Antioxidant and antimutagenic properties of calcium sennosides in ?-Irradiated human blood cultures

Background: calcium sennosides are the main active metabolites of sennas, which have a powerful interest to phytochemical and pharmacological research, due to their brilliant medicinal values. It is well known in folk medicine for their laxative and purgative uses

Materials and Methods: this experiment aimed to assess cytogenetic [micronucleus assay and chromosomal aberration study] and biochemical effects of calcium sennosides at a working dose [24 or 48 mg/ml] on suppressing radiation hazards in human blood cultures. Biochemical investigations include superoxide dismutase [SOD], catalase [CAT], tumor necrosis factor-alpha [TNF-alpha], interleukin-8 [IL-8], cyclooxygenase-2 [COX-2] and lactate dehydrogenase [LDH] levels. The treatment periods were 48 and 72 hrs post-irradiation at a dose of 3 Gy. Triple blood cultures for each blood sample were set Up

Results: ionizing radiation exposure induced significant increase in micronuclei [MN] frequencies in both mono- and bi- nucleated cells, and all types of chromosome aberrations, beside significant decrease in SOD and CAT activities. While TNF-alpha, IL-8, COX-2 and LDH levels were significantly increased after irradiation. Treatment with calcium sennosides exhibited decreased of micronuclei and chromosome aberration numbers and enhancement in the level of SOD and CAT activities. In addition, a significant amelioration in IL-8, TNF-alpha, COX-2 levels and LDH activity were scored

Conclusion: present results revealed the antimutagenic and the anti-inflammatory effects of sennosides against oxidative stress induced by gamma-irradiation

Different prevalence of chronic-non-infectious diseases

Inflammatory bowel disease, coronary artery disease, cerebrovascular disease, hypertension, diabetes, tumours, are examples of chronic degenerative diseases that have a high prevalence in developed nations. These chronic-non-communicable diseases have multifactorial aetiologies that considered to be caused by the interaction of environmental risk factors with multiple predisposing genes. Genetic researches on these diseases have traditionally focused on investigation aimed at identifying disease-susceptibility genes. Recent evidence suggests that somatically acquired DNA mutations may also contribute significantly to the pathogenesis of these disease states such as coronary artery disease indicating a similarity between the atherosclerotic and carcinogenic processes. The high incidences and prevalence of these chronic diseases in the Western World in comparison with the East and changing trends in disease incidence [seen in many countries] provide strong evidence that those environmental factors as playing a major influence in disease- expression. There is an ample reason to believe that environmental factors have contributed to inducing alterations in genetic code in precedent generations, which were subsequently inherited and further modified by modern life style activities. Consequently, we now see the appearance of chronic degenerative diseases and their higher incidences in the Western nations as compared with the Eastern ones

Má rotação intestinal em adulto, relato de caso e revisão da literatura / Adult intestinal malrotation, case report and literature review

INTRODUÇÃO: Má rotação intestinal é entidade clínico-cirúrgica que faz parte do cotidiano do cirurgião pediátrico, mas que se torna um desafio diagnóstico quando desenvolve sintomas em adolescentes e adultos. RELATO DO CASO: Mulher deu entrada no hospital com quadro de intensa dor abdominal com três dias de evolução e piora progressiva nas últimas 24 horas. A dor apresentava piora importante após as refeições, quando era acompanhada de náuseas e vômitos. Ao exame físico apresentava-se em bom estado gera, abdômen plano, flácido, ruídos presentes, levemente doloroso à palpação de epigástrio, mas sem sinais de irritação peritoneal. Exames laboratoriais encontravam-se dentro dos limites da normalidade, bem como estudo ultrassonográfico. Não houve melhora clínica apesar do tratamento instituído e optou-se por investigação cirúrgica por tomografia sugerir má rotação intestinal. No intra-operatório observou-se todo o intestino delgado disposto para o lado direito do abdômen e o cólon para o lado esquerdo. Além disto, o jejuno proximal encontrava-se isquêmico e fazendo um volvo de 720º sobre o eixo dos vasos mesentéricos superiores. Para a correção da anomalia fez-se enterotomia do jejuno proximal, a cerca de 10 cm do ligamento de Treitz, e desconfecção do volvo, o que cursou com melhora progressiva da isquemia intestinal, permitindo que se fizesse enteroanastomose. Realizou-se ligadura do pedículo da artéria cólica média em sua origem e colectomia direita seguida de anastomose íleo-transversa látero-lateral. A paciente evolui bem. CONCLUSÃO: - A má rotação intestinal em adultos é doença de difícil diagnóstico primário, devido a não constar entre as hipóteses diagnósticas iniciais do cirurgião geral.

