Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study

Background: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding. Patients and Methods: A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay. Results: Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay. Conclusion: The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Objective: The objective of this study was to compare the suitability (efficacy and safety) of dexmedetomidine versus propofol for patients admitted to the intensive care unit (ICU) after the cardiovascular surgery for the postoperative sedation before weaning from mechanical ventilation. Background: Sedation is prescribed in patients admitted to the ICU after cardiovascular surgery to reduce the patient discomfort, ventilator asynchrony, to make mechanical ventilation tolerable, prevent accidental device removal, and to reduce metabolic demands during respiratory and hemodynamic instability. Careful drug selection for sedation by the ICU team, postcardiovascular surgery should be done so that patients can be easily weaned from mechanical ventilation after sedation is stopped to achieve a shorter duration of mechanical ventilation and decreased the length of stay in ICU. Methods: A total of 50 patients admitted to the ICU after cardiovascular surgery, aged from 18 to 55 years and requiring mechanical ventilation on arrival to the ICU were enrolled in a prospective and comparative study. They were randomly divided into two groups as follows: Group D patients (n = 25) received dexmedetomidine in a maintenance infusion dose of 0.8 μg/kg/h and Group P patients (n = 25) received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The patients were assessed for 12 h postoperatively, and dosing of the study drug was adjusted based on sedation assessment performed with the Richmond Agitation-Sedation Scale (RASS). The patients were required to be within the RASS target range of −2 to +1 at the time of study drug initiation. At every 4 h, the following information was recorded from each patient such as heart rate (HR), mean arterial pressure (MAP), arterial blood gases (ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure, respiratory rate and the rapid shallow breathing index, duration of mechanical ventilation, midazolam and fentanyl dose requirements, and financial costs. Results: The study results showed no statistically significant difference between both groups with regard to age and body mass index. Group P patients were more associated with lower MAP and HR than Group D patients. There was no statistically significant difference between groups with regard to ABG findings, oxygenation, ventilation, and respiratory parameters. There was significant difference between both the groups in midazolam and fentanyl dose requirement and financial costs with a value of P < 0.05. Conclusion: Dexmedetomidine is safer and equally effective agent for the sedation of mechanically ventilated patients admitted to the ICU after cardiovascular surgery compared to the patients receiving propofol, with good hemodynamic stability, and equally rapid extubation time.

Case Report: Suprachoroidal Catheterization “ab-interno” for Treatment of Open Angle Glaucoma: “BABLY TECHNIQUE”.

A cataractous and open angle glaucomatous right eye of a 60 year old man was surgically treated in a different way. First, phacoemulsification with posterior chamber intraocular lens was done, then, under gonioscopy, I track, I science microcatheter was introduced in the suprachoroidal space and heavy viscoelastic was injected. Preoperatively, intra ocular pressure was 28 mmHg on three topical medications, Travatan, Cosopt and Alphagan. One month postoperatively, IOP was reduced to 16 mmHg without medications. Suprachoroidal catheterization is a safe, easy and effective technique in treatment of open angle glaucoma. Studies with long-term follow up are needed to assess efficacy and safety of the procedure. Suprachoroidal catheterization should be tried in different types of glaucoma.

Histological and biochemical evaluation of the effects of some antioxidants on aged testes

Different studies have demonstrated that aging clearly affects male fertility which may be attributed to the androgen deficiency. Reactive oxygen species play a central role in the pathophysiology in the aged-related decrease in male fertility. Some antioxidants have ameliorative effects on different aged organs. The present study aimed to evaluate the effects of some antioxidants on aged testes. Ten adult and fifty aged male albino rats [Rattus albus] were divided into six groups. Group I [control adult], Group II [control aged], Group III [Vitamin E-treated aged], Group IV [Vitamin C-treated aged], Group V [Zinc sulphate-treated aged], Group VI [Vitamin E-, Vitamin C-and Zinc Sulphate-treated aged]. Vitamin E, Vitamin C and Zinc were administrated in doses 2.52 mg, 3.15 mg and 0.693 mg, respectively. Histological and ultrastructural evaluation of the testes were examined as well as Follicle stimulating hormone [FSH], Luteinizing hormone [LH], total and free testosterone levels in the serum were measured. Counting the number of litters per animal and the teratogenic effects was noticed. Giving zinc alone or combined with other antioxidants gave better ameliorative effects on the testicular structure and hormonal levels in the serum. No teratogenic effects of the aged animals`offspring were noticed

Infusion of low-dose vasopressin improves left ventricular function during separation from cardiopulmonary bypass: A double-blind randomized study.

