Types of the endoneurial oedema after the crush injury of the peripheral nerve in albino rat

This study included 20 male albino rats; the left common peroneal nerves of 18 rats were subjected to crush injury, while 2 rats were used as a control. The common peroneal nerves were exposed and some of their parts distal to the crush injury were taken. The specimens were prepared for study by electron microscope. The results showed that the endoneurial edema was distributed all over the endoneurium, especially in the sub-perineurial and perivascular areas forming sub- perineurial and perivascular edema. The axoplasm of the nerve axons showed edema fluid causing a separation of its contents of the cell organelles, intra-axonal edema. Also, the mitochondria became swollen with ill-defined internal cristae, intra-mitochondrial edema. The endothelial cells of the endoneurial blood vessels became partially swollen due to internal edema. The perineurium also became thick and edematous due to the presence of fluid between its layers, intra-perineurial edema

Anatomical study for the infraorbital foramen

One hundred and twenty Egyptian adult skulls were examined to ascertain the location of the infraorbital foramen and the direction of the infraorbital canal to the face. Fifty halves head and neck of adult male cadaveric specimens were dissected to study the locational relationship of the infraorbital foramen to the angles of the eye and to study the contents of the foramen. Dry skulls were differentiated into 62 males, 46 females and 12 of undetermined sex. Bony results demonstrated that the most common position of the infraorbital foramen was opposite the second upper premolar tooth. The most common direction for the infraorbital canal into the face was downwards, forwards and medially. The mean distance between the center of infraorbital foramen and the midsagittal plane was 30.9 mm on the right side and 30.6 mm on the left side in males; while this distance was 29.6 mm on the right side and 29.7 mm on the left side in females. The mean distance between the center of the infraorbital foramen and the inferior orbital margin was 8.6 mm on the right side and 9.2 mm on the left side in males; while this distance was 7.0 mm on the right side and 7.3 mm on the left side in females. The mean distance between the center of the supraorbital notch and the midsagittal plane was 24.5 mm on the right side and 24.8 mm on the left side in males; while this distance was 24.2 mm on the right side and 24.3 mm on the left side in females. The mean distance between the center of the supraorbital notch or foramen and the center of the infraorbital foramen was 43.2 mm on the right side and 42.9 mm on the left side in males; while this distance was 40.8 mm on the right side and 41.0 mm on the left side in females. The mean angle between the line joining the supraorbital notch and the infraorbital foramen and the vertical line parallel to the midsagittal plane was 7.3 degrees on the right side and 7.2 degrees on the left side in males; while this angle was 8.8 degrees on the right side and 8.9 degrees on the left side in females. These locational relationship would be helpful clinically to determine the location of infraorbital foramen by palpation of supraorbital notch. Dissection of 50 halves head and neck revealed that in most specimens [80%] the infraorbital foramen was present exactly at a vertical line passing at the middle of the horizontal line passing between the lateral and medial angles of the eye. These findings may be helpful in anaesthetic block of infraorbital nerve at its passage through infraorbital foramen

Anatomical study of the extensor caropi radialis muscles

This study was conducted on 94 fresh and preserved upper limbs. Twenty of them were injected with red latex through the axillary artery to study the arterial supply of the extensor carpi radialis muscles. Careful dissection was done to demonstrate the arterial and nerve supply of these muscles. The aim of this work was to study the attachment, length, breadth, thickness and anatomical variations of the extensor carpi radialis muscles as-well as their arterial and nerve supply. The extensor carpi radialis longus [ECRL] muscle was found to have a single arterial pedicle from the radial recurrent artery, which entered the proximal part of the muscle together with its nerve supply. The arterial supply to the extensor carpi radialis brevis [ECRB] muscle was formed of multiple arterial pedicles [3-5] from the radial artery that entered the muscle through its medial surface. The ECRL muscle was found to have a good arc of rotation either medially or anteriorly or anteriorly and more suitable for tendon transfer than ECRB muscle. Several anatomical variations were found in the form of extra muscle belly and extra tendon arising from either ERCL muscle and inserted with ECRB muscle and vice versa; also two extra tendons were found to arise from both ECRL and ECRB muscles. These muscles and extra tendons are valuable source for tendon transfer in reconstructive surgery

Anatomical study of the osteomusculocutaneous flaps based on the lateral circumflex femoral artery

This study was carried out on sixteen lower limbs [12 preserved and 4 fresh] from the Anatomy Department, Faculty of Medicine, Alexandria University. The preserved lower limbs were injected with red latex in the femoral artery to study the branches and the distribution of the lateral circumflex femoral artery. The fresh lower limbs were injected with methylene blue in the lateral circumflex femoral artery to measure the skin surface area supplied by perforators of this artery. The results of this study showed that the ascending branch of the lateral circumflex femoral artery supplied the tensor fasciae late muscle and the muscle receives an additional arterial supply from the superior gluteal artery. This muscle receives and additional branch from the descending branch of the lateral circumflex femoral artery. The musuclocutaneous perforators of the ascending and the descending branches were found to supply the skin of the anterolateral aspect of the thigh. The terminal branch of the ascending branch of the lateral circumflex femoral artery were found or supply the ilium bone and gives branches to the outer cortex of the iliac crest. Including the ascending and descending branches of the lateral circumflex femoral artery as the pedicle vessels, cobined anterolateral flap and vascularized iliac bone graft may be easily obtained as an osteocutaneous flap with of without tensor fasciae latae muscle. So, the iliac osteomusulocutaneous flaps based on the lateral circumflex femoral artery seems to overcome the disadvantages of other osteocutaneous flaps and is suitable for reconstruction of a large mandibular defect involving large soft tissue defects

Mesenteric vein thrombosis: a diagnostic and therapeutic challenge

Mesenteric vein thrombosis [MVT] is a rare but a potentially lethal form of mesenteric ischemia. Thirteen patients having MVT [7 males and 6 females] were included in this study. Their ages ranged from 30 to 50 years with a mean +/- standard deviation [SD] of [46.15 +/- 5.52]. Nine of these patients [9/13; 69%] had associated hepatopancreatic diseases: 4 with hepatocellular carcinoma [HCC] on top of cirrhosis, 3 with cirrhosis and previous splenectomy, one with cirrhosis, and one with pancreatitis. The remaining four patients [4/13; 31%] had associated nonhepatopancreatic disease: 2 with deep venous thrombosis [DVT], and 2 with history of contraceptive pill intake. Severe subcontinuous abdominal pain out of proportion to the physical findings [11/13; 84%] and abdominal distention [9/13; 69%] were the major symptoms. Color duplex ultrasound [US] was performed in all patients and was diagnostic for MVT in only 10 patients [10/13; 77%]. In the remaining 3 patients, diagnosis of MVT was established by computed tomography [CT] in 2, and mesenteric angiography in one. Once the diagnosis of acute MVT was confirmed, all patients were anticoagulated with heparin.Signs of peritonitis were the main indication for immediate exploratory laparotomy in the studied cases [8/13; 61.5%]. Minimal small bowel resection with primary anastomosis was performed in 5 patients, minimal small bowel resection with diverting ileostomy in one, extended small bowel resection with primary anastomosis in one, and laparotomy without resection in one. The determination of viability in the marginally perfused bowel was done with clinical assessment. For further evaluation of bowel viability in borderline cases, Doppler US was performed in 4 patients. The 30-day operative mortality was reported in three patients [3/8; 37.5%]. All of them were having liver cirrhosis that was associated with malignancy in one and splenectomy in another. The 30-day mortality in the five non-surgically treated patients was 60% [3/5] that was mostly due to advanced liver malignancy. In conclusion; a high index of suspicion and recognition of high risk factors coupled with a history of non-specific abdominal symptoms should alert clinicians to the possibility of MVT. Early diagnosis using color duplex US or CT and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel. Although a primary anastomosis can be accomplished in most situations, a diverting ileostomy may often be the prudent approach in cases with poor liver function and bad general conditions. During operation, all nonviable bowels should be resected with intent for a second-look laparotomy after 24 hours if there is any question of ongoing ischemia. We recommend using intraoperative Doppler US for detection of the arterial signals in evaluation of the marginally viable bowel

