BLOC1S1 promotes proliferation of goat spermatogonial stem cells / 生物工程学报

With the rapid development of gene editing technology, the study of spermatogonial stem cells (SSCs) holds great significance in understanding spermatogenesis and its regulatory mechanism, developing transgenic animals, gene therapy, infertility treatment and protecting rare species. Biogenesis of lysosome-related organelles complex 1 subunit 1 (BLOC1S1) is believed to have anti-brucella potential. Exploring the impack of BLOC1S1 on goat SSCs not only helps investigate the ability of BLOC1S1 to promote SSCs proliferation, but also provides a cytological basis for disease-resistant breeding research. In this study, a BLOC1S1 overexpression vector was constructed by homologous recombination. The BLOC1S1 overexpression cell line of goat spermatogonial stem cells was successfully constructed by lentivirus packaging, transfection and puromycin screening. The overexpression efficiency of BLOC1S1 was found to be 18 times higher using real time quantitative PCR (RT-qPCR). Furthermore, the results from cell growth curve analysis, flow cytometry for cell cycle detection, and 5-ethynyl-2'-deoxyuridine (EdU) staining showed that BLOC1S1 significantly increased the proliferation activity of goat SSCs. The results of RT-qPCR, immunofluorescence staining and Western blotting analyses revealed up-regulation of proliferation-related genes (PCNA, CDK2, CCND1), and EIF2S3Y, a key gene regulating the proliferation of spermatogonial stem cells. These findings strongly suggest that the proliferative ability of goat SSCs can be enhanced through the EIF2S3Y/ERK pathway. In summary, this study successfully created a goat spermatogonial stem cell BLOC1S1 overexpression cell line, which exhibited improved proliferation ability. This research laid the groundwork for exploring the regulatory role of BLOC1S1 in goat spermatogonia and provided a cell platform for further study into the biological function of BLOC1S1. These findings also establish a foundation for breeding BLOC1S1 overexpressing goats.

Awareness of First Aid in Different Burn Degrees and its Surgical and Psychiatric Aspects on Patients, in Hail, Kingdom of Saudi Arabia

Background: Burn injuries are one of the most traumatizing and damaging wounds. Causing considerable mortality, prolonged hospitalization, disfigurement, disability, often with resulting social stigma, rejection, psychiatric issues in long run. We aimed to assess the knowledge of general population on first aid and surgical intervention in different degrees of burns and psychiatric aspect on patients; so, the results of this study could help to manage burn injuries. Methods: A descriptive cross-sectional community-based survey was conducted in shopping malls of Hail KSA. Data was collected from the audience who attended Health Awareness Campaign on Burns between 15th of December 2019 and 15th of January 2020. Data was fed and analysed by using SPSS version 23. Results: Forty-seven Percent of the respondents have received information on burns. Half of respondents had history of either oneself being affected by burn incident or any one of their close relatives. Out of 273 burn cases, 65 had complications later. Almost 29% developed psychiatric issues after that incidence but just 8% consulted Psychiatrist. Only 2% were familiar with the surgical aspect for healing of second-degree burn. Conclusion: Knowledge of respondents on the burn’s issues is very scanty as revealed in our results. 15%-24% 0f respondents did not know what to do in 1-3 degree of burns that is very alarming. Just 16% knew that there is any role of Plastic Surgery in 3rd degree burns. Twenty-nine Percent had suffered from psychiatric problems after burn incident but just 8% consulted any Psychiatric and those were ones who had total monthly income ≥ 10,000 Saudi Riyals (p ≤ 0.05). These results emphasize the importance of implementing Health Awareness Campaigns in community and in institutions that could minimize burn incidents and psychiatric issues in general population.

Insight of Saudi Women towards Breast Self-Examination in Qurayyat, Northern Saudi Arabia

Background: Implementing early detection’s sustainable programs of breast cancer is fundamental for better disease management. Therefore, the present study aimed to assess the insight of Saudi women towards Breast self-examination (BSE) in Qurayyat, Northern Saudi Arabia. Methodology: This descriptive study included 620 Saudi volunteers living in the city of Qurayyat, Northern Saudi Arabia. Women who denied to participate in the breast self-examination workshop were included for perception assessment. Results: A previous BSE was experienced by 217/620 (35%). “Previous knowledge about BSE”, (response=536) good knowledge 217 (40%), poor knowledge 208 (39%), know nothing 111 (21%). Conclusion: There is relatively lower knowledge regarding BSE and its related factors in Northern Saudi Arabia. Saudi Northern women have positive attitudes towards health education and training on BSE.