We aimed to investigate whether low-dose vasopressin administered to patients undergoing coronary artery bypass grafting (CABG) surgery with preexisting mild to moderate systolic dysfunction can produce sustained improvement in cardiac function. This double-blind randomized study was conducted in a hospital where a single anesthetic and surgical team performed elective CABG. Twenty patients aged 32-61 years who underwent elective CABG between January 2007 and December 2007 were enrolled in this study. The patients randomly received either vasopressin 0.03 IU/min (Group A) or normal saline (Group B) in equal volume for 60 min after cardiopulmonary bypass (CPB). The cardiac output, cardiac index, stroke volume index, fractional area of contraction and systemic vascular resistance index were significantly higher in Group A than in Group B. Adrenaline (mean dose: 0.06 μg/kg•min-1) was required in seven patients from Group B but in none of the Group A patients on initial separation from CPB (P< 0.05). Of the 10 patients in Group B, five required phenylepherine to maintain the mean arterial pressure (MAP) >65 mmHg, whereas none of the Group A patients required phenylephrine for MAP regulation (P< 0.05). We conclude that Infusion of low-dose vasopressin for patients with mild to moderate left ventricular systolic dysfunction during separation from CPB is beneficial for the postoperative hemodynamic profile, reduces the catecholamine doses required and improves left ventricular systolic function.

effects of different nutritional supplements on experimentally induced osteoporosis in male albino rats: a scanning electron microscopic study

Osteoporosis is one of the major health problems afflicting our modern world, especially disuse osteoporosis. Reduction of mechanical stresses on bone could lead to osteoporosis. To study the role of Ca and vitamins D and K on the prevention of immobilization osteoporosis. The study included 30 adult male albino rats, They were divided into three groups. Group I [the control group] and group II were immobilized by casting their right lower limb for 4 weeks. Group III [the immobilization group that concomitantly received a dietary supplement] was further subdivided into four subgroups; subgroup IIIa was given Ca citrate, subgroup IIIb was given vitamin D [alfacalcidol], subgroup IIIc was given Ca and vitamin D, and subgroup IIId was given vitamin K during the same period of immobilization. The distal ends of the femur of the immobilized limb were taken, processed, and examined using scanning electron microscopy. Morphometric studies were carried out. The results showed significant thinning of both compact and cancellous bone on immobilization. Multiple cavities and cracks and widening of the Haversian canal were detected in the compact bone. Thin irregular spike-like bone traveculae and fracture were also seen in the cancellous bone trabeculae. Administration of either Ca [subgroup IIIa] or vitamin D [subgroup IIIb] with immobilization did not improve most of the previous results. Combined administration of both Ca and vitamin D [subgroup IIIc] improved cortical bone thickness but not the thickness of cancellous bone. Administration of vitamin K [subgroup IIId] with immobilization resulted in extensive branching and anastomosing bone trabeculae in the metaphysic. For the period of this experiment, vitamin K proved to be more effective as a protective agent compared with combined Ca and vitamin D administration in cases of immobilization osteoporosis

Comparative study on the effect of vitamin K versus combined Ca and vitamin D administration on the prevention of experimentally-induced osteoporosis in adult male albino rats

Immobilization is one of the important causes of osteoporosis especially after cast application and in the elderly people who might be bedridden or suffering from joint diseases. To compare between the effects of vitamin K and the combined use of Ca and vitamin D on the prevention of experimentally-induced osteoporosis of the femur. This study included 24 adult male albino rats. They were divided into four groups: group 1 [control group], group 2 [immobilization group that were immobilized by casting of their right lower limb for 4 weeks], group 3 [immobilization group that concomitantly received 0.0009 mg/g body weight of vitamin K daily during the casting period], and group 4 [that was given Ca [0.09 mg/g body weight daily] and vitamin D [0.5 micro g/kg alfacalcidol daily] during the casting period]. At the end of the experiment, the distal end of the femur of the immobilized limb was taken, processed, and examined by different histological techniques. A morphometric study was conducted to measure cancellous bone thickness, osteoid thickness, osteoid surface percentage, and the eroded surface percentage. The data were statistically analyzed. It was observed that immobilization caused marked thinning of the cancellous bone trabeculae. Erosion cavities were frequently seen in both compact and cancellous bones. Increased mean eroded surface percentage and decreased mean osteoid thickness and mean osteoid surface percentage were also noticed with immobilization when compared with the control group. Concomitant administration of vitamin K with casting resulted in significant improvement of most of the above-mentioned bone parameters. With combined administration of Ca and vitamin D with immobilization, erosion cavities were still seen in a few areas. Decreased mean cancellous bone thickness was also noticed when compared with groups 1 and 3. According to the results of this experiment, vitamin K proved to be more effective, as a protective agent, than combined Ca and vitamin D administration in cases of immobilization osteoporosis. Level of evidence Level three in vitro [prospective case-control study in vitro]

