Extravesical ureteral re-implantation versus intravesical techniques for vesicoureteral reflux in children

Objectives: To analyze the efficacy and outcome of extravesical [EUR] and intravesical ureteral re-implantation [IR] techniques in primary and secondary vesicoureteral reflux [VUR] in children

Patients and Methods: Between 1997 and 2000, 218 patients [339 ureters] admitted to the Hospital for Sick Children, Toronto, Canada, underwent ureteral reimplantation. The patients were stratified into four groups: primary or secondary VUR and EUR or IR. We analyzed the success rates, contralateral VUR, postoperative retention, de-novo hydronephrosis and surgical complications

Results: The mean age at presentation and surgery was 2.5 [birth-12 years] and 5.5 [1-19 years] years, respectively. Mean followup was 15 months. Hospital stay was 2.3 and 4.2 days for EUR and IR, respectively. In primary VUR, 147 patients [235 ureters] underwent EUR and 6 [12 ureters] IR. Success rates were 94.5% and 91.7% at 3 months, and 97.3% and 91.7% at 15 months, respectively. In secondary VUR, 41 [56 ureters] and 24 patients [36 ureters] had EUR and IR, respectively; the success rates were 93% and 88.9% at 3 months and, 98.2% and 91. 7% at 15 months, respectively [p=ns]. Contralateral VUR was detected in 11.8% after EUR and de-novo hydronephrosis in 14.2% and 28.6% in both groups, respectively. Six patients had retention after bilateral EUR and one after bilateral IR

Conclusion: Both the extravesical and intravesical re-implantation methods yield excellent results in the treatment of vesicoureteral reflux. However, the easy application of the extravesical approach, its high success rate in primary as well as secondary reflux, the brief hospital stay and the decrease in the urinary retention rate after bilateral surgery with technical improvements make it our preferred approach for open surgical repair in primary and secondary VUR

Effect of aortic valve replacement on the severity of associated mitral valve incompetence

The study included 80 patients divided into three groups according to the severity of MVI [trivial, mild and moderate]. All the studied patients had no obvious organic MV lesions and underwent mechanical aortic valve replacement. Pre- and postoperative echo evaluated severity of MVI, mitral annular area and LV EDD, ESD. There was marked improvement in the clinical status after AVR in 78 [97.5%] patients. There was a general improvement in the seventy of MVI. In univariate analysis, there was no significant statistical effect in correlation of the changes in the severity of MVI to the studied variables as age, mitral annular area and LV dimensions. However, there was a significant statistical change in the mitral annular area in all studied groups from pre- to postoperative measures. At the last period of follow up there was improvement in the left ventricular dimensions, but was not significant statistically from pre- to postoperative measurements, especially in LVEDD. There was no incidence of valve thrombosis or endocarditis

Can vitamin E be used in prevention of amiodarone pulmonary and hepatic toxicity?

Sixty mature albino rats were divided equally into two test groups and onecontrol group. Amiodarone, a widely used antiarrhythmic agent, was givenorally to rats of the first test group at a dose of 40 mg/kg body weight for30 days. The rats of the second test group were given the same dose ofamiodarone in combination with vitamin E at a dose of 50 mg/kg body weightintraperitoneally for the same period. Blood urea and serum creatinine wereinsignificantly elevated in the two test groups which also showedinsignificant ultrastructural and histopathological changes in the kidneys,heart and brain. On the other hand, the statistical analysis of the values ofserum ALT, AST alkaline phosphatase and total bilirubin showed a significantelevation in the group given amiodarone alone and insignificant changes, whenvitamin E and amiodarone were given concomitantly except AST as compared withthe control group. These biochemical results coincided completely andconfirmed by the ultrastructural and histopathological findings in the liversof the two test groups. Also, amiodarone induced pulmonary toxicity wasreversed when it was given in combination with vitamin E. These resultsindicated that chronic amiodarone therapy can induce pulmonary and hepatictoxicity, which can be prevented or reduced by a simultaneous administrationof vitamin E with amiodarone. Thus, when ever possible, chronic treatmentwith this drug should be avoided or vitamin E is given in combination with thedrug to prevent its toxicity

Inhibition of copper corrosion in acidic solution by 2-thio-imidazol-4-one

Many studies have been reported on the inhibition of the corrosion of copper in an aqueous acid or neutral solutions by benzotriazoles [1-5]. The inhibition mechanism of the corrosion of copper by benzotriazoles and its derivatives Was previously reported [6-8] The inhibition effects of ring substituted benzotriazoles on the corrosion of copper in chloride and sulphate solutions were investigated [9-12]. Recent studies on the corrosion inhibition of copper by some heterocyclic compounds [13], viz., tosyl hydrazine, 4, nitrobenzoyl-hydrazine and terephthalye [14], piperidine, piperidones and tetrahydrothiopyrones [15] silane-modified imidazoles [16] and benzenethiols [17] have been reported. The present study aims to investigate the effect of some controlling factors on the corrosion inhibition of copper in HNO- by 2-thio-imidazol-4-one I such as inhibitor concentration and temperature applying a weight loss and polarization techniques

Case control study of giardiasis in diarhoeas versus non diarrhoeal children aging 6-12 years

The aim of this work is to study the prevalence, the clinical presentation and the different methods of diagnosis of giardiasis among school children aging 6-12 years suffering from acute diarrhea. The prevalence of giardiasis was 26% and 6% in diarrheal and non- diarrheal children, respectively. Children with giardiasis were younger, without sex difference and in lower socioeconomic status that those without giardiasis. Simple stool analysis detected 43.8%, simple flotation method detected 68.8% while, duodenal aspiration detected 81.3% of giardia cases. Stools in giardiasis was offensive, pale whitish and not bloody. Offensive stool was the commonest manifestation [87.5%] followed by diarrhea [81.3%]. It was concluded that the clinical picture of giardiasis is suggestive and duodenal aspiration is a good diagnostic methods. Large scale study and duodenal biopsy are recommended

Study of serum prostaglandin E levels in patients with bone fracture

23 patients were the subject of this work. They were 14 males and 9 females. Their ages ranged from 20 to 52 years. They were suffering from fracture femur and undergoing internal fixation. The objectives were to determine the possible effect of bone fracture on the levels of prostaglandin E [PGE] and to determine the possible effect of internal fixation on such levels. 10 healthy volunteers of matching age were selected and served as a reference group. There was a highly significant increase in PGE levels in the patient group when compared with the reference group [P <0.001]. Also, there was a highly significant increase in PGE levels after internal fixation when compared with the levels before surgical interference [P <0.001]. This could be attributed to the increase in PGE release from the fractured bone and the surrounding muscles. PGs are important mediators of inflammation. Their increased formation in repose to fracture and internal fixation may stimulate the vascular changes, bone resorption and the proliferation of osteogenic cells observed after trauma to bone

Multi-resistant salmonella to different antibiotics

Blood cultures were taken from 42 children [29 males and 13 females] aged 4-12 years over a period of 5 months. The children were clinically suspected to suffer from typhoid fever with no response to antibiotics for 2 weeks. 15 cases [36%] yielded positive blood cultures. 9 [21%] of these cultures proved to be salmonella. 2 [22.2%] out of the 9 salmonella cases were resistant to ampicillin and chloramphenicol, 5 cases [55.6%] were resistant to tetracycline and trimethoprim sulphamethoxazole, 8 cases [88.9%] were resistant to erythromycin, and 3 cases [33.3%] were resistant to amoxycillin and kanamycin. Resistance to ampicillin, chloramphenicol and erythromycin was statistically significant P <0.05. Conjugation between salmonella strains resistant to ampicillin and chloramphenicol and E. coli strains sensitive to both drugs showed transfer of resistance to sensitive E. coli strains. Since the resistance is plasmid mediated, the problem is likely to be aggravated

