Obesity, an enemy of male fertility: a mini review

Obesity is a highly prevalent non-communicable disease worldwide and is commonly associated with male infertility. Several etiopathological theories have been mentioned in the literature by which obesity affects spermatogenesis, thus affecting the male fertility potential. Mechanisms for explaining the effect of obesity on male infertility include endocrinopathy, increased aromatization activity, associated erectile dysfunction, psychological and thermal effects, obstructive sleep apnea, increased leptin and oxygen free radicals, and associated inflammatory and obstructive elements of epididymitis. Treatment of such a complex problem includes weight reduction [by lifestyle modification and increased physical activity], optimization of altered testosterone-to-estradiol ratio using aromatase inhibitors and/or gonadotropins, treatment of associated comorbidities by phosphodiesterase inhibitors for erectile dysfunction, and insulin-sensitizing agents for the management of diabetes. The aim of this mini-review is to highlight the pathological basis of this problem and to focus on obesity as an etiology of male infertility

Fibrin Sealant and Lipoabdominoplasty in Obese Grade 1 and 2 Patients

BACKGROUND: Ever since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients. METHODS: Sixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21. RESULTS: The age range was 31 to 55 years (38.5+/-9.5 years) in group A and 25 to 58 years (37.8+/-9.1 years) in group B, while the mean BMI was 31.4 to 39.9 kg/m2 (32.6 kg/m2) in group A and 32.7 to 37.4 kg/m2 (31.5 kg/m2) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05). CONCLUSIONS: Lipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.

Brain-stem auditory evoked responses in COPD patients

COPD is a multi-system disorder. It appears to be associated with the presence of systemic inflammatory markers as C reactive protein. The present study aimed to evaluate the brain-stem auditory evoked potentials [BAEP] abnormalities in stable COPD patient and its correlation with high sensitivity C reactive protein [hs-CRP] as a part of multi-system disorder. This case control study was carried out at Mansoura University Hospital Egypt from October 2009 to February 2010. The study comprised 40 stable COPD patients and 15 healthy controls with no risk that may lead to neuropathy. All the patients and controls were subjected to the following: I-Thorough history taking and clinical examination. II-Pulmonary function tests including: 1-Spirometry 2-Body plethsymography 3-Arterial blood gases analysis. III- Record of brain-stem auditory evoked potentials [BAEP] including: latencies of waves I, II, III, IV and V together with interpeak latencies [IPLs] of I-III, I-V and III-V and amplitudes of waves I-Ia and V-Va. IV - Measurement of serum high sensitivity C reactive protein [hs-CRP] by ELISA technique. V - Statistical analysis. The level of hs-CRP reactive protein in COPD was significantly elevated and correlated with spirometric, blood gases parameters and GOLD stage. The BAEP latencies of waves I, II, III, IV and V, together with interpeak latencies and amplitudes of waves I-Ia and V-Va measured on both ears were significantly different in COPD patients than controls. The prevalence of brain-stem auditory evoked potentials abnormalities was higher among very severe group of COPD. Most of BAEP wave latencies together with interpeak latencies and wave amplitudes on both ears were significantly correlated with the spirometric and blood gases parameters. The level of hs-CRP was correlated significantly with abnormalities of BAEP variables. This study showed significant subclinical BAEP abnormalities in studied stable COPD male patients. This indicates conductive defect of auditory nerve, cochlea and even hearing pathway in the brain as a part of systemic inflammation. Theses BAEP abnormalities were significantly correlated with GOLD classification, hs-CRP and PaO[2]

Letrozole as an appropriