Role of magnetic resonance spectroscopy in grading of primary brain tumors

To assess the usefulness of MR spectroscopy [MRS] in grading of primary brain tumors. MRS was performed in a 22 patients with primary brain tumors. Metabolite ratios of Choline [Cho] / N-acetyle Laspartate [NAA]. Cho/ Creatine [Cr], Cho+Cr/NAA as well as lipids and lactate [LL]/Cr were calculated at short and intermediate echo time [TE]. Additionally, myoinositol [ml]/Cr was calculated at short TE. Tumors were subdivided into low grades and high grade on the basis of histopathology Receiver operating characteristic analysis of metabolite ratios was performed to find the cut off values between high and low grade tumors. The resulting sensitivity, specificity and accuracy were calculated. At intermediate TE, Cho/NAA, Cho+Cr/NAA and Cho/Cr were significantly higher in high grade tumors than in low grade ones. At short TE, Cho/Cr and LL/Cr ratios were significantly higher in high grade tumors than in low grade ones. The diagnostic accuracy of metabolite ratios at intermediate TE was 86% whereas at short TE, the diagnostic accuracy was 75%. Combination of both TEs revealed a diagnostic accuracy of 88%. Cho/NAA, Cho+Cr/Cr/NAA and Cho/Cr are reliable in determining the tumor grade. LL/Cr is highly related to high grade tumors. Combination of both short and intermediate TEs provides better accuracy, in grading of brain neoplasm, compared to that when using each TE separately

Flexor tendon repair in the hand: the use of early postoperative therapeutic exercises alone versus its combination with laser

The aim of the study was to compare between early uses of therapeutic exercises alone versus the effect of its combination with the use of laser after hand flexor tendon repair in zone II. A prospective study was done on a thirty patients operated at Elsahel Teaching Hospital for a flexor tendon repair in zone II using a modified Kessler' technique. Patients have an average age of 25.26+ 6.37 years and they were randomly divided into two equal groups, the first group [A] received only therapeutic exercises, and the same program of exercises in addition to the use of laser therapy was applied in group [B] after operation. In both groups, results after 3 months showed a statistically significance increase as regards duration of post operative rehabilitation program in total active motion [TAM] of P.IP and DIP, [Group A at 3 weeks showed 53 +/- 45.85 and at 3 months 110.33 +/- 32.15, Group B showed at 3 weeks 102 +/- 34.37 and at 3 months 149.66 +/- 26.95]. the same significant results was also seen in case of maximal hand. grip strength [MI-IG], [Group A showed at 3 weeks a result of 17.56 +/- 3.96 and at 3 months 54.01 +/- 15.15 and Group B showed a mean results at 3 weeks of 23.02 +/- 7.06 and at 3 months 82.6 +/- 16, 48. In addition group [B] showed highly significant improvement in TAM and MHG as compared to group [A]. It was concluded that the addition of laser with early therapeutic exercises plays an important roles to improve results at postoperative rehabilitation after hand flexor tendon repair

combined effect of mobilization technique and therapeutic exercises versus therapeutic exercises in treatment of shoulder impingement syndrome

The objective of our work is to compare between the use of combined effect of mobilization technique and therapeutic exercises versus therapeutic exercises as regard pain functional disability at the shoulder and motion in case pf supraspinatus, impingment syndrome. Thirty patients diagnosed as shoulder impingement syndrome [SIS] due to functional causes [stage II Neer classification] participated in this study. Patients were randomly distributed into two groups. The first group consisted of 15 patients with a mean age 36.47 [ +/- 6.68], they received infrared radiation followed by a program of therapeutic exercises. The second group consisted of 15 patients with a mean age 36.26 [ +/- 6.54], they received infrared radiation followed by a combined program of mobilization techniques and therapeutic exercises. Treatment was given 3 times per week, each other day, for 4 consecutive weeks. Patients were evaluated pretreatment and posttreatment for shoulder pain severity, shoulder functional disability, shoulder flexion, abduction and internal rotation motions as well as for the acromiohumeral distance in adduction and abduction using ultrasonography. Both groups of patients showed significant improvement in all the measured variables. There was a significant reduction of both shoulder pain severity and functional disability as well as significant increase of shoulder flexion, abduction and internal rotation motions. In addition to that there was also a significant increase in the acromiohumeral distance in adduction and abduction. However the combination of mobilization and therapeutic exercises was more effective than the therapeutic exercises alone in improving the measured variables. Use of a combined program of mobilization and therapeutic exercises is more significantly effective than therapeutic exercises in treatment of shoulder impingement syndrome

Unipolar versus bipolar hemiarthroplasrty for dispalced fracture neck femur in elderly

The incidence of femoral neck fracture among the elderly is expected to increase dramatically because of increased the population aged 60 years and older, increased life expectancy, and the rising incidence of osteoporosis. Hip fractures are common occurrence in elderly with various methods of treatment practiced for management. Hemi replacement with different types of prosthesis is most widely practiced, and cemented unipolar prosthesis being the current trend. The aim of this study is to compare the outcome of unipolar prosthesis, which is the current practice at our hospital, with the bipolar prosthesis. This prospective trial to compare a cemented unipolar prosthesis [Thompson] with a cemented bipolar prosthesis in treatment of displaced intra capsular fractures of the hip in patients over 60 years of ages. Cemented unipolar prosthesis was used in 30 patients and in other 30 patients bipolar prosthesis was used. Functional outcome using Harris Score was compared between the two groups. The two groups of patient did not differ in their pre-injury characteristics [age, sex, fracture pattern, ASA grading, co-morbidity, mode of injury and pre-injury ambulatory status] and peri-operative parameters such as duration of operation, blood loss, hospital stay. The study was designed to determine whether there were any significant differences in the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and the functional outcome, including the incidence of hip pain and recovery of pre-injury levels of ambulatory status and activities of daily living, at a minimum of eighteen months of follow-up. There was no statistical difference in the functional parameters such as Harris Hip Score, and rate of complication in both the groups

