Comparative study between mini-incision and conventional surgical approaches for carpal tunnel release

Background: Conventional approach is an effective method for carpal tunnel release, however it causes scar discomfort, pillar pain and cosmetic complaints. Several mini-incision techniques were introduced to avoid such complications. Aim of the study The aim of this study is to compare the results of two surgical techniques, the conventional longitudinal incision over the transverse carpal ligament (TCL), and the mini-incision at the distal wrist crease and near the proximal border of the TCL for carpal tunnel release. Patients and Methods: This study included 20 patients with carpal tunnel syndrome. 10 were operated upon by classical open palmar incision (group A) and 10 through mini-incision technique at distal wrist crease (group B). Follow up was after 2 weeks, 1, 3 and 6 months. Incisional pain, pillar pain using Visual Analog Scale (VAS), Levine symptom and function severity scores were evaluated at 3rd and 6th months postoperatively. Patients' satisfaction about surgery and cosmetic results were evaluated using Visual Analog Patient Satisfaction Scale (VAPSS). Patients graded their cosmetic results from poor to excellent. Results: There were no intraoperative complications. Group B showed significantly less incisional and pillar pain. Patients were significantly more satisfied about cosmetic results in group B. There was no significant difference between both groups regarding time taken to return to daily life activities. Conclusion: Conventional and mini-incision surgical approaches are both safe effective methods for carpal tunnel release. Mini-incision technique provided smaller and less painful scar, hidden in the wrist crease

Formulation and in vivo evaluation of diclofenac sodium sustained release matrix tablet: Effect of compression force

In the present study, Diclofenac Sodium [DS] matrix tablets were prepared by direct compression method under different compression forces [5, 10, 15 and 20 KN], using ethylcellulose as matrix forming material. The produced tablets were characterized on the foundation of satisfactory tablet properties such as hardness, friability, drug content, weight variations and in vitro drug release rate. Differential scanning calorimetry [DSC], Fourier Transform Infrared [FT-IR] spectroscopy and X-ray diffraction have been used to investigate any incompatibilities of the tablet's ingredients. Additionally, in vivo bioavailability has been investigated on beagle dogs. Data obtained revealed that, upon increasing compression force the in vitro drug release was sustained and the Tmax value was four hours [for formulations compressed at 15 and 20 kN] compared to the conventional voltarine [register trademark] 50 tablets [T[max] value of 2 hours]

Study of the interaction between insulin, insulin-like growth factor-1 [IGF-1] and sympathetic nervous system in patients with hepatorenal syndrome

The current study was conducted to understand the interactions between the sympathetic nervous system [SNS], insulin and IGF-1 in cirrhotic patients with renal impairment. This study included 42 patients with cirrhosis [14 cases without ascites, 16 with ascites and 12 with HRS] and 13 healthy subjects as a control group. Enzyme immunoassay technique was used for measurement of serum insulin, serum IGF-1 plasma noradrenaline and plasma neuropeptide Y [NPY]. The results suggested that low circulating IGF-1 might contribute to renal functional impairment in cirrhotic patients. Further studies are necessary to evaluate whether IGF-1 can become a useful therapeutic agent in patients with liver cirrhosis and HRS. Progressive impairment in systemic hemodynamics in cirrhotic patients might underlie a detective sympathetic response which deserves intensive research studies

Early shifts of adrenal steroidogenesis in male patients with liver cirrhosis

Despite its positive effects on the secretion of cortisol, interleukin [IL]-6 suppresses adrenal androgen production. Adrenal androgens, particularly dehydroepiandrosterone [DHEA], may have important regulatory effects on the immune system in humans. It provides an immunostimulatory influence opposing the effect of glucocorticoids. As bacterial infection is likely to recur in cirrhotic patients with increased IL-6 levels, we hypothesized that sustained elevation of IL-6 levels in patients with liver cirrhosis might be associated with dysregulation of adrenal steroidogenesis and defective adrenal DHEA production. Forty-four male patients with hepatic cirrhosis [10 Pugh-Child's grade A, 17 grade B, and 17 grade C], and 10 healthy age-matched control male subjects were included in this study. Enzyme immunoassays were used for measurement of plasma adrenocorticotropic hormone [ACTH], serum cortisol, serum dehydroepiandrosterone sulfate [DHEAS], as a marker of DHEA production, and serum IL-6. Serum C-reactive protein [CRP] concentration was determined immunoturbidimetrically. Serum IL-6 and DHEAS showed significant change [increase in the former and decrease in the later] in cirrhotic patients with grades B and C as compared to healthy subjects [P<0.05]. Increased serum levels of cortisol and the cortisol/DHEAS molar ratio were found in the three groups of patients [grades A, B and C] in comparison to healthy subjects [P<0.05]. Child-Pugh's score was correlated positively with serum IL-6 [r=0.508, P=0.0004]; serum CRP [r=0.431 P=0.0035]; and serum cortisol [r=0.329, P=0.029]; and negatively with DHEAS/IL-6 ratio [r= -0.374, P=0.012]. Our results revealed that the severity of liver cirrhosis is associated with enhanced serum IL-6 and cortisol levels, and a decrease in serum DHEAS in relation to serum IL-6 concentrations. These perturbations accounted for the early shift of adrenal steroidogenesis to cortisol production at the expense of androgen production. This might participate in the increased susceptibility of cirrhotic patients for infectious complications. Future research should, therefore, focus on the evaluation of DHEA replacement in cirrhotic populations

Expression of intercellular adhesion molecule ICAM-1 and cytokeratin as Potential markcrs of disease activity in the Egyptian pattern of chronic hepatitis C

Chronic hepatitis C [ch.HCV] and schistosomal hepatic fibrosis or both as a mixed hepatic lesion [MHL] are among the most common causes of endemic chronic hepatic disease in Egypt. Adhesion molecules especially ICAM-1 play an important role in inflammatory and immunological responses of chronic liver disease. Cytokeratin 18 [CK-18], although normally expressed in hepatic tissue, yet it is altered during chronic inflammatory hepatic lesions. This work was planned to study ICAM-1 as expressed in hepatic tissue in the different grades of the disease activity, in relation to its circulating levels in patients sera, and to evaluate the level of CK-18 expression in relation to the different grades of chronic inflammation and stages of fibrosis in the examined liver biopsies. The material for this study comprised 33 patients [17 ch.HCV and 16 MHL]. Seven cases, that proved to have nearly normal serological data and insignificant histopathological hepatic features, were considered as controls. All patients were assessed for HCV serological markers as well as serum levels of soluble ICAM-1 [sICAM-1] by the Enzyme Linked Immunosorbent. Assay [ELISA]. Liver needle biopsy specimens were processed and assessed for the histopathological grade of the disease activity and stage of fibrosis of the hepatic lesion. Tissue expression of ICAM-1 and CK-18 was detected using immunohistochemical techniques. Our results revealed significantly higher levels of serum sICAM-1 in both ch.HCV and MHL groups compared to controls [p<0.01]. Meanwhile, higher levels of sICAM-1 were recorded in the MHL cases relative to ch.HCV cases. ICAM-1 expression was not detected in any of the control cases, while it was positively expressed in all ch. HCV and MHL cases, with a higher score recorded in the later group [P>0.001 compared to the control group]. ICAM-1 expression was detected mainly within the sinusoidal cells [endothelial and Kupffer cells], hepatocytes, mononuclear inflammatory cells and vascular endothehail cells in portal areas. On classifying patients according to their grades of active inflammation and stages of fibrosis, higher scores of ICAM-1 expression within the hepatic tissue were recorded in cases with more active inflammatory grades and higher fibrotic stages. On the other hand, serum of ICAM-1 levels though were significantly elevated in patients with higher grades of inflammatory activity yet, they were decreased in patients with higher fibrotic stages. CK18 expression was mainly detected within hepatocytes of the periportal areas [in a combined membranous and intracytoplasmic pattern], as well as within the bile ducts epithelium in the portal areas. Over expression of CKI 8 was detected in both the ch.HCV and MHL groups [p<0.001 relative to controls], but the expression scores were higher in the MHL group. From these results we may conclude that MHL is a more aggressive and active chronic inflammatory hepatic disease than ch.HCV alone. Also, serum levels of sICAM-1 as well as hepatic expression of both ICAM-1 and CK-18 are related to the degree of disease activity, which may point out to the possibility of using serum sICAM-1 levels as well as the expression scores of hepalic ICAM-1 and CK-18 as efficient tools for monitoring the disease activity in ch. HCV and MHL patients. While ICAM-1 expression in tissue could be used as indicator for the stage of fibrosis in those patients also recommend that both ICAM-1 in serum andhepatic tissue could be used for monitoring the effect of therapy on the studied pattern of chronic hepatitis C

