Comparison of second molar protraction using different timing for piezocision application: A randomized clinical trial

ABSTRACT Objective: To compare second molar protraction between early, late and no piezocision groups. Material and Methods: Forty subjects with bilaterally extracted mandibular first molars were selected to participate in the study. Subjects were subdivided into two groups: piezocision and no piezocision. The piezocision group was further subdivided into two subgroups: early piezocision (piezocision performed immediately before second molar protraction) and late piezocision (piezocision performed three months after starting molar protraction). In the no piezocision group, molar protraction was done without surgery. The intervention (piezocision group and timing of piezocision/side within group) was randomly allocated using the permuted random block size of 2, with 1:1 allocation ratio. The amount of second molar protraction, duration of space closure and anterior anchorage loss were measured. A repeated measures analysis of variance was conducted to define the differences between the measured variables at the different time intervals. Differences between groups were assessed using ANOVA test. Results: No difference was detected between early and late piezocision groups in the amount of molar protraction at the end of space closure. Duration of complete space closure was 9 and 10 months in the piezocision and no piezocision groups. Anchorage loss was similar between the three studied groups. Conclusions: Early and late piezocision have similar effect and both increased the amount of second molar protraction temporarily in the first 2-3 months after surgery. Duration of mandibular first molar space closure was reduced by one month when piezocision was applied. Anchorage loss was similar in the three groups.

RESUMO Objetivo: Comparar o efeito dos tempos de aplicação precoce, tardia e sem piezocisão, na protração de segundos molares. Métodos: Quarenta indivíduos com os primeiros molares inferiores extraídos bilateralmente foram selecionados para participar do estudo, sendo divididos em dois grupos: piezocisão e sem piezocisão. O grupo de piezocisão foi subdividido em dois subgrupos: piezocisão precoce (piezocisão realizada imediatamente antes da protração de segundos molares) e piezocisão tardia (realizada três meses após o início da protração dos molares). No grupo sem piezocisão, a protração de molares foi feita sem cirurgia. A intervenção (grupo de piezocisão e momento da piezocisão/lado dentro do grupo) foi alocada aleatoriamente usando o tamanho de bloco aleatório permutado de 2 com proporção de alocação de 1:1. A quantidade de protração de segundos molares, tempo para fechamento de espaços e perda de ancoragem anterior foram medidos. Uma análise de variância para medidas repetidas foi realizada para definir as diferenças entre as variáveis medidas nos diferentes intervalos de tempo. As diferenças entre os grupos foram avaliadas pelo teste ANOVA. Resultados: Não foi detectada diferença entre os grupos de piezocisão precoce e tardia, em relação à quantidade de protração de molares ao fim do fechamento dos espaços. O tempo para o fechamento completo do espaço foi de nove e dez meses nos grupos piezocisão e sem piezocisão, respectivamente. A perda de ancoragem foi semelhante nos três grupos avaliados. Conclusões: As piezocisões precoce e tardia têm efeito semelhante e ambas aumentaram temporariamente a quantidade de protração dos segundos molares nos primeiros dois a três meses após a cirurgia. A duração do fechamento de espaço dos primeiros molares inferiores foi reduzida em um mês quando a piezocisão foi aplicada. A perda de ancoragem foi semelhante nos três grupos.

Pulpal blood flow changes and pain scores related to using Superelastic 0. 018-inch Nickel Titanium as the first orthodontic alignment archwire: a prospective clinical trial