Hepatitis B and C viruses: clearance and persistence

The aim of this review is to highlight the immunologic and virologic aspects of hepatitis B virus [HBV]/ hepatitis C virus [HCV] infections. Although, antibodies and cell mediated immunity play important roles in the clearance of both viral infections, the elimination of acute virus infected cells is the function of CD8+ cytotoxic T lymphocytes. Different viral evasion strategies are involved in HBV/HCV persistence within an infected host

Effect of temporary submandibular duct-ligation on the myoepithelial cells in albino rat. A light and electron microscopic studies

The duct of the right submandibular gland was doubly ligated with metal clips to study the effects of duct ligation and ligature removal in albino rat submandibular gland to elucidate the relationship between duct ligation and removal of the ligature and to determine whether proliferation of myoepithelial cells occur in atrophic rat submandibular glands. Twenty adult male albino rats were used in this study. Rats were divided randomly into 3 main groups: a submandibular gland atrophy group [Ligated Group] in which the right main submandibular duct was ligated for 1, 2 and 4 weeks; a recovery group in which duct ligation was in place for 2 weeks and then removed and the rats were sacrificed after 2 weeks and the 3rd group was not subjected to operation and used as control group. At the assigned date, the animals were sacrificed. The right submandibular glands were thoroughly-dissected and removed. Specimens of the gland were cut at 6-8 micro m thickness and stained with haematoxylin and eosin. Other specimens of the gland were taken and prepared for electron microscopy study. Duct ligation of the submandibular gland was accompanied by progressive atrophy of the gland. After 4 weeks of duct-ligation, light microscopy showed that the acini became atrophied and contained few secretory granules. There was dilated inter-lobular and intralobular ducts that lined by cuboidal flat cells. The inter-lobular connective tissue was increased in thickness. Persistent myoepithelial cells were also found in atrophic rat sumandibular gland. After removal of the ligature, the gland revealed histological evidence of regeneration and persistent myoepithelial cells. All cellular components manifested recovery and became similar to the control condition. The present observations also suggest that ligation of the main duct of the rat submandibular gland produces a pronounced atrophy that is reversed upon ligature removal

use of progressive tension sutures in abdominoplasty for fewer complications and a speedy recovery

Abdominoplasty is one of the commonest plastic surgery procedures done worldwide, however, it is plagued by a number of local complications including; hematoma and seroma formation, flap necrosis and hypertrophic scars. To avoid these complications, suction drainage and limitation of postoperative ambulation are widely used by most surgeons. The use of progressive tension sutures [PTS] has been introduced in plastic surgery in various operations to ease the advancement of various skin flaps. The basic concept of their use in abdominoplasty is to control redrapping of the abdominal flap eliminating dead space and nullifying the need for drains. It also avoids tension on the terminal suture lines by dividing flap tension over many successive points thus minimizing the possibility of flap edge necrosis and allowing early postoperative ambulation. Progressive tension sutures were used in 15 cases. No drains were used and early ambulation was allowed in all cases. The incidence of complications was very low [0. 13%], minimal seroma was encountered in one case [6.65%] and was managed conservatively and superficial flap necrosis in another case [6.65%] which was managed by repeated dressings. The average duration of operation was 2.4 hours and the average postoperative hospital stay was 2.6 days. These results suggest that the use of progressive tension sutures in abdominoplasty reduces the risk of local complications, ease the early postoperative period without adding significant operative time or hospital stay

Postpartum involutional hypomastia: management by augmentation mammaplasty with submuscular textured saline-filled implants