Effect of delclophenac phonophoresis versus low level laser therapy on osteoarthritis knee

Osteoarthritis of the knee is reported to be a major health problem worldwide. To compare between the declophenac phonophoresis and low level laser therapy in the treatment of knee osteoarthritis, thirty patients with knee osteoarthritis from both genders were selected, aged between 40-60 years. They were divided into two equal groups, fifteen patients in the first group received declophenac phonophoresis in addition to traditional exercise program in the form of stretching and strengthening exercises. Patients in the second group received laser therapy in addition to the same traditional exercise program. The program was done 3 times a week for 4 weeks. Pain level, range of motion of the knee joint and functional performance were measured before and after treatment, there were significant difference within the two groups before and after treatment and between the two groups after treatment in Pain, range of motion and functional disability. Declophenac phonophoresis was proved to be more beneficial in reducing knee pain, improving range of motion and reducing of functional disability in patients with knee osteoarthritis

Open versus arthroscopic technique for anterior cruciate ligament reconstruction with patellar tendon graft. An early results on post-operative pain, rehabilitation and stability

Anterior cruciate ligament [ACL] reconstruction is a common procedure performed by many surgeons, different grafts have been used but the bone- patellar tendon graft has considered the gold standard for many years. The graft can be inserted either arthroscopically assisted with femoral half tunnel created from the joint, thus avoiding the lateral incision or making two tunnels through a mini-arthrotomy and a lateral femoral incision. A great controversy have been claimed for the advantage and the disadvantage of the two procedure as regards early rehabilitation period and stability. A fourty male patients with ACL deficiency were included in a prospective randomized trial comparing the two procedure with a follow up period of one year. The data obtained preoperatively did not show any significant differences between the two groups. At early follow up there was a differences observed with respect to complications and the progress of rehabilitaion. Evaluation at 12 months postoperatively using Lysholm scoring system revealed good to excellent results in 80% of patients in the first group and 70% in the second one. ACL reconstruction reduced anterior tibial translation of the knee significantly at 6 months follow up with a slight increase of degrees of instability at 12 months in both groups. The arthoroscopic single incision technique did show better results as regards early postoperative pain, swelling, range-of motion or any rehabilitational parameters. We conclude that an arthroscopic single incision technique for ACL reconstruction has an advantage over open mini-arthrotomy two incision technique as regards subjective more than objective parameters

Ear-lobe electro-cochleography [ECochG] in Meniere's disease

Twelve Meniere's disease patients participated in this study and compared with a normal hearing control group. A classical picture of Meniere's disease [vertigo, tinnitus, hearing loss and feeling of pressure in the ear] was present. Pure tone audiometry showed a significant elevation in hearing threshold at all frequencies in comparison with the control group. However, the classic low frequency SNHL of mild to moderate degree with preserved higher frequencies was the hearing threshold configuration. Semicircular canal weakness was documented. Extratympanic noninvasive ECochG using a horizontal recording montage was used with a surface active electrode on the ipsilateral earlobe and a reference electrode on the contralateral one. A low forehead surface electrode served as a base. The ECochG showed enlarged SP and SP/AP ratio than the normal control. SP/AP ratio was 0.248 +/- 0.094 for the control and 0.683 +/- 0.123 for the study group. The sensitivity of ECochG was 90% in the control and 83.3% in the Meniere's groups. Extratympanic earlobe ECochG offers a valuable objective test for the diagnosis of Meniere's disease. It permits a high quality recording with a minimal professional time or patient discomfort

Auditory brainstem response [ABR] findings in post-meningitic children

Auditory brainstem response [ABR] was performed on 39 children after the recovery from meningitis in addition to 20 healthy children served as controls. Hearing loss was detected in the form of sensorineural hearing loss in 16 patients of which ten had bilateral profound hearing loss. A mild conductive hearing loss was present in four patients and 19 patients showed normal hearing. Brainstem abnormalities were present in the form of prolonged latencies of waves I, V, interwave latencies of I-III and I-V. The age of onset of meningitis and associated neurologic complications were not associated with an increased incidence of hearing loss

Otoacoustic emission in cases of presbyacuosis

This study conducted on 100 cases divided into two groups the study group included 60 patients with mean age 68.48% +/- 8.8, the control group included 40 persons with mean age 33.90% +/- 7.77 years, all of them subjected to pure tone audiometery. immitancemetery and transient evoked otoacoustic emission [TEOAE]. All patients showed diminusion of hearing at all frequencies, all patients had normal tympanogram [Type A] except 20% showed negative middle ear pressure [Type C]. 55.75% of the patients showed absent acoustic reflex. The study group showed absent 50% of TEOAE at 1,2 3 and 4 KHz with decreased amplitude and wave reproducibility. We concluded that TEOAE response decreased substantially with age and there was a good correlation between b and reproducibility and pure tone audiometery also between b and reproducibility and acoustic reflex at 1 KHz and there was a good relationship between absence of acoustic reflex and absence of TEOAE at 1, 2 and 4 KHz