Abstract Background Optimal orthodontic force results in maximum rate of tooth movement without tissue damage. Even though starting orthodontic treatment with a thicker archwire may shorten treatment duration, the evidence on the effect of using 0.018-inch NiTi as the first alignment archwire on pulpal blood flow (PBF) status is still scarce. Objectives to record PBF changes and pain scores associated with using 0.018-inch NiTi as the first alignment archwire during fixed orthodontic treatment. Methodology Patients were selected from subjects attending postgraduate orthodontic teaching clinics at Jordan University of Science and Technology. In total, forty healthy patients who exhibited mild lower arch crowding were included. A split-mouth trial design was used. Each patient received two archwire sizes at one time joined in the midline by crimpable hook and applied in the lower arch. Patients were assigned into one of two groups based on archwire sizes used. Group 1: 0.014-inch and 0.018-inch NiTi (Six males, 14 females aged 19.4±1.33 years) and Group 2: 0.016-inch and 0.018-inch NiTi (Seven males, 13 females aged 19.6±1.45 years). The archwire size group was randomly allocated with a 1:1 allocation ratio. A Laser Doppler Flowmeter was used to measure PBF at different time intervals (T0-T5). Pain scores were recorded using a visual analogue scale (VAS). A repeated measures ANOVA and a post-hoc Bonferroni comparison tests were conducted to examine differences at the different time points before and during orthodontic alignment. Results For all studied archwire sizes, PBF decreased 20 minutes after their placement. Most PBF changes occurred within 24hours and continued to decrease until 72 hours after archwire placement where the maximum reduction was reached. Eventually, normal values were reverted within 1 month. PBF changes were similar between all alignment - groups. Conclusions Initial orthodontic alignment with 0.018-inch NiTi does not cause irreversible changes to pulpal vasculature or produces higher pain scores.

Dental age estimation of Jordanian children: applicability of Demirjian method / Estimativa de idade dentária em crianças jordanas: aplicabilidade do método Demirjian

ABSTRACT Objectives: To evaluate the accuracy of Demirjian method in estimating the chronological age of male and female Jordanian children and to establish a new dental age curve if the Demirjian method was not found to be accurate. Methods: Orthopantomograms (OPTs) of 1374 Caucasian Jordanian children (684 females and 690 males) aged 4 to16 years were selected and the dental age was determined by Demirjian method. The chronological ages of the children were obtained by subtracting their birthdates from the date of taking the radiograph. The OPTs were obtained from Archives of Dental Teaching Clinics /XXX and other private orthodontic practices in Irbid and Amman. Results: Demirjian method overestimated chronological age in female and male subjects aged 4 to 8 years. Afterwards, the method underestimated chronological age in females aged 9-11 years and 14-16 years. In male subjects, chronological age was underestimated in subjects aged 9-12 years and 15-16 years. New the dental age curves for Jordanian females and males were constructed. The constants for the quadratic model for the new curves were (b0=-25.341, b1=17.557, b2=-0.623) for females and (b0=-29.809, b1=17.396, b2=-0.595) for males. Conclusion: Demirjian method overestimated the chronological age of Jordanians below the age of 8 years and underestimated the age of Jordanians above 8 years. A new DA standard for Jordanian children was developed and tested for accuracy.

RESUMO Objetivo: Avaliar a precisão do método Demirjian na estimativa da idade cronológica de crianças jordanianas do sexo masculino e feminino e estabelecer uma nova curva de idade dentária, se o método Demirjian não for acurado. Métodos: Foram selecionados radiografias panorâmicas (OPTs) de 1374 crianças jordanianas caucasianas (684 do sexo feminino e 690 do sexo masculino) com idades entre 4 e 16 anos, e a idade dentária foi determinada pelo método de Demirjian. As idades cronológicas das crianças foram obtidas subtraindo as datas de nascimento a partir da data da realização da radiografia. Os OPTs foram obtidos em Archives of Dental Teaching Clinics / XXX e outras clínicas ortodônticas particulares em Irbid e Amã. Resultados: O método Demirjian superestimou a idade cronológica em indivíduos do sexo feminino e masculino com idades entre 4 e 8 anos. Posteriormente, o método subestimou a idade cronológica em mulheres de 9 a 11 anos e 14 a 16 anos. Nos homens, a idade cronológica foi subestimada nos indivíduos de 9 a 12 anos e 15 a 16 anos. Novas curvas de idade dentária para mulheres e homens jordanianos foram construídas. As constantes para o modelo quadrático para as novas curvas foram (b0 = -25.341, b1 = 17.557, b2 = -0.623) para mulheres e (b0 = -29.809, b1 = 17.396, b2 = -0.595) para homens. Conclusão O método Demirjian superestimou a idade cronológica dos jordanianos abaixo de 8 anos e subestimou a idade dos jordanianos acima de 8 anos. Um novo padrão DA para crianças jordanianas foi desenvolvido e testado quanto à precisão.