Hydrogen breath test and lactose malabsorption among diarrheic cases

To study the efficacy of HBT versus stool analysis test in identifying lactose malabsorption, 150 infants with diarrhea and 30 normal controls aged 2-12 months were included in this study 55.3%, 52.7% and 48% of diarrheal cases had acidic stool +ve clinitest and +ve HBT respectively. False positive results were found among controls, since 23.3% and 16.7% of them had acidic stool and +ve HBT were more increased significantly among malnourished infants as well as ones with diarrheal duration > 1 week and insignificantly among infants aged 6-12 months, males and nonexclusive breast-fed cases [mixed, artificially and weaned-fed ones]. The relative degree of lactose malabsorption among +ve HBT cases measured as mean peak hydrogen excretion [PPM] was more increased significantly in infants aged 6-12 months [96.7 +/- 11.32] than ones aged <6 months [9.15 +/- 10.3], in malnourished infants [98.5 +/- 11.7] than well-nourished ones [91.4 +/- 10.4] and in intolerant cases [100.3 +/- 4.19] than tolerant ones [91.7 +/- 10.7], while the mean peak H2 excretion was more decreased significantly in exclusion breast-fed cases [90.3 +/- 8.9] than other fed groups [94.8 +/- 17.5]

Fibrinolytic activity in hepatocellular carcinoma

The observed effect of hepatocellualr carcinoma on the fibrinolytic system is contradictory. This lead us to study the changes in fibrinolytic activity in 13 patients of hepatoma compared to 10 controls. Our patients especially the group with evidence of liver cirrhosis showed significant; hypofibrinogenaemia, increase in fibrinogen degradation products [FOPs], prolongation of prothrombin and thrombin time and overall reduction in prothrombin concentration. In addition there was also significant thrombocytopaenia. Such alterations favor the assumption of increased fibrinolysis and/or dissiminated intravascualr coagulation which are important factors in th pathophysiological mechanisms underlying the haemorrhagic diasthesis in patients with hepatocellular carcinoma

Kidney function in healthy elderly people

All aspects of renal function, including GFR, salt and water handling, acid-base and electrolyte homeostasis and hormonal balance decline with advancing age. The present study was conducted on 45 Egyptian farmers [38 males and 7 females] divided into three groups. Group I [20-30 years], group II [65-74 years] and group III [75-85 years]. For each subject serum creatinine, urinary creatinine and endogenous creatinine clearance were done. 1. Serum creatinine showed a significant increase with age in geriatrics in comparison with age group 20-30 years. 2. Urinary creatinine shows no significant change with age in the three groups. 3. Endogenous creatinine clearance shows a highly significant decline in geriatric groups in comparison with age group 20-30 years. There is about 26% decline in GFR at age 85 years. The increase in serum creatinine with age may be due to decline in GFR. The decrease in endogenous creatinine clearance with advancing age may be due to: 1. Reduction in number of functioning glomeruli. 2. Decline in renal blood flow. 3. Reduction in renal mass. 4. Subclinical or hidden disease. 5. Associated malnutrition in old subjects. 6. Misunderstanding of instructions given to the older subjects

Alternation in cellular immunity with aging

The aim of this work was to study the effects of aging on the cellular-mediated immune response and to search for any alterations in the total lymphocyte count and the absolute number of T-lymphocytes accompanying aging of man. This study was carried out on: thirty four Egyptian farmers above 60 years old [mean age= 66.4 years] and they were 22 females + 12 males and they were apparently healthy and on 17 healthy Egyptian farmers [mean age = 37.6 years] and they were 9 females + 8 males as control. All studied individuals were subjected to full history taking, clinical examination and fresh samples of peripheral blood were taken to count the total lymphocytes, and the lymphocytes had been isolated using the ficoll-hypaque. The absolute T-lymphocytes were estimated using the E-rosette formation between sheep RBC's and the lymphocyte suspension. T-cell percent to total lymphocytes were estimated. Results showed that: - There were no decrease in the lymphocyte count with aging; in the older group it was =2113/mm[3] while in the control group, it was 2106/mm[3]. The percentage of T-lymphocytes showed no appreciable change with aging; in the geriatric group it was =69.2% while in the control group = 69.5% i.e. As light decrease with aging had happened. The absolute T-lymph count showed no change with aging: In the old group it was =1465/mm[3], while in the control group = 1459 /mm[3] i.e. in both groups it was [nearly] equal. From these results, it was concluded that; aging is not accompanied with alterations in the total lymphocytic count or in the absolute T-cell number/mm[3]. It was referred that aging is associated with changes in cell-mediated immune response, these changes are mainly functional and due to alterations in the T-cell subset-proportions in the body of man