Follow-up study of bone mineral density and C-terminal telopeptide marker as predicators of fracture risk

Osteoporosis is a major health problem in many countries. Osteoporotic fractures are the main consequence of osteoporosis. Our aim was to identify the usefulness of bone mineral density and C-terminal telopeptide of type 1 collagen as predictors of fracture risk. We evaluated both BMD and serum carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen [ICTP] in 212 subjects recruited from the community. This included healthy postmenopausal women and males over 60 years. Subjects were followed up for the occurrence of fractures jar one year. X-ray radio graphs of thoracic and lumber regions were done to detect silent vertebral fractures at baseline, and at the end of 1 year. Male gender was associated with a higher level of serum ICTP. BMD was insignificantly higher in males compared with females. Age, weight, BMI were significantly correlated with BMD. Age was significantly correlated with ICTP levels. BMD proved to be a strong predictor of incident fracture specially vertebral and hip fractures. Serum levels of ICTP were also predictors of incident fracture and this observation was more evident in females compared to males. Advancing age and low weight were predictors of increased incidence of fractures. Coffee was found to increases bone resorption, accordingly has a detrimental effect on bone strength. Other caffeine containing beverages [tea, cola] were not fond to have a significant effect on bone resorption

Ultrasonographic assessment of intracranial hemodynamics in acute stroke patients

Transcranial ultrasound [TU] is a noninvasive, easy-to-repeat diagnostic technique that is being used widely for the evaluation of cerebral heamodynamic. The aim of the study was to explore and demonstrate the findings that can be afforded by the Transcranial ultrasonography, the non imaging Transcranial Doppler sonography [TCD] and the imaging Transcranial color-coded Doppler sonography [TCCS], with more emphasis on the practical work of the TCCS. During a period of one academic year from October 2005 to October 2006, 50 non consecutive patients, seen at the stroke clinics of two medical institutions, were enrolled in the study. They were divided into two groups. The 1st group comprised of 25 patients recruited from Ain Shams specialized hospital who had TCD. The 2nd group comprised of another 25 patients recruited from Cairo University Hospital who had TCCS. Extra cranial Carotid Duplex had been done for both groups. In the two groups, the effect of the supplying artery on the insonated intracranial arteries was put in consideration whenever TCD or TCCS was done. Out of the 50 patients, 40 [80%] were successfully insonated yet in 10 [20%] patients, insonation through the temporal acoustic window failed; of which 6 [60%] were females and 4 [40%] were males. We found 11 [14%] MCAs which revealed abnormal waveform patterns [10 dampened and 1 blunted], reversal of flow in the ACA was noticed in three cases and a dampened waveform pattern in 12 PCAs. Regarding intracranial arterial stenosis, it was detected in 21 arteries [13 MCAs, 2 ACAs, 6 PCAs], 16 showed < 50% stenosis [9 MCAs, 2 ACAs, 5 PCAs] and 5 showed >/= 50% stenosis [4 MCAs, I PCAs]. We recommend that acute stroke patient, must perform a baseline TCU which, provide a hemodynamic intracranial image to what is present extracranially, Repeated examination can be achieved by TCU to serially monitor the therapeutic or spontaneous recanalization

Detection of vertebral fractures versus bone mineral density in early ankylosing spondylitis

To determine bone mineral density [BMD] in patients with mild ankylosing spondylitis [AS], to establish the prevalence of vertebral fractures and fracture risk in these patients, and to determine the relationship between BMD and vertebral fractures. Twenty patients were compared with five healthy subjects were included in the study as a control group. Bone mineral density [BMD] was evaluated at the lumbar spine, forearm and femoral neck by dual X-ray absorptiometry [DXA] and A clinical index of disease activity [BASDAI; Bath Ankylosing Spondylitis Activity Index] was also evaluated and plain radiographs of the thoracic and lumbar spine were obtained in all subjects. In patients with AS, BMD was reduced in both the lumbar spine T score -1.0700 +/- 1.9572] and femoral neck [T score -1.3850 +/- 1.2999] and forearm [T score-.9150 +/- 7969] There was no correlation between BMD of the lumbar spine, forearm or femoral neck and duration of disease in patients with AS. four of 20 [20%] patients with AS had a vertebral fracture. Patients with AS with fractures were not significantly older [mean age 34.0 +/- 2.120P=0.301], but had significantly longer disease duration [7.4500 +/- 1.1459, P<0.05] than patients without fractures. No significant correlation between indices of disease activity [ESR and BASDAI] and vertebral fractures in patients with AS. No significant correlation was observed between BMD of the lumbar spine, forearm or femoral neck and vertebral fractures in patients with AS. In addition, there was no significant difference in the lumbar spine, forearm or femoral neck BMD in AS patients with fractures compared with those without. Osteopenia of spine, forearm and femur and vertebral fractures are a feature of mild AS. However, there was no correlation between BMD and vertebral fractures in these patients. AS patients with mild disease had a higher risk of fractures compared with the normal population and this increased with the duration of disease