Correlation of Serum CA-125 and progesterone levels with ultrasound markers in the prediction of pregnancy outcome in threatened miscarriage

Background: The aim of this study was to evaluate the relationship between ultrasonographic findings and serum progesterone and cancer antigen-125 [CA-125] levels in threatened miscar-riage and to predict pregnancy outcome

Materials and Methods: In a prospective comparative case-control study, serum CA-125 and progesterone levels were measured for 100 pregnant women with threatened miscarriage who attended the outpatient clinic or the causality department of Obstetrics and Gynecology at Kasr El-Aini Hospital, Giza, Egypt, during the period from March 2013 to October 2013. Ultrasound was performed for fetal viability, crown-rump length [CRL], gestational sac diameter [GSD] and fetal heart rate [FHR]. The patients were followed up and divided into two groups based on the outcome: 20 women who miscarried [group 1], and 80 women who continued pregnancy [group 2]. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and overall accuracy were tested for CA-125 and progesterone levels in prediction of the pregnancy outcome. Correlation of these chemical markers with the ultrasound markers was also examined

Results: In the group that miscarried, CA-125 level was significantly higher [P<0.001] and serum progesterone level was significantly lower [P<0.001]. For prediction of the outcome of pregnancy, the cut-off limit of 31.2 IU/ml for CA-125 level yielded sensitivity, specificity and an overall accuracy of 96.2, 100 and 99.4% respectively. The cut-off limit of 11.5 ng/ml for progesterone level yielded sensitivity, specificity and an overall accuracy of 97.5, 100 and 99.8% respectively. CA-125 level had a negative correlation with progesterone level and FHR levels [r=-0.716, P<0.001] and [r=-0.414, P<0.001] respectively. Serum progesterone level correlated with GSD [r=0.521, P<0.001] and with CRL [r=0.407, P<0.001] and FHR [r=0.363, P<0.001]. CA-125 level was significantly higher in the group that showed hematoma as compared with the group without hematoma [P<0.001]. Also, serum progesterone level was significantly lower in the group that showed hematoma as compared with the group without hematoma [P=0.017]

Conclusion: Serum CA-125 and progesterone levels are valid early predictors of the outcome of pregnancy in women with threatened miscarriage. They are correlated with some ultrasonographic markers [GSD, CRL, and FHR]

Protective effects of benfotiamine in the experimentally-induced nephrotoxicity with cisplatin in rabbits

Cell death is the component of many response patterns of living tissues to xenobiotics including cytotoxic drugs, and one of the possible ways to ameliorate this response is through interference with the process of apoptosis which can be fulfilled by many candidate substances like benfotiamine. This study was designed to evaluate the possible cytoprotective effect of orally administered benfotiamine against cisplatin -induced nephrotoxicity in rabbits. Twenty adult rabbits are used in this study and allocated into 4 groups; treated as follow: Saline treated as controls, cisplatin [2.5mg/kg] treated group; benfotiamine [70mg/kg] seven days before and during cisplatin treatment and thiamine [70mg/kg] treated rabbits. At the end of treatment all animals are sacrificed, serum and kidney tissue homogenate are prepared for the assay of urea, creatinine, uric acid and thiamine in the serum; malondialdehyde [MDA], glutathione [GSH] and thiamine levels in kidney tissue homogenate. Kidney tissue sections are prepared for histological examination. Benfotiamine treatment resulted in ameliorating the nephrotoxicity induced by cisplatin as evidenced by lowering serum urea and creatinine levels, while uric acid was not affected. Concerning the effect on oxidative stress parameters; MDA levels in tissue homogenate were significantly reduced while GSH levels not improved significantly. Histological evidences supported the biochemical parameters which indicate nephroprotective effect of Benfotiamine. The orally administered prodrug elevates thiamine levels in kidney tissue homogenate many fold greater than those produced by conventional thiamine. According to the results obtained in this study one can conclude that benfotiamine has the ability, through a mechanism not related to direct antioxidant property, to provide cytoprotective effects against drug-induced nephrotoxicity; and might be a good candidate to be tried experimentally and clinically in this respect

