Comparative study of respiratory and hemodynamic effects of thoracoscopy versus laparoscopy for repair of congenital diaphragmatic hernias in neonates and infants

The use of minimally invasive surgery has been expanding steadily in pediatric surgical practice. Thoracoscopy and laparoscopy have been used for correction of congenital diaphragmatic defects in neonates and in young children. This study aimed at comparing cardiorespiratory effects of both techniques when used for the repair of congenital diaphragmatic hernias. From January 2007 to December 2007, 20 neonates and young infants were enrolled in the study. Children were all ASA II and III their age ranged from 0-6 months and their mean weight was 4485g. ETCO2, O2 saturation, HR and MAP were recorded at basleine [before insufflation], at 30, 60 minutes after insufflation and 10 minutes after desufflation, also minute volume and peak inspiratory pressure were recorded before and after insufflation. The operative time was also recorded and compared in both groups. The mean operative time was 116 +/- 9.3 minutes for thoracoscopy and 152 +/- 12.5 minutes for laparoscopy p<0.05. O2 saturation decreased from 99.4% +/- 1.3 to 96.1 +/- 4.8 p<0.05 and from 99.2 +/- 1.6 to 95.8 +/- 4.8 p<0.05 in the laparoscopic and thoracoscopic groups respectively. ETCO2 increased from 28.2 +/- 5.4 to 36.1 +/- 6.9 mmHg p<0.05 and from 27.4 +/- 6.5 to 39.8 +/- 4.2 mmHg p<0.05 in the laparoscopic and thoracoscopic groups respectively. The duration of insufflation influenced the increase in ETCO2, as values of ETCO2 recorded after one hour showed the greatest values [39.2 +/- 5.3 and 40.3 +/- 3.9 in the laparoscopic and thoracoscopic groups respectively all patients showed increase in HR from 119 +/- 12.7 to 134 +/- 17.2 heats/minute p<0.05 and from 121 +/- 11.9 to 138 +/- 14.7 heats/minute p<0.05 in the laparoscopic and thoracoscopic groups respectively after CO2 insufflation, in 90% of cases the MAP was stable during CO2 insufflation. In conclusion, this study demonstrated comparable cardiorespiratory effects of thoracoscopy and laparoscopy-within the mentioned insufflation pressure in the study- for repair of CDH in neonates and young infants nevertheless thoracoscopy could be performed in a significantly shorter time

Correlation between some angiogenic and apoptotic factors in acute leukemias

Objective: to evaluate matrix metalloproteinase-9 [MMP-9], inhibitor of metalloproteinase-1 [TIMP-I], sFas, hepatocyte growth factor [HGF] and myeloperoxidase [MPO] levels in newly diagnosed patients with acute leukemias and to correlate their levels with the patients' clinical data. We also tried to study the correlation between apoptosis and angiogenesis in acute leukemias

Patients and Methods: this study included 15 patients with acute lymphoblastic leukemia [ALL]. 15 patients with acute myeloblastic leukemia [AML] and 15 healthy persons of matched age and sex served as controls. The levels of serum human total matrix metailoproteinase-9 [MMP-9], human tissue inhibitor of metalloproteinase-1 [TIMP-I], human sFas and plasma concentration of hepatocyte growth factor [HGF] were determined by enzyme linked immunosorbent assay. The measurement of MPO was done in peripheral blood polymorphonuclear layer

Results: elevated levels of the angiogenic factors [MMP-9. its inhibitor TIMP-I, and HGF] as well as the apoptotic factor [sFas] were detected in both acute leukemic groups when compared with controls while MPO was significantly decreased in both groups as compared to controls. Significantly higher levels of MMP-9 and MPO were present in AML group than ALL group while sFas level was significantly higher in ALL than AML group. HGF level was insignificantly different between both groups. Higher values of MMP-9, HGF and sFas were observed in M4 and M5 than other FAB subtypes and in adult than child ALL. No correlation was present between angiogenesis and apoptosis in acute leukemic patients

Conclusion: angiogenesis and apoptosis are independent processes in acute leukemias

Role of splenic autotransplantation in management of thalassemia major in children

The aim of this study was to assess the outcome of pediatric patients with beta thalassemia undergoing splenectomy with splenic autotransplantation. It was conducted on 20 children suffering from beta thalassemia major over a period of two years. The rate of blood transfusion decreased considerably in both groups. One patient developed severe pneumonia in the NST group. The postoperative laparoscopic biopsy confirmed the reticular pattern of the implants with perivascular lymphocytic aggregations. All the transplanted splenic tissues showed a good uptake on scintigraphy with a gradual increase in C3, IgM and IgG levels at one and three months postoperatively with 1.5-2 fold increase of IgM and IgG levels after vaccination. Splenectomized only patients showed no significant increase in these levels