INTRODUCTION: Intestinal malrotation is a clinical surgical entity that is present in the everyday practice of the pediatric surgeon. However, it becomes a diagnostic challenge when symptoms develop in adolescents and adults. CASE REPORT: A woman presented to the hospital with intense abdominal pain of three days' duration and progressive worsening over the preceding 24 hours. The pain increased markedly after meals, accompanied by nausea and vomiting. On physical examination, the patient was in good general health, her abdomen was flat, flaccid, with normal bowel sounds, and tender to palpation of the epigastrium, yet with no signs of peritoneal irritation. Laboratory test results were within the limits of normal, as was ultrasonography. No clinical improvement was achieved despite the treatment instituted; surgical exploration was chosen as tomography was suggestive of intestinal malrotation. Intraoperatively, all the small intestine was found to be positioned to the right side of the abdomen and the colon, to the left side. In addition, the proximal jejunum was ischemic and forming a volvulus of 720º over the axis of the superior mesenteric vessels. In order to correct the anomaly, enterotomy of the proximal jejunum was performed at approximately 10 cm from the ligament of Treitz, and the volvulus was corrected. This promoted a progressive improvement of the intestinal ischemia, which made enteroanastomosis possible. The middle colic artery pedicle was ligated at its root and a right colectomy was performed, followed by a side-to-side ileo-transverse anastomosis. The patient is doing well. CONCLUSION: Intestinal malrotation in adults is a condition of difficult primary diagnosis, since it is not among the initial diagnostic hypotheses of the general surgeon.

Comparative evaluation of jojoba oil versus formocresol pulpotomy in primary molars - in vitro study [histopathological and immunohistochemical]

This study was conducted to evaluate and compare the histopathological and immunohistochemical responses of dog's dental pulp to formocresol pulpotomy versus jojoba. It was conducted on 32 primary molars of four dogs between the ages of one to two months. One of the dogs was used as control, while the rest of the molars were treated by formocresol and jojoba oil [pulpotomies]. The animals were destroyed after one month. The pulp tissues of all the teeth were submitted to histological and immunohistochemical evaluation. The pulp of the Jojoba oil treated group revealed slight hypervascularization, some blood vessels showed dilatation and areas of pulp calcification were detected. The cellularity of the pulp and its fibrous elements appeared normally with no inflammatory cell infiltration, while the pulp treated with formocresol was highly vascularized with high number of chronic inflammatory cells, areas of calcification with obvious increased collagen fiber density, in addition to numerous vacuoles and necrotic areas. In addition jojoba oil showed moderate immunoreactivity of von Willebrand factor in endothelial cells which may indicate increase in nitric oxide synthase. Histological and immunohistochemical reactions of dental pulp to Jojoba oil were more favorable than formocresol. The greater success rate of jojoba oil rather than FC pulpotomy in this study is attributed to anti inflammatory effect of jojoba oil compared to formocresol

Cognitive dysfunctionin among schizophernic: first episode versus chronic patients

To compare the cognitive functioning of a sample of patients experiencing their first episode of schizophrenia with that of patients with an established schizophrenia illness. Thirty patients who were experiencing their first episode of schizophrenia. Thirty patients with an established schizophrenia illness and thirty control subjects volunteered to undergo the procedures. The cases were recruited from psychological medicine hospital [Kuwait]. All patients met DSM-IV criteria for diagnosing schizophrenia [group II, III]. All the three groups underwent Wechsler Adult Intelligence Scale [WAIS], Wisconsin Card Sorting Test [WCST]. Wechsler Memory Scale [WMS] and Positive and Negative Symptom Scale [PANSS], this related only to group II and III [patients groups]. Socio demographic characteristics of study sample showed that the mean age in years in group I is 27.77, in group II is 24.87and in group III is 31.37 the study revealed cognitive impairment in the early first-episode schizophrenia either IQ, memory or executive function, the study showed no relation between these cognitive deficits and the demographic variables, in both groups II and III with cognitive deficits. These results support the findings of previous studies suggesting that first-episode patients demonstrate cognitive impairments similar to those of patients with an established schizophrenia illness

