Impact of leptin levels upon left ventricular structural abnormalities in non-insulin-dependent diabetics

Non-insulin-dependent diabetes mellitus adversely affects left ventricular [LV] structure. ri.ecent studies have shown that leptin increases in insulin-resistant states, such as obesity and hypertension. The levels of plasma leptin have been found to be associated with LV myocardial growth.To assess fasting serum leptin concentrations in the type 2 diabetic patients and to correlate its level with the LV structural changes. Patients and Twenty four type 2 diabetic patients with LV structural changes and twenty four type 2 diabetic patients without LV structural changes [controls] participated in this study. The following LV structural parameters were assessed by Two-dimensional echocardiography: left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], interventricular septal thickness [IVST], left ventricular posterioi wall thickness [PWT], relative wall thickness [RWT] and left ventricular mass index [LVMI]. left atrium [LA] and aortic root [Ao] dimensions were also assessed. Fasting serum leptin, insulin, glucose and glycosylated hemoglobin [HbAlc] were determined. The correlations of eptin to LV structural parameters were statistically analyzed. Body mass index [BMI], FBG and fasting serum concentrations of leptin and insulin were significantly greater in patients than controls. There were statistically significant differences between the two groups in all echocardiographic parameters apart from LVEDD, LVESD, RWT, LA and AO In the case group, leptin was positively correlated with FBG and insulin. A significant correlation was also found between serum leptin and echocardiographic parameters; PWT. IVST, SWI and LVMI. Hyperleptinemia in type 2 diabetic patients with LV structural changes and the association of leptin with indexes of LV structure may reflect its role in the development of myocardial wall thickening in non-insulin dependent diabetes mellitus

Manometric evaluation of continence after surgery for imperforate anus

Functional results after surgical correction of anorectal anomalies were assessed in 45 patients clinically and manometrically, in addition to 5 control children. The clinical assessment followed Kelly score. Continent patients had marked high pressure zones. Thus, anorectal pressure profile was found to correlate well with continence. Patients with high anomalies had lower pressure zones whatever the operation done if compared to patients with intermediate or low anomalies yet the results varied according to the operation done. Manometry was compared to defecography and was found to be more accurate

Bladder mucosal graft technique for hypospadias repair, study of 24 cases

The use of bladder mucosa for repair of proximal hypospadias offers several advantages. Twenty-four children suffering from proximal hypospadias, their ages ranged from 4 to 12 years, were included in the study. The repair was completely successful in 18 patients without minor or major complications. However, 2 children developed fistula at the site of the anastomosis and were in need for further closure. Three children developed meatal sticking and stenosis, two of them responded to regular meatal dilation and the 3rd was in need for meatoplasty. One child developed extensive infection and complete wound disruption that was in need for refashioning

Diuretic therapy in hypertension, and its effects on lipoprotein pattern

In this work, 19 hypertensive patients were thoroughly examined, and divided into 3 groups according to the diuretics used. The first group comprised 5 diabetic patients given spironolactone, the second contained 6 diabetics given ethacrynic acid, but the third group consisted of 8 non diabetic patients given frusemide. Investigations were done for every case e.g. urine and stool analyses, X-ray chest, E.C.G., blood sugarlevel and serum creatinine, in addition after treatment. In group I, we found insignificant increase in cholesterol triglycerides and total lipids but in group II, inspite of insignificant increase in triglycerides and total lipids, the cholesterol was decreased insignificantly. In the third group there were significant increase in triglycerides and ongly insignificant increase in both cholesterol and total lipids

Effect of diuretics on some respiratory function tests in bilharzial patients with and without ascites

This work comprised 20 male bilharzial patients, devided into 2 groups, 10 bilharzial patients without ascites, 10 patients with ascites and in addition, 10 healthy subjects as a control group. All cases were subjected to thorough history taking, complete clinical examination and the following investigations: urine and stool analysis, blood urea, serum creatinine, x-ray chest, electrocardiography and ventilatory function tests particulary 1C, ERV, FVC, FEV[1], MVV, FMEF, FMEFT, FEF and AVI. Percutaneous transsplenic portal manometry was done for nonascetic and ascitic group, and the intraperitoneal presure was measured for ascitic group only. Bilharzial patients without ascites have obstructive ventilary defect only, while patients with ascitis has combined obstructive and restrictive defects, and diuretics improved these defects. There is negative correlation between portal venous pressure and intraperitoneal pressure and all ventilatory function tests except FMEFT where the correlation is positive. From the preceeding we can see that diuretics are of value in improving organ funciton not only in the ascitic bilharzial patients but also in the non ascitic cases and wherever oedema is interferring with function i.e. interference with digestion in patients with portal hypertension or ascites, and interference with ventilation due to oedema of the bronchial mucosa