Distraction osteogenesis and orthognathic surgery in the treatment of bilateral temporomandibular joint ankylosis

Bilateral temporomandibular joint TMJ ankylosis during the active growth period presents with a conglomerate of clinical features namely severe micrognathia, inability to open the mouth and upper airway obstruction. Early treatment is recommended to avoid the secondary affection of the maxilla and midface. Six patients with bilateral TMJ ankylosis were included in this study. They were divided equally into two groups. The standard treatment was followed in group I which consisted of the release of ankylosis as a primary procedure. After an appropriate period of physiotherapy, mandibular osteotomy with iliac bone grafts and advancement genioplasty was performed in the mandible and Le Fort I osteotomy in the maxilla to correct maxillary canting. As for the cases in group II, mandibular advancement by means of distraction osteogenesis were carried out first by means of two extraoral multi-guide distractors fixed bilaterally to the mandible followed by the release of ankylosis. Evaluation included clinical examination, photography and radiographic analysis [orthopantomogram, lateral and posteroanterior cephalometry]. The distraction gap was assessed by means of ultrasonography and ultrasonometry. Dexa was used in one case. The advantages of both procedures are discussed

Comparative study of misoprostol versus dinoprostone in cervical ripening and labour induction

The aim of this study was to compare the safety and efficacy of intravaginal administered misoprostol [cytotec] versus dinoprostone pessary [prostin E2] for cervical ripening and labor induction. Sixty patients requiring induction of labor for different medical or obstetrical indications were included in this study. The misoprostol group had a significant reduction in median induction delivery time compared to dinoprostone group. There was a reduced need for the oxytocin augmentation and there was no significant difference in the mode of delivery. There were no adverse neonatal outcomes associated with the use of misoprostol. It was concluded that 100 mug vaginal misoprostol was a more effective induction agent than 3 mg dinoprostone vaginal pessary

Hemostatic suturing technique for uterine bleeding in post-partum hemorrhage

The objective of this study was to assess the efficacy of multiple square suturing technique as a conservative surgical intervention in the management of postpartum hemorrhage. This technique was used in 20 patients with postpartum hemorrhage who did not respond to the conservative management. In 18 cases, bleeding decreased markedly and hysterectomy was avoided. Hemostatic multiple square suturing was an easy, safe conservative surgical technique alternative to hysterectomy for treating uncontrollable postpartum hemorrhage

Enhanced fracture healing with pulsed electromagnetic field

Our study was designed to examine the effect of pulsed electromagnetic field [PEMF], capacitative technique, on the healing of fractures at different stages. Forty-four patients were included in the study. They were divided into three groups. The first group comprised twenty-three patients who were subjected to PEMF after application of plaster cast [early treatment group]. The second included six patients who received PEMF after removal of the cast at 8 weeks [late treatment group]. The third group comprised fifteen patients who were only treated with fixation in plaster cast and served as a control group. The three groups were investigated using cross-sectional osteocalcin level at the start and at 8 and 12 weeks. Plain x-rays were done every 2 weeks and bone mineral density [BMD] was assessed with the quantitative CT of periosteal callus and expressed as F [fracture] / N [normal]% at 8 and 12 weeks. Laboratory and radiological data were statistically analyzed. We concluded that PEMF accelerates bone healing as there was a statistically significant difference in osteocalcin level between early treated patients and controls at 8 weeks and a highly significant difference at 12 weeks for patients who continued treatment. Late treatment patients were found to have increased osteocalcin level too. Radiological results confirmed the laboratory results for the positive effect of PEMF on bone healing. We recommend the use of PEMF for enhancement of fracture healing in cases of delayed union and in old age

Endothelin-1 plasma level in children with chronic liver disease: Impact on renal hemodynamics and portal hypertension

