Posterior septectomy in transnasal endoscopic choanoplasty

Congenital choanal atresia [CA] is a challenging surgical problem. Choosing between the transnasal and transpalatal routes is still a controversial feature in the surgical management of CA. The purpose of this study was to evaluate the results of transnasal endoscopic choanoplasty with versus without posterior septectomy. Thirteen patients were included in this study [8 females and 5 males] aged 3 days to 17 years [mean age 4.06 years], 7 cases with bilateral CA and 6 cases with unilateral CA who underwent surgical repair at Al-Azhar university hospitals between 2004 and 2008. All patients underwent transnasal endoscopic repair using powered instrument. The first 5 cases had repair without posterior septectomy, while the last 8 cases had repair with posterior septectomy. All cases were stented for 4 to 6 weeks and followed for at least 10 months. Postoperatively, 11 patients [84.6%] had successful repair, while 2 cases [15.4%] had restenosis which needed revision surgery. Restenosis occurred in 2 of the 5 cases who underwent repair without posterior septectomy. No restenosis in patients who underwent repair with posterior septectomy. One patient developed pressure necrosis of the palate few days after surgery, which healed after replacement of the stent by a smaller one

Endoscopic appearance of the nasal opening of human nasopalatine duct

The nasopalatine duct [NPD] in human adults is rarely patent and likely exists as a vestigial remnant. NPD is a common site for infection, tumors and cysts. This study was done to describe the location and gross anatomy of the nasal opening of the human NPD. A total of 100 volunteers, at Al-Azhar university hospitals, were examined by 30° telescope for the site and appearance of the nasal opening of NPD and photographs were taken and examined. Our results showed that the NPD was located 3 mm +/- 0.2 mm [mean +/- SD] above the nasal floor on the nasal septum, in both nostrils [90% bilateral], 2 cm +/- 0.03 cm dorsal to the columella. NPD was detected in 95% of the examined nostrils. The shape of the NPD fossa was oval [70%], and round [30%]. In the center of the fossa, a small, round aperture was visualized in 33% of fossae. In conclusion, the nasal opening of the NPD is an easily detectable bilateral and symmetrical structure, located at the junction of the nasal septum and floor of the nasal cavity. It can be potentially useful as an anatomical landmark

detection of Giardia lamblia coproantigen as a sensitive immunodiagnostic method for human giardiasis

This study was designed to develop a sandwich ELISA for detection of G. Iambiia antigens in stool and sera of giardiasis patients as a better diagnostic alternative to routine parasitological methods. Anti-G. Iamblia antibodies were produced by immunization of rabbit with G. lamblia antigen obtained from cultured trophozoites. Raised antibodies were then employed in sandwich ELISA for detection of G. lamblia antigen in collected sera and stool samples. In this study sera and stool samples from 80 G. lamblia infected patients, 71 patients infected with other parasites [Entamoeba histolytica, Schistosoma mansoni and Fasciola hepatica] and 30 uninfected individuals were tested by sandwich-ELISA for detection of G. lamblia antigen. The sensitivity of coproantigen assay reached 98.8% for detection of Giardia antigens in stool and 87.5% for detection of Giardia antigen in sera of giardiasis patients. The specificity of the assay was 94.1% for stool samples and 91% for sera of negative controls and patients harboring other parasites collectively. A positive correlation between age of patients and the antigen levels in both sera and stool samples of G. lamblia infected patients was observed. The sensitivity of antigen detection assay was directly related to the intensity of infection. The positivity rate for detection of coproantigen in stool was compared to the number of cysts in stool. Patients passing < 8 cysts showed false negativity in stool samples [one patient] compared to 100% positivity in patients passing > 50 cysts of stool [79 patients]. Moreover, a positive correlation was found between coproantigen level in stool and number of cysts in stool of G. lamblia infected patients [r=0.887, p< 0.001]. In conclusion, our data demonstrated that the employment of rabbit anti-G. lamblia IgG antibodies in sandwich ELISA for the detection of G. lamblia coproantigen in stool provided a sensitive and specific tool for immunodiagnosis of G. lamblia infection