Acromioclavicular dislocation, conservative versus surgical treatment

In this study, 30 patients with grade 3 acromioclavicular dislocation were evaluated to determine the outcomes of nonoperative and operative management. They were divided into two groups; operative and nonoperative. The operative management consisted of open reduction of the dislocation and fixation by 2 Kirschner wires together with a repair of the acromioclavicular and coracoclavicular ligaments. The nonoperative management consisted of short-term immobilization with an early range of motion and rehabilitation. A follow up evaluation was performed for a range of three months to two years after injury. The results indicated that the operative management was superior to the nonoperative management as regards time to attain completely pain free status, the patients subjective impression of pain, range of motion and functional limitation

Immediate endoscopic injection therapy of bleeding oesophagea varices: a prospective comparative evaluation of injecting materials in egyptian patients with portal hypertension

This study was conducted to compare usual sclerosants [polidocanol 1%, ethanolamine oleate 5%] and the tissue adhesive [cyanoacrylate] in the control of esophageal variceal bleeding in Egyptian patients with portal hypertension in a prospective comparative trial. 60 patients with portal hypertension due to schistosomal hepatic fibrosis and/or post-hepatitic liver cirrhosis who had presented with acute esophageal variceal bleeding were enrolled. Patients received balloon tamponade prior to injection were excluded. Resuscitation had been done before or during emergency endoscopy. Emergency endoscopy was conducted within 2 hours from the onset of hematemesis. Patients were immediately randomized during emergency endoscopy to receive polidocanol 1%, ethanolamine oleate 5% or tissue adhesive. Variceal rebleeding was managed by reinjection. The 3 groups were comparable for age, sex, etiology of portal hypertension, Child-Pugh class and findings at emergency endoscopy. From the results obtained, it was concluded that polidocanol, ethanolamine and cyanoacrylate are equally safe and effective. For immediate endoscopic injection therapy, an experienced team must be available

Endoscopic control of gastric variceal bleeding with butyl cyanoacrylate in patients with schistosomiasis

100 patients with portal hypertension due to schistosomal hepatic fibrosis and/or post-hepatitic liver cirrhosis were included. All patients presented with bleeding from gastric varices, either fundal [80 patients] or inferior extension of esophageal varices [20 patients], were enrolled. Injection therapy was administered as the first active measure. No tamponade or drugs were used. Cyanoacrylate was mixed with lipid and injection through a hand-made probe. A mean of 3 [range 1 - 9] ampoules of cyanoacrylate were used per injection session. Bleeding stopped at the end of all sessions. Ten patients with fundal varices had rebleeding during the first 24 hours. Reinjection could control bleeding in 6 patients with a total success rate of 95%. Four patients were managed surgically. Fatal pulmonary embolism developed in one patient with fundal varix. Another five patients [6.25%] died from bleeding-related liver failure. In conclusion, injection of cyanoacrylate is highly satisfactory in controlling bleeding from both types of gastric varices

Laparoscopic cholecystectomy in acute cholecystitis

To study the role of laparoscopic surgery in treatment of acute cholecystitis in different aspects including peri and post operative outcomes. Forty cases with acute cholecystitis were included in this study, that underwent laparoscopic cholecystectomy within 48-72 hours of admission to the hospital. Operating time, estimated blood loss, febrile morbidity, length of hospital stay, recovery from pain, post-operative recovery and return to normal activities and work. Cost-effectiveness, and doctors training were also, evaluated. The procedure was successfully completed in 34 cases [85%], and no operative mortality was reported. These data, suggest that laparoscopic cholecystectomy is a good as well as can be safely attempted in cases presented with acute cholecystitis