Anthropometric measurements and vital signs compared to imaging studies in high risk newborns

Our study was conducted on 81 high risk newborns 35 preterm, 46 fullterms] in addition to 20 healthy newborns [9 preterms, 11 fullterms] as a control group matched with study group. Anthropometric measurements [weight, length and head circumference] vital signs [heart rate, systolic blood pressure, respiratory rate and temperature]. Radiological investigations were done for all cases and controls including transcranial sonar, brain CT, and transcranial Doppler studies of internal carotid artery, middle cerebral artery and anterior cerebral artery for mean velocity, pulsatility index and resistive index. The group of CNS congenital anomalies showed significantly lower birth weight and significantly bigger head circumference. The group of preterms with meningitis showed significantly bigger head circumference. The group of preterms with HIE and the group of fullterms with meningitis showed significantly lower HR. The groups of HIE [preterms and fullterms] as well as complicated LBW showed significantly higher RR than controls. Higher percentage of abnormalities was observed by CT than by transcranial sonar. IVH and PVE were found only in preterms, PVE was not seen by CT while lVH and ventricular dilatation were equally seen by sonar and CT Brain oedema was over diagnosed by sonar than by CT. Other lesions including cortical damage, WMH, meningeal enhancement and subarachnoid hemorrhage were seen only by CT. Lower birth weight in preterms [<1220 gm] was significantly associated with higher frequency of abnormal sonar and abnormal CT and IVH, also Lower birth weight in fullterms [<2750 gm] was significantly associated with higher frequency of abnormal CT and ventricular dilation. Bradycardia [HR <120/m] was significantly associated with significantly higher frequency of abnormal sonar and abnormal CT in our high risk newborns [prerterms and fullterms] particularly significantly higher frequency of IVH in preterms and WMH in fullterms. Hypotension in preterms [B.P. <45mmHg] was significantly associated with significantly higher frequency of abnormal sonar and abnormal CT, lVH and PVE, also hypotension in fullterms [B.P. <50mmHg] was significantly associated with higher frequency of abnormal CT and WMH. Transcranial Doppler findings revealed higher mean velocity and lower PI and RI in preterms and fullterms with HIE and meningitis than controls. Also lower MV and higher PI and RI than controls. ln preterms and fullterms with bradycardia we observed higher MV and lower PI and RI. In preterms and fullterms with hypotension, we observed lower MV and higher PI and RI. Significant -ve correlations were observed between MV and HR, also significant +ve correlations were observed between PI as well as RI and HR

Conclusion: transcranial sonar is very helpful in diagnosis or various CNS affection in high risk newborns particularly in complicated LBW, HIE, meningitis and CNS congenital anomalies. Higher rates of abnormalities both by transcranial sonar and CT were observed in relation to bradycardia and hypotension. The use of transcranial Doppler may not reflect a specific disease entity because it could be affected by other different factors

Comparative study between pedicular screws, interbody fusion cages and combined procedures in management of spondylolisthesis

Background and Objective: to evaluate surgical management of spondylolisthesis through posterior approach using different instrumentation including fixation by pedicular screws/rods with posterolateral arthrodesis, posterior interbody titanium threaded [stand alone] cages as PLIF or pedicular system and posterior different types of cages [titanium or carbon] to bold the bony interbody fusion

Patients and Methods: sixty patients with lumbar spondylolisthesis were classified into three groups: Group A [n=20] was fixed by pedicular-screws/rods fixation with posterolateral arthrodesis; group B [n=20] had posterior interbody titanium threaded [stand alone] cages as PLIF; and group C [n=20] was fixed by pedicular system and posterior different types of cages [titanium or carbon]. All patients underwent serial clinical evaluations at regular 3-month intervals between the 3rd and the 12th postoperative months. At the second year they were examined at 6-month intervals. Functional disability was measured by the Oswestry low back pain disability questionnaire. Radiological evaluation was done with 6 months interval for 2 years to evaluate: fusion status; hardware status [correct placement or failure]; anatomical correction [horizontal displacement, angular displacement; disc height]; and instability and degenerative . changes on adjacent levels. All surgical problems were recorded including intraopertaive, early and late postoperative ones

