Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma

Background/Aims@#Malignant portal vein thrombus (PVT) is found in up to 44% of patients with hepatocellular carcinoma (HCC). The nature of the thrombus influences treatment selection. The aim of this study was to assess the safety and efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in determining the nature of PVT in liver cirrhosis and/or HCC. @*Methods@#A prospective study was conducted in 34 patients with liver cirrhosis and/or HCC with PVT. Under EUS guidance, PVT was punctured using a 22 G FNA needle (Cook Medical, Bloomington, IN, USA) followed by monitoring of the puncture tract using color Doppler. Patients were followed for adverse events 2 hours after recovery. @*Results@#Throughout the 30-month study period, 34 patients, including 24 males with a mean age of 59±8 years, were enrolled. There were 8 patients with known HCC and 26 with no liver masses detected by computed tomography (CT). EUS-FNA from PVT was positive for malignancy in 3 patients (8.8%), of which only 1 patient was diagnosed with HCC by CT and 2 patients were newly diagnosed with HCC after EUS-FNA. No major complications were reported. @*Conclusions@#EUS-FNA is a safe and effective technique for determining the nature of PVT that does not fulfill the malignant criteria via imaging studies in patients with liver cirrhosis and/or HCC.

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma

Background/Aims@#Malignant portal vein thrombus (PVT) is found in up to 44% of patients with hepatocellular carcinoma (HCC). The nature of the thrombus influences treatment selection. The aim of this study was to assess the safety and efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in determining the nature of PVT in liver cirrhosis and/or HCC. @*Methods@#A prospective study was conducted in 34 patients with liver cirrhosis and/or HCC with PVT. Under EUS guidance, PVT was punctured using a 22 G FNA needle (Cook Medical, Bloomington, IN, USA) followed by monitoring of the puncture tract using color Doppler. Patients were followed for adverse events 2 hours after recovery. @*Results@#Throughout the 30-month study period, 34 patients, including 24 males with a mean age of 59±8 years, were enrolled. There were 8 patients with known HCC and 26 with no liver masses detected by computed tomography (CT). EUS-FNA from PVT was positive for malignancy in 3 patients (8.8%), of which only 1 patient was diagnosed with HCC by CT and 2 patients were newly diagnosed with HCC after EUS-FNA. No major complications were reported. @*Conclusions@#EUS-FNA is a safe and effective technique for determining the nature of PVT that does not fulfill the malignant criteria via imaging studies in patients with liver cirrhosis and/or HCC.

Diagnostic Efficacy of Endoscopic Ultrasound Elastography in Differentiating Solid Pancreatic Lesions: A Single-Center Experience

BACKGROUND/AIMS: Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions. METHODS: The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed. RESULTS: In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%. CONCLUSIONS: The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.

Variations of corneal hysteresis in myopic patients with normal pentacam findings

Background: hysteresis refers to the energy lost during the stress/strain cycle which is the result of viscous damping in the corneal tissue, is an indicator of corneal biomechanical properties. Refractive surgery currently uses corneal thickness as a basic qualification and planning parameter. However, corneal hysteresis may be more useful as a qualification factor for LASIK, a significant decrease in the IOP and biomechanical properties is found in eyes following LASIK surgery

Objective: this study aimed to reveal the variations of corneal hysteresis in patients with normal pentacam findings and to see if a correlation exists between corneal hysteresis, corneal resistance factor, mean keratometric reading, central corneal thickness and anterior chamber depth during the pre-operative assessment of myopic patients going for LASIK

Patients and Methods:in this study we did an analysis of corneal hysteresis in a group of myopic patients with normal pentacam findings undergoing evaluation for refractive surgery. In our study we included 50 eyes of 26 patients aged between 18 and 44

Results: this study included a mean keratometric reading of 44.108 D+/- 1.3243D, the mean central corneal thickness was 522.1um+/-38.416um, the mean anterior chamber depth was 3.2098mm+/-0.249mm the mean corneal hysteresis was 9.582 mmHg+/-1.4702 and the mean corneal resistance factor was 9.64 mmHg +/-1.9838

Conclusion: our data suggested that patients should get their corneal hysteresis tested as a part of their routine investigation portfolio before undergoing refractive surgery as it may play a role in determining patients that are at higher risk of developing ectasia after surgery

Comparative study between femoral arterial doppler and echocardiography in fluid responsiveness assessment in septic shock patients

Background: Fluid replacement is considered the cornerstone of resuscitation in critically ill patients especially in patients with septic shock. However, only about 50% of critically ill hemodynamically unstable patients are responsive to fluids. Furthermore, both under resuscitation and overzealous fluid administration adversely affect the outcome. Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients’ intravascular volume status and their volume responsiveness

Aim of the Study: The aim of this study is to compare between the femoral arterial doppler and Echocardiography in fluid responsiveness assessment in septic shock patients

Methodology: The study was conducted on 30 adult male and female patients admitted to Critical Care Department in Ain shams University Hospitals with the diagnosis septic shock. All patients in this study have the Criteria of Septic shock. Echocardiographic examination and femoral Doppler were done for all included patients. Velocity time integral on left ventricle outflow tract and Velocity time integral on femoral artery were measured before and after fluid resuscitation, after infusion of 30 ml/kg over 3 hours

Results: These results show that there were 23 patients were responded clinically to fluid resuscitation from all total number of 30 patients. From all total number of patients whom clinically responded, 22 patients responded to fluid resuscitation by transthoracic echocardiography and 23 patients responded by femoral Doppler

Conclusion: These results showed that femoral Doppler parameters were a reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock as well as transthoracic echocardiography in dynamic monitoring of the change in stroke volume after a maneuver that increases or decreases venous return [preload]. However femoral Doppler seems to be easier and rapid tools to be used by junior staff

Timothy grass pollen sensitization in asthmatic egyptian children

Background: Allergic diseases are considered a major problem for healthcare systems in both developed and developing countries. Longitudinal epidemiologic studies have shown an increased prevalence of sensitization to common allergens, and increased prevalence of asthma, atopic dermatitis, food allergy, and allergic rhinitis in children. The increase in allergies is a phenomenon that is being observed in all fast-developing countries. For a long time, science has taken as a starting point that solely a genetic predisposition is a precondition for the development of an allergy. Today, knowledge of environmental factors that can alter genes or the transcription of genes in the cells, has improved

Aim of the Work: We aimed to investigate the rate of sensitization to Timothy grass pollen in a group of asthmatic Egyptian children in relation to other markers of disease expression. Our ultimate objective was to add information to the map of aeroallergen sensitization in our country

Patients and Methods: This analytical cross sectional study was conducted on children with bronchial asthma following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from September 2017 to March 2018. The sample included 100 asthmatic patients who were enrolled consecutively. Patients were classified into intermittent and persistent Asthma according to the 2009 VA/DoD asthma management guidelines

Results: The current study revealed a high frequency of Timothy grass pollen [TGP] sensitization representing 61% of the studied sample. The diameter of wheal in sensitized children ranged between 3-7 mm with a median [IQR] of 4 [3- 4]. None of our subjects had wheal diameter >/= 8 mm, which denotes severe reaction. In our study, Patients with persistent asthma were more prone to be TGP sensitized [80.3%] than those with intermittent asthma [19.7%]. Sensitized children with persistent asthma showed larger wheal diameter [median= 4 mm, range: 4-7 mm] than those with intermittent asthma who showed smaller diameter [median= 3.5 mm, range: 3-4 mm]

Conclusion: Sensitization to TGP might point a persistent phenotype of pediatric asthma and may be linked to severity and need to step up and/or add on therapeutic options

Traumatic cerebrospinal fluid leakage following septorhinoplasty

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

Acute mesenteroaxial gastric volvulus: a rare cause of haematemesis

Gastric volvulus is a rare condition that is typically characterised by abdominal pain and unproductive retching. The volvulus occurs around an axis formed by two fixed points, organoaxial or mesenteroaxial. Although a rare diagnosis, primary care providers and emergency room physicians should be aware of the telltale signs of gastric volvulus, and endoscopists should be able to recognise the endoscopic features that are suggestive of this diagnosis. Although haematemesis is a commonly encountered emergency, acute mesenteroaxial gastric volvulus is an uncommon cause

Prevalence of chlamydophila pneumoniae in patients with pneumonia in the Main University Hospital in Alexandria

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups and is the leading cause of death in children in low income countries. This prospective study was done at Department of chest diseases and microbiology from January 2011 to July 2011. A total of 60 patients, with pneumonia were included in the study. The present study was conducted on 60 patients with pneumonia who have been admitted to the Chest Department in the Main University Hospital in Alexandria [55 patients] and El Maamoura Chest Hospital [5 patients] in the period from January 2011 to April 2011. The patients were subdivided into 2 groups: group I includes 30 patients with CAP and group II includes 30 patients with HAP; 16 patients with COPD, 7 patients with bronchial asthma, 4 patients with bronchogenic carcinoma and 3 patients with ILF. We can conclude that, Chlamydophila pneumoniae cannot be ignored as a cause of pneumonia. ELISA is an excellent screening test because of its high sensitivity for detection of C. pneumoniae while PCR is more accurate because of its high sensitivity and high specificity in diagnosis of C. pneumoniae infection.DM is a risk factor for C. pneumoniae infection

Removal of tracheobronchial foreign bodies using flexible and rigid bronchoscopy

Foreign body inhalation is one of the life threatening emergencies. It may happen at any age, however, most of these accidents occur in children especially below the age of five. This prospective study was done at Department of chest diseases from March 2008 to November 2011. A total of sixty patients, with suspicion of tracheobronchial foreign body were included in the study. Sixty patients were studied. Forty [66%] were female and twenty [34%] were male. 45 patients [75%] were above 15 years, 5 [8%] were between five and fifteen years and 10 [17%] were below fifteen years. Thirty five patients [58%], presented mainly with chocking, while fifteenth patients [25%] had cough at initial presentation and ten patients [17%] presented with mild stridor. Thirty five patients [58%] had nothing on chest examination while fifteenth patients [25%] had wheeze on auscultation and ten patients [17%] had decreased air entry on auscultation. Head pin was the commonest foreign body retrieved in thirty five patients [58%]. Other foreign bodies were peanut [17%], seeds [12%], Homos [8%], pieces of chicken bone [1.5%], and piece of Sullivan paper of biscuits [1.5%]. needle of dental syringe [1.5%].Foreign body inhalation is more common in female patients, mostly above fifteenth years of age. Chocking is the commonest symptom and nothing on chest auscultation is the typical examination finding. Peanut has been found to be the commonest type of foreign body below the age of five

relation between maternal vitamin D levels and their neonates

In recent years, despite of the numerous preventive and therapeutic strategies now available, vitamin D deficiency has resurfaced as a global health problem among infants and children. There has been a resurgence of nutritional rickets in children in many developing countries and some developed countries. We evaluate the magnitude of vitamin D deficiency among Kuwaiti mothers and their neonates to provide adequate basis for recommendation to prevent or at least minimize vitamin D deficiency effects. We determined vitamin D levels among mothers and their neonates to detect if their relationship, if any to infantile rickets. One hundred twenty eight full term pregnant mothers and their neonates were selected from medical consultation center in Kuwait. All mothers had normal vaginal delivery. On the day of delivery 2.5ml of maternal blood and 2.5 of cord blood samples were withdrawn .Serum 25-hydroxyvitamin D[25 OHD] was determined in duplicate by radioimmunoassay using lncstar kit. A total 128 mother-neonates pairs were selected from medical consultation center The mean [ +/- SD] age and parity of the mother were 24.7[4,6], 2.48 [1.51] respectively. The mean [ +/- SD] 25OHD levels of mothers their neonates were 17.5 [6.8] ng/ml, 8.1[6,1]ng/ml respectively. Our results demonstrated that vitamin D of the mothers and neonates are highly correlated About 60%of neonates and 45%of their mothers are vitamin D deficient on the day of delivery

Ventilator associated pneumonia: the role of typical, atypical bacteria and fungi; comparison between endotracheal aspirate and bronchoalveolar lavage

