Recurrence after laser assisted uvulopalatoplasty [LAUP], long-term study

Laser assisted uvulopalatoplasty is a well established operation for treatment of snoring and mild obstructive sleep apnea with good results on short term basis. However, long term follow-up studies, in addition to their scarcity, had conflicting results regarding the percentage of recurrences and the change of snoring quality. This is a long term retrospective follow up study conducted on 676 patients operated upon by laser assisted uvulopalatoplasty as an office based procedure in National Institute of Laser Enhanced Sciences, Cairo university. A specially designed questionnaire was used to ask the patients about the quality of snoring regarding its severity, relation to sleeping position and loudness and all was expressed using visual analogue score. The patients were asked for weight and neck circumference. The patients were evaluated preoperatively, 6 weeks postoperatively and on long term follow-up [mean 59 months]. After the initial improvement 6 weeks postoperatively, on long term evaluation, 64.5% had reported recurrence, however, the recurrence showed marked improvement in snoring quality subjectively in the three criteria examined. In conclusion, laser assisted uvulopalatoplasty is a good operation for snoring but with long term recurrence, which can be explained by the gain of extra weight

Laser assisted turbinate reduction [LATR] comparative study

One of the major causes of chronic nasal airway obstruction is the inferior turbinate hypertrophy. There is no agreement on how to deal with this problem. Surgical treatment of nasal turbinates has been indicated when medical treatment fails. Laser surgery of inferior turbinate was first described in 1977 by Lenz et al. Laser surgery of inferior turbinates can be performed as an outpatient procedure under local anesthesia. Due to a minimally invasive and controllable coagulation and ablation of soft tissue, almost no considerable complications or bleeding were observed during the operation or postoperatively, therefore no need for nasal pack. The aim of the present work is to prove the efficacy of laser-assisted turbinate reduction [LATR] and to compare between different types of lasers with different techniques in this respect. Sixty patients with irreversible turbinate hypertrophy were selected and divided into four groups; each included 15 patients: Group 1: Turbinate Reduction using CO[2] laser [Non- contact technique]. Group 2: Turbinate Reduction using Diode laser [Contact technique]. Group 3: Turbinate Reduction using KTP laser [Interstitial technique]. Group 4: Turbinate Reduction using Nd: YAG laser [Interstitial technique]. All patients were operated upon in the National Institute of Laser Enhanced Sciences [NILES] in the period between 2001 and 2004. The results of obstruction were good and satisfactory for all types of lasers until the 6th month postoperatively, after which the results became less impressive with increasing recurrence rate. Two years postoperatively, YAG cases had the lowest recurrence rate [20%], then both KTP and Diode cases [26.6%], and finally the CO[2] cases that had the highest recurrence rate [about 40%]. It was concluded that LATR is a good short-term alternative procedure for turbinate reduction. It is rapid safe procedure, with minimal pain and bleeding, easy done under local anesthesia as an outpatient procedure, no need for nasal packing in most cases with minimal mucosal damage specially in the interstitial technique that leaves intact mucosa. It is recommended particularly for non- allergic patients as multiple sessions to achieve relatively long-term result. On the other hand, in allergic patients the allergic manifestations alleviated to some extent but with short-term effect

Nerve welding using CO[2] laser: an experimental study

The ultimate goal of any peripheral nerve repair is maximum sensory and motor recovery of the distal denervated part. Conventional suture repair may result in neuroma formation and a fibrotic reaction that is detrimental to nerve regeneration. Further studies concerning laser and its effect on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis. In the field of otorhinolaryngology, facial nerve anastomosis, particularly in difficult-to-reach sites, may need such a non-contact sutureless laser technique to overcome the difficulties of other conventional methods. The aim of this work is to assess the effect of CO[2] laser as a tool for sciatic nerve welding in rats [with and without solder] and comparing it with the conventional suture repair. Sixty rats were used in this study classifying into 5 Groups: Group A: 12 rats for laser nerve welding without solder. Group B: 12 rats for laser nerve welding with solder. Group C: 12 rats for nerve anastomosis with sutures. Group D: 12 rats for delayed laser nerve welding without solder [one week after cut]. Group E: 12 rats for delayed laser nerve welding without solder [two week after cut]. After follow-up period of 8 weeks the rats of each group were assessed physically for functional recovery [motor and sensory], elecrtophysiologically for nerve conduction and histopathologically for morphological study of nerve fibers. It was found that no significant difference between laser groups and suture group regarding physical, electrophysiological and histopathological results. Only the dehiscence rate was higher in laser groups than in suture group. The soldered laser group was the least one concerning dehiscence. It is concluded that CO[2] laser -assisted nerve welding is as effective as microsuturing technique, but easier, less tedious, less time consuming and easy to reach difficult areas

New concept in histopathological grading and staging of chronic hepatitis C infection at Sharkia Governorate, Egypt

In this study, the Knodell histology activity index and the semi- quantitative reproducible description of the various morphological lesions of chronic hepatitis were applied on 109 liver biopsies taken from Egyptian patients infected with hepatitis C virus [HCV]. It was found that the presented histopathological features may be unusual for any of the known scoring systems. Therefore, a new system was suggested for grading and staging of liver diseases in Egyptian patients infected with HCV. Accordingly, the degrees of necro- inflammations are classified into 3 grades [1-3] and the progression of fibrosis is classified into 3 stages [1-3]. The reduced numbers of grades and stages proposed in this study may be attributed to the rapid course among Egyptians who differ in the environmental circumstances