The plasma level and pathophysiologic consequences of endothelin-1 [ET1], a potent vasoconstrictor with preferential action on renal vessels, have been investigated in 40 children with chronic liver disease [CLD] [27 males and 13 females; mean age = 8.62 +/- 4.04 years] and 15 sex and age matched clinically healthy children [9 males and 4 females; mean age = 8 +/- 4.17 years]. The children with CLD were divided into 3 subgroups : subgroup I [n = 13] had chronic hepatitis [CH], subgroup II [n = 13] had cirrhosis without ascites and subgroup III [n = 14] had cirrhosis and ascites. The cirrhotic children [n = 27] included 17 children in Child's A class and 10 children in Child's B + C class. Besides routine liver and renal function tests, serum electrolytes as well as a doppler duplex study of the portal vein and the arcuate arteries of both kidneys at the level of the corticomedullary junction, were done to all candidates of the study. The resistive index of renal vessels was calculated. ET-1 level was found to be significantly elevated in all groups of children with CLD. The highest level was in children of subgroup III [x = 4.26 +/- 2.12 ng/ml] followed by those in subgroup II [x = 1.49 +/- 0.61 ng/ml] and lastly came children with CH ie. subgroup I [x = 1.01 +/- 0.46 ng/ml].Children with Child's B+C cirrhosis had a significantly higher level [4.62 +/- 2.4 ng/ml] than those with Child's A cirrhosis [1.93 +/- 1.04 ng/ml]. Serum albumin had a significant negative correlation with ET-1 [r = 0.64] ET-1 level showed a significant negative correlation with serum sodium [r = 0.4]. It correlated positively with portal hypertension as indicated by a positive correlation with portal vein diameter [r = 0.48] and a negative correlation with portal vein flow velocity [r = 0.35]. The resistive index was significantly higher in patients with CLD compared to controls. It showed a significant positive correlation ET-1 [r = 0.49]. Thus, ET-l is elevated in patients with CLD; its elevation being related to the severity of liver disease. It could be involved in the pathophysiology of the hyponatraemia portal hypertension and disturbed renal hemodynamics seen in children with CLD

Balloon dilatation of cradiac achalasia in children

Surgical treatment of cardiac achalasia in children is still the main line of treatment with a success rate of 70-80%. Balloon dilatation is less widely used due to inappropriate size of balloons. The authors report their experience in 11 children with cardiac achalasia over the last 3 years using balloon dilatation as the first line of treatment. There were 8 boys and 3 girls -with ages ranging from 1.5-14 years [average 7.5 years]. One family presented to us [brother and sister] but with no glucocorticoid deficiency or other anomalies, one patient had mental retardation otherwise the rest had no associated anomalies.All Patients presented with vomiting, 7 with dysphagia, 6 with loss of weight, 5 with recurrent chest infection and 2 with retrostenal pain. Radiological diagnosis was accurate in all patients, endoscopy with biopsy were done to confirm diagnosis and exclude other pathology, manometry was confirmative in 4 patients. Dilatation was done under fluoroscopic control, balloons were used over a guide wire [balloon size were 18-35 mm]. Seven patients had 2 sessions and 4 had 3 sessions with radiological follow up after the second dilatation. Follow up ranged from 6 months to 3 years: excellent results were achieved in 8 pateints [72.7%] with disappearance of symptoms and marked radiological improvment, 2 still have mild symptoms with over all success of [90.9%] one has mild gastroesphageal reflux controlled medically and one has mild dysphagia but better than before dilatation. One pateint had recurrent dysphagia necessitating cardiomyotomy [9.1%]. Results were not related to age and sex. the authors recommend balloon dilatation in children with achalasia as the first line if not the definitive line of treatment

role of colour doppler imaging in follow up of choroidal malignant melanoms

We evaluated the blood flow in nine cases of choroidal malignant melanoma before and after radiotherapy using colour doppler imaging. Tumoral blood flow was detected in all cases prior to treatment. Significant flow reduction was noted as early as the first post-irradiation month. Tumour regression occurred in four cases and was preceeded by slowing or complete cessation of tumor circulation in all cases. On the other hand, 3 recurrences occurred and were preceeded by or accompanied with increase in Doppler velocities in tumolur vessels

M-Mode echocardiography versus ECG and chest X ray in evaluating hypertensive cardiac changes and their response to treatment

Arterial hypertension is a very common disease in Egyptians. The left ventricle response to the chronic pressure overload by myocardial hypertrophy. The aim of this study was to evaluate the sensitivity of various diagnostic modalities in detecting this hypertrophy. Also the detect the response of myocardium to antihypertensive therapy. 75 patients were studied by M-mode echo-cardiography, chest X-ray and E.C.G. before and after treatment. The results proved that M-mode echocardiography is more sensitive than chest X-ray or E.C.G. in assessment of ventricular hypertrophy and in the follow-up response to therapy

Shock-wave lithotripsy for gall-stones

Sixty-two patients with gall-bladder stones, were treated by extracorporeal shock wave lithotripsy [ESWL]. A total of 3500 shock wave discharges were delivered to the patient in each treatment session. In 69% of cases, fragmentation was not satisfactory and a second ESWL session was given after 2 days. All patients received adjuvant litholytic therapy with bile acids to dissolve remaining stone fragments. Complete disappearance of stones within 12 months after lithotripsy was obtained in 82% of patients with two or three stones. Twenty-three% of patients suffered one or more attacks of biliary colic after treatment and 18% wave entry. Seven% of patients developed gall-stones after complete disappearance of the original stones and discontinuing adjuvant dissolution therapy. Cholecystectomy was required for 19% of patients in whom fragmentation was not satisfactory. The preliminary results indicate that ESWL is a promising therapeutic alternative in selected cases of symptomatic gall-bladder