Anterior versus posterior sagittal anorectoplasty without colostomy for repair of vestibular anus

In this study, rectovestibular and anovestibular fistulae were repaired in 30 girls using the sagittal anorectoplasty technique without colostomy over a period of three years. A preoperative preparation of the bowels was performed using low residue diet, oral mannitol 10% as laxative, intestinal antiseptics and broad spectrum antibiotics with a gradual restoration of oral feeding after surgery. The anterior approach was adopted in 15 consecutive patients and their results were compared with those of other 15 ones to whom the posterior approach was performed. The incidence of wound infection was slightly higher in the PSARP group than in the ASARP, but in both groups, it was mild with no complete disruption of the wound. Generally, excellent results with normal bowel function were obtained in 19 cases with nearly equal results in both ASARP and PSARP groups. Good results having mild constipation that responded to diet or simple laxative with occasional soiling occurred in eight cases. Fair outcome was more frequent in PSART group. Complete incontinence with a poor outcome was not encountered in any of the two groups

Effect of certain fertilizers and growth regulators on the growth and alkaloidal content of Catharanthus roseus donn

This investigation was carried out to study the effect of some fertilizers and growth regulators separately and the interaction between them, on growth, alkaloidal concentration and yield of Catharanthus roseus plant. All the fertilization levels increased plant height, number of leaves and branches per plant, dry weight of leaves and roots per plant as well as alkaloidal concentration. The growth regulators used were gibberellin, cycocel and ethrel. Gibberellin at 100 ppm markedly increased the vegetative growth characters, alkaloidal concentration and yield in the different plant organs. Significant increase in these characters resulted from the combined treatment between the high fertilization level [N300 P150 K75 kg/feddan] and the different concentration of gibberellin and cycocel. On the other hand, reduction in these characters was observed with the combined treatments between ethrel concentrations and different fertilization levels

Management of rodent ulcer

* 24 pationts with rodents ulcer of the eye lids and adjacent areas of the face were studied. * The commonst sites were in the lower lid and the inner canthus. * Eight of the cases were recurrent ulcer. 6 of them have been recived local treatment. * Two of patients presented with aggressive ulcer. * No palpable glands were detected in any of the cases. * Wide excision and skin graft were done. Free full thickness grafs forAsmall tumours not invading deebly and not reaching the lid margin. * Rotation and advancement skin flaps were used for inner and outer canther tumours. * In the follow up, no secondaries were dected

Occular side effects of oral contraceptives-clinical and experimental study

A] Clinical work: included complete ocular examination of 100 women receiving oral contraceptive pills from 6 months to 10 years and 10 male patients suffering from cancer prostate and receiving oestrogen injections for its treatment. The results of this study showed occurrence of different clinical complications such as central retinal vein thrombosis, central retinal artery occlusion, secondary optic atrophy, optic neuritis, retinal haemorrhage and elevation in the intraocular pressure. These observations are most probably due to ocular vascular thrombo-embolism. B] Experimental work: showed that the oral contraceptives cause atrophy of the iris, ciliary body and the optic nerves and narrowing and occlusion of their blood vessels. Moreover it was found that the degenerative changes occurred are most probably due to the oestrogen component of the contraceptive pills

Incidence and clinicopathological aspects of phlyctenular keratoconjunctivitis

Phlyctenulosis is a disease of children and young adults affecting females more than males. It may present as a conjunctivitis, keratitis or keratoconjunctivitis, The microscopic picture showed thining of the epithelium and the subepithelial tissue was infilterated with lymphocytes, histocytes and some polymorphs. The blood vessels were dilated and congested but there was no thrombosis nor haemorrhage

Ocular side effects of oral contraceptives clinical and experimental study

The work in this paper consists of a clinical part and an experimental part. The clinical work included complete ocular examination of 100 women receiving oral contraceptive pills from 6 months to 10 years and 10 males pateints suffering from cancer prostate and receiving oestrogen injections for its treatment. The results of this study showed occurrence of different clinical complications such as central retinal vein thrombosis, central retinal artery occlusion, secondary optic atrophy, optic neuritis, retinal haemorrhage and elevation in the intraocular pressure. These observations are most probably due to ocular vasuclar thromboembolism. The experimental work showed that the oral contraceptives cause atrophy of the iris, ciliary body and the optic nerves and narrowing and occlusion of their blood vessels. Moreover it was found that the degenerative changes occurred are most probably due to the oestrogen component of the contraceptive pills