Results: excellent postoperative Brodsky scores of pain were reported by 50%, 55% and 60% in group A, B and C respectively, showing a significant difference to preoperative scores in each group. The success rates were 80%, 85% and 90% in group A, B and C respectively. Correction Rate [CR] of preoperative symptoms was 90% in group C, 85% in group B and 75% in group A. Obvious fusion was detected in 18 cases [90%] of group C, 16 cases [80%] of group B and 14 cases [70%] of group A, i.e. the fusion rate after circumferential fusion is higher and reliable than that in stand-alone procedure. Immediately after surgery, there was a significant reduction in horizontal displacement [HD], and angular displacement [AD], and a significant increase in disc height [DH] in all groups, which still significant after 2 years in group B and group C only. There was non significant difference in the rate of complications except the significant increase in-operative time > 4 hours in group C

Conclusion: in cases of spondylolithesis grade I. and II, fixation by pedicular system and posterior different types of cages [titanium or carbon] provide a more solid mechanical construct -when compared with the pedicle screws used alone or stand alone cages. All surgical procedures are effective, although combined procedure showed better clinical outcomes if quality of life, pain improvement, and functional recovery are considered

Iatrogenic bile duct injury : evaluationby MR cholangiopancreatography

Iatrogenic bile duct injury is a complex problem for both surgeons andpatients. This study was designed to assess the diagnostic role of MRcholangiopancreatography [MRCP] in the evaluation of bile duct injury

Patients and methods: In this prospective study, MRCP was performedin 11 postoperative patients [7 females and 4 males], mean age 43 [range26 - 65] years, suspected of having bile duct injury as a result of surgery. Presence or absence of biliary dilatation, fluid collection and freefluid were noted using abdominal ultrasonography, spiral CT or MRI. Ex-cision injury was diagnosed if a segment of bile duct was not visible onany of the MRCP sequences. Positive cases were classified according toanatomic location and extent of injury. Results were compared with per-cutaneous transhepatic cholangiography [PTC] in five patients, endoscop-ic retrograde cholangiopancreatography [ERCP] in two surgery in fiveand clinical follow up in three

Results:Three patients had normal findings on MRCP and remained asymptomatic on clinical follow up. Five patients had bile duct excision injury on MRCP that was surgically provenand were treated by hepaticojejunostomy Rouxen Y, one patient had biliary stricture, confirmed by PTC and was treated by balloon dilatation. Of these sex patients, one had Bismuth type I injury, two had Bismuth typeII, one had Bismuth type III and two had type IV. Two patients had findings suggestive of bile duct leak on MRCP, one was treated by endo-scopic sphincterotomy and percutaneous drainage was done for the second patient followed by surgery because the collection was increasing

Conclusion: MRCP is an accurate diagnostic technique in the identification of postoperative biliary strictures and excision injuries. This technique allows exploration above and below the level of obstruction, a resource provided by neither ERCP nor PTC, and can characterize and ana-tomically classify these injuries for planning reparative surgery. It can also suggest the presence of cystic duct leaks in patients who have un-dergone cholecystectomy

Anocutaneous advancement FLAP plasty for high [primary or recurrent] perianal fistula

