Evaluation of subtotal splenectomy in the management of hereditary spherocytosis

To evaluate the clinical and hematological response to subtotal splenectomy in children with hereditary spherocytosis [HS]. The authors analyzed the main clinical and hematological features in 18 patients with HS treated by subtotal splenectomy. The average age at the time of operation was 4 years. The indications for subtotal oplenetomy were hypersplenism and severe anemia. The diagnosis of HS was made according to standard methods. The lower three fourth of the spleen were removed and the upper pole was preserved. The effect on hemolytic rate was assessed by comparing the presurgical and postsurgical values of hemoglobin, reticulocyte number and RBC life span. The residual splenic phagocytic function was assessed using technetium 99m scan and number of pitted red cells. The splenic regrowth were measured by ultrasonography. There were no complications related to the surgical procedure in any of the 18 children. The mean follow up period was 30 +/- 8 months. At the end of follow up hemoglobin increased on the average by 3 gm/dl, reticulocyte count decreased by 300x10[6]/L, and bilirubin level decreased. Normal technetium uptake was noted in the splenic remnant. Splenic regrowth were noted in 4 patients, two of them still need more than 2 transfusion/ year. No postoperative overwhelming infection occurred. Subtotal splenectomy can be performed without major blood loss in patients with HS. Up to 95% of the spleen can be safely removed. It is effective in decreasing the hemolytic rate while maintaining residual splenic function

Mineralization of 14C-carbofuran in soil under aerobic and anaerobic conditions

The mineralization of 14C-carbofuran in clay loam soil was determined during a three months laboratory incubation period under anaerobic and aerobic conditions. 14C-activity in solution was directly determined by liquid scintillation counting. Unextractable soil residues were determined by combustion. Evolution of 14CO2 increased with time and reached to 7.5% and 12.0% of the initial 14C-concentration, within 90 days in case of anaerobic and aerobic conditions, respectively. At that time, soil contained about 58% of the applied dose as extractable residues under anaerobic conditions and 59% under aerobic conditions. The unextractable pesticide residues were gradually increased with time and the highest binding capacity of about 5.3% and 13% in case of anaerobic and aerobic conditions, respectively were observed after 90 days of incubation. Chromatographic analysis of methanolic extracts revealed the presence of labelled carbofuran, carbofuran phenol and 3-hydroxycarbofuran as main products. Radiorespirometiy was used to evaluate the effect of carbofuran on soil microbial activity for 14 days. Both 3 and 9 mg carbofuran/kg soil depressed 14CO2 evolution from 14C-glucose and microbial activity was significantly inhibited especially in case of the high dose

Reconstruction of the knee extensor mechanism after wide excision of intramuscular hemangiomas affecting the quadriceps femoris muscles

The wide excision of intramuscular hemangioma, which affects the quadriceps femoris muscle, usually is followed by inefficient knee extension, and patellar instability. The surgeons with this problem in their minds sub-totally excised it, and this is usually followed by high recurrence rate. Five patients with large symptomatic intramuscular hemangioma affecting the quadriceps femoris muscles, constitute the material of this study from September 1996 to June 2001; in 2 of them the hemagioma were previously incompletely excised and recurred. Three patients were males and two were females. Their ages ranged from 6 to 24 with average 12.4 years. The right side was affected in 3 patients, while the left in 2 patients. The vastus medialis was affected in 3 patients and the lateralis in 2 patients. Wide excision with reconstruction of the extensor mechanism was done for every patient. The shortest follow up period was 3 years, and the longest was 8 years. The results obtained were excellent in all patients [100%], no good or poor cases [zero%]

Splenectomy and extraperitoneal splenic slice grafting in the treatment of thalassemia

The risk of total splenectomy in children with thalassemia is septicemia and overwhelming infection. Splenectomy with splenic slice grafting is an alternative in patients with thalassemia. 16 transfusion-dependent, high risk thalassemic patients [10 boys and 6 girls] underwent splenectomy and splenic slice grafting by the same surgeon from March 1998 to September 2001 at Health Insurance Hospital for children [Abu-Elrish Pupil Hospital], and El Hussein University Hospital. The patients age ranged from 4 to 8 years. The need for splenectomy in these cases was determined by the increasing need for blood transfusions and hypersplenism. Follow-up was from 1 to 4 years. Pre-and postoperative blood transfusions, length of operation, postoperative complications, fate of the grafts and their immune status before and after operation were evaluated. The procedure had good advantages of splenectomy and immunoconservation. Functioning splenic slice grafting which is detected by immunological assay and normal radionuclide splenic scan. Postoperatively there were no systemic infections or overwhelming post splenectomy sepsis. There was no incidence of death or rejection of the grafts during the follow-up period in our series. Splenectomy with splenic slice grafting greatly reduces and in some cases eliminates, the need for blood transfusions

