Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients

Purpose@#The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery. @*Methods@#An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann’s procedure, HP), and 35 patients underwent SEMS insertion. @*Results@#All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. @*Conclusion@#SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.

Phytochemical and biological studies of butea frondosa roxb. Leaves growing in Egypt

This study aimed to the discovery of new biologically active natural products with hormonelike activity from Butea frondosa Roxb., Family Leguminosae growing in Egypt. The investigation of estrogenlike activity showed that both the successive non-polar and methanolic extracts showed a significant estrogen-like activity in immature female rats. GLC analysis the non-polar bioactive revealed the presence of eicosane [22.5%] and beta -amyrin [20.5%] as the major components in the unsaponifiable matter, while palmitic [24.9%] and linoleic [36.8%] acids were the main saturated and unsaturated fatty acids. The successive bioactive methanolic extract was subjected to chromatographic separation to yield five flavonoids identified as vicenin II, vitexin, chrysoeriol 7-o- beta -D-glucuronic acid, 6,8-di-C-rhamnosyl apigenin and luteolin

Tear function abnormalities in down syndrome

Down syndrome is a common chromosomal anomaly, characterized by specific facial features, eye anomalies with repeated ophthalmic infections. The integrity of the ocular surface is maintained by the tear film. To determine the presence of tear function changes in children with Down syndrome and their relation with the development of ophthalmic diseases. Tear film was evaluated by the ferning test and breakup time [BUT] measurement in 23 patients [46 eyes] confirmed as having Down syndrome by cylogenetic analysis and 20 normal control children [40 eyes] with matched age and sex. There was an alteration in both ferning and BUT tests in children with Down syndrome compared to controls. Abnormal ferning test was found in 28 out of 46 tear samples from the patient's eyes compared to 2 out of 40 normal control eyes. BUT test results showed that the preocular tear film stability was poor in 65.2% of patients' eyes, average in 26.1% and good in only 8.7% of their eyes; while controls had good and average tear film stability each representing 50% of eye's number. These tear function abnormalities may have a role in the frequent infectious pathologies found in the anterior eye segment in patients with Down syndrome which necessitates applying new stringent strategies for ophthalmologic care and management of these patients

Role of rehabilitation of chronic obstructive pulmonary disease patients in intensive care unit

The COPD are the most common chronic lung disease and the major impetus for the development of pulmonary rehabilitation program. Poor endurance, dyspnea, and deconditioning are the hallmarks of the presenting symptoms. The key components of pulmonary rehabilitation are education, exercise training, psychosocial/behavioral intervention and outcome assessment. The present study was designed to study the effects of pulmonary rehabilitation on patient of COPD and compare between comprehensive rehabilitation program and progressive ambulation as regard some physiologic variables. This study included eighty COPD patients recovering from an episode of acute respiratory failure and admitted to RICU of Zagazig University Hospital. All of them fulfilled the American Thoracic Society criteria of COPD 1995, with the age ranging from 51 to 80 years. Evaluating measures were done as early as possible at admission, discharge and after 3 months and they include: arterial blood gases [ABG], pulmonary ventilatory tests [PVT], maximal inspiratory pressure [MIP], visual analog scale [VAS] and 6 min walking distance [6 m WD]. Rehabilitation program were usually begun as early as possible for clinically stable patients, it consists of daily session 30-45 min for each and of four different steps of increasing difficulty. Our results showed that pulmonary rehabilitation is of great beneficial effects for critically ill COPD patients admitted to RICU and early intervention give better results. Also comprehensive program was superior to ambulation program