The management of high perianal fistula [high transsphincteric and su-prasphincteric] remains a difficult surgical dilemma. Treatment of these complex fistulas by a traditional [laying open] technique, which is the standard treatment of low fistulas will lead to an almost complete transsection of the anal sphincters with wide separation of both ends and incontinence. Mucosal advancement flap can be technically difficult and is associated with ectropian, mucus leakage and incontinence. This study was designed to evaluate the healing rate of high [primary or recurrent] perianal fistula after anocutaneous advancement flap repair with core fistulectomy as a sphincter - preserving alternative, and to examine the impact of this procedure on foecal continence. Between April 2001 and December 2004, 16 patients [12 males], mean age 39 [range 27 - 63] years, with high [primary or recurrent] perianal fistula of cryptoglandular origin [10 high primary and 6 high recurrent] were treated. In all patients, perianal sepsis was allowed to resolve completely before definitive surgery. The technique used involved core fistulectomy, drainage or excision of any side tract[s] with curettage of any residual epithelium, closure of the defect in the internal anal sphincter, and a V-Y advancement buttock flap to cover the internal opening, leaving the site of the external opening for drainage while preserving both internal and external sphincters. Outcome was assessed in terms of healing and continence. Most patients were discharged from the hospital within 6 [range 5-9] days. Median follow up was 26 [range 6 - 32] months. In the high primary group [n = 10], the healing rate was 90% and continence was preserved completely in all patients. In the high recurrent group [n = 6], the outcome was poor. The healing rate was 50% and continence was preserved in 67% of patients. Overall: 12/16 [75%] of patients experienced complete healing of their fistulas and recurrence occurred in 4/16 [25%] of patients. The overall continence status was excellent in 14/16 [87%] of patients and disturbance in continence occurred in 2/16 [13%] of patients. High primary transsphincteric and suprasphincteric fistulas can be treated effectively by this procedure. It is simple, easy to perform, healing is rapid and it involves total sphincter preservation. Based on the relatively low healing rate and deterioration of continence, this procedure seems to be less suitable for high recurrent perianal fistula

Laparoscopic treatment of common bile duct stones: [single stage] laparoscopic approach to cholelithiasis and choledocholithiasis

Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance. There are several disadvantages to ERCP including the additional invasiveness of endoscopic procedures, moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES [endoscopic sphincterotomy]. Peroperative real time cholangiography has the advantage of addressing choledocholithiasis with a single procedure LCBDE [Laparoscopic Common Bile Duct Exploration] while leaving the sphincter of Oddi anatomically intact without added morbidity. The choice of treatment between immediate laparoscopic common bile duct exploration, open exploration of CBD and transsphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and examine the biliary ductal system by laparoscopic intra-operative cholangiography [IOC] during laparoscopic cholecystectomy [LC]. The aim was to visualize the ductal anatomy and any anomalies on filling with contrast [to avoid biliary injury], detect any CBD stones and assess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Intraoperative cholangiography was performed for 302 patients underwent LC for chronic calcular cholecystitis [CCC] in Benha University Hospital from Dec. 1999 to Jan 2004. Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patients [11.3%] were harbouring silent CBD stones managed immediately for CBD clearance. LCBDE was feasible in 23/31 cases who had choledecholithiasis [74.2%], while 8 patients needed conversion to open choledochotomy. 28 patients [9.3%] had preoperative ERCP, endoscopic sphincterotomy [ES], stone retrieval Operative cholangiography during LC proved residual stones in CBD in 2 of them [7.1%] and were treated by open choledochotomy. LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choledocholithiasis as a [one step] procedure

Feasibility of combined laparoscopic cholecystectomy and anti-reflux surgery: evaluation and outcome

This study was designed to evaluate the outcome of combined laparoscopic cholecystectomy and fundoplication during one single laparoscopic procedure. The study included only patients assigned to undergo cholecystectomy for calcular cholecystitis and had symptomatic gastroesophageal reflux disease [GERD], 22 patients [7 males and 15 females] were enrolled in the study. All patients underwent clinical history taking including duration of symptoms, physical examination and upper gastrointestinal endoscopy. Esophageal manometry was performed preoperatively and 2 and 6 months after surgery. Laparoscopic procedures were performed through 5-port access. Operative time and the frequency of conversion to open surgery, time till initiation of oral intake, postoperative hospital stay and complications and time to recover full activity were recorded. Through a monthly visit for 6 months after surgery, patients were monitored for the extent of resolution of GERD-related symptoms. There was a significant increase [p<0.001] of postoperative lower esophageal sphincter [LES] pressure compared to preoperative pressure with a non-significant difference between pressures estimated at 2 and 6 months. No intraoperative complications were encountered and there was no need for conversion to open surgery in any case. The mean operative time was 78.3+/-9.7; range: 60-90 minutes. All patients tolerated oral ingestions after the first 48 hours. The mean duration of postoperative hospital stay was 4+/-0.8; range: 3-5 days and 9 patients [40.9%] were discharged on the 3[rd] postoperative day. The mean duration till resumption of full daily activities was 11.6+1.4 [10-14] days. Clinically, a marked resolution of symptoms due to reflux was observed, only one patient developed dysphagia for solid food and a sensation of trapped air occurred in two patients causing discomfort, however, these three patients were asymptomatic at 6 months after the surgery. It could be concluded that combined laparoscopic surgery for cholelithiasis and GERD is an appropriate procedure, when indicated, giving excellent short-term outcome results and could be managed during one single laparoscopic procedure