Periodontal health knowledge and awareness among subjects with fixed orthodontic appliance

Abstract Objective: To report on periodontal health knowledge and awareness among orthodontic patients and to investigate the effect of age, attitude and duration of orthodontic treatment on periodontal health awareness among orthodontic patients. Methods: A total of 297 orthodontics patient (90 males, 207 females) with mean age of 17.7 ± 5.0 years (older then 18 years = 119, 18 years or younger = 178) were included in this study. Subjects were currently wearing upper and lower fixed orthodontic appliances for an mean period of 12.55 ± 10.86 months (less than or equal to 18 months = 231, more than 18 months = 66). Data was collected through a self-administered questionnaire (demographic characteristics, subjects' awareness toward their periodontal health, periodontal knowledge among orthodontic patient and patients' attitude toward orthodontic treatment regarding periodontal health) and clinical periodontal examination. Results: Periodontal knowledge was poor among orthodontic patients in relation to dental plaque. Only 24 subjects (8%) correctly answered knowledge-related questions. Adult orthodontic patients reported negative attitude toward fixed orthodontic treatment in respect to periodontal health (p<0.001). Duration of orthodontic treatment negatively affected subjects' attitude toward fixed orthodontic treatment (p<0.01). The majority of subjects were in the high level of awareness group (64%). Orthodontic patients' awareness toward their periodontal health during fixed orthodontic treatment was affected by attitude scores (p=0.005), number of teeth with gingival recession (p=0.041), Gingival Index (p=0.000), duration of treatment (p=0.047) and age (p=0.008). Conclusions: Periodontal health knowledge among orthodontic patients was poor. Orthodontic patients' awareness of their periodontal health was moderate and was affected by age, attitude and duration of orthodontic treatment.

Resumo Objetivo: relatar sobre o conhecimento e a conscientização quanto à saúde periodontal dos pacientes ortodônticos e investigar os efeitos da idade, atitude e duração do tratamento sobre a conscientização da saúde periodontal entre esses pacientes. Métodos: um total de 297 pacientes foi incluído nesse estudo (90 homens e 207 mulheres), com idade média de 17,7±5,0 anos (maiores de 18 anos = 119, iguais ou menores de 18 anos = 178). Os indivíduos estavam usando aparelhos ortodônticos fixos nas arcadas superior e inferior por um período médio de 12,55±10,86 meses (18 meses ou menos = 231, mais de 18 meses = 66). Os dados foram coletados por meio de um questionário autoaplicável (características demográficas, conscientização com relação à saúde periodontal, conhecimento periodontal entre os pacientes ortodônticos e a atitude dos pacientes com relação ao tratamento ortodôntico com relação à saúde periodontal) e exame clínico periodontal. Resultados: o conhecimento periodontal entre os pacientes ortodônticos foi pequeno com relação à placa bacteriana. Somente 24 indivíduos (8%) responderam corretamente às questões relacionadas ao conhecimento. Os pacientes ortodônticos adultos relataram uma atitude negativa quanto ao tratamento com aparelhos fixos, com relação à saúde periodontal (p<0,001). A duração do tratamento afetou negativamente a atitude dos indivíduos com relação ao tratamento com aparelhos fixos (p<0,01). A maioria dos indivíduos estava no nível mais alto do grupo conscientização (64%). A conscientização dos pacientes ortodônticos com relação à sua saúde periodontal durante o tratamento ortodôntico com aparelhos fixos foi afetada pelos escores da atitude (p=0,005), pelo número de dentes com retração gengival (p=0.041), Índice Gengival (p=0,000), duração do tratamento (p=0,047) e idade (p=0,008). Conclusões: o conhecimento sobre a saúde periodontal entre os pacientes foi pequeno. A conscientização dos pacientes quanto à sua saúde periodontal foi moderada e foi afetada pela idade, atitude e duração do tratamento ortodôntico.

D2-40/podoplanin expression in chronic villitis of the placenta / Expressão de podoplanina/D2-40 em vilosite crônica placentária

ABSTRACT D2-40/podoplanin (D2-40/PDPN) is a multifunctional protein that can be expressed in lymphatic endothelium and immune cells. D2-40/ PDPN expression in chronic villitis (CV) has not been studied. In 22 cases of CV, we analyzed both D2-40/PDPN expression as well as its coexpression with immune cells markers, and the relationship with stromal cells. In the non-inflamed villi, the D2-40/PDPN positive plexiform pattern has a lymphatic-like conductive network. In the inflamed villi, the D2-40/PDPN expression, predominantly restricted to stromal cells forming a cellular network, is likely related to a phase of the inflammatory response, such as reorganization of the damaged tissue.