Molecular cytogntic profiles of hepatitis C infection in patients at Sharkia Governorate, Egypt

In this study, 40 paraffin blocks liver tissues from HCV-PCR positive patients [HBV seronegative] were examined using DNA image cytometry to evaluate its role in diagnosing hepatocellular carcinoma [HCC] associated with hepatitis C virus [HCV] infection. Fluorescent in situ hybridization [FISH] technique using LSIZNF 217 chromosome 20q 13.2 probe was applied. The results showed a high percentage of S- phase fraction in cases of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA aneuploidy with a severe amplification of chromosome 20q 13.2. Consequently, DNA imaging cytometry is considered a good approach in differentiating dysplasia from well- differentiated HCC on the top of HCV infection. In conclusion, HCV has an acquired role in the development of HCC through the amplification of the aggressive tumor behavior oncogene LSIZNF 217 at chromosome 20q 13.2

Haematologial manifestations in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate the hematological manifestations occurring in patients suffering from chronic hepatitis C virus [HCV] infection. Positive HCV-RNA cases [109] were subjected to complete blood count [CBC], prothrombin time [PT], partial thromboplastin time [PTT], bleeding time [BT], coagulation time [CT], detection of fibrinogen degradation products [FDPs], measurement of plasma alpha- antitrypsin [AAT], then bone marrow [BM] aspiration and examination for 20 cases. The patients were classified into three groups according to the histopathological staging and grading of liver biopsy. The comparison between groups according to histopathological grading and staging for hematological and chemical parameters revealed a significant statistical difference in platelets count, S albumin, ALT and AST levels. The comparison between groups according to histopathological grading and staging for coagulation profile, AAT level and FDPs revealed a significant statistical difference between all parameters. Bone marrow aspiration and examination revealed mild hypocellularity with an increased number of lymphocytes and a relevance of plasmacytoid-lymphocytes

Autoantibodies in HCV infected patients at Sharkia Governerate, Egypt

The aim of this study was to evaluate some immunological manifestations in chronic hepatitis C patients and to find out its relationship with liver pathology. The study included 109 positive HCV-RNA patients classified according to liver histopathology into three groups: Group I included 22 patients [G1S1], group II included 67 patients [G2S2] and group III included 20 patients [G3S3], where G = the degree of necro-inflammatory process and S = the stage of liver fibrosis. All patients were investigated for the presence of cryoglobulin, antineutrophil cytoplasmic [ANCA], anti-liver kidney microsomes [LKM], anti-double stranded DNA, [ds-DNA], anti-nuclear [ANA], anti-mitochondrial [AMA] and anti-smooth muscle [ASMA] autoantibodies. The high prevalence of autoantibodies in chronic HCV patients suggests that HCV may trigger an autoimmune reaction, but most probably do not indicate a distinct autoimmune mechanism. Cryoglobulins and ANCA may be considered as useful prognostic indicator for the increased risk of cirrhosis in chronic HCV patients. Follow up studies were recommended

HCV and associated concomitant infections at Sharkia Governorate Egypt

This study was performed on 109 cases divided into 6 groups according to the concomitant infection with hepatitis C virus [HCV]. The results proved that groups 1, 3 and 5 had a higher level of viremia than the other groups and a higher risk was found in these groups, as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The study concluded that these factors play an important role in the progression of HCV infection. The death of the patients of this progressive condition occurs in younger age and due to liver failure more than to HCC

Non-invasive markers and predictors of severity of hepatic fibrosis in HCV patients at Sharkia Governorate, Egypt

This study included 109 patients with detectable hepatitis C virus [HCV] by real time PCR. The patients were classified into three different pathological stages and grades according to the new concept of histopathological staging and grading. The different clinical, biochemical, virological and ultrasonographic parameters were assessed and analyzed and the variables that showed a significant association with the histopathological staging and grading were included in the multivariate logistic regression analysis. The regression model revealed that platelet count, matrix metalloproteinase-9 [MMP-9], portal vein diameter, splenic longitudinal axis, alanine transaminase, aspartate transaminase and viral load added a significance to the model in a decreasing order of significance. From these findings, a new score ranged from 0-9 was generated. The score model was applied to the patients to assess its validity, where it proved to be accurate in discriminating patients with mild inflammation and fibrosis [sensitivity 81.8%, specificity 80.5% and accuracy 80.7%] and more accurate in detecting patients with cirrhosis [specificity 96.6%, sensitivity 80% and accuracy 93.6%], but less accurate in detecting patients with moderate to severe fibrosis [specificity 66.7%, sensitivity 68.7% and accuracy 67.9%]. Also, the results revealed that co-infection with schistosomiasis, old age >/45 years and positive history of blood transfusion as a source of infection were significantly associated with severe hepatic pathology

role of aflatoxin-contaminated food materials and HCV in developing hepatocellular carcinoma in Al-Sharkia Governorate, Egypt

In this study, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique revealed that corn, wheat, peanut, lupine "tennis", white rice, cowpea "lobiya", fava bean and brown rice showed a prevalence of AFB1 [64.7%, 53%, 53%, 47%, 47%, 41%, 29.4% and 29.4%, respectively]. A positive correlation was found between aflatoxin and positive HCV- PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV- infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products