One-stage primary ileo-colic or ileo-rectal anastomosis. For acute malignant left colonic obstruction

The aim of this study was to evaluate the immediate and short-terme follow-up results of one-stage subtotal or total colectomy and anastomosis for patients with malignant left colon obstruction. The study comprised 21 patients [10 males and 11 females] with age range of 36-81 years; presented by acute large bowel obstruction with clinical and radiological evidence of obstruction. The choice of the extent of resection was determined by the extent of fecal load, the presence of colonic perforation, serosal tears of the cecum and/or massive colonic distension with concomitant ischemia: the presence of these features in a hemodynamically stable patient favored subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis. The site of obstruction was at the sigmoid colon in 9 patients [42.9%], rectosigmoid in 8 patients [38.1%], splenic flexure in 3 patients [14.3%] and descending colon in one patient [4.7%]. Ileosigmoid anastomoses were done in 13 patients [61.9%] and 8 patients [38.1%] had ileorectal anastomoses. The mean operative time was 201+/-33.2; range: 150-270 minutes, the mean operative blood loss was 633.3+/-408.2; range: 250-1800 cc; 11 patients [45.8%] required blood transfusion with a mean number of blood bags used was 2.8+/-1.2; 1-5 bags. Oral feeding was resumed after a mean period of 4.9+/-0.9; range: 4-7 days and the mean postoperative hospital stay was 10+/-2.2; range: 8-18 days. Overall, after 12-months follow-up only one patient had anastomotic line recurrence with a recurrence rate of 4.75%, one patients died of acute liver failure secondary to hepatic metastasis with mortality rate of 4.75% and 19 patients had follow-up free of morbidity with no-local recurrence or metastasis and a follow-up free rate of 90.5%. Thus, it could be concluded that one-stage subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis are safe procedure with satisfactory outcome for management of obstructing malignant lesions of the left colon

Mother's attitude towards their children with acute respiratory infections

A study carried out to identify the mother's practice in case of occurrence of ARI in there children.the sample of the study consist of [100] mothers of children ARI selected randomly from Ibn AL- Atheer hospital from pediatric, a AL- Kansa,a from pediatric and maternity, AL-Hada,a Primary health center and AL-Rashedia Primary health center, as [25] mothers in each above. The sample interviewed personally to complete questionnaire which prepared by pilot study [open- end question] with 10 mother, the investigators measured the validity and reliability. The study carried out from 15-30 April - 2000. Results of the study indicated that half of the children 50% with ARI Under "1" year majority of cases occurred in mother children with low level education [36%], in large families[9childand above] [38%], housewife mother's [52%], majority of children problems is pneumonia [42%], acute bronchitis [34%], and the majority of mother's Practices were correct and healthy. The study recommended about health education for mothers about essential symptoms, how to prevent it, how to care for child during attack. The study also recommended the importance of children's immunization in suitable time and reinforced breast feeding

Haemorrhoidectomy for advanced haemorrhoidal disease, comparative study between the conventional and modern techniques

Surgical excision is considered the ideal treatment for the third and fourth degree haemorrhoids. Inspite of being safe, surgical excision is liable to some complications as postoperative bleeding, pain, discharge, stenosis and recurrence So, a wide variety of techniques had been developed to avoid these complications. This study was performed for two hundred patients complaining of third or fourth degree haemorrhoidal disease. Their ages ranged between 18 and 66 years, [mean 40.28 +/- 11.84 years]. The patients were divided into four groups. Group I, [50 patients], for whom stapler haemorrhoidectomy was done. Group II, [50 patients], for whom rubber band ligation was performed. Group III, [50 patients], for whom Good-Sall's stitch technique was done. Group IV [50 patients], for whom conventional haemorrhodectomy was performed. The aim of this study was evaluation of the four techniques regarding, the operative time, hospital slay, time off work, postoperative pain, bleeding and post operative complications: For each technique the study concluded that: The shortest mean operative time was in group II, [5.7 +/- 2.14 mins.]. The shortest hospital slay and shortest time-off work was in group II, [1.60 +/- 0.91 days] and [3.12 +/- 1.39 days] respectively. Minimal post operative pain was in group I. The highest incidence of postoperative minor bleeding pruritis and wound discharge was recorded in group IV. The highest incidence of recurrence was recorded in group II. The results seen with stapler haembrrhoidectomy are very promising and actually superior to that of conventional haemorrhoidectomy in treatment of third and fourth degrees haemorrhoidal disease. Cost which remains high, seems to be balanced by the superior results obtained and the significant rapid return to normal activities and patient satisfaction