Ventilator associated pneumonia [VAP] is defined as pneumonia occurring after the first 48 hours of starting mechanical ventilation. The incidence of VAP varied between 7-70% in different studies. The pathogenesis of VAP usually requires the occurrence of two important processes: bacterial colonization of the aerodigestive tract and the aspiration of contaminated secretion into the normally sterile lower respiratory tract. The principal promise of bronchoscopy for the diagnosis consists of the ability to retrieve uncontaminated lower respiratory secretions and consequently doing quantitative cultures, this should allow a valid differentiation of colonization from infection. The aim of this study was to determine the role of legionella species, mycoplasma pneumoniae, Chlamydia pneumoniae, mycobacterium tuberculosis, fungi, and anaerobes as etiologic agents of VAP and to compare between quantitative Endotracheal Aspirate [EA] and bronchoalveolar lavage[BAL] techniques for the diagnosis of VAP. The study was conducted on 30 patients admitted to the critical care medicine department of Alexandria main university hospital who required invasive mechanical ventilation for at least 48 hours and developed clinical manifestations of VAP. Gram negative bacteria were the most common etiologic pathogens, followed by atypical bacteria. There was no statistically significant difference between both EA and BAL regarding the aetiologic pathogens

utility of nasal endoscopy in the diagnosis of sinonasal and pulmonary sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology that may affect any organ. Although involvement of the epithelium of the upper respirafory tract is comparatively infrequent, nasal symptoms may be the first manifestation of the disease. In this study, we are trying to highlight the importance of the noninvasive nasal endoscopy in the early detection and diagnosis of patients with sarcoidosis. Our study population consisted of 80 patients; group A [50 patients with biopsy proved pulmonary sarcoidosis] and group B [30 patients with quiery pulmonary sarcoidosis]. Positive nasal biopsies were found among 14% and 16.6% of both groups respectively. The easily accessible nasal cavity can yield important information that help diagnose patients with sarcoidosis without resorting to any invasive procedures

Fracture shaft femur in children: the role of external fixation

Purpose: the present study aimed to evaluate the advantages of external fixation in the management of femoral shaft fractures in. older children [6 years or over]

Patients and methods: between September 200J and September 2005, we treated 14 children with 15 femoral shaft fractures using external fixation. Thirteen of them were available for follow up [14 fractures]. Four fractures were open and ten closed. There were 9 boys and 4 girls. Their average age on the day of injury was 8.4 years [ranged from 6-12 years]. All the patients were managed by closed reduction and application of monoplanner external fixator under control of image intensifier

Results: average follow-up was 12 months [ranged from 6-18 months]. The time to radiological union ranged from 2 to 3 months with an average of 2.5 months. Full range of motion was regained in all patients except two Pin track infection developed in 4 patients. Leg length discrepancy was minimal without any clinical complications and detected in three cases. No significant rotational deviation was seen. Refractor happened in one patient

Conclusion: management of fracture shaft .femur in older children [older than 5 years] by external fixation provides available alternative to conservative treatment

Coraco-clavicular screw fixation with ligaments suture: a simple treatment of acromioclavicular joint dislocation

Purpose: the aim of this study is to evaluate the results of Coraco-clavicular screw fixation with ligaments suture for the treatment of complete acute acromioclavicular joint [ACJ] dislocation

Material and methods: eighteen patients with complete ACJ dislocation were treated operatively in El-Minia University Hospital. According to the classification of Rockwood and colleague's they had type ill, IV or V lesion. They were operated within three weeks of injury by Coraco-clavicular screw fixation with suture of the Coraco-clavicular ligaments. There was a postoperative immobilization of the injured shoulder for 3 weeks

Results: follow-up period ranged from 6 months to 2 years. Sixteen patients achieved excellent outcome with full range of shoulder movement and pain free. One patient developed chronic shoulder pain [Follow-up X-rays revealed mild subluxation of the acromio-clavicular joint] and one had painful hypertrophic surgical scar

Conclusion: our results indicate that this procedure can be recommended

Diagnostic accuracy of combined clinical, ultrasonography and fine needle aspiration cytology for thyroid swelling assessment