RESUMO Podoplanina/D2-40 (PDPN/D2-40) é uma proteína multifuncional que pode ser expressa no endotélio linfático e nas células imunes. Na vilosite crônica (VC), a expressão de PDPN/D2-40 ainda não foi estudada. Em 22 casos de VC, analisamos tanto a expressão de PDPN/D2-40 como sua coexpressão com marcadores de células imunes, além da relação com células estromais. Nas vilosidades não inflamadas, o padrão plexiforme PDPN/D2-40 positivo tem aspecto de rede condutora linfática. Nas vilosidades inflamadas, a expressão de PDPN/D2-40, com predominância restrita às células estromais, formando rede densa está, possivelmente, relacionada com uma fase da resposta inflamatória, como a reorganização do tecido danificado.

Prevention and treatment of Encephalitozoon cuniculi infection in immunosuppressed rabbits with fenbendazole

This study was conducted to evaluate the efficacy of oral administration of fenbendazole [20 mg/kg body weight] prior to and after experimental infection of immunosuppressed rabbits with Encephalitozoon cuniculi. A total of thirty rabbits were divided into five groups: NN [non-immunosuppressed; non-infected], IN [immunosuppressed; non-infected], IPI [immunosuppressed; protectedinfected], ITI [immunosuppressed; treated-infected], and II [immunosuppressed; infected] groups. Fenbendazole was administered as a prophylactic for seven successive days before infection with E. cuniculi and as a treatment for four weeks initiated on the 28[th] day post-challenge [PC]. Experimental rabbits were infected with intraperitoneal injection of 2 × 105 E. cuniculi spores. Parameters evaluated were body weight, detection of spores in urine, serum antibody assay, hematological, biochemical and histopathological changes. The IPI and ITI groups showed a significant better final bwt than the II group. Spores were detected in urine of all infected rabbits from the 28[th] day PC until the end of the study. The IPI group showed the least values of antibodies [IgG] compared to the ITI and II groups. Concerning histopathological changes, the intensity of the lesions was marked particularly in the II rabbits and to a lesser extent in the ITI rabbits. Noticeable improvement was found in the IPI rabbits. It could be concluded that fenbendazole was effective to some extent in protection of rabbits against E. cuniculi infection, while when administered as a therapeutic no significant effects were observed

Benign parapapillary choledochoduodenal fistula associated with ampullary carcinoma: case report and literature review

Parapapillary and periampullary choledochoduodenal fistulas [CDF] are rare conditions. We here report a case of benign parapapillary choledochoduodenal fistula associated with early ampullary carcinoma [pT1NoMo]. A 54-year-old Jordanian man had recurrent cholangitis without clinical jaundice. He had marked elevation of the alkaline phosphatase [AP] and Gamma Glutamyl Transferase [GTT]. Abdominal ultrasonography showed distension of the gallbladder with dilatation of the common bile duct [CBD]. Duodenoscopy showed a swollen ampulla with no intraduodenal growth. Cannulation the orifice of the papilla of Vater failed. But endoscopic biopsy revealed adenocarcinoma. Magnetic resonance cholangiopancreatiocography showed a dilated bile duct with a filling defect in its most distal part. With the diagnosis of ampullary carcinoma, the patient underwent pylorus-preserving pancreatico-duodenectomy [PPPD]. The gross and microscopic examination of the resected specimen showed a dilated CBD, a small-sized benign choledocho-duodenal fistula to the CBD above the tumor, and a non-dilated pancreatic duct that opened above the tumor. The smallsized fistula was missed by all used diagnostic procedures. This communication presents a unique case of association between ampullary carcinoma with benign small sized parapapillary CDF that caused cholangitis with marked elevation of AP and GTT but without clinical jaundice. The benign CDF may cause cholangitis and together with the high bilio-pancreatic junction may increase the risk of biliary cancer

Dietary habits and physical activity levels in Jordanian adolescents attending private versus public schools

The present study examined differences in dietary habits and physical activity levels between students attending private and public high schools in Jordan. A total of 386 secondary-school males and 349 females aged 14–18 years were randomly recruited using a multistage, stratified, cluster sampling technique. Dietary habits and physical activity level were self-reported in a validated questionnaire. The prevalence of obesity was significantly higher among adolescents in private [26.0%] than in public schools [16.7%]. The frequency of breakfast intake was significantly higher among adolescents in private schools, whereas French fries and sweets intake was significantly higher in public schools. Television viewing showed a significant interaction with school type by sex. A higher rate of inactivity was found among students attending private schools. Despite a slightly better overall dietary profile for students in private schools, they had a higher rate of overweight and obesity compared with those in public schools.

