Regenerative Strategies in Treatment of Peripheral Nerve Injuries in Different Animal Models

BACKGROUND@#Peripheral nerve damage mainly resulted from traumatic or infectious causes; the main signs of a damaged nerve are the loss of sensory and/or motor functions. The injured nerve has limited regenerative capacity and is recovered by the body itself, the recovery process depends on the severity of damage to the nerve, nowadays the use of stem cells is one of the new and advanced methods for treatment of these problems.METHOD: Following our review, data are collected from different databases ‘‘Google scholar, Springer, Elsevier, Egyptian Knowledge Bank, and PubMed’’ using different keywords such as Peripheral nerve damage, Radial Nerve, Sciatic Nerve, Animals, Nerve regeneration, and Stem cell to investigate the different methods taken in consideration for regeneration of PNI.RESULT: This review contains tables illustrating all forms and types of regenerative medicine used in treatment of peripheral nerve injuries (PNI) including different types of stem cells ‘‘ adipose-derived stem cells, bone marrow stem cells, Human umbilical cord stem cells, embryonic stem cells’’ and their effect on re-constitution and functional recovery of the damaged nerve which evaluated by physical, histological, Immuno-histochemical, biochemical evaluation, and the review illuminated the best regenerative strategies help in rapid peripheral nerve regeneration in different animal models included horse, dog, cat, sheep, monkey, pig, mice and rat. @*CONCLUSION@#Old surgical attempts such as neurorrhaphy, autogenic nerve transplantation, and Schwann cell implantation have a limited power of recovery in cases of large nerve defects. Stem cell therapy including mesenchymal stromal cells has a high potential differentiation capacity to renew and form a new nerve and also restore its function.

Posterior lumbar interbody fusion in treatment of lumbar spondylolithesis

This prospective study was conducted to evaluate the results of Posterior Lumbar Interbody Fusion in treatment of Lumbar Spondylolithesis. This study included 20 patients with Lumbar Spondylolithesis [9 Grade I, 8 Grade II and 3 Grade III]. All patients had low back pain and 17 of them had also associated radicular pain. There were 13 females and 7 males. The patients aged between 34 and 55 years with an average 37.5 years. Posterior Lumbar Interbody Fusion with two hallow threaded cylindrical cages filled with cancellous bone graft with the use of transpedicular screws fixation was done in all patients. All patients were followed up for east 2 years. Satisfactory osseous fusion was recorded in 17 patients [85%] after one year. Two patients had Satisfactory osseous fusion at the end of 2 years. Only one patient had no fusion at the end of the follow up. There was significant decrease in pain and significant functional improvement. There was no nerve root affection after operation. So we recommend the posterior Lumbar Interbody Fusion. In treatment of Lumbar Spondylolithesis to increase fusion rate, pain relief and functional improvement

Bipolar versus fixed head hip arthroplasty for femoral neck fractures in elderly patients

Between 2002 and 2006, fifty elderly patients with displaced femoral neck fractures were treated with hip replacement at Emergency Hospital Mansoura University. Patients were randomly selected with 25 patients had either cemented or cementless bipolar prosthesis and another 25 patients had either cemented or cementless fixed head prosthesis. There were 34 females and 16 males with an average age of 63.5 years [range between 55 - 72 years]. All patients were followed up both clinically and radiologically for an average follow up period 4.4 years [range between 2-6 years]. At the final follow up, the average Harris hip score among the bipolar group was 92 points [range between 72-97 points], while the fixed head group was 84 points [range between 65 - 95 points]. Radiologically, joint space narrowing more than 2 mm was found in only 8% [2 patients] among the bipolar group, and in 28% [7 patients] of the fixed head group. Through the follow up period, total hip replacement was needed in 2 cases of the bipolar group and 7 cases of the fixed head group. Bipolar hemiarthroplasty offer a better range of movement with less pain and more stability than the fixed head hemiarthroplasty in elderly patients with displaced femoral neck fractures regardless to the cost factor

Non operative treatment versus posterior fixation for thoracolumbar burst fractures without neurologic deficit

A Prospective study was conducted to compare the results of non operative treatment versus short- segment posterior fixation using pedicle screws for thoracolumbar burst fractures without neurologic deficit . This study involved 40 patients. Neurologically intact patients with single - level closed burst fracture involve T 11 - L2 were included in the study . Patients in the non operative group were allowed activity to the point of pain tolerance beginning on the day of injury using hyperextension brace . Patients in the operative group underwent two levels [one above and one below] fixation using transpedicuar screws. The follow up period was 1 year. The surgical group had less pain up to 3 months and a better outcome up to 6 months, but the outcome was similar afterward. No neurologic deficit developed in any patient . In the non operative group, the kyphosis angle worsened by 4o and retropulsion decreared from 35% to 15%. Short - segment posterior fixation provides partial kyphosis correction and earlier pain relief but functional outcome at 1 year is similar in both groups