Some platelet functions in patients with diabetes mellitus and hepatosplenic bilharziasis

Our aim was to study platelet count, adhesiveness and aggregation in patients with hepatosplenic bilharziasis and diabetes mellitus. Our material comprised 10 non-ascitic patients with hepatosplenic bilharziasis, 7 uncomplicated diabetes mellitus and 8 patients with hepatosplenic bilharziasis and diabetes mellitus. 5 apparently normal subjects were taken as a control group. All groups were subjected to through history taking, clinical examination, urine and stool analysis blood picture, bleeding and coagulation times, serum creatinine, serum bilirubin, serum glutamic pyruvic tranaminase, fasting blood sugar; platelet count, adhesiveness and aggregation. Platelet count, adhesiveness and aggregation were decreased in patients with hepatosplenic bilharziasis, increased in patients with diabetes mellitus while they were non significantly, changed in patients with hepatosplenic bilharziasis plus diabetes mellitus. So, while diabetic patients should receive antiplatelet drugs like aspirin and dipyridamole; such drugs are contraindicated in patients with hapatosplenic bilharziasis for fear of bleeding and they are not recommended in cases with combined diabetes mellitus and hepatosplenic bilharziasis

Combined drug therapy of intestinal bilharziasis with and without polyposis

In endemic areas treatment of intestimal schistosomiasis, especially when complicated with polyposis, is a major medical problem. In the past few years introduction of new drugs gave hope for treatment of such cases. These drugs were mainly niridazole and oxamniquine. Niridazole has to be given repeatedly at two months intervals over a period up to one year. Oxamniquine provides the advantage of short term therapy over 3 days but the cure rate was much lower than niridazole. The two drugs are different pharmacolozically and this encourages us to give both drugs in succession, then simultaneously without accentnation of the side or toxic effects than when either drug was given alone. In this study 493 patients of intestinal bilharziasis, 39 of them with bilharzial colonic polyposis were included, using different schedules of therapy. Niridazole in a dose 4 mg/ kg. B. W. daily for 20 days and oxamniquine 60 mg/kg. B.W. as a total dose divided over 3 days. The best results were obtained when both drugs were given simaltaneously. The cure rate in non polypotic bilharzial cases was 96.5% and in patients with plyposis 64.3%, while the cure rate using oxamniquine alone or using the two drugs in succession starting by either of them gave much less cure rate, [not more than 40%]. We can conchude that the best treatment of intestinal schistosomiasis with or without polyposis is the simultaneous administration of oxamniquine and niridazole in the above mentioned dosage schedule

Leucocytic margination in typhoid and hepatosplenic bilharziasis

Adrenaline injection induced a significant blood cellular changes, which were more at phase I than at phase II except a reverse pattern occurs to platelets, phase II of adrenaline response is not to stimulation of pituitary adrenal axis, the total leucocytic counts were positively correlated with neutrophils and lymphocytes. In bilharzial cases, the maximum adrenaline induced increase of the formed blood elements was larger than in normal persons, negative correlation between grades of splenomegaly and base line level of all formed blood cells, positive correlation between grades of splenomegaly and the maximum adrenalin test can be used a diagnostic of cellular sequenstration in grades II and III bilharzial splenomegaly. Marginal bool of noutrophils is increased and positively correlated with the grades splenomegly and the maximum increase of lymphocytes after adrenaline test was larger than that of neutrophils. A suggestion for lymphocytes margination and was positively correlated with the grade of splenomegaly. In enterica, neutrpenia is due to increase of their marginal pool, relative lymphocytosis may b due to decrease of their margination. The maximum increase of lymphocytes after adrenaline injection was lower than of neutrophils