Bone mineralization and body composition in turner syndrome

Females with Turner syndrome are at risk for decreased bone density from ovarian failure and possibly from haploin-sufficiency for bone-related X-chromosome genes. We studied the relation between bone density, anthropometry, body composition and chromosomal abnormalities in Turner syndrome. The study included 18 females with Turner syndrome. They were divided in two groups. Group A consisted of 12 cases with 45, X karyotype [classic Turner syndrome] and their mean age of 13.5 +/- 5.5 years. Group B included 6 cases with mosaic karyotype and their mean age of 16.3 +/- 4.2 years. Bone mineral density [BMD] was determined using dual energy X-ray absorptiometry scans [DEXA]. BMD was measured in the femoral neck [FN], lumber spine [LS], and forearm [FA]. Body composition was assessed using RJL body fat analyzer. Anthropometry was carried out for each case. Seventy-two percent of females investigated had osteope-nia. When BMD was expressed as z-scores [individual values compared to normal reference data matched for age and weight] for all cases at it was 0.587 +/- 0.10 at FN and was 0.630 +/- 0.17 at LS. In group A bone mineral density was decreased [osteope-nia] by 66.7% in FN, and 25% in LS. In group B bone mineral density was decreased by 66.7% in FN, and 50% in LS. When comparing females in group A with those of group B, there was no statistical difference in BMD at femur and spine. The ostopenia found in patients of group A and B was not related to type of X-chromosomal aberrations. Group A showed significant increase in TBW and Corinic index SDS as compared to group B. Body fat and lean percentages are similar in the two studied groups. Also, no correlation was found between BMD and body weight, body height, body fat or percentage body fat. Body composition changes seem to be more impressive in classic Turner patients, while BMD changes are similar in the two groups. Achieving optimal bone density is of critical importance for fracture prevention in TS

Hemostatic markers of coagulopathy in acute promyelocytic leukemia

Hemostatic disorders are leading causes of death in patients with acute myeloid leukemia [AML] and particularly those with acute prom yelocytic leukemia [APL]. A contribution of fibrinolytic mechanisms has been claimed in the patho genesis of APL coagulopathy but investigations of the fibrinolytic activity of prom yelocytes have yielded conflicting results, sometimes based on reports of scattered [single] cases. The aim of this work is to study the changes of the different markers of thrombin generation and fibrinolysis in patients with APL and those with other AML subtypes [non APL-A ML], and to clarify the patho genesis of coagulopathy in patients with APL compard with those with non APL -A ML. The study included blood samples of 15 patients with APL and 25 patients with non APL-A ML, as well as 20 apparently healthy children with matched age and sex as a control group. Cases and controls were all subjected to the following investigations: pro thrombin concentration [PC], activated partial thromboplastin time [APTT], thrombin-anti thrombin complex [TAT], prothrombin fragment 1+2 [PF1+2], fibrinopeptide A [FPA], D-dimer, fibrinogen level, plasminogen activator inhibitor [PAI] and alpha 2-antiplasmin [alpha 2-AP]. As regards the markers of thrombosis PC was significantly lower in APL and AML in comparison to controls and in the same time it was significantly lower in APL in comparison to AML. PT, APTT, TAT, PF1+2, FPA and D-dimer levels in plasma of both APL and AML were significantly higher than controls and also it was found that these markers were significantly higher in APL than AML. About the fibrinolytic markers, fibrinogen was significantly lower in the cases of APL and AML than controls and it was found to be significantly lower in APL than AML. PAI and alpha 2-AP were significantly lower in APL and AML than controls but there was no significant difference between APL and AML. In the APL group a positive correlation was found between bone marrow promyelocyte% and D-dimer [r= 0.718, P< 0.003**] and between TAT and prepheral absolute promyelocyte [x10/L] [r=0.677, P< 0.006**]. In conclusion, acute myeloid leukemia in children, either APL or non-APL causes some changes in hemostatic mechanisms leading to acute DIC which was proved by the following tests: * Procoagulant activation which is proved by prolongation of APTT, PT, increased TAT, prothrombin fragment 1+2, fibrinopeptide A plasma levels as well as decreased prothrombin concentration and fibrinogen levels. * Fibrinolytic activation proved by decreased plasminogen activator inhibitor, alpha 2-antiplasmin plasma levels as well as increased plasma level of D-dimer which is a marker of plasmin activation. * Inhibitor consumption, proved by the study showed that the aforementioned laboratorial abnormalities were aggravated among cases with APL than those with non-APL-AML So DIC can be detected before bleeding

Hereditary non-syndromic hearing loss: influence of different variables

Non-syndromic hearing loss [NSHL] was studied in twenty-five patients using a clinical, audiological, cytogenetic and neurobiochemical evaluation. The study group was divided into five subgroups according to severity of hearing loss. Positive parental consanguinity was present in 84% of cases and similarly affected family members were present in 76%. All patients had no congenital malformations and were not dysmorphic. Patients possibly exposed to environmental factors were excluded from the study. Abnormal karyotyping was present in three cases, one case showed chromosome 15p 4, another case showed chromosomal del 11q22.1 and in the third case [47,XY] there was marker chromosome 15. Fluorescence in situ Hybridization [FISH] technique was performed on the case which showed marker. The study group showed significant lowering of five plasma amino acid levels [glutamic acid, aspartic acid, histidine, 3-methylhistidine and carnosine]. There was significant correlation between severity of hearing loss and each of the following: patient's age, glutamic acid, aspartic acid, 3-methylhistidine and carnosine. Identification of NSHL early after birth, as well as, amino acid screening is essential, to allow for faster therapeutic intervention and proper genetic counseling

Growth charts of Egyptian children with Down syndrome [0-36 months]

A study established growth and growth velocity curves for weight, length and head circumference in 350 Egyptian Down syndrome children [188 males and 162 females] from 0-36 months. Down syndrome children had poorer growth variables than normal healthy children through the first 3 years of life. Down syndrome children with associated congenital heart disease [90 cases] had significantly lower weight, especially in girls, compared with those without heart disease. In the first 2 years, growth velocity for weight and head circumference were higher in Down syndrome females than males, while growth velocity for length was higher in males. Down syndrome boys had slightly higher velocity of length than normal children in the first 3 years of life

Ropivacaine combined with sufentanil for intrathecal labor analgesia; a comparion with bupivacaine

To compare the onset, duration and quality of analgesia as wall a' the side effects between ropivacaine and bupivacaine, combined with sufentanil, when injected intrathecally as a part of combined spinal epidural technique for labor analgesia. This controlled double-blinded study included 60 primiparous women ASA physical status I/II, in early labor [cervical dilatation 2-5 cm] where they received labor analgesia using, combined spinal epidural technique. They were randomly assigned into 3 equal groups [20 women in each] to receive one of the three intrathecal study solutions; BS Group: bupivacaine 2.5 mg and sufentanil 10 micro g. RS2.5 Group: [n =20] ropivacaine 2.5 mg and sufentanil 10 micro g, RS4 Group: ropivacaine 4 mg and sufentanil 10 micro g. Every 5 mm for the first 30 mm then every 15 mm until first analgesic request, blood pressure, pulse rate and respiratory rate were recorded and pain was assessed using a 4-point verbal rating score. Motor block was assessed before and 20 mm after injection using 4-point modified Bromage score. Fetal heart rate and uterine activity were monitored. The use of prostaglandins [PGE[2]] or oxytocin was recorded The mode of delivery, 1-mm and 5-mm Apgar scores and umbilical artery pH were also recorded. The duration of analgesia was not significant different between groups. The duration of analgesia in BS Group was [105 +/- 26 mm] compared to [97 +/- 19 mm] in RS2.5 Group and [110 +/- 23 mm] in RS4 Group. Motor impairment was significantly more in BS group [40%] compared to both ropivacaine groups [0% and 15%]. Analgesia was adequate in all groups but the quality of analgesia was considered superior in 85 Group as more pain assessments were grade 0 compared to both ropivacaine groups and the difference was significant when compared to the group given the equivalent ropivacaine dose [2.5 mg]. [1 Intrathecal ropivacaine [2.5 mg] has the same onset and duration or analgesia as bupivacaine [2.5 mg] when either of them is added to sufentanil. 10 micro g for labor analgesia. However, ropivacaine has the advantage of less motor block. [2] Increasing the dose of IT ropivacaine to 4 mg with sufenil has no advantage over 2.5 mg dose. [3] The IT technique and drugs used were well tolerated and safe for both mothers and babies

prevalence of psoriatic toe nails with onychomycosis: an Egyptian study

There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared with non-psoriatics. The aim of this Study was to investigate the prevalence of fungal infection in patients with psoriasis with toe-nail affection and to compare the type of fungal elements in psoriatic nails with fungal infection with those in patients with onychomycosis. One hundred cases were included in the present study and were classified into two groups: group of 50 patients complaining of psoriasis with toe-nail affection; the other group of 50 patients without any clinical signs of psoriasis and complaining of toe-nail onychomycosis. Nail specimens were collected from both groups of patients and examined by direct microscopy using 20% freshly prepared KOH and by culture on Sabouraud dextrose agar with added chloramphenicol and cycloheximide and another culture on Sabouraud dextrose agar with added chloramphenicol only. Our results revealed that 23 cases [46%] out of 50 cases of psoriasis with toe-nail affection had mycological evidence of onvchomycosis while 27 cases [54%] gave negative mycological results and these results indicate high prevalence of onychomycosis among the psoriatic patients with toe-nail involvement and such prevalence is higher among males [32%] than females [14%]. In the group of patients with psoriasis with toe-nail affection; identification of the causative fungi revealed that non -dermatophyte molds were isolated in high percentage [45.83%], followed by yeasts [33.33%] and finally dermatophytes [20.83%] and these results were similar to those of the group of patients with onychomycosis alone with respect to isolated species. Accordingly, psoriatic patients with nail affection should be routinely examined mycologically to rule out the presence of onychomycosis and to effectively treat those patients. These patients often need to break old habits and learn new, healthier, habits to achieve an optimal therapeutic response and prevent re-infection. Appropriate nail care should be explained to the patients and they should stop a range of potentially risky behaviors as using occlusive foot wears on wet skin. Drying of feet following ablution in Moslems should be stressed upon

Mucopolysaccharidosis type I: clinical and biochemical study

Of 1240 outpatients referred to the Human Genetics Clinic between 1997 and 1998, 248 [20%] had inborn errors of metabolism, 36 [14%] of which were diagnosed as mucopolysaccharidoses. Parental consanguinity was present in 82% of these patients. Deficiency of alpha-L-iduronidase [IDUA] enzyme in leukocytes and increased urinary mucopolysaccharides excretion were detected in 17 patients. The urinary spot test for glucosaminoglycans was inconclusive in 4 of the 17 cases. Results showed a correlation between the biochemical enzyme activity in leukocytes, the amount of excreted mucopolysaccharides and the subtype and course of mucopolysaccharidosis type I. We conclude that estimation of IDUA enzyme activity in leukocytes can differentiate between clinically overlapping cases of MPS I and MPS II and given the clinical manifestations of MPS I is a definitive and unequivocal method of diagnosis while the urinary spot test is inconclusive

Clinical and biochemical variability of the classical smith-lemli-opitz syndrome in Egyptians

Smith-Lemli-Opitz syndrome [SLO] is the first true metabolic malformation syndrome. The underlying defect is absent or deficient activity of 7-dehydrocholesterol reductase, which is the enzyme catalyzing the last step of cholesterol synthesis. We report on the first Egyptian cases [seven males] with SLO. We studied the clinical and biochemical variability of the syndrome and its relation to patients' age. Mental retardation, 2/3 toe syndactyly and genital anomalies were present in all patients. The distinct facial appearance became less obvious with age. All patients had marked elevation of plasma 7-dehydrocholesterol, which were measured by use of ultraviolet spectrometry. Plasma cholesterol measured by calorimetric method, were within the low normal range in most patients. Dietary cholesterol supplementation in two patients resulted in improvement of behaviour, better tolerance of infection, diminution of photosensitivity, pubertal progression and improvement in plasma sterol levels. The clinical phenotype of SLO is widely variable and plasma cholesterol levels are not reliable for detection of the syndrome. Therefore, diagnosis of SLO by demonstrating increased plasma concentrations of 7-dehydrocholesterol using ultraviolet spectrometry is a rapid and reliable method. Increased awareness of SLO is required for early diagnosis and dietary treatment of affected individuals

Analgesic effect of intra-articular neostigmine after operative knee arthroscopy comparative study of neostigmine, tenoxicam, morphine and placebo

This study was designed to compare the postoperative peripheral analgesic effect of intra-articular [IA]: neostigmine, tenoxicam, morphine and placebo. The study included forty unpremedicated adult patients with ASA status 1 or 2, scheduled for operative knee arthroscopy under general anaesthesia. Patients were randomly allocated into four equal groups [each 10 patients] Group A received 500 micro g neostigmine in 30 ml saline IA, group B received 20 mg tenoxicam in 30 ml saline IA. group C received 2 mg morphine in 30 ml saline IA, and group D received 30 ml saline [placebo control group]. Postoperative pain was assessed using a 10-cm visual analogue scale [VAS] at 1.4,8,24 and 48 hours and at time of dem and ing analgesia. Time to first analgesic administration and the total amount of analgesic consumption over 48 hrs were compared in the four groups. There was a significant reduction in VAS in the neostigmine group at 1,4 hrs compared to tenoxicam. morphine or saline groups, and at 8, 24 hrs compared to morphine and saline groups. At 48 hrs no intergroup difference was detected. Time to first analgesic administration was significantly longer in the neostigmine group, also, the total amount of analgesic consumption per 48 hrs was significantly less in the neostigmine group in comparison to tenoxicam. morphine or saline groups. It can be concluded that neostigmine induces effective postoperative analgesia at peripheral sites of about 8-9 hrs, provided no atropine was given, with no side effects. Analgesic efficacy of intra-articular neostigmine is better than either tenoxicam or morphine given intra-articuLarly