Role of exercise echocardiography in decision making of balloon valvuloplasty in moderate mitral valve stenosis

Assessment of value of exercise echocardiography using in patients with rheumatic moderate mitral valve stenosis in interventional decision making [percutenous balloon mitral valvuloplasty]. 30 patients with moderate mitral stenosis were participated in the study. All patients were subjected to exercise echocardiography and were divided into two groups. Group I: 20 patients with good exercise tolerance and group II: 10 patients with poor exercise tolerance and mitral valvuloplasty was done, and then reevaluated with exercise echocardiography one month after valvuloplasty. In group [I] mean pressure gradient across mitral valve at peak of exercise was ranged between 12 and 16 mmHg with mean of 134.78 +/- 1.33 mmHg, while in group[II] mean pressure gradient across mitral valve at peak of exercise was ranged between 17 and 20 mmHg with mean of 18.30 +/- 1.25 mmHg. In group [I] pulmonary artery pressure at peak of exercise ranged between 25 and 40 mmHg with mean of 30.00 +/- 5.38 mmHg, while in group [II] it was ranged between 35 and 40 mmHg with mean of 39.00 +/- mmHg at peak of exercise. All members of group II had subvalvular affection [high score] and 50% of them had high score for calcification with poor exercise tolerance while non of group I had subvalvular affection and only 10% of them had law calcific score]. Exercise echocardiography plays an important role in evaluating true symptomatic patients and assesses the hemodynamic severity in patients with moderate mitral stenosis

Platelet aggregation abnormalities in end-stage renal disease; a possible cause of hemorrhagic diathesis

End-stage renal disease patients [ESRD] are at risk of hematological complications. Hypercoagulability and paradoxically hemorrhagic tendency have been described in uremic patients. Hemorrhagic complications are primarily due to uremic platelet dysfunction and intermittent anticoagulation therapy used in hemodialysis. The aim of this study was to investigate the effect of hemodialysis [HDD] on platelet aggregation abnormalities and hence its role in bleeding in ESRD patients on maintenance hemodialysis. Forty two patients with ESRD on maintenance HD, in the hemodialysis unit at Sohag University Hospital utilizing polysulphon memrance and using Fresenius machines 94008 B] were included in this study and compared with a control group; of fourteen healthy adult volunteers. Blood samples were obtained for laboratory investigations form patients and controls before HD session and after the session from patients only the following laboratory investigations were performed; Complete blood cont [CBC]. serum urea, creatinine, Bilirubin, AST, ALT and hepatitis markers [HBsAg and anti HCV antibody]. tests for coagulation screening; PT and PTT, Study of platelet aggregation with ADP and Ristocetin. For all patients and controls bleeding time [BT] was performed at the time of sample taking. Bleeding time is significantly prolonged after the HD session comparing to results before the HD session and that of controls, platelet aggregation with ADDP and Ristocetin were significantly decreased in HD patients before and after session comparing to controls and also statistically significant comparing the results of patients before and after HD session. There is no statistically significant difference in the results of INR and PTT when comparing results of patients before and after sessions and when comparing the results of patients to controls, HD sessions in ESRD patients lead to platelet aggregation abnormalities which may resulted in hemorrhagic disorders in HD dependent patients

Anemia in systemic lupus erythematosus [SLE] patients; types, simple diagnosis and role of erythropoietin [EPO]

Anemia is a common hematological abnormality in Systemic lupus erythematosus and can easily be categorized with simple laboratory tests; the aim of this study was to investigate types and causes of anemia in SLE patients and to evaluate the role of EPO in different types of SLE anemia. Patients and methods; forty three male and female patients with SLE were investigated for types and possible causes of anemia among the follow up patients of the rheumatology outpatient clinic of Sohag university hospital in one year, blood and urine samples were obtained for laboratory investigations, patients with hemoglobin level less than 14 gm/dl for male and 12.3 gm/dl for female were consider anemic and enrolled in the study. Thirty nine patients [90.7%- 1 male and 38 females] were anemic, with mean age of 31 +/- 10 years, the types and incidence of anemia were; iron deficiency anemia [IDA] n = 22 [56.4%], anemia of chronic disease [ACD] n = 12 [30.8%] and autoimmune hemolytic anemia [AIHA] n=5 [12.8%], mean levels of hemoglobin were 10.4 +/- 1.3, 9.6 +/- 1.1 and 7.7 +/- 0.8, in the three groups respectively, low levels of complement C3 and C4 were observed in AIHA, and ACD, but not in patients with IdA. Anti-dsDNA antibodies were seen in all patients with AIHA, and in 10 patients with IDA, CRP concentrations were not related to severity of anemia in the three groups, higher levels of serum creatinine and proteinuria were detected in the three was no difference in the mean levels of EPO among different groups. Anemia in SLE can be easily diagnosed by simple methods, IDA is very common among SLE patients in our community, Erythropoietin [EPO] may have no role in SLE anemia and the presence of Anti Erythropoietin antibodies [AEA] and its role can not be ruled out