Childhood diabetes in alexandria: mode of presentation and progress

This study was designed to characterize clinical and autoimmune features in all children with newly diagnosed IDDM diagnosed between 1994 and 1998 as well as to follow up their clinical progress. The study was performed on all newly diagnosed children with IDDM presented to the Alexandria University Children's Hospital between 1994 and 1998 [60 children]. After the primary diagnosis and management, the patients were followed up every 2-3 months in the IDDM clinic. The details of any medical problem during the period of study were recorded during the visits. A questionnaire was completed for each newly diagnosed child. This questionnaire was divided into 4 sections and focused on demographic and family characteristics, family history of diabetes, previous medical history of the child and manifestations before diagnosis. Details of clinical and laboratory data at diagnosis were recorded. The clinical features evaluated were the duration of symptoms before admission to the hospital. All blood samples were obtained before initiation of insulin therapy to measure blood glucose, hemoglobin A[1c], venous blood gases, serum electrolytes and ketones. During each clinic visit, the children were examined with emphasis on nutritional and growth data and their anthropometric measurements recorded. The height standard deviation score, body mass indices and growth velocity per year were calculated and recorded. Hemoglobin A[1c] was estimated every clinic visit. Hormonal evaluation for all children included measurement of free thyroxine [FT4], and IGF-1. The results included family history of autoimmune diseases, symptoms occurring within 3 months prior to diagnosis. Polyuria was the most common presenting symptom present in 87%, followed by fatigue/lethargy/malaise [53%], febrile illness [23%], nausea and vomiting [20%], and abdominal pain [15%]. Secondary nocturnal enuresis occurred in [23%]. Mumps was reported in 2 children while chicken pox was reported in 1 child 3-5 weeks before diabetes was diagnosed. The plasma glucose level was 22.3 +/- 5.6 mmol/L, it was related neither to age nor to duration of symptoms. The HbA[1c] concentration was 15.5 +/- 2.9%. Levels of HbA[1c] were correlated with serum glucose concentration. The frequency of DKA, its degree at presentation and associated biochemical changes is presented. As regards the progress of the disease, insulin was withdrawn in two of the 60 children in whom remission lasted 6 and 14 weeks respectively. The risk of readmission was 0.2 per patient during the first year and 0.12 during the second year. Re-admission for poor glycemic control was more common in young children. Children with good glycemic control had better linear growth compared to those with bad glycemic control. With follow up, 3 children developed hypothyroidism, 1 developed vitiligo, 1 developed chronic active hepatitis, 2 developed significant proteinuria. One child died of hepatorenal failure at the age of 5 years. In conclusion, children diagnosed as having diabetes below 5 years seem to present acutely and have highest risk of developing hypoglycemia during the first year after diagnosis

Serum total cholylglycine level as a liver function test in obesity

The plan of the work is to use the RIA technique for estimation of serum cholylglycine as a sensitive liver function test, in a trial to clarify the controversy about hepatic assessment in obese subjects. The study was carried on 29 healthy normal nonobese subjects [BMI <27 kg/m2] and 41 obese subjects [BMI >30 kg/m2]. The results demonstrated significant elevation of blood pressure as well as significant rise in fasting and postprandial plasma glucose levels in obese patients as compared to control. The combination of obesity, hypertension and glucose intolerance is known to predispose to ischemic heart diseases. The results of the work showed insignificant changes in the levels of creatinine, ALT, AST and ALP activities between obese and nonobese subjects. In this study, a positive significant correlation was observed between BMI and serum bile acid levels in both obese and nonobese subjects. This finding was further confirmed by the positive significant correlation that was observed between bile acid levels and activities of AST, ALT in both groups of the study. This correlation suggested two possible explanations to the elevated bile acid level in obesity, which could be either due to the release of bile acids, ALT and AST from injured hepatocytes or diminished hepatic clearance of bile acids. The present of significant positive correlation between alkaline phosphatase activity and serum bile acids in obese patients only, could suggest to some extent the possible role of obesity developing obstructive biliary disorders

Prothrombotic markers in NIDDM

The present work comprised the study of 50 cases besides 10 controls. The necessary clinical and laboratory investigations had been carried out for all subjects. In addition, PC was assayed. A significant prolongation of PT, APTT has been observed in all diabetic group as compared to the control group. Insignificant decrease in fibrinogen level has been observed in all diabetic group as compared to control group. Insignificant increase in PC activity has been observed in all diabetic group as compared to control group. This may be an attempt by the body to overcome hypercoagulability [Vigano et al. 1984]. Significant decrease in PC activity has been observed in diabetic bilharzial group as compared to the diabetic non bilharzial group

effect of combined oral contraceptive pills on pituitary-thyroid axis

Thyroid hormones, thyroxine binding globulin [T.B.G] and thyrotropin [T.S.H] were studied in 39 women receiving combined oral contraceptive pills [C.O.C] and 18 normal controls not receiving pills and of matched age and weight. Statistical analysis of the results revealed a significant elevation of T.B.G and T[3] levels inpatients as compared controls and insignificant elevation of T[4], T.S.H and reverse T[3] levels in patients as compared to controls. F.T[4] was highly significantly low in patients as compared to controls. F.T[3] was insignificantly low in patients as compared to controls. We concluded that chemical changes in thyroid functions can occur in women receiving C.O.C without clinical manifestations and we have to depend on F.T[3] concentration and T.S.H in evaluating thyroid functions in cases receiving C.O.C pills or other oestrogen containing drugs

Salmonella-induced enteritis clinical, serotypes and treatment

Salmonella-induced enteritis is a widespread cause of morbidity and mortality especially in developing countries. The frequency of different Salmonella serotypes in different areas varies according to time and locality. The prevalence of different Salmonella serotypes in Yanbu area was studied in 136 stool cultures from patients admitted with gastroenteritis, to the medical ward of Royal Commission Hospital in the period 1/6/1991 to 30/10/1991. Fifteen different Salmonella serotypes were determined among 31 positive Salmonella isolates and all were of the gastroenteric group, diarrhoeagenic but noninvasive. The most common serotype was S.typhimurium [45.16%] followed by S.enteritidis [9.62%] then S.virchow [6.46%]. Other forms of Salmonella were isolated from one patient each 3.23%, S.paratyphi B Java, S.heidelberg, S.livingstone, S. infantis, S.bovis morbificans, S.corvallis, S.eastbourne, S.give, S.senftenberg, S.poona, S.adelaide, and S.johannesburg. Saudi patients comprised about 71% and 29% were patients of four different nationalities. Antibiograms of these cultures proved to be all sensitive to norfloxacin with different forms of resistance to chloramphenicol, ampicillin and trimethoprim. Norfloxacin proved to be effective in the treatment of resistant forms of Salmonella with negligible side effects and wide safety range