Quality of life and coping among caregivers of diabetic and epileptic children in Kuwait: a comparative study

To compare the quality of life and coping capacity among primary care givers of Insulin Dependent Diabetes Mellitus [IDDM] children and epileptic ones. The study included 40 primary care givers of children with IDDM and 40 caregivers of children with benign childhood generalized absence seizures. The care givers of both diseased children were subjected to World Health Organization Quality of Life Brief scale [WHO QoL Brief] and Abdel Basset Coping Scale. There are statistically significant differences between the two groups in all domains of WHO QOL Brief and coping scores including total, active coping, emotional, emotional based cognitive processes indicating that quality of life and coping abilities are better for caregivers of diabetic children than those of epileptic ones. Also there is statistically significant correlation between those having IDDM boy, higher educational level of the caregivers and lower scoring on quality of life and coping capacity. In care givers of epileptic children significant correlation noted between duration, frequency of seizure, number of antiepileptic drugs, having an epileptic girl, higher educational and occupational status of care givers and poor quality of life and impaired coping capacity. Caregivers of epileptic children have poor quality of life and impaired coping capacity than those of IDDM children. This may increase the need for educational and psychological support to improve the quality of life and alleviate burden experienced by family having diabetic and epileptic child, especially family having an epileptic child

[Microbiological studies of spiced beef burgers in Tripoli city, Libyan Arab Jamahiriya]

We investigated the microbiological quality of uncooked and cooked spiced beef burger in restaurants and fast food places in Tripoli city and surrounding areas. Thus 151 samples [92 cooked and 59 uncooked] were analysed microbiologically. The results showed that all samples were highly contaminated with bacteria; 74.5%, 28.8%, 27.1% and 18.6% of the uncooked samples were contaminated with Escherichia coli, Aeromonas spp., Staphylococcus aureus and E. coli O157:H7 respectively. Additionally 11.9%, 9.9%, 5.4% and 3.2% of the cooked samples were contaminated with E. coli, Aeromonas spp., E. coli O157:H7 and S. aureus respectively

Association of hyperleptinemia and insulin resistance with ischemic heart disease in type II diabetes

Insulin resistance and hyperinsulinemia often coexist with a cluster of metabolic factors including visceral obesity and referred to as the metabolic syndrome. These factors contribute to increased risk to type II diabetes and to ischemic heart disease. We investigated whether plasma leptin and insulin levels were linked with the coronary heart disease independent of the presence of diabetes mellitus. This study was conducted on 80 persons who were divided into 4 groups. Group I included 20 healthy volunteers Group II included 20 patients suffering from IHD without DM. Group III included 20 patients suffering from DM without IHD and Group IV included 20 patients suffering from both DM and IHD. Investigations were done including; FBS, PPS, urea, creatinine, cholesterol, TG, LDL-c, HDL-c, fasting serum insulin and leptin using RIA technique in addition to an EGG. Insulin resistance was calculated using HOMA test. Both mean leptin level and insulin resistance showed no statistical significant difference between ischemic heart disease group and the control group, but were significantly higher in diabetic groups [III, IV] than non-diabetic groups [I, II]. Within diabetic patients we found no significant difference in leptin and insulin resistance levels between those with IHD and those without IHD. In our study we found positive correlation between insulin resistance and BMI, cholesterol, LDL-c and leptin within ischemic heart disease group. Leptin and insulin resistance are associated with increased risk for atherosclerosis and ischemic heart disease in the presence of diabetes mellitus

influence of intact pleura on postoperative respiratory dysfunction after coronary artery bypass grafting [CABG] using bilateral internal mammary arteries [BIMA]

Bilateral internal mammary artery harvesting for coronary artery bypass graft had shown to be superior compared to venous grafts in regard to cardiac events, however the major drawbacks from such technique is early postoperative complications; namely bleeding, wound infection [deep or superficial] and impairment of respiratory function. We tested the hypothesis of modifying the surgical technique when harvesting bilateral mammary arteries with maintaining pleural integrity [Npo group A n=25] and conventional technique with pleura opened [po group B n=25] and its effect on early postoperative complications. Patients in group A [Npo] had demonstrated more favorable early postoperative outcome compared to group B [po] evidenced by better PaO2/FiO2, dynamic spirometry function [FEV1 72.5% versus 59.9% of expected and FVC 64.5% versus 52.3% of expected], less morbidities [4 incidences versus 10 incidences], less postoperative bleeding [461 ml versus 570.8 ml] and better cough score. Meticulous harvesting of bilateral internal mammary artery with preservation of pleura could dramatically decrease early postoperative complications associated with such technique

Composite arterial bypass grafting of the left coronary circulation using left Internal thoracic and radial arteries versus bilateral skeletonized internal thoracic arteries: early results of a multi-center study

Total arterial revascularization offers a potential to avoid the problems associated with vein graft failure. We aimed to evaluate the benefits of using composite grafts in T or Y fashion: free RA implanted on intact full-pedicle LIMA; versus using skeletonized RIMA implanted in T or Y fashion on intact skeletonized LIMA for adequate revascularization of the left coronary artery branches. This randomized prospective comparative study was performed in the Departments of Cardiothoracic Surgery, Kasr El Aini Faculty of Medicine of Cairo University and lmhaba National Heart Institute; the Cardiology Department, El Faioum University; and the Departments of General surgery Cairo university and Anaesthesiology department Am Shams University between 2004 and 2007. The study enrolled 100 male ischemic heart disease patients who were submitted for elective isolated CABG Surgery using conventional CPB and antegrade intermittent warm blood cardioplegia. Mean age was 48 +/- 2.4 years [range 41-64 years], Patients were allocated into two equal groups: Group A encompassed 50 patients in whom a intact full-pedicle left internal mammary artery [LIMA] was grafted to the LAD coronary vessel, and free pedicled RA grafts to revascularize left coronary branches from the LIMA in a T or Y fashion, and a free SVG from the aorta to branches of the right coronary system. In group B, 50 patients received a free skeletonized RIMA graft between the left coronary branches and LIMA which was skeletonized and implanted to the LAD. The RA grafts were managed according to the Hong- Kong University Protocol. Follow-up was complete for all cases. Data were prospectively collected in both groups. Results were analyzed by clinical assessment and special investigations as ECO, Lab Enzymes, and echocardiography, both intraoperatively and during the in-hospital patient stay. The mean total operative time was 3 +/- 0.7 hours [range 3-4.5 hours] for group A, versus 4.5 0.6 hours [range 4-5.5 hours] for group B. The mean cardiopulmonary bypass time was 70 +/- 30 minutes [range 65-120 minutes], versus 75 +/- 25 minutes [range 69-127 minutes] in group B. The mean aortic occlusion [ischemic] time was 48 +/- 4 minutes [range, 33-99 minutes] for group A, versus 52 +/- 6 minutes [range 40-102 minutes] for group 13. In group A, 3 +/- 0.02 distal anastomotic points were fashioned in each patient versus 3 +/- 0.04 in group B. There was no incidence of new isehemic pain: perioperative MI; cerebral stroke, or neurovascular hand complications. Patients of group B needed a longer ICU time [statistically-significant] with a mean of 42 +/- 3.2 hours [range 30-49 hours]; versus 33 +/- 3.5 hours [range 24 - 38 hours]. The time spent by the patient on mechanical ventilation was longer [statistically-significant] in group B patients with a mean of 8 +/- 1.5 hours ranging between 6.10 hours; versus mean of 13 +/- 4.5 hours ranging between 8-14 hours for group A patients. The amount of pleuro-mediastinal blood loss was more [statistically- significant] in group B patients with mean of 900 +/- 150 mls ranging between 750-1100 mIs; versus 1400 +/- 350 mis ranging between 1000- 1800 mIs. The total hospital time was longer [statistically-significant] in group B patients ranoing from 5-12 days with a mean of 5 +/- 2.2

Soluble intercellular adhesion molecule -1 in sera of patients with chronic hepatitis C

Soluble intercellular adhesion molecule-1 [sICAM-1] is a marker of inflammation and tissue damage. To determine the serum level of sIC AM-1 in patients with chronic HCV and to correlate the results with the histopathological changes. The study included thirty subjects divided into two groups: group I [GI] comprising 20 patients [mean age 39.7 +/- 8.5 years] with chronic hepatitis C virus infection and group II [Gil] of 10 healthy age and sex-matched control subjects [mean age 37.8 +/- 10.52 years]. Serum concentrations of sICAM were measured by enzyme linked immunosorbent assay [ELISA] kit as per manufacturer's instructions [R and D Systems, Europe, Abingdon, UK]. Diagnosis of HCV was done by detection of HCV-antibodies by 3[rd] generation ELISA, detection of HCV-RNA using a quantitative automated nested reverse transcriptase PCR assay [COBAS AMPLICOR HCV MONITOR Test, v 2.0., Roche Molecular Systems, Switzerland] and histopathological examination of Liver biopsy. Histological grading and staging were assessed with reference to modified histological activity index [HA1] scoring system. The level of sICAM in GI [mean 1046.5 +/- 1059.5 ng/ml] was significantly higher than Gil [mean 233.8 +/- 115.65 ng/ml] [t = 2.4; P = 0.02]. The levels of sICAM correlated positively in GI with serum bilirubin [r=0.65, P=0.003], ALT [r=0.63, P=O.OI], AST [r=0.64, P=0.02], grade and stage of hepatitis [r=0.75, 0.68; P=O.OOI, 0.005 respectively]. There was a significant negative correlation between sICAM and both serum albumin [r=-0.71; P=0.001] and prothrombin activity [r=-63; P=0.01]. However, sICAM was not correlated with the levels of HCV-RNA [r=0.38; P=0.1]. The level of HCV-RNA was not correlated to any of the liver function tests as well as grade and stage of hepatitis. The severity of liver disease was independent of serum level of HCV-RNA; the measurement of sICAM-1 serum levels in chronic hepatitis C patients can be considered as a useful non-invasive marker for monitoring liver disease activity

Chronotherapeutics of intrathecal fentanyl added to bupivacaine for labour analgesia

Chronotherapeutics is the optimization of pharmacotherapies, taking into consideration rhythm-dependence in the kinetics and dynamics of medications plus predictable-in-time variability in the manifestations and severity of human disease. The aim of the present work was to determine whether the efficacy and side-effects of intrathecally administered mixture of a small dose of fentanyl and bupivacaine, to relieve labour pain, is influenced by the hour of administration. One hundred parturients requesting neuroaxial labour analgesia were assigned to one of four equal groups based on the time period when the intrathecal mixture was administered. Group E= evening, group N= night, group M= morning and group AN= afternoon. Maternal demographic and obstetric data, and the characteristics of the intrathecal blocks were recorded Demographic data, gestational age and cervical dilatation were similar in the four groups. The incidence of oxytocin use was lower in E and N groups than M and AN groups. The base-line visual analog pain score [VAPS] was higher in E and N groups than in M and AN groups. The onset of analgesia was delayed in E and N groups than M and AN groups [8.6 [3.4], 8.2 [3.1] Vs 6.5 [2.5], 6.6 [2.6], mm respectively]. There were no significant cant differences between groups as regard the upper sensory level, the number of parturients with detectable motor block or side effects. The duration of analgesia was shorter in groups E and N than in groups M and AN [75 [22] and 71 [19] Vs 108 [33] and 102 [31] mm respectively]. Maternal and midwife satisfaction scores were lower in groups E and N than in groups M and AN but no significant difference at 30 mm and at reinjection. Fentanyl and bupivacaine exhibit a temporal pattern of kinetics and dynamics when administered intrathecally for labour analgesia and this should be considered in future comparative studies and in analysis of previous studies and clinically to administer the suitable dose over the 24 hours of the day