Immunoglobulin E in some intestinal parasitic infections

48 patients and 10 control subjects were studied. Their ages ranged from 6.5-60 years. 15 patients were bilharzial; 10 non ascitic and 5 ascitic; 9 patients with ascariasis; 6 patients with oxyuris, 6 withgiradiasis; 6 with H. nana and 6 patients with trichostrongyloides. The control group consisted of 10 apparently normal subjects. All cases were subjected ta thorough history taking, clinical examination, urine and stool analyses, sigmoidoscopy and mucosal biopsy, complete blood picture, ESR and immunoglobin E estimation. There was significant increase in IgE levels in all parasitic infections except in H. nana group. The highly significant elevation was found in ascariasis and bilharzial group [specially the non ascitic cases]. The triad of anemia, raised ESR and high level of IgE may be a feature of some parasitic infections; namely bilharziasrs, ascariasis, oxyuriasis and trichostrongyloides. IgE estimation may be a useful parameter in the diagnosis and follow up of cases with bilharziasis as well as other parasites, higher levels being obtained with ascariasis [which can be excluded by stool analysis] and bilharzial cases where diagnosis is sometimes difficult. As individual parasitic infections were found to raise IgE level, it is expected that mixed parasitic infestations may raise IgE and this may be of diagnostic value and usefulness in follow up of these infections

Neutrqphils phagocytic power in chronic asthmatic bronchitis and pulmonary tuberculosis

This work comprised 16 and 14 tuberculous patients in addition to 16 healthy control subjects. All cases were submitted to full history taking, thorugh clinical examination, x-ray chest, laboratory investigations including: urine analysis, stool analysis, blood picture, E.S.R., serum creatinine and post prandial .blood sugar. Sputum smear with Ziehl Neelsens and sputum culture and sensitivty test. Estimation of serum IgA, G, Mi and C[3], and determination of the phagocytic power of neutrophils. The asthmatic and control groups were subjected to pulmonary function tests. The results revealed: mild anaemia with normal leucocytic count in both groups. The phagocytic power of neutrophils was markedly depressed in all patients which is mainly due to cellular defect, rather than humoral as there is normal serum IgA and C[3] and elevated IgM and IgG. The only specification in tuberculous group is elevation of C[3] with no difference in phagocytic power among sputum positive and negative subgroups

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

Ascariasis: a surgical problem in children

Complications of ascariasis requiring surgical intervention have been frequently recorded in the literature, intestinal obstruction is the commonest complication, and could be produced by several mechanisms. In the majority of our cases, the obstruction was subacute and responded to conservative treatment. If the response is unsatisfactory, dispersal of the worms without opening the bowel should be tried firstly. But, there should be no hesitation to resect bowel if necessary. Perforation of the bowel is the most serious complication. It can occur in ulcerative lesions of the small intestine especially due to typhoid fever, meckel's and caecal diverticulitis with perforation and escape of ascaris into the pritoneal cavity have also been described [Van Rensburg and Kark, 1958]. It should be serious to perform intestinal resection in the presence of ascaris. For this reason, elective operation on the gastro-intestinal tract should be delayed until eradication of ascaris. We discussed our results in 28 children who presented with complications due to ascariasis

Serum, ascitic fluid and urinary biochemical changes in bilharzial patients with refractory ascites

15 ascites patients with aepatosplenic bilharziasis responding to diuretic therapy were taken as control group. 20 patients with bilharzial hepatosplenic affection and retraciory ascites were the material of the present study. All patients from both groups were subjected to investigations to prove pure bilharzial etiology. In their serum, and serum and ascitic fluid enzymes [GOT, G.P.T., Alkaline phosphatase and L.D.H.], Proteins [Albumin total globulin, Alpha[1], Alpha[2] Beta and Gamma globulin]; glucose, cholestrol, bilirubin [total and direct], B.U.N., creatinine and electrolytes [Phosphorus, calicum, pottassium, sodium and chloride] were assessed. Urinary electrolytes [Phosphorus, calcium, calcium potassium, sodium and chlorid] were also meadured for all. The serum biochemical data of patients with refractory ascites showed that they were in a more advanced stage of hepatocellular damage than patients with non refractory ascitis. The ascitographic picture of biochemical data of both groups showed selective significant differences that can be taken as a parameters to fortell refractoriness of ascites during the follow up of cases in the course of that disease. Selective significant differences in urinary electrolytes of both groups can also be taken as forerunnex to predict refractoriness of ascites. The A/S ratio of different biochemical data in both groups showed selective significant differences that can be taken as a parameters for detection of the impending refractory ascitic stage in the course of bilharzial hepatosplenic affection. The concept of an active role for the peritoneum in ascitogrophic biochemical patterns construction was proposed and discussed

