/- 0.22] and control group [2.82 +/- 0.52]. There was no significant difference in APC-SR between APC positive stroke and APC positive myocardial infarction. PTT was significantly decreased in APC positive patients as compared to control and APC negative subjects [P <0.01]. Other parameters of study did not show any siginificant difference between different groups and subgroups of study. Significant positive correlation was found between APC-SR and PTT in all patients of this study [r = 0.408, P < 0.05].Smoking was found to increase the relative risk of thrombosis among APC positive cases by about 2 folds, while hypertension increases this relative risk by 3 folds than normotensive APC positive cases. We can conclude that APC resistance may be a strong risk factor for premature arterial thrombosis [before 45 years] and the risk of thrombosis among APC positive cases increases with smoking and hypertension

Post-mastectomy seroma: a look into etiology and prevention

Accumulation of serous fluid in the axillary fossa and under the mastectomy flaps, still remains a common and annoying problem [17% - 63%] after modified radical mastectomy for cancer breast patients. In our study we tried to understand the causes and methods which can reduce or prevent the occurrence of seroma after modified radical mastectomy. One hundred patients with stage II cancer breast randomized into five matched groups were included in this study.The occurrence of seroma was high with the advance of the age, with hypertension, diabetes, obesity and when radial skin incision was used. Shoulder immobilization either alone or with tranexamic acid administration pre and postoperative gave the least incidence of seroma formation [10% and zero respectively] in spite of highest reversible shoulder stiffness [15% and 10% respectively]. Closure of the axillary fossa and fixation of the skin flaps to underlying muscles also, gave good result [15%] but still inferior to shoulder immobilization.The result of use of tranexamic acid alone [20%] and the use of suction drain and compression over skin flaps" traditionally used method "still have a high incidence of postmastectomy seroma [30%]. Post mastectomy seroma rarely causes a serious problem, but can lead to more morbid sequelae as delayed wound healing "thereby delaying further therapy for carcinoma if required ", wound flap necrosis, infection and lymphedema

Role of interleukin-10 as an immuno modulatory cytokine in rheumatoid arthritis

Interleukin-10 [IL-10] levels were measured by specific enzyme linked immunosorbent assay in the serum of rheumatoid arthritis [RA] [n = 52 patients] and in a group of control subjects, including carefully matched 20 healthy volunteers and another 20 patients with osteoarthritis [O A]. IL-10 levles were also, measured in synovial fluid [SF] spicements extracted from 20 patients within the RA group and from all patients within the OA group. From the results obtained it was concluded that IL-10 production is increased in RA with highest values in the more severe cases. It may play a role in B-lymphocyte hyperactivity with subsequent increase in RF and autoantibody production in RA

Pain relief after haemorrhoidectomy; evaluation of a new simple technique

This study included 120 patients with 2nd, 3rd, or 4th degree piles. They were divided into 4 equal groups A, B, C and D. Hemorrhoidectomy by excision and ligation was done for all of them, and for groups C and D internal sphincterotomy was also done. Intermitent perfusion of the anal canal with bupivacaine 0.5% was done for groups B and D after the operation. Postoperative pain was assessed according to the amount of analgesics needed by the patients. It was found that analgesic requirment was more or less similar in groups B and C, while it was significantly less in each of them compared to group A [P <0.01]. The reduction of analgesia was highly significant in group D compared to group A [P <0.001]. Postoperative retention of urine was found to be significantly less in group D than in group A which reflects the marked relief of pain offered to the patients by doing internal sphincterotomy together with perfusion of the ana canal with bupivacaine. So, it was recommended that the addition of these two procedures to the classical hemorrhoidectomy in order to reduce the posthemorrhoiectomy pain

Bone activity under the influence of estrogen replacement alone and with testosterone in ovariectomized rats

Replacement therapy with estrogen alone or in combination with testosterone was studied in ovariectomized rats. Bone activity was estimated by serum alkaline phosphatase, calcium and parathyroid hormone and urinary excretion of calcium. It was found that estrogen replacement resulted in considerable fall in serum calcium [14-18%], alkaline phosphatase [20-25%] and urinary calcium/creatinine ratio [28-34%]. Administration of estrogen combined with testosterone resulted in more decrease in all of these values. Parathyroid hormone returned to normal serum level after estrogen therapy and significantly increased more than normal levels after the combined therapy. These results proved that replacement therapy with estrogen in combination with testosterone is more effective than estrogen alone in treating osteoporosis after oophorectomy

Peritoneal lavage in acute peritonitis

This study was carried out on 60 patients presented by generalized peritonitis. After doing exploratory laparotomy and removal of the discharge by suction and dealing with the cause of peritonitis, the peritoneal cavity was cleaned using wet towels in 20 patients [dry toilet] and peritoneal lavage was done with normal saline for 20 patients and with 1% povidone iodine [PI] in 20 patients. Follow up was done for all the patients during their hospital stay with special reference to the number of daily dressings of the wound according to the amount of discharge, condition of wound healing and its complications, residual intra-abdominal abscesses and mortality in each group. We found better results in the group of saline lavage in the form of better healing of the wound, no residual abscesses and shorter hospital stay. So we recommend the use of normal saline in peritoneal lavage for acute peritonitis

Diabetes mellitus among a group of farmers in Sharkia Governorate: an epidemiological study

To study the magnitude, trends and determinant factors of diabetes mellitus [D.M] in a rural area, this study was carried out upon 500 farmers, selected randomly from a village in Sharkia Governorate during the year 1990. For detection of diabetic cases, an examination protocol was used which include: personal interview, medical examinations and determination of glucose in urine and capillary blood by using simple methods suitable for field screening. The main findings of this study were as follows: the prevalence of D.M. was 3.4% [4.14% males and 2.71% femals]. D.M. was more prevalent among age group > 30 years [765%] and among obese than non obese subjects [8.33% vs 1.23%]. 28.6% of diabetic persons reported a history of bilharzial infestation, while 14.3% had previous viral infection. In view of these results, mass screening for detection of missed diabetic cases in various sectors of population should be done in an out reach health programmes. Further studies should be devoted to investigate the role of bilharzial infestation and other infection in development of diabetes in susceptible subjects, and to study the impact of agricultural total environment upon D.M. as a multifactorial disease