Blunt hepatic injuries: incidence, evaluation and management in Zagazig University Hospitals

A prospective study including most of the patients, [374 patients] admitted to emergency department of Zagazig University hospitals as a blunt abdominal trauma during the period from January 1998 to December 2001. Liver injury was found in 86 of them [those patients represents the material of this study]. The age of liver injured patients ranged between 9 to 59 years [mean 35 years]. 67 males and 19 females. Motor vehicle accident was the cause of liver injury in 53 patients [61.6%], train accident in 4 patients [4.6%] and fall from a height in 29 patients [33.8%]. The liver injured patients had exra-abdominal injuries in the form of, head injuries in 15 patients [17.4%]; chest injuries in 21 patients [24.4%] and orthopedic injuries in 33 patients [38.3%]. After exploration of 77 patients with liver injury there were other abdominal injuries as the following: spleen in 16 patients [18.6%]; mesentery [haematoma and/or tears] in 7 patients [8.1%]; small intestine in 5 patients [5.8%]; colonic injury in 3 patients [3.4%]; retroperitoneal haematoma in 12 patients [13.9%]; pancreas in one patient [1.15%]; kidney in 2 patients [2.3%] and diaphragm in one patient [1.15%]. All liver injured patients were categorized according to the degree of injury to five grades. The following techniques were used in the management of our liver injured patients. 1-Non-operative treatment: [12 patients], proved grade I, II or III by CT scan with mild to moderate intraperitoneal haemorrhage in haemodynamically stable patients. Early operative intervention was required in two patients with evidence of continuing intra-abdominal bleeding, and in one patient with signs of other associated injury which necessitates laparotomy. 2-operative treatment: For [77 patients]. The procedures used were: abdominal drainage only when the liver injury was minimal without obvious blesding or non expanding haematoma; topical haemostatic agent, as gelfoam or fibrin glue and electrocautary for superficial ooze occurs from decapsulated liver and superficial bleeding fracture; suturing: when bleeding was occurred from within the liver substance without a visible vessels; suture ligation of visible bleeding intra-hepatic blood vessels and injured bile ducts using the finger fracture technique; resection debridement [non anatomical resection] of devitalized or almost detached segments of the liver and peri-hepatic packing, in multiple and complex liver injuries beyond the surgeon's ability to manage and used with other surgical procedures, particularty when hypothermia and coagulopathy promotes diffuse bleeding which is not possible to alleviate by other means. The packs were removed when the patients were haemodynamically stable and coagulopathy was corrected, usually 3-5 days after first exploration. Further debridement of liver necrotic tissue was performed and new peritoneal drains were applied. Thirteen patients [15.1% of liver injured patients] died, two in grade II, one in grade III and three in grade IV i.e. 6 patients died [46% of all deaths] due to associated chest and head injuries [i.e. deaths not related to liver injury]. Three patients in grade V died on table due to massive, uncontrollable bleeding from hepatic injury. One patient died as a result of massive postoperative haematemesis, one due to rebleeding and irreversible shock 24 hours postoperatively in ICU and two patients died due to hepato-renal failure postoperatively. The hospital stay for all liver injured patients ranged from 6 to 31 days [mean 11 days]