Outcome of surgical repair of iatrogenic injuries of major bile ducts

Bile duct injury is a severe and potentially life-threatening complication of open cholecystectomy [OC] or laparoscopic cholecystectomy [LC]. The management of bile duct injuries remains a challenge for most surgeons. The purpose of this study was to evaluate the presentation, characteristics, related investigation, and outcome of patents who underwent immediate or late repair of iatrogenic major bile duct injuries [MBDI]. Twenty three patients with post-cholecystectomy [OC or LC], and postoperative abdominal surgery presented with manifestation of biliary tract strictures or injuries between January 2000 and March 2005 in Sohag university hospital were included in this study. Those patients either underwent their primary surgery in the university hospital or were referred to the university hospital after their primary surgery was performed in other hospitals in our locality. Patients were subjected to clinical examination and to the following; laboratory investigations [blood picture, blood sugar, liver function test, serum urea and creatinine], abdominal ultrasound examination, CT scan, PTC, ERCP, and MRCP in selected cases. These patients then subjected to endoscopic and/or open surgical treatment. This study included 23 patients, 21[91.3%] after cholecystectomy [14 OC and 7 LC], and 2 patients after other abdominal surgeries. Bile duct injuries were recognized immediately in 5 patients [21.7%] [2 after OC and 3 after LC], and 18 patients [78.3%] presented later after the primary surgery. Their clinical presentations were obstructive jaundice in 13 patients [56.5%], external biliary fistula in 5 patients [21.7%], and biliary collection in 3 patients [13%]. The level of obstruction or injury was classified as Bismuth type 1 in 14 cases [61%], Bismuth type 11 in 6 cases [26%], and Bismuth type III in 3 cases [13%]. Bismuth IV and V types were not recorded among the studied cases. End-to-end anastomosis was done for 5 cases [21.7%]. The 5 patients [21.7%] to whom end-to-end anastomosis was done; failure was seen in 4 of these 5 cases [80%] and was corrected by re-exploration and reaired by hepaticojejunostomy. Choledochojejunostomy and hepaticojejunostomy were performed in majority of cases and showed no failures. Cholecystojejunostomy was done for the 2 cases [8.7%] that presented with bile duct obstruction after other abdominal operations. Postoperative complications includes, minor leakage in 5 [21.8%] patients was managed conservatively. Wound sepsis was seen in 8 [34.8%] with burst abdomen occurred in 3 [13%] of them. No operative mortality encountered in our patients. Late stricture encountered on long-term follow up [3 years] in 3 cases [13%]. The overall success after repair by Roux-en-Y hepaticojejunostomy was 78.3%. Major bile duct injuries after cholecystectomy and other abdominal surgeries are a considerable surgical challenge. Surgical reconstruction using Roux-en-Y hepaticojejunostomy mucosa to mucosa repair remains the golden standard procedure of choice for treating these injuries with successful outcome and better long-term result. Early recognition and adequate treatment at socialized institutions account for the key of prognostic parameters. Finally, as always, the true key to successful treatment of these injuries remains prevention

Homocysteine a risk factor for cardiovascular disease in patients with type 2 diabetes mellitus

Diabetes mellitus has been widely recognized as major risk factor for coronary artery disease and, at the present time, diabetics are considered at high risk for coronary events independently of prior evidence of atherosclerotic disease [1]. Hyperhomocysteinemia has emerged as a novel risk factor for myocardial infarction. Diabetes shares many common mechanisms of plaque development with hyperhomocysteinemia, such as those related to endothelial dysfunction, thrombosis and oxidative stress [2]. To study the importance of serum homocysteine [Hcy] level as a predictor of myocardial infarction in patients with type 2 diabetes mellitus and to detect that this level is of an equal importance as other cardiovascular risk factors such as hypertension, hypercholesterolemia and smoking. Forty individuals were divided into three groups: group I [acute myocardial infarction with type 2 diabetes group, n=15], group II [uncomplicated type 2 diabetes group, n=15] and group III [normal control, n=10]. Diagnosis of myocardial infarction was confirmed from ECG criteria together with significant elevations in serum creatine kinase activity and echocardiographic examination. Higher homocysteine levels was found in AMI patients with type 2 diabetes and in uncomplicated type 2 diabetic patients [P< 0.01] than the normal control. Homocysteine was positively associated with total cholesterol, LDL-c, P.PB.S, and negatively associated HDL-c. Higher homocysteinemia was predominantly observed in type 2 diabetic patients with myocardial infarction especially those presenting low HDL-c, high LDL-c. Serum homocysteine is considered to be one of the strong and important predictor of myocardial infarction in type 2 diabetes

