Shock wave lithotripsy for lower calyceal stone

To evaluate the effect of SWL, anatomical influence on fragmentation and stone clearance. The success of Shock Wave Lithotripsy [SWL] arises from effective fragmentation and stone clearance. One hundred patients [65 males and 35 females] with lower calyceal stones treated with SWL were enrolled in the study and analyzed retrospectively, at Al-Azhar Lithotripsy Unit, Al-Hussein University Hospital. Stone was single in 90 patient and multiple in 10 patients. Regarding stone radiodensity, the stones were hyper dense in 35 patients, dense in 50 patients and radiolucent in 15 patients. Those patients were divided into two groups, Group I includes 60 patients, they were considered to be completely stone free 6 months after SWL, and forty patients were having residual stones in Group II. The mean size of stones in group I was 0.9cm in diameter, while in group II the mean size was 1.7cm. The PC angle, diameter of lower calyx infudibulum and lower pole calyceal pattern were determined from intravenous urography. Residual stones were found in 100% of patients with PC angle<90°, in 100% of patients with an infundibular diameter<4mm, and in 100% of patients with complex lower calyceal pattern. From the presenting results the PC angle, lower calyx infundibular diameter and anatomy of lower pole calyx SWL for lower calyceal stones

Laparoscopic simple nephrectomy: preliminary experience in theodor bilharz research institute

Aim: The open simple nephrectomy is associated with significant mobidity and laparoscopic nephrectomy is now becoming the standared of care in many centers. In this study we will try to evaluate the actual results of laparoscpic nephrectomy for benign renal lesions in comparison to open nephrectomy

Methods: 17 patients were divided into 2 groups in a non-randomized trial. 8 patients 5 males and 3 females, aged 19-56 underwent open simple nephrectomy. 9 patients, 3 males and 6 females, aged 16-53, underwent laparoscopic simple nephrectomy [3 retroperitoneal and 6 transperitoneal]

Results: In spite of the high conversion rate [4 out of 9 cases] the laparoscopic simple nephrectomy was superior to the open technique in terms of intraoperative complications [0 versus 2 patients who needed blood transfusion and another with pleural injury], duration of analgesia requirements [2 versus 4.5 days post operative], starting oral feeding [1 versus 3 days post operative], wound infection [0 versus 2 cases], hospital stay [3 versus 7.5 days] and time for full recovery [22 versus 40 days] The superiority of the laparoscopic simple nephrectomy in terms of analgesia requirement, post operative oral feeding, hospital stay and time for complete recovery were all statistically significant

Conclusion: In spite of this being a preliminary experience of the Urology Department started in association with the General Surgery Department in TBRI, laparoscopic simple nephrectomy was not only found to be a safe procedure but also other all parameters were in favor of the laparoscopic versus the open simple nephrectomy. The conversion rate was expectedly high but it is not until the learning curve peaks up before the true rate appear and properly judged

role of bronchoscopy versus fluoroscopy in diagnosing persistent stridor in infants and children

Stridor is a high pitched respiratory sound usually inspiratory, but may be expiratory or biphasic produced by turbulent airflow due to partial airway obstruction at the level of the pharynx, larynx and/or trachea. Stridor can be classified into two types: acute stridor and persistent or chronic stridor. Evaluation of child with persistent stridor includes radiological assessment mainly plain X-ray and fluoroscopy. Direct visualization of the airway is often necessary to confirm the diagnosis and is essential in children with persistent stridor. The aim of this study was to determine the role of flexible fiberoptic and rigid bronchoscopy in comparison with fluoroscopy in diagnosing the site of partial upper airway obstruction in infants and children with persistent stridor. The study was conducted on 35 infants and children presented by persistent stridor. Fluroscopy and bronchoscopy [Flexible or rigid] were done for all the cases. The results obtained from fluoroscopy were compared to those obtained from bronchoscopy. The most common type of stridor was inspiratory in 80% of cases followed by biphasic stridor [11.4%], and lastly, the expiratory stridor [8.6%]. The most common cause of stridor in the studied group was Laryngomalacia in 17 cases [48.6%]. Flexible and rigid endoscopy were able to diagnose the site as well as the pathology in 35/35 of studied cases [100%]. Fluoroscopy delineated the site of obstruction in 4/35 cases [11.4%], two cases had external compression by vascular ring, one case of subglottic stenosis and one case with congenital tracheal stenosis. This study demonstrated the usefulness and safety of bronchoscope either flexible or rigid, in infants and children with persistent stridor. It usually provides rapid and precise diagnosis without significant complications. Diagnostic radiological modality as fluoroscopy needs more improvement. It may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway

LCAT activity, APO A1 and HDL-C in staging patients with hepatosplenic bilharziasis

The aim of this study was to assess the lipids and lipoproteins abnormalities as indicators of hepatic dysfunction in hepatosplenic bilharziasis. Patients with different clinical stages of hepatosplenic affection were involved in this study. 15 patients were in the hepatic phase [stage I], 25 in the phase of shrunken liver and splenomegaly [stage III] and 30 patients were in the terminal phase of shrunken liver and ascites [stage IV]. 25 healthy subjects were carefully selected as a control group. In addition to the routine liver function tests, serum total, free and esterified cholesterol, triglycerides, low and high density lipoproteins-cholesterol, apolipoprotein Al levels and lecithin cholesterol acyl transferase [LCAT] activity were estimated. From the present study, unlike the routine liver function tests, direct assessment of LCAT activity or indirect assessment of this activity by measuring apolipoprotein Al and/or HDL-C are sensitive markers of hepatic affection from the early stages of hepatosplenic bilharziasis. They also reflect the degree of hepatic affection as the disease progress

Effect of zinc on the antipseudomonal activity of cefoperazone, ciprofloxacin and tobramycin in vivo and in vitro

The effect of zinc sulfate on the in vitro activities of cefoperazone, ciprofloxacin and tobramycin was evaluated against 10 clinical isolates of Pseudomonas aeruginosa isolated from patients of cystic fibrosis associated with pulmonary pneumonia. Adding zinc of commercial media deficient to this cation increased the MICs and MBCs of the three tested antibiotics. Concurrent administration of zinc with each of the three antibiotics resulted in significant reduction in the antipseudomonal activity of both cefoperazone and tobramycin, while the activity of ciprofloxacin did not significantly altered. The response of pulmonary arterial rings isolated from Pseudomonas aeruginosa infected rabbits to serotonin was significantly reduced when compared to those isolates from control rabbits. Cefoperazone potentiates the response of the pulmonary arterial rings isolated from infected rabbits to serotonin when compared to control rings. Zinc either alone or in combination with cefoperazone significantly reduced the response of the pulmonary rings isolated from infected rabbits to serotonin when compared with control. The results of the present study showed that, zinc reduced the antipseudomonal activities of cefoperazone and tobramycin and did not altered the activity of ciprofloxacin in vivo

Effect of pH and human serum on the in-vitro activity of B-lactam and aminoglycoside combinations

The effect of three pH values [5.8, 7.4, and 8.0] and human serum on the activity of ampicillin, cefazolin, and cefotaxime alone and in combination with four aminoglycoside antibiotics [streptomycin, tobramycin, gentamicin, and amikacin] against sensitive and resistant strains of Staphylococcus aureus and Pseudomonas aeruginosa was evaluated. The change of pH from 5.8 to 8 noticeably affected the activity of all studied combinations. In general, the five B-lactam aminoglycoside combinations were more active at alkaline pH [pH 8]. However, pH shift towards the acidic side [pH 5.8] decreased their activity and increased their FIC indices. Addition of human serum decreased the in vitro antibacterial activity of B-lactam and aminoglycoside antibiotics, as well as their combinations against the used strains. The degree of influence was related to the ability of each antibiotic to bind with serum albumin. Cefazolin/streptomycin and cefazolin/tobramycin combinations showed the highest degree of protein binding effect

Effect of magnesium and calcium supplementation on the in-vitro activity of some -lactam-aminoglycoside combinations agents staphylococcus aureus

The effect of physiological levels of Mg +2 and Ca +2 on the in vitro activity of cephradine [Cep], cefoperazone [Cef] and cefotaxime [Ctx] alone and in combination with three aminoglycoside antibiotics [gentamicin [Gm], tobramycin [Tm], and netilmicin [Nt]] was evaluated against ten strains of Staphylococcus aureus. Adding Mg +2 or Ca +2 to commercial media deficient to these cations increased the MICs and MBCs of the three cephalosporins 2 to 4-fold, while aminoglycoside antibiotics revealed 4 to 8-fold increase in their MICs and MBCs. The combined antibacterial activity of the studied cephalosporin/aminoglycoside combinations decreased by the addition of Mg +2 or Ca +2

