Prostaglandin E [2] level in patients with liver cirrhosis with and without hepatorenal syndrome

Eighty subjects were selected for this study, 65 of them were patients of liver cirrhosis [43 males and 22 females] and 15 of them were normal individuals as a control group [11 males and 4 females]. All the 80 subjects were subjected to full clinical assessment, biochemical liver profile, kidney profile, abdominal ultrasonography and estimation of plasma prostaglandin E2 [PGE2]. It was found that PGE2 was significantly increased in cirrhotic patients and this increase was more in ascitic than non-ascitic patients and more in Child C patients than in other Child classes, but there is evident marked significant drop in PGE2 level with the development of hepatorenal syndrome [HRS]. It was concluded that the increase of the vasodilator PGE2 in cirrhotic patients is a protective factor against the catastrophic effect of increased vasoconstrictor mediators characteristic of liver cirrhosis and the drop of PGE2 could be a causative factor in pathogenesis of HRS as it drops leaving the kidney under the vigorous effect of vasoconstrictors. The study postulated a new formula which might be more sensitive for the prediction of HRS

Assessment of diastolic and systolic left ventricular function by tissue doppler imaging in patients with type 2 diabetes mellitus: predictive value of B-natriuretic peptide

We sought to valuate left ventricular [LV] diastolic and systolic function in asymptomatic patients with type 2 diabetis mellitus [DM] using tissue Doppler [TD] analysis of mitral annulus dynamics and to investigate the potential value of brain natruretic peptide [BNP] as an early marker of systolic and/or diastolic failure in this group of patients. Epidemiologicall data document a greater risk of cardiovascular morbidity and mortality, particularly congestive heart failure [CHF], in patients with DM. Since BNP is a marker of early heart failure, it may serve to identify diabetic patients with preclinical abnormalities before progression to clinically evident diabetic cardiomyopathy. We studied 39 patients with type 2 DM [DM group] aged 37 to 70 years; without evidence of diabetic compications, hypertension, coronary artery disease, CHF, thyroid or overt renal disease and 15 age and sex matched healthy subjects [control]. Peak velocity and time-velocity integral were measured from TD tracings at the septal and lateral borders of the mitral annulus and the timing of the velocities in relation to the electrocardiogram. BNP was measured in plasma by chromatographic purification and separation using microseparation column C18 followed by enzyme immunoassat.The lateral TD systolic[S[ann]] velocity was significantly lower in DM group compared to controls [10.1 +/- 1.9 vs.11.5 +/- 2.0cm/sec.respectively;p> 0.005]. The septal and lateral TD early diastolic velocities E[ann] were significantly lower in DM group compared to controls [8.3 +/- 2.2 vs. 12.1 +/- 3cm/sec and12.1 +/- 3.8 vs. 17.5 +/- 3.8cm/sec respectively; both p> 0.00.01]. Thesetal and lateral TD time-velocity integral of E[ann] were significantly lower in DM group compared to controls [0.7+/0.3 vs.> 0.0001]. The septal and lateral TD early to late diastolic velocity ratio E[ann] /A[ann] were significantly lower in DM group compared to controls [0.8 +/- 0.3 vs. 1.4 +/- 0.5 cm and 1.1 +/- 0.5 vs. 1.9 +/- 0.6 cm respectively; both p> 0.0001]. Septal TD showed significantly prolonged regional ios-volumic relaxation time in DM group compared to controls [78.6 +/- 13.5 vs. 64.3 +/- 13.4msec respectively; p> 0.0001]. Plasma BNP level was significantly higher in DM group compared to controls [311.2 +/- 112.6 vs.38.2 +/- 4.8 pg/ml respectively; p> 0.0001].A significant negative correlation was detected between plasma BNP level and septal TD S[ann] velocity [r = -0.6; p> 0.001].A significant negative correlation was also detected between plasma BNP level and lateral and septal TD E[ann]/A[ann] velocity ratio [both r = -0.5; p> 0.001].Mistral annular contraction and relaxation velocities detected by TD imaging, are reduced in patients with type 2 DM compared to controls. The significantly higher plasma BNP level identified in diabetics correlated well with the degree of systolic and diastolic dysfunction detected by TD analysis of mitral annulus dynamics and so may be a useful marker for early heart failure in this group of patients

Non-operative treatment for blunt liver trauma in children: a successful, safe, cost effective protocol

In this study, a protocol for managing hepatic trauma in hemodynamically stable children was proposed where specific criteria for pediatric ICU admission were applied and ultrasonography replaced CT scan for following up the process of hepatic healing. The study was carried out on 51 children with blunt hepatic trauma. Initial CT scan was done to 49 patients and identified the hepatic injuries and their grade in all patients. Intraperitoneal fluid was found in 26 of these patients. CT scan at discharge confined the ultrasound findings in 47 discharge patients. Four patients died, one due to grade VI liver injuries and the other three due to severe associated head injuries. Although the pediatric ICU was the standard location for initial nonoperative management of children with blunt hepatic injuries, yet a successful, safe and cost effective treatment could be achieved for properly selected hemodynamically stable patients. Ultrasonography was an effective alternative to CT for following up the healing process of these liver injuries