Fas antigen in serum and liver tissue of patients with chronic hepatitis C

Fas [APO-1/CD95], a member of the tumor necrosis factor receptor Family, can mediate apoptosis when engaged by its ligand or by anti-Fas antibody. Fas is upregulated on the surface of hepatocytes in patients with a variety of liver pathologies, including hepatitis, alcoholic cirrhosis, and acute liver failure. Moreover, expression of Fas ligand is substantially upregulated, in areas of lymphocytic infiltration, in liver diseases, suggesting Fas/FasL interactions may mediate liver damage in humans. The purpose of this study was to evaluate the relationship of serum soluble Fas [sFas] levels and hepatic Fas antigen expression with the degree of hepatic inflammatory activity in patients with chronic hepatitis C infection. The effect of concomitant schistosomiasis, as an endemic liver disease in Egypt, on serum and liver Fas expression was also studied. Serum sFas levels were measured by enzyme-linked immunosorbant assay in 69 chronic hepatitis C patients; 16 of them were under 18 years and compared with those in normal volunteers, and patients with chronic HBV infection. The results of serum tests were compared with ALT levels. HCV-RNA titer, histological inflammatory activity, and Fas expression in liver biopsies. The effect of combined HCV infection and schistosomal infestation on serum sFas and tissue Fas expression was also studied. Serum sFas and tissue Fas expression were then evaluated with each components of histological inflammatory activity scoring system [modified Knodell's HAI]. Serum sFas levels in chronic hepatitis C patients were significantly higher than those in normal volunteers [p<0.001]. They showed no difference from those in patients with chronic HBV infection [p>0.05]. Hepatic schistosomiasis didn't affect serum sFas levels or tissue expression of Fas antigen in chronic hepatitis C patients. Histologically, serum sFas levels showed strong correlation with tissue Fas expression [p<0.001] and with the degree of hepatic inflammatory activity [p<0.01]. Likewise, tissue Fas expression correlated with the degree of histological inflammatory activity [p<0.05]. Moreover, positive correlation was found between serum sFas and tissue Fas expression and the degree of interface hepatitis [piecemeal necrosis] in chronic hepatitis C patients with mild [p<0.01] and moderate and severe activity [p<0.05]. However, no correlation was observed between serum sFas and serum ALT levels. Also, no correlation was observed between HCV-RNA titer and sFas levels or tissue Fas expression. Our findings suggest that serum sFas levels may reflect the expression of Fas antigen on hepatocytes and the severity of liver inflammation in chronic hepatitis C and may be used as a serological indicator of histological inflammatory activity. They also support the concept that immune-mediated apoptosis may play a crucial role in the pathogenesis of chronic hepatitis C. Hepatic schistosomiasis seems to have no impact on serum sFas levels or hepatic tissue Fas expression

Origin, course, distribution of the superior gluteal nerve and its relation to the superior gluteal artery and gluteal muscles

Ten pelvic halves of five Egyptian male cadavers were dissected in order to obtain a precise anatomical knowledge of the origin, course and distribution of the superior gluteal nerve and its relation to the corresponding artery. The more anterior parts of the glutei medius and minimus were innervated by branches of the superior gluteal nerve that were revealed to originate more cranially, and the tensor fasciae latae was innervated by the cranialmost element of the nerve. Based on these findings, it might be proposed that the course and distribution of the superior gluteal nerve are directly influenced by the anterior rotation of the gluteus medius

Rubella antibodies in diabetes mellitus

17 patients with type I and 30 patients with type II diabetes mellitus were investigated in this study, and the results were compared to those of 25 normal controls. Rubella antibodies were detected in 41% of patients with type I and in 40% of patients with type II diabetes mellitus as compared to 48% in our control group. The difference between the results in the three groups was statistically insignificant [P>0.05]. So the possibility of considering rubella virus as an aetiological factor in diabetes mellitus is excluded

Abnormal zinc metabolism in diabetes mellitus type II

This study included 20 adult patients with type II diabetes mellitus and 10 normal controls. We estimated serum glucose and zinc [Fasting and at 60, 120, 180 minutes after oral ingestion of gelatin capsule containing 25 mg zinc sulfate], serum creatinine, creatinine clearance, urine volume/ 24 hours and its contents of zinc, glucose and protein. We found that all patients had diminished serum zinc concentrations, and all demonstrated hyperzincuria as compared to the control group. Urinary loss was greater when proteinuria was present. Studies of gastrointestinal zinc absorption suggested zinc mal-absorption in patients with type II diabetes mellitus. Glucose metabolism was improved by zinc supplementation. It is concluded that zinc deficiency in our diabetics may be due to malabsorption of zinc, hyperzincuria, or both. We also concluded that glucose metabolism was improved by addition of zinc