Blood lead level among Palestinian schoolchildren: a pilot study

In Palestine, chronic exposure to lead has not been adequately addressed as a problem for children. To assess the exposure of Palestinian school children, we surveyed blood lead levels in 3 schools in Nablus city and collected demographic and clinical data. Blood samples were collected from 173 children [140 boys/38 girls], age range 6-8 years. The overall mean blood lead level was 3.2 [SD 2.4] microg/dL, and 4.5% of children had levels above 10 microg/dL Blood lead levels were significantly higher among children living in refugee camps near industrial high traffic regions than among children living in residential areas of the city. Blood lead levels were positively correlated with family size [r = 0.15] and negatively correlated with household area [r =0.18]. Blood lead levels among these Palestinian schoolchildren were higher than those of other countries where leaded gasoline has been banned and seemed to be higher in more economically deprived children

Efficacy evaluation of the protein isolated from Peganum harmala seeds as an antioxidant in liver of rats

OBJECTIVE@#To evaluate the curative effect of the 132 KD protein isolated from the seeds of Peganum harmala (P. harmala) L. against carbon tetrachloride (CCl(4)) induced oxidative stress in rats.@*METHODS@#Animals were post treated intraperitoneally with 132 KD isolated protein at doses of 4 and 8 mg/kg body weight and bovine serum albumin (BSA) (8 mg/kg body weight) as well as vitamin C (250 mg/kg body weight p.o.) for 7 d after they challenged with CCl(4) orally (1 mL/kg body weight) in olive oil (50%) for 2 d.@*RESULTS@#The purified protein from seeds of P. harmala plant showed in vitro antioxidant activity with DPPH assay. Administration of CCl(4) induced induction in serum aminotransferases (AST, ALT), alkaline phosphatase (ALP), lipid profile parameters and liver malondialdehyde (MDA) and decrease in serum total protein, liver superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels. 132 KD protein treatment of rats post CCl4 intoxication successfully alleviated the toxic effects of CCl(4).@*CONCLUSIONS@#The isolated protein possessed strong antioxidant activity comparable to that of BSA (negative control) and vitamin C (positive control).

Utilization and cost of antibacterial drugs in 2 general surgery units in Palestine measured using anatomical therapeutic chemical classification and defined daily dose methodology

This study compared the utilization and cost of antibacterial agents in surgical units of 2 government hospitals in Palestine. The consumption and cost of drugs was estimated in the units over a 1-month period in 2010 using the anatomical therapeutic chemical classification and defined daily doses [DDD] per 100 bed-days. The total consumption of antibacterial agents was 414.1 DDD and 591.5 DDD at Thabet and Rafidia hospitals respectively. These corresponded to 133.6 DDD/100 bed-days and 162.2 DDD/100 bed-days respectively, figures that were higher than those reported in surgical units in many other countries. Total cost of antibacterial agents during the study period was 24 800 and 23 481 NIS for Rafidia and Thabet hospitals respectively. Approximately 11.2% and 18.0% of the total antibiotic DDD in Rafidia and Thabet hospitals were given to patients with clean surgeries in which antibiotic prophylaxis is not indicated

value of magnetic resonance sialography and magnetic resonance imaging versus conventional sialography of the parotid gland in the diagnosis and staging of Sjogren's syndrome

The conventional sialography [CS] and minor salivary gland biopsy have been considered the cornerstones of the diagnosis of Sjogren's syndrome [SS]. However, they are invasive and with risk of complications to the patient. Magnetic resonance imaging [MRI] has been widely replacing conventional invasive examinations. They provide insufficient data for diagnosing and staging SS, because while they address the detection and diagnosis of parenchymal salivary gland disease they do not assess duct abnormalities. The introduction of magnetic resonance sialography [MRS] protocol was the first step towards non-ionizing non-invasive technique enables a more accurate assessment of the duct system. Moreover, it is postulated that the combined use of MRI and MRS is useful for the assessment of damaged salivary glands in SS. This preliminary study aimed to assess the role and efficacy of MRS and MRI in imaging the parotid gland in SS patients' and to compare their results with that of CS in the diagnosis and staging of SS. The parotid gland was examined by MRS, MRI and CS in 15 SS patients. Scoring system for overall branching pattern, ductal system staging, sialectasis for both CS and MRS was used. MRI scoring system for glandular parenchymal pattern, size and contour and lymph node was used. This revealed non-significant difference between CS and MRS findings in the diagnosis and staging of SS. Furthermore, no statistically significant correlation was found between the clinical and SS stage in both CS and MRS. On the other hand, a statistically significant positive correlation was found between the clinical findings and the MRI parenchymal stages. Moreover, MRS showed higher sensitivity and diagnostic accuracy values than CS. Combining the MRS and MRI abnormalities, 100% sensitivity diagnostic accuracy values were achieved in the diagnosis and staging of SS. The inter-observer agreement was higher in MRS than in CS and was perfect in MRI. In this preliminary study, MRS showed a higher sensitivity and accuracy in diagnosing and staging SS and may safely and securely replace CS. MRI and MRS give information on different aspects of glandular and duct pathology; therefore, both should be performed when examining the parotid glands in SS patients

Assessment of metabolic response to pre-operative treatment of rectal cancer

In the era of targeted therapy and high precision radiotherapy for patients with cancer, tailoring and individualization of treatment is needed more and more. In part to avoid ineffective administration of a toxic treatment to a patient that unlikely to get any benefit of it. And also to decrease the expenses of treatment and saving the drugs and resources to patients that deserve. Many predictive factors and markers are searched and well-known in many malignancies, but still rectal cancer lacks such predictors. As the pre-operative chemoradiotherapy is becoming the standard of care of treating patients with locally advanced rectal carcinoma, a predictive factor, or at least an early indicator, of patient's response to treatment is needed. First, it may help to modulate the pre-operative treatment by employing another chemotherapeutic or targeted agent e.g. oxaloplatin or cetuximab instead of the standard fluorouracil compounds. It may also help to avoid continuation of unnecessary protracted course of radiotherapy for 5-6 weeks for a patient who is unlikely to achieve a satisfactory response. This will help to avoid the definite toxicity of pelvic irradiation and avoid wasting time before going to surgery. Here comes the role of imaging techniques in predicting the metabolic response such as functional computerized tomography [CT] and magnetic resonance imaging [MRI] or positron-emission tomography [PET] scan. In this review we will go through the principles, indications and benefits of employing such techniques in the assessment of response to pre-operative chemoradiotherapy of rectal cancer

Association of parental history of type 2 diabetes mellitus with leptin levels in Jordanian male youths

To investigate the association between high level serum leptin in male youths in relation to parental history of type 2 diabetes mellitus [T2DM] and body mass index [BMI]. This cross-sectional study was carried out at the Department of Medical Technology, Applied Science University, Amman, Jordan during the period from January to April 2009. One hundred and sixteen Jordanian male nursing students aged 18-24 years were divided into 4 groups according to parental history of T2DM and BMI. Fasting blood samples were measured for blood glucose, lipid profile, and serum leptin. Serum leptin levels in overweight and obese male youth diabetic patients with parental history of T2DM were significantly higher than in those overweight and obese without parental history [p<0.001]. Of the 116 subjects, 83 [71.6%] had a positive parental history of T2DM. Compared with other groups, significant [p<0.001] elevation was observed in the mean cholesterol and triglyceride levels of obese T2DM. No significant differences were detected in high-density lipoprotein, low-density lipoprotein, and blood glucose levels among all study groups. High levels of leptin in overweight and obese Jordanian male youths were more likely associated with a positive parental family history of T2DM than BMI factor