Histological change of intraneural and peri-neural injection of the local anesthetic ropivacaine in the rat sciatic nerve

Neural damage is a possible complication during locoregional anaesthesia. Damage may be caused by direct trauma, toxicity of the local anaesthetic drugs or ischaemia from decrease in the nerve blood flow. These mechanisms may occur either alone or in combination. We have studied the histological findings of perineural and intraneural injection of ropivacaine in rat sciatic nerve. 60 male albino rats were assigned into two equal groups. Group I received intraneural ropivacaine [50 microl] on the right sciatic nerve and an equivalent volume of saline intraneurally on the left sciatic using an insulin needle. In group II, the same volumes of ropivacaine and saline were injected perineurally on the right and left sciatic nerves respectively. Each group was subdivided into three equal subgroups according to whether the animals were sacrificed at 10 minutes 7 days or 30 days after injection. Nerves were harvested, fixed and processed for light and electron microscopic examination. Nerves injected perineurally with ropivacaine showed intraneural disruption, edema and fibroblasts after seven days. Nerves injected intraneurally with ropivacaine or saline presented with disruptions, edema and hemorrhage immediately after injection. After 7 days, disruption, degeneration and regeneration were observed. Mitochondrial swelling was observed 7 days after intraneural and perineural ropivacaine but not after saline. In both groups, regeneration started early [after 7 days] to become more or less complete after 30 days. These results demonstrate the safety of the use of ropivacaine for peripheral nerve block even if inadvertent intraneural injection occurred. However, to avoid neuropathy, the use of nerve stimulator should be encouraged to avoid nerve trauma during repeated puncture in the search for paraesthesia. Injection should be stopped if painful to avoid intraneural injection

Epidural tramadol for postoperative pain relief in Cesarian section delivery

The efficacy of epidural tramadol was studied for the relief of postoperative pain in sixty patients scheduled for elective caesarian section under epidural anesthesia. A test dose of bupivacaine 0.5% was followed by the study drug using a 10 ml coded syringe: group I 10 ml of 0.5% bupivacaine containing tramadol 50 mg; group II 10 ml of 0.5% bupivacaine containing tramadol 100 mg; group III 10 ml of 0.5% bupivacaine. Then, sufficient bupivacaine was administered to achieve a block up to T[4]. The study lasted for 24 h from the end of surgery. When requested by the patient, an epidural injection using a 10 ml coded syringe was given containing tramadol 50 mg [group I] or tramadol 100 mg [group II], or 0.25% bupivacaine 10 ml [group III]. A total of 4 epidural doses were allowed in the 24 h period then pain was treated by giving morphine 2 mg i.v. as needed. Time to first analgesic request was recorded. Pain scores, heart rate, blood pressure, respiratory rate and arterial blood gases were recorded postoperatively at 15 min and at 1, 4, 8, 12 and 24 h. Side effects were also recorded. Time to first analgesic request was significantly longer in group II [21.25 +/- 4.4 h] compared to group I [13.3 +/- 5.3 h] and group III [6.1 +/- 1.9 h]. Patients in tramadol 100 mg group had a significantly lower number of epidural doses. Pain scores were significantly lower in group II at 1h and 12 h when compared to group III. Mean PaO2, PaCO2 and respiratory rate did not change during the study period. The incidence of nausea and vomiting was significantly higher in group II. The difference between the mean Apgar scores in the three groups at 1 and 5 minutes was not significant: epidural tramadol 100 mg can be used to provide prolonged postoperative pain relief in patients undergoing caesarian section without serious side effects to the mother or neonate. Patient can be nursed safely on a general ward basis. An anti-emetic should be routinely used to avoid nausea and vomiting