High-resolution ultrasound imaging guidance increases efficacy and safety of supraclavicular brachial plexus block

High frequency ultrasound [12 MHZ] imaging equipped with a digital linear scanhead offers excellent resolution of superficial structures during brachial plexus block. Ultrasound can be used to identify the brachial plexus before block, guide the block needle to reach the target nerves, and visualize the pattern of local anesthetic spread. In the present study we compared the state-of-the-art ultrasound technology for supraclavicular brachial plexus block with the classical technique that depended on the anatomical landmarks as regard efficacy, quality and safety. We found that ultrasonic guidance decreased the time to perform the block, shortened the onset of block, prolonged the duration of postoperative analgesia, increased the proportion of successful blocks, increased patient's satisfaction and reduced the incidence of complications than the classical method of supraclavicular blocks. High resolution ultrasound guided supraclavicular block is easier, more effective, of better quality, and safer than the classical block that depends on the anatomical landmarks

Application of hazerd analysis and critical control point [HACCP] system on tortillas production

Fifty three samples were collected during tortillas Processing [corn bread] produced at Food Technology Research Institute. Twenty-four samples were collected from the different steps before and so forth after application of HACCP system. The other five samples from final product considered as verification procedures. The samples were examined for the presence of total bacterial count [T.B.C.], Coliform, Bacillus cereus, Staphylococcus aureus and mold and yeast [M and Y]. The obtained results indicated that, the microbial load of samples before HACCP application system were higher than 25 24 that after HACCP application steps. Its ranged between 10[2] to 10[5] cfu/gm and 10[2] to 10[4] cfu/gm before HACCP and < 30 to 10[3] cfu/gm and < 30 to 10[2] cfu/gm after HACCP respectively. Also the results showed that the final product was free from microbial and physical hazards after HACCP system application

Potential protective effect of grape seed extract against acrylonitrile-induced mutagenicity in rats

Acrylonitrile [ACN], an environmental toxic pollutant, has been detected in drinking water, food products and occupational environment. ACN is reported as a potent in vivo and in vitro mutagen and carcinogen in human and experimental animals. Grape seed proanthocyanidine extract [GSE] is a highly bioavailable biologically active polyphenolic bioflavonoid. It is a potent antioxidant posses a broad spectrum of pharmacological and therapeutic activities against free radicals, DNA damage and oxidative stress. The objective of the present study was to investigate the possible in vivo protective effects of GSE against ACN-induced micronucleus and chromosomal aberrations in male rats. Animals were exposed to a single s/c dose of ACN [115 mg/kg body weight]. Another two groups of animals were pretreated with GSE in a dose of 100 and 200 mg/kg body weight orally for seven consecutive days prior to ACN administration [single s/c dose of 115 mg/kg body weight]. The animals were subjected to cytogenetic analysis in bone marrow by micronucleus induction and chromosomal aberrations assays. The present results indicate that ACN significantly induced micronuclei and chromosomal aberrations. Pretreatment with GSE significantly improved these mutagenic effects in a dose related manner

Antioxidant and hepatoprotective effects of thymoquinone against carbon tetrachloride-induced hepatotoxicity in isolated rat hepatocytes