Cimetidine in duodenal ulcer in children

l.20 children suffering from duodenal ulceration were classified into two groups: a] Group I : treated with antacids and antihistaminics b] Group II : treated with cimetidine 2. It was found that cimetidine has offered healing in higher percentage of patients than those in the first group without side effects. 3. We recommend the use of cimetidine in duodenal ulcer in children in a dose of 0.6 to 0.8 gm. daily for maximum 6 weeks 4: The views of the other investigators were discussed

Reversion of oesophageal acid perfusion test results after paracentesis abdominis in ascitic cases of bilharzial hepatic fibrosis

Twenty six patients with hepatosplemc schistosomiasis and tense ascites, having positive acid perfusion test results, were the candidates of this research. All cases were investigated for brtharzlal aetiology, portal pressure manometry, ascitic fluid volume and pressure estimation and oesophageal acid perfusion test were done before and 10 days after slow paracentesis abdominis. The following results were found: 1. Positive correlation between portal and ascitic fluid pressures before and after paracentesis. 2. Both portal and ascitic fluid pressures were significantly reduced after tapping in all patients. 3. The oesophageal acid perfusion test turned negative in 61.53% of patients 10 days after tapping. 4. The degree of portal and ascitic fluid pressure reduction was more significant in the group showed reversion of oesophageal acid perfusion test. 5. While test reversibility was linked to the portal hypotensive effect of tapping, non reversibility was indicative of inefficient non significant tapping. We can conclude from this work the great value of this simple test in indicating and evaluating the success of tapping in lowering the portal and ascitic fluid pressures in bilharzial ascitic patients

Anaemia in diabetes mellitus

Eighty five patients with diabetes mellitus and 25 normal controls were studied clinically together with evaluation of their red cell values, bone marrow picture, serum iron and liver function tests. Normochromic normocytic anaemia was found to be a characterstic feature of diabetics having chronic complications or infections. Macrocytic normochromic anaemia was present in diabetics having ketoacidosis. Possible underlying mechanisms for the present anaemia was discussed. In non complicated diabetics anaemia was not present and serum iron was within normal limits. Conclusion was reached that the presence of anaemia in a diabetic patient is a sign of diabetic complications

Blood viscosity in diabetes mellitus

Eight five diabetics and 25 normal controls of matched age and sex were studied. Estimation of the whole blood viscosity by using the U-shaped viscometer tube was made. Significantly higher blood viscosity was a constant feature for diabetics. Correlation of viscosity to diabetic complications and type of diabetes was carried out. Hyperlipidemia, hyperfibrinogenaemia, increased alpha[2] and beta globulins showed a linear relation to the blood viscosity. Conclusions were reached that the estimation of blood viscosity in diabetics is a rapid, simple and reliable prognostic test for diabetics especially in complicated cases

Thyroid and male infertility

The functional state of the thyroid gland was evaluated clinically and by PBI for 104 infertile males and 25 normal controls. An euthyroid state was found to be fundamental for spermatogenesis. Hypothroidism was detected in 3 cases and a case record of azoospermic thyrotoxicosis is described with normalization of semen picture after medical control of the hyperthyroid state. Liothyronine therapy [20 ug/day] was very effective among infertile males with hypothyroidism and useless in euthyroidism. Study of the functional state of thyroid gland is essential before T 3 therapy

Correlation of the rise in serum acid phosphatase with the degree of hyperglycaemia and vasculopathy in diabetic patients

Serum acid phosphatase and oral glucose tolerance test [OGTT] have been determined in thirty one diabetic patients [thirteen males and eighteen females], and ten normal subjects [five males and five females]. In male patients, the prostatic fraction of the enzyme has also been determined, in addition to the total enzyme activity. In the diabetic patients there is a significant increase in serum acid phosphatase. In male patients the increase was due to rise of the non prostatic fraction of the enzyme. The diabetics were classified into four groups according to the fasting blood glucose level: the first having a fasting level below 100 mg%, the second from 100-200 mg%, the third from 200-300 mg% and the fourth above 300 mg%. no positive correlation were found between the rise in serum acid phosphatase and the extent of impairment in glucose tolerance. Further classification of the diabetic patients was done according to presence or absence of diabetic vasculopathy. Serum acid phosphatase was significantly elevated in patients with vasculopathy, but in the other group without vasculopathy the enzyme level was not different from the normal control. It was concluded that the principle factor underlying rise of the serum acid phosphatase in diabetic patients is the presence of vasculopathy rather than the severity of glucose intolerance