Unrecognized foreign body in an elderly patient

Although aerodigestive foreign bodies are commonly seen in the paediatric age group, adults and elderly patients are not exempt from this problem. Respiratory tract foreign bodies are usually seen in extremes of ages and may not be discovered immediately, either due to the inability of the patients to express their symptoms, absence of protective airway reflexes or altered level of consciousness. A high index of suspicion is a must to discover and diagnose these cases. Here we report a unique case of a 68 year old man with a normal level of consciousness who was suffering from recurrent attacks of breathlessness [for almost 2 months] but who was treated as a case of bronchial asthma exacerbation because the patient was a known asthmatic. Following admission and investigation for stridor, his problem was found to be due to a foreign body lodged in the larynx

Laparoscopy in the treatment of a giant [true] epiphrenic diverticulum with migration of the gastrointestinal anastomosis staples

Our case is a 62-year-old diabetic man with a long-standing history of regurgitation, halitosis, recurrent chest infection, and most recently upper gastro-intestinal bleeding. He was diagnosed 10 years earlier with an epiphrenic esophageal diverticulum, and also has a family history of this condition. Barium study revealed a 10x10 cm epiphrenic diverticula with a 4 cm neck, the lower margin of the opening lying 6 cm from the gastro-esophageal junction. Endoscopy confirmed the x-ray findings, and motility studies were within normal limits. The patient underwent laparoscopic excision of the diverticulum via the trans-abdominal approach. Histopathological examination revealed this diverticulum to be of the true type

Further investigation on ferula communis grown in Saudi Arabia

Three compounds were isolated from the coumarin fraction of Ferula communis aerial parts [Fam. Apiaceae. They were identified as farnesiferol A [I], umbelliferone, [II] and umbelliprenine [III]. Also, psitosterol and sitgmasterol were isolated from the unsaponifiable fraction

Laparoscopic enucleation of a duodenal lipoma, with review of the literature

We present a case of duodenal lipoma in a 53-year-old lady causing symptoms of vomiting and abdominal discomfort, treated by laparoscopic enucleation. Lipomas of the duodenum are rare tumors with less than 230 cases reported in the literature, most of these are from autopsy records rather than clinical experience. Most recent reports are of endoscopic excision of these tumors while operative procedures, although less frequent, have been described for specific indications. We present a case of a duodenal lipoma excised laparoscopically with a review of the literature.

Diagnosis of sex chromosome disorders and prenatal diagnosis of Down syndrome using interphase fluorescent in-situ hyperidization technique

Thousands of infants are born each year with chromosomal abnormalities that severely impact physical and mental development. Among common genetic disorders are Down syndrome [trisomy 21] and sex chromosomal disorders. Evaluation of guidelines used for prenatal diagnosis of Down syndrome [DS] as well as sex chromosomal disorders including interphase Fluorescent In Situ Hyperidization [FISH] technique. Enrolled cases were among those presenting to Genetics and Neonatology Units, Mansoura and Ain-Shams University hospitals,[Egypt] during 2002 to 2004. These included: Groups 1 comprised fifty pregnant women presenting for genetic counseling. They were subjected to complete history analysis, ultrasound examination in addition to triple screening test [for alpha feto protein [AFP], human chorionic goandotrophin [HCG] and unconjugated esteriol [E2]. Results were confirmed by doing routine karyogram on cultured amniotic fluid. Groups 2 comprised suspected cases with sex chromosomal disorders including neonates with ambiguous genitalia [64 cases] and adults with primary amenorrhea [69 cases] or infertility [38 cases]. They were subjected to a diagnostic workup including. Among the pregnant women group, seven were found to be at a high risk of having DS fetuses including 3 cases with a history of affected off-springs, 2 cases with age above 35 years, and 2 cases with high triple test. Only one case had positive trisomy 21 on interphase FISH confirmed by karyogram on cultured amniotic cells. The other 6 ladies had normal FISH confirmed by karyograms. Regarding the other group, 5 cases out of the 9 females were proved to be feminized males, one proved mosaic turner, one proved mixed gonadal dysgenesis and 2 normal females. On the other hand one out of three males were proved to be verilized female while the other one was a male with incomplete testicular feminization and the last one was a male with infertility diagnosed as Klinefelter syndrome at the age of 26 years. Interphase FISH is a rapid, accurate and very sensitive method in sex chromosom and autosomal abnormalities. It adds to the diagnostic utility of routine cytogenetics and its use on interphase nuclei overcomes the difficulty of conventional cytogenetics. It could be used in the prenatal diagnosis of DS in addition to ultrasonography, and triple test