Study of urethral stricture in children after repair of hypospadias

The objective of this study was to evaluate the different modalities in the treatment of symptomatic urethral stricture after repair of hypospadias depending upon clinical picture and uroflowmetry. A total of 480 boys aged 12-72 months [mean 36 months] underwent surgical correction of hypospadias were included in this study. Symptomatic stricture rate was 6.25%, the presenting symptoms of urethral stricture was difficulty voiding [26.6%], weak stream [33.3%], fistula [10%], dysuria [10%], incidental [difficult catheterization] [6.6%], spraying [10%] and retention [3.3%]. 22 of 30 patients underwent initial attempts of urethral dilation, 14 patients were symptom free after dilation and eight patients required open urethroplasty. The study recommended routine uroflowmetry to monitor the functional status of the urethra after complex hypospadias repairs, so that strictures can be diagnosed at the earliest possible stage

Repair of common bile duct defects with stented autologus vein graft: an experiemental study

This experimental study was done to investigate the effectiveness of using an autologus vein graft and stent in the repair of large defects of the common bile duct [CBD] in a canine model. A 3-cm segment of the great saphenous vein and a 2 - cm segment of the [CBD] were removed from five healthy dogs with normal blood biochemistry levels. A stent was passed through the vein segment, and one end was introduced into the proximal end of the [CBD] while the other end was introduced into the distal end. The venous graft was then sutured to the [CBD]. A liver biopsy was taken for histopathological examination during laparotomy and relaparotomy. Blood samples were obtained on postoperative days 7,14 and 20 for biochemical examinations. The defect was effectively repaired by the autologus vein graft and stent in all the five dogs. No change in blood biochemistry was observed postoperatively, and no histopathological change in the liver was found in the preoperative or postoperative periods. These findings indicate that the use of an autologus vein graft and stent to repair [CBD] injuries could be a feasible and an alternative method of treatment

Study of antioxidants defense system, lipid pattern and left ventricular geometry in hypertensive patients

Free radical activity oxidative stress has been implicated in the pathogenesis of a variety of human diseases. In an attempt to define the role of oxidative stress, dyslipidemia and geometric changes in hypertensive patients [HT], we studied 44 patients, 20 [45.5%] Essential hypertensive [EH], 14 [31.8%] diabetic hypertensive [DH] and 10[22.7%] renal hypertensive [RH]. They were assessed by measurement of some free radicals and antioxidants, serum lipids and echocardiography, the data was compared with 10 age and sex matched normal subjects. There was a significant decrease in important natural antioxidant vitamins C, E, A and reduced glutathione [RG] and a significant increase in lipid peroxide level [LPO] in all groups of hypertensive patients as compared to control. The mean value of cholesterol [C] concentrations in all the hypertensive patients was significantly higher than in controls [P<0.001] Triglycerides [TG] were significantly higher in diabetic hypertensive patients in comparison to controls [P<0.001], HDL-C mean values were reduced significantly in [EH], [RH] groups. LDL-C mean values in all groups of hypertensive were significantly increased [P<0.01]. 38.6% of our patients had concentric left ventricular hypertrophy [CLVH], 13.6% had eccentric left ventricular hypertrophy [ELVH], 13.6% had concentric remodeling [CR] and 34% had normal geometry. We conclude that oxidative stress was observed in all groups of hypertensive patients and we recommend the use of antioxidants as an adjunct to antihypertensive therapy

role of hyperbaric oxygen in ventricular fibrillation in dogs

The protective effects of hyperbaric oxygen has been studied in 75 dogs. For the first time in experimental surgery the study is conducted in wakeful unanaesthesised dogs under control and hyperbaric conditions using our especially devised remote occlusion. Under hyperbaric oxygenation the early [1 hr.] and late [48 hrs] survivals have increased from 60 to 90% and from 30 to 80% respectively. The survival of dogs vulnerable to ventricular fibrillation, as assessed by test remote occlusion, after resuscitation has risen from 0 to 57%