Herbs are known to play a vital role in the management of various liver diseases. Thymoquinone [TQ] is the bioactive constituent of Nigella sativa seed. The present work was planned to evaluate the potential hepatoprotective effects of TQ against the cytotoxic effects and the oxidative stress induced by carbon tetrachloride [CCl4] in isolated primary rat hepatocytes. Cytotoxicity was determined by assessing cell viability and leakage of cytosolic enzymes, such as lactate dehydrogenase [LDH], alanine transaminase [ALT] and aspartate transaminase [AST]. Oxidative stress was assessed by determining reduced glutathione [GSH] level and lipid peroxidation as indicated by thiobarbituric acid reactive substances [TBARS] production. Exposure of isolated rat hepatocytes to CCl4 [5mM] caused cytotoxicity and oxidative injury, manifested by loss of cell viability and significant increase in LDH, ALT and AST leakages. As well as, CCl4 caused progressive depletion of intracellular GSH content and significant enhancement of TBARS accumulation. Preincubation of hepatocytes with either TQ [1mM] or silymarin [5 mM] which is a known hepatoprotective agent, ameliorated the hepatotoxicity and oxidative stress induced by CCl4, as indicated by significant improve in cell viability, significant decrease in LDH, ALT and AST leakages, significant prevent GSH depletion and significant decrease in TBARS formation as compared to CCl4 alone-treated cells. The present results indicate that CCl4 has a potential cytotoxic effect in rat heptocytes; and TQ can afford a significant protection against CCl4 -induced hepatotoxicity

Intrafocal K wire stabilization for colles type fracture in active people using Kapandji technique

This work aimed to investigate intrafocal pinning performed by Kapandji in the treatment of Colles type fractures as a relatively and not costly method. Twenty-eight wrists in 27 cases [one bilateral] having Colles type fracture were investigated. Under general or local anesthesia, 2-3 K wires 1.5 mm were applied percutaneously, intrafocally through fracture site, then proximally into far cortex or into medullary canal. A below elbow back slab was applied. Back slab and wires were removed in six weeks and early exercises were advised. A follow up was done up to four months. All fractures united in six weeks by the time of removal of K wires. Pin track infection occurred in 3/28 cases. Over-reduction was the commonest complication [6/28]. It did not affect the functional outcome. Radial shortening was common, but did not exceed 2-3 mm. In conclusion, intrafocal pinning for Colles type fractures in active patients was recommended, as it is simple, safe and not costly and the outcome was found be superior to that of conservative management

Tibial interlocking nail without fracture table traction a review of 34 cases

Thirty-four acute or nonunited tibial shaft fractures were treated in this study by intramedullary interlocking nail with both proximal and distal locking, on radiolucent table using manual traction with leg draped free. It was easy to pass the guide wire through comminuted and segmental fractures with the leg free under image. Distal locking was done by free hand technique by elevating the extended affected leg over a folded towel to facilitate imaging and the foot stabilized by an assistant. All fractures united in an average of 3.5 months. There was no infection, nerve palsy or vascular injury. This technique is easy and saves the time and effort of positioning and reduction. It also avoids calcaneal pin traction, which is a minor operation in itself

Percutaneous kirschner wire fixation for acute type III dislocation of acromioclavicular Joint

Seventeen patients having percutaneous K wire fixation under image intensifier and GA for type III dislocation of acromioclavicular joint [ruptured acromioclavicular and coracoclavicular ligaments] with two or three 2 mm K wires were included in this study. The patients were relatively young working men [23-50 years]. A follow up was done up to six months. All patients returned to work within 10-16 weeks. The results ranged from good to excellent according to the radiographic findings, residual pain, range of movement and patients satisfaction. After wire removal in 6-8 weeks, the radiographs showed a maintained reduction in most of the cases [12/17]. Some cases had minor displacement [about half the width of clavicle]; this did not greatly affect the functional outcome. All patients had uneventful recovery, except one patient who developed grade IV pin track infection which was cured by antibiotic. All patients regained a full range of movement of shoulder within 4-6 months. Pain was found only during the last few degrees of abduction in 7/17 patients; it was moderate in 2 and mild in 5 cases

Total knee replacement without drain

In this study, 80 primary total knee replacement operations were done for indicated cases over the last eight years in three different hospitals without using a postoperative suction drain. This was replaced by a firmly applied compression crepe bandage at the end of the operation before the release of tourniquet. The compression applied by the bandage was lightened in 24-36 hours. The criteria for not using a drain in this work depended on the skin condition of the knee and how fat the leg is. This method was not used in rheumatoid patients with fragile skin, very old people or those having previous operations with large scars on the knee close to the new incision. The follow up ranged from six months to eight years. This method can be recommended for indicated cases, as it saves blood loss, time and effort as well as it avoids the possibility of bacterial contamination from the drain