Post antibiotic effect of gentamicin in combination with cephradine, cefotaxime on pseudomonas aeruginosa

The post-antibiotic effect [PAE] of gentamicin [Gm] alone and in combination with cephradine [Cef] or cefotaxime [Ctx] was studied for five isolates of Pseudomonas aeruginosa. Cultures of Pseudomonas aeruginosa isolates were incubated with cephradine or cefotaxime [4 MIC] for one hour. Two different concentrations of gentamicin [0.5 and 1.0 MIC] were then added. Incubation of the combinations continued for one more hour. The antibiotics were eliminated by dilution. The post-antibiotic effects produced by the drugs in combination were longer than the sum of the individual effects of the drugs when they were used alone. A synergic post-antibiotic effect was also found when Pseudomonas aeruginosa strain No. 1 simultaneously exposed to gentamicin combination with cephradine or cefotaxime for 2 hours

Effect of schistosoma mansoni infection, starvation and molluscacides on acid phosphate, transminases and total protein in tissues and hemolymph of biomphalaria Alexandrina

The activities of GOT and GPT in the hemolymph of B. alexandrina were significantly decreased by S. mansoni infection. However, the total protein concentration and AcP activity were increased. Although the snail starvation decreased AcP activity in the ovotestis, it increased GOT activity in the other organs of the snails. On the other hand, the snail feeding after starvation increased significantly AcP activity in ovotestis. Natural and synthetic molluscicides inhibited the activities of GOT and GPT, however, they increased the total protein concentrations and AcP activities in the examined organs

Antibacterial activity of cefoperazone alone and in combination with aminoglycoside antibiotics

The in-vitro antibacterial activities of cefoperazone [Cef], amikacin [Am], tobramycin [Nn] and gentamicin [Gm] as well as the combinations of cefoperazone with the three aminoglycoside antibiotics were tested againts five strains of each of Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus using the checkerboard agar dilution method. All antimicrobial combinations demonstrated some synergy and no antagonism was observed. A synergistic effect was observed with the combinations of cefoperazone plus amikacin, cefoperazone plus tobramycin and cefoperazone plus gentamicin against four of five and three of five of the tested clinical isolates of Pseudomonas aeruginosa and Escherichia coli respectively. Staphylococcus aureus clinical isolates exhibit an additive or indifferent effect towards all tested combinations. No antagonistic activities were found with any of the strains using such combinations

Interaction of rifampicin with piroxicam and prednisolone

The effect of rifampicin on the anti-inflammatory activities of both piroxicam and prednisolone was studied using two models of inflammation. Carrageenin-induced rat hind paw edema model revealed that intraperitoneal administration of rifampicin [50 mg/kg] in combination with piroxicam [5 mg/kg] significantly diminished the anti-inflammatory effect of the tater. The anti-inflammatory activity of prednisolone [10 mg/kg] in this model was only slightly implantation. Sponge implantation-induced granuloma model showed that the intraperitoneal administration of rifampicin [50 mg/kg] in combination with piroxicam [5 mg/kg] or prednisolone [10 mg/kg] once daily for 8 days resulted in a significant reduction in the anti- inflammatory activities of both piroxicam and prednisolone. The effect of piroxicam and prednisolone on the bactericidal activity of rifampicin was also evaluated both in broth and in rat serum after i.p. injection. In vitro broth studies of the bactericidal activity of rifampicin [5 mug/ml] or prednisolone [3 mug/ml] against Staphylococcus aureus did not show any significant difference between the killing rats of these regimens. Studies on rat sera showed that the bactericidal activity of sera of rats injected with rifampicin [50 mg/kg i.p.] alone against Staphylococcus aureus was significantly higher than those sera of rats received rifampicin in combination with prednisolone [10 mg/kg]. The anti-staphylococcal activity of rifampicin in rat serum was not significantly affected by concomitant administration of piroxicam [5 mg/kg i.p.]