AO universal interlocking femoral nail: technical faults with the entry hole and with locking

One hundred and twenty six fresh femoral fractures treated using the universal AO interlocking femoral nail were studied to evaluate the technical faults with the entry hole and with locking. An entry hole from the piriform fossa was used in 105 femora and resulted in a straight nail in all cases except one. An entry hole from the greater trochanter was used in 21 femora and resulted in a good reduction with a mild nail bend in 15 femora, a good reduction with a straight nail in 4 femora and a varus malalignment in 2 femora. The decision to lock was based on Winquist, et al recommendations. The technical errors with locking included unnecessary locking, no locking although needed, difficult locking, inability to lock, bent screw, broken screw, and long screw. It was concluded that the piriform fossa is the recommended entry point, but the greater trochanter can be used in middle and distal third fractures if needed. Stable isthmic fractures can be treated by unlocked nailing. Axially stable extraisthmic fractures can be treated by dynamic locking, while unstable fractures are treated by static locking

Diabetic nephropathy as a cause of end stage renal disease among the Egyptian hemodialysis population

Diabetes mellitus is one of the leading causes of end stage renal disease [ESRD] all over the world. The aim of this work was to find out the prevalence of diabetic patients among the Egyptian hemodialysis [HD] population. This work is a multicenter cross sectional study carried out in multiple HD centers all over Egypt, and involved 1000 uremic patients on regular HD. Patients were subjected to detailed history taking, full clinical examination, fundus examination. ECG, blood chemistry [including renal and liver function tests, serum calcium and phosphorous, FBS and PPBS], and complete blood picture. Patients were clinically classified into three groups. Group A included uremic patients with IDDM. Group B included uremic patients with NIDDM, and group C included uremic non diabetic patients who were taken as a patients control group. The results of this study showed that 98 patients [9.8%] out of the 1000 uremic patients studied had DM as a cause of their ESRD. Diabetic uremics were found to be more frequently hypertensive, hypercholesterolemic and suffered more from coronary heart disease than non diabetic uremics. This study also showed that the relative contribution of IDDM and NIDDM among HD patients was 38.8% and 61.2%, respectively. The, duration of NIDDM was significantly shorter indicating that the progress of renal complications in this type is much faster than in IDDM. The result of C-peptide measurement perfectly matched with the clinical criteria for classification of the type of DM. where the predictive value was 100%. Finally, this study recommends to improve the medical care given to the diabetic patients establishment of education programs for diabetics stressing upon how to avoid diabetic complications and the importance of early intervention for treatment of those complications should they occur

Injuries of the tarso-metatarsal joint results of surgical treatment

Eleven cases of tarsometatarsal fracture - dislocations were treated by open reduction and Kirschner wire fixation. These were ten males and one female. The age ranged from twenty three to forty seven with a mean age of thirty two. The follow up period ranged from ten months to five years with an average of 3.3 years. Good functional results were achieved in seventy three percent. Functional results were better than radiological results

Shoulder-forearm functional coupling after forearm diaphyseal fractures

A group of adult patients with forearm diaphyseal fractures were treated by AO plate osteosynthesis. The clinical versus functional recovery of forearm rotation was assessed. It was found that pronation loss is more common than supination loss but since pronation loss can be compensated for by shoulder abduction, the ultimate functional recovery of rotation is good

Cast bracing of tibial shaft fractures

Eighty patients with simple tibial shaft fractures were treated conservatively at Orthopaedic Department Ain Shams University. Forty patients were treated functionally by below knee brace, designed originally by Sarmiento [1970] and modified recently by us and the rest conventionally by above knee plaster cast. The average healing time of the functionally treated cases was eight weeks compared with 13.7 weeks of the control group. The rate of healing was found to be correlated with the time of weight bearing, the earliest was the time of weight bearing, the faster was the union. Comminuted and lower third tibial fractures took longer time to heal in the functional group but still less than the other group. The functionally treated cases showed full range of both knee and ankle joints with no wasting of the thigh or calf muscles. Complications of the functional bracing technique was found to be minimal