Management of civilian colon injuries

Over the past three decades, primary repair of colonic injuries has become more accepted and there has been a trend toward using this procedure for repairing civilian colonic injures. However, the best procedure remains controversial. Forty patients with colonic injuries alone or associated with other organ injuries were included in the present study over a 44 months period Benha University Hospital. After resuscitation, exploratory laparotomy was done and other organ injuries were appropriately managed. Colonic injuries were dealt with either by primary repair, age, blood transfusion, mechanism and site of injury and injury severity indices. The mechanism of injury was stab injury in 37.5% gunshout in 32.5% iatrogenic in 17% and blunt trauma in 13%. Isolated colon injuries were found in 27.5% and associated with small intestinal injury in 47%. The left colon injuries were found in 40% followed by transverse colon in 37.5%. Primary repair, either by debridement and simple closure in 2 layers or by segmental resection and primary anastomosis was done in 65% of patients while diversion procedures were carried out for 35% of patients. There were 3 mortalities and complications occurred in 30% of the studied patients. From this study we can conclude that there is no single policy for management of colon injuries either by diversion or primary repair. Good results can be obtained by proper decision of an experienced surgeon according to the individual circumstances of each case rather than following solid scheme by less experienced surge Primary suture should be limited to early cases induced by sharp agents or iatrogenic injury. For most severely traumatized patients diversion remains the most dependable method of treatment as it is followed by the least morbidity and mortality

Clinical significance of the immunological and serological parameters in early and long standing rheumatoid arthritis

To investigate the additional predictor value of different immunological and serological parameters by evaluating the relationships of these parameters to each other, to the activity, and to the radiological damage in RA patients with different disease durations and grades of activity. Sixty patients [53 females and 7 males], mean age 36.2 years [range 20 - 57] and median disease duration from <6 weeks-28 years were evaluated clinically, with laboratory and radiology in the Rheumatology Department of Assiut University Hospital. Patients met the 1987 American College of Rheumatology Revised [ACR] Criteria. The disease duration didn't seem to influence the rate of occurrence of RF or ANA. The results presented here support that there was a significant positive correlation between CRP with the mean disease grading activity MDGA [p<0.01] and with the degree of radiological damage [p=0.02]. While RF levels in seropositive patients with different grades of activity did not correlate with any of the disease parameters used for assessment of the patients. However, positive RF positively correlated with radiological damage [p=0.04]. ANA positivity only correlated with pain score but not with grades of the disease activity or the severity of the radiological damage

Breast conservation therapy in treatment of cancer breast

Breast conservation therapy [B.C.T.] comprises local excision, axillary dissection and post operative radiotherapy. Numerous studies have now shown that although local recurrence may be slightly more common after breast conservation than mastectomy, disease-free survival and overall survival are the same. The primary goals of breast conservation therapy are tumour control and acceptable appearance of the breast. Twenty female patients were included in this study. All patients were suitable for B.C.T. Their ages ranged from 25 to 60 years [mean age 41.3 +/- 8.8 years]. All patients were subjected to mammography, fine needle aspiration cytology [FNAC] and metastatic work up [chest x -ray, abdominal ultra sonography and bone scans].The study included 4 patients [20%] in stage I, 14 patients [70%] in stage II and 2 patients [10%] in stage III One patient showed positive safety margin of the lumpectomy specimen and for whom mastectomy was done. The remaining 19 cases were followed up for two years. The study showed an excellent cosmetic appearance however, local recurrence occurred in 3 cases [15.78%]. The higher incidence of total recurrence in the present study may be related to the histopathological nature of the tumour, the biological behavior of breast cancer in Egypt or even the sample is so small in number

Laparoscpy in diagnosis of acute lower abdominal pain

Thirty patients with acute lower abdominal pain of uncertain diagnosis were the material of this study. After a short time of observation without a definitive diagnosis. laparoscopic exploration was performed to help in establishing a correct diagnosis and management and avoid unnecessary laparotorny. At laparoscopy the diagnosis of acute appendicitis was made in ten patients. Gynaecologjcal pathology was diagnosed in thirteen patients, one patient had Mekel's diverticuiltis, while in six patients no definitive pathology was found. One patient among the last six had acute appendicitis as the appendix was not visualized completely, laparoscopy reduced the number of un necessary laparotomy. The procedures and the results were reviewed with the conclusion that laparoscopy is safe and useful as a diagnostic and therapeutic tool in management of patients with uncertain diagnosis of acute lower abdominal pain