The present study was designed to evaluate applicability of combination of clinical examination, neck conventional ultrasonography [US] and US-guided fine needle aspiration cytology [FNAC] as a strategy for assessment of thyroid swellings and differentiating between malignant and benign thyroid lesions. The study included 50 patients [5 males and 45 males with a mean age of 37.1+/-6.9 years] with nodular thyroid swelling. All patients underwent complete history taking, full clinical examination, neck US and US-guided FNAC. All patients underwent thyroidectomy and excised specimens were examined histopathologically. All patients passed smooth intra- and postoperative course apart from 4 cases that developed postoperative hematoma collection, one of them required evacuation. Histopathological examination defined 5 [10016] papilary and one [2%] follicular carcinoma and 44 [88%] benign nodules. Clinical examination detected 14 patients [28%] with criteria of suspicious malignancy while the other 36 patients showed no criteria of suspicious malignancy. Clinical diagnosis could define malignant thyroid lesions with sensitivity 66.7%, specificity 77.3% and accuracy 76%. The receiver operating characteristic [ROC] curve analysis for the diagnostic yield of clinical findings for differentiating between malignant and benign thyroid as judged by the area under the curve [AUC] showed AUC=0.652. Conventional US diagnosis depending on US signs of malignancy revealed that 2 malignant lesions were solid, hypoechoic nodules with blurred margins, no halo sign and with fine calcification, another 2 malignant nodules were solid, isoechoic nodules with blurred margins, no halo sign and with coarse calcification, whereas the remaining 2 malignant nodules were solid, hypoechoic nodules with well-defined margins, present halo sign and with coarse calcification, ROC curve analysis for the diagnostic yield of each US finding separately showed that presence of fine calcification had the highest diagnostic yield [AUC=0. 739], presence of blurred margin and absent halo sign [AUC=0. 72], internal echogenecity [AUC=0.667] and echostructure [AUC=0.527]. Fine needle aspiration was carried out successfully in 48 patients with a success rate of 96% and diagnosed 4 specimens as papillary carcinoma, 5 as follicular neoplasm and 39 specimens as hyperplastic nodules. FNAC could diagnose malignancy with sensitivity 83.3%, specificity 90.5% and accuracy rate of 89.6% and ROC curve analysis for the diagnostic yield of FNAC showed AUC=0.871. It could be concluded that the combined dependence on clinical judgment, the result of US-guided FNAC and the presence of blurred margin of the nodule associated with absence of Halo sign and micro-calcification using conventional neck US provided the most significant diagnostic yield for differentiating between malignant and benign thyroid lesions

effect of electromagnetic field on fetal cardiac output

The use of cellular [mobile] phone has been exploded world wide during last decade. Their rapid adoption by general public has resulted in an increased research interest in possible harmful health effects[Tahavanainen et al., 2004], This common use of cellular phones had, given rise to concerns about the potential influences of electromagnetic fields on human physiology [Croft et al., 2002]. We studied the effect of electromagnetic fields emitted by cellular phone on fetal heart rate patterns, end diastolic volume, end systolic volume stroke volume and cardiac output. Our results showed that after use of mobile phones on different gestational ages [group I, II and III], significant increase in FHR and significant reduction of EDV, ESV, SV and Cop. The percent of reduction in EDV was more than the percent of reduction in ESV in all groups. This prominent decrease in EDV more than the decrease in ESV suggests that the decrease in SV is mainly due to decrease in contractility. We conclude that the use of mobile phone has a negative effect on. Fetal heart so we recommend avoidance of cellular phone use especially in the early weeks of gestation and f necessary, the phone call should be less than ten minutes

comparatively studies for missing data in regression analysis

The statistical analysis with missing data is an important applied problem because missing data are commonly encountered in practice and most data analysis procedures were not designed for missing data. In this paper, we introduce a recent comparison for the methodologies that handle missing data problems. Some real examples of missing data problems, the pattern of missing data and the mechanisms that lead to missing data will be introduced in the case of regression analysis. A comparative study among the complete case [CC] method, the available case [AC] method, the least squares [LS] on imputed data and the maximum likelihood [ML] are presented. A real data and GPA scores for undergraduate students, College of Administrative Sciences at King Saud University in 1998, is used to make an artificial missing data in three different types of the mechanisms: Missing At Random [MAR], Missing Completely At Random [MCAR], and Missing Not At Random [MNAR] Then we reanalyze the new data set, using a Monte Carlo simulation, for the different methods to make some comparisons