Urinary tract infection in childhood the role of nitrite test

Since the symptoms of urinary tract infection may be vague or abscent and the urine abnormalities may be variable. The practitionner must maintain a high degree of suspicion in order not to overlook the diagnosis.The accurate diagnosis of urinary tract infection is the first and the most important state of the child's management. The aim of this study is to evaluate urinary tract infection [UTI] as a community problem and to compare between some diagnostic methods used in diagnosis of UTI. This work was carried out in Pediatric Department, Zaggazig University Hospital in association with clinical Pathology Department .65 subjects 30 were males, 35 were females, the age ranged between 1.5-14 years with a mean of 5.4 years, they were divided into: Control group 20 children [10 males- 10 females] Group I : 30 cases with symptoms of urinary tract infection, positive urine culture.Group II : 15 cases with repeated UTI and detected radiological abnormalities of urinary tract. All children were age and sex matched and they were subjected to : full history-taking complete physical examination and laboratory aids [urine examination-urine culture-urine nitrite test-C-Reactive protein-serum creatinine].Radiological examination [plain-x ray- abdominal ultrasonography].Our results were: UTI was more prevalent among females [55.5%] than males [44.5%] between age of 1.5-14 years. Lack of circumcision and catheterization represented an important predisposing factors for UTI among our cases. Frequency, dysuria and enuresis were the commonest presenting clinical manifestation of lower UTI while fever and loin pain were the commonest clinical manifestations of upper UTI.E.coli was being the commonest urinary pathogen among our manifested cases [80% group I and 53.3% group Il] coming next, Citobacter and Staphylococcus among group I [10% and 10%] respectively Klebsiella and Pseudmonmonas [33.3%, 13.3%] respectively among group II. Leucocyturia [> 10 WBC/HPF] was of low sensitivity [74.4%] and specificity [50%] but of high positive predicitve value [96.7%] in diagnosis of UTI. Nitrite test showed a low sensitivity [34.9%] high specificity [100%] and high positive predicitive value [100%] in diagnosis of UTI

role of urinary secretory immunoglobulin [A] in diagnosis of pediatric urinary tract infection

Secretory immunoglobulin A [SIgA], an immunoglobulin synthetized locally in, mucosal surfaces, plays a vital role in preventing mucosal localization by pathogenic bacteria. Its protective effect in urinary tract is still less well documented. This study was done to elucidate the role of SIgA in children with urinary tract infection. The work was carried out in Pediatric Department Zagazig University Hospitals in association with Clinical Pathology and Radiological Departments. 115 children [54 males-61 females] their age ranged between 1.5-14 years with a mean age of 5.4 years. They were classified into 4 clinical groups: Control Group: 40 healthy children who denied any history of urinary tract infection [UTI] and urine culture free. Group I: 30 cases subjects studied at the time of the first symptomatic [UTI]. Group II: 30 cases subjects who had a history of at least 2 documented episodes of UTI but had normal urinary tract and had negative bacterial culture at the time of the study.Group III: 15 cases subjects with symptomatic UTI and had an abnormal urinary tract .All subjects were age matched and subjected to full history taking-complete physical examination and laboratory aids and various radiological investigations. Urinary SIg A excretion rate was determined by immunodiffusion plates [L.C.partigen immunodiffusion plates from Behring AG Marburg, Germany]. Our results showed that: Urinary SIg A excretion rate was high among group I [1.74 +/- 0.13 mg/gm creatinine]-very high among group III [2.247 +/- .22 mg/gm creatinine] and low among group II [0.446 +/- 0.05 mg/gm creatinine]. The variation of SlgA urinary excretion among manifested our cases [group I, group Ill] was related to type of urinary pathogens involved. There was no correlation between urinary SIgA and number of bacterial colonies on urine culture.In localizing the site of UTI using SlgA excretion rate versus scintigraphy urinary SlgA was significant in localizing UTI in cases of group I and has no significance in cases of group Ill. Reflux, stricture urethra and stone Kidney were the commonest urinary abnormalities in our studied cases of group III and there were accompanied by high urinary SlgA excretion

Study of different risk factor profiles in stroke patients in Alexandria

The study included 94 stroke cases. They were admitted at the Internal Medicine Department between October 1994 and March 1995. For each case studied, an attempt was made to obtain, from the same hospital, age and sex matched control patient. The aims of this work are to identify different stroke risk factors and to measure the strength of association of the different risk factors and stroke. Results of this work revealed that hypertension, diabetes mellitus, ischemic heart diseases, arrythmias possible symptoms of transient ischemic attacks and android type of fat distribution are major risk factors of stroke in Alexandria. This necessitates initiation and continuation of stroke control program in Alexandria

Human blood circulation before the age of Ibn El Nafees

It is well known that the Arab physician Ibn El Nafees [607 H./1210 A.D.-676 H./1288 A.D,] was the first to discover clearly the lesser or pulmonary circulation between the heart and lungs. What was the historical and anatomical basis of this discovery? Had some trials been made by earlier Arab anatomists to describe the blood circulation in man? .In this paper some light is going to be shed on these problems. The reference used for these previous trials before the age of Ibn El Nafees to describe the blood circulation in man is the encyclopedic work entitled Miracles of Creatures" by Imani Abdu Allah.Zakariya lbn Mohained Al Kazwini [600 H./1204 A.D.-686 H./l283 A.D.]. This book represents an invaluable great encyclopdia containing astronomy, geography. minerals, plants, animals, in addition to some medical studies on the human body including anatomy. In this book some human organs were described in an attempt to study the blood circulation in man by early Arab anatomists. In the following paragraphs the statements of Al Kazwini, reflecting a period before the time of Ibn El Nafees, about certain human organs like heart, liver, arteries and veins are quoted and subjected to comment

Laparoscopic cholecystectomy: technical consideration and preliminary results

Laparoscopic cholecystectomy is widely gaining acceptance among surgeons. It is an effective and safe procedure which has the advantages of being minimally invasive and of decreasing the hospital stay of the patients and hence decreasing the costs incurred by the patients subjected of cholecystectomy. Attention to the minute details of the technique and acquiring the necessary training should be a must before using this procedure with its associated high technology. The present work underlines the details of the technique and presents the preliminary results of the initial 12 cases