One of the most common indications for augmentation mammaplasty is postpartum involutional hypomastia, with or without a varying degree of ptosis. The goal is to achieve a good and lasting aesthetically pleasing result, to preserve nipple sensation, and to avoid the most distressing and difficult to remedy complication capsular contracture around the implant, To achieve these goals, several factors should be taken into consideration; the biochemical nature of the implant, the surface of implant envelope, the plane of implantation, the use of povidone-iodine irrigation, the use of postoperative compression and the prevention of early hematoma formation and infection. 20 cases of postpartum involutional hypomastia were managed by submuscular implantation of textured saline filled implant. The aesthetic result was satisfactory in 95% of cases, Inframammary approach allowed adequate medial pectoral fibre release in 39 sides [97.5%] with only one case needing correction of unilateral implant migration by adhesive strapping. The nipple sensation was preserved in all cases. There were no incidents of capsular contracture or - late implant failure over a 1-year follow up period The results suggest that the use of the submuscular plane, the textured surface and the saline filled nature of the implant greatly minimizes the risk of capsular contracture development and that the use of inframammary approach makes operation easier, allowing adequate pocket dissection and muscle medial release and under vision Hemostasis. it also allows preservation of lateral thoracic nerve responsible for nipple sensation

Long-term effect of intravenous alfacalcidol on secondary hyperparathyroidism in uremic patients on hemodialysis

Uremic patients almost have secondary hyperplasia of the prarathyoid glands. Many clinical trials have demonstrated the benefit of treatment with active vitamin D metabolites. Intravenous preparations seem to be more effective. However, there is paucity of data regarding the effect of various medical therapeutic modalities in uremic patients with severe secondary hyperparathyroidism [HPT]. To evaluate the long-term efficacy of intravenous 1 a-hydroxycholecalciferol [alfacalcidol] treatment in severe secondary HPT, in uremic patients on regular hemodialysis [HD]. Patients and 20 uremic patients on regular HD and suffering from severe secondary HPT were treated by intravenous alfacalcidol after each HD session, thrice weekly, for a period of 2 years. Alfacalcidol doses were carefully titrated according to the biochemical values. The dialysate calcium concentration was set to 1 mmol/l and calcium carbonate tablets were given at doses modulated to guard against hypercalcemic episodes. Patients were subjected to baseline and follow up laboratory tests especially s. intact PTH, s. calcium, s. inorganic phosphorus and s. bone alkaline phosphatase, as well as imaging procedures includinggg U/S examination of the neck, thallium-technetium scintigraphy and plain radiographs of the skeleton. S. intact PTH showed a rebound increase, and reached a mean value comparable to the basesline on the long-term [P=0.895 at 24th month], after an initial response to alfacalcidol therapy. The s. iPTH response to treatment was also heterogeneous and showed no correlation with the given dose. 74% of patients had at least one clinical episode of hypercalcemia versus 65% for hyperphosphatemia. This resulted in limitation of the alfacalcidol dose. The parathyroid gland size at end of study was significantly inccreased compared to the baseline [P=0.042]. Long-term intravenous alfacalcidol pulse therapy was not effective in controlling severe secondary HPT in HD patients. It also failed to correct the increased parathyoid gland size

Allergic fungal sinusitis diagnosis and endoscopic management

Diagnosis and management of fungal affection of the sinuses gained much interest in the last few years. It is important to suspect, correctly diagnose and treat the condition. In a trial to achieve such target the present study was planned utilizing the endonasal endoscopy. The study included 20 patients with chronic sinusitis, subjected to full history ENT examination, endonasal endoscopic examination, CT scan study, preoperative nasal smear and culture for fungus, as well as preoperative laboratory investigation. Findings were collected criteria for diagnosis are proposed, Patients went FESS which proved to be an effective way for management of allergic fungal sinusitis [AFS]. Postoperative follow up extended for one year. It was found that suspicion of AFS should be put in mind in patients with chronic sinusitis having longstanding history, resistant to medical treatment with history of hypersensitivity, unilateral or asymmetry of the lesion with discharge of mucin and characteristic CT scan findings as bone ghosting, heterogenous unilateral [or asymmetric] sinus opacification with calcium deposits as well as polypi. Preoperative nasal smear were positive in 20% of cases while Postoperatively they were positive in 80% of cases. Aspergillus fumigatue represented 65% and Aspergillus flavus in 15%. Short course of steroids was used as well as application of local antifungal cream. One year postoperatively 80% of patients got healthy mucosa with no mucin and only 20% of patients got edematous or polypoid mucosa without mucin. The use of the sinuscope proved to be effective in diagnosis, surgery and follow up of AFS cases. The goals for surgery are to remove polypi, diseased tissue, fungal mud and mucin as well as to ensure good ventilation and drainage of the sinuses

Role of zinc administration on the effect of lead on the ovary of adult female albino rats. Histological and histochemical study

The risk of lead exposure and lead poisoning has been a major area of concern for several years mainly for women in both industrialized and developing counteries. The present study was designed to investigate the effect of chronic lead exposure on the ovary of adult female albino rats, and the role of zinc supplementation. Thirty adult female virgin albino rats were utilized in this study. They were classified into three equal groups, the 1[st] group was administered 1ml dist. Water orally and served as control group. The 2[nd] group [Lead - treated group] was administered lead acetate at a dose of 50 mg/kg b.wt. orally. The 3[rd] group [Zinc - supplemented group] was administered lead acetate as in tile 2[nd] group and zinc sulphate at a dose of 1mg /kg b. wt. orally. At the end of three months, animals were killed and ovaries were dissected out, fixd in 10% formol saline and processed for histological and histochemical studies using Hx, E, Masson Trichrome, PAS and Methyl Green and Pyronine stains. Tile histological and histochemical results revealed that chronic lead exposure resulted in degenerative changes in the ovaries and these changes were ameliorated with coadministration of zinc. This protective effect of zine could be attributed to differential distribution of lead, either because of competition between lead and zinc or displacement of lead by zinc

Thyroid gland volume in infants, children and adults from Sharkia governorate: Ultrasonographic study

Thyroid ultrasonography has proven a useful and practical method for the assessment of thyroid size.Thyroid ultrasonography were carried out first to determine the standard thyroid volume in normal children and adolescents.Second to establish a standard growth curve of thyroid volume with respect to age, sex, height and weight. We effected sonographic examination of 220 patients [110 females and 110 males] from Sharkia governorate aged between 1 day and 18 years and body weight from 2.0 kg to 90.0 kg. In this study the volume of thyroid glands in newborn is 0.8 ml +/- 0.21 ml. Mean thyroid volume was found 5.5 ml +/- 0.61 ml in 6-8 years old, while it was 17.5 ml +/- 2.35 ml in 14-16 years old male and 15.3 ml +/- 2.51 in 14-16 years old female. The right lobe was larger than the left one in all age groups. Thyroid volume determined by ultrasound in control children increased with age up and was correlated with height and body weight

Intraoperative lymphatic mapping and sentinal node biopsy predicts axillary nodal involvement and avoids negative axillary dissections in [N0] breast cancer

The status of the axillary nodes is the strongest known prognostic variable in patients with breast cancer, and is routineely used in planning postoperative therapy. Conventional axillary dissection is limited by sampling error and potential morbidity With new wide scale regimens of screening and growing consensus of early diagnosis of breast cancer increasing numbers of negative axillary nodal dissections are encountered. Sentinel node biopsy techniques have revolutionized the management of axillary nodes. Accurate identification and focused histologic evaluation of the sentinel node allow accurate prediction of the status of other axillary nodes, thereby avoiding the morbidity and expense of a complete axillay dissection in node negative patients. In 26 cases of breast cancer, SLN intraoperative mapping was done following preoperative subcutaneous dye injection over breast mass. SLN detection success rate was 76.92%. Pathological examination of detected SLN[s] and comparison with the rest of axillary nodes revealed an accuracy rule of 90% in detection of axillury status with negative predictive value of 80%. With further evaluation and growing experience with the technique it can be a useful method to decide when to procced with formal axillary dissection in cases with no clinically detected nodes

Morphometry of the lens development in albino rat

This study analysed pattern of growth of the lens by measuring the lens surface area, circumference and diameters in relation to the eye ball in albino rat at ten stages, 12, 13, 14, 16, 18 and 20 days of embryonic development and 1, 7. 14 and 28 days of post-natal development. We used the recent technique DIAD [Digitizing and Image Analyzing Device] and runing the autocad program. Surface area of the lens increases during different stages of development and reachs its maximum percentage in relation to the eye ball during the 4[th] and 5[th] stages. Surface area of the lens at 10[th] stage is more than 60 folds than the 1[st] stage. Transverse diameter of the last stage is more than 8 times of the first stage. Anteroposterior diameter is nearly equal the transverse diameter up to the 5[th] stage then it declines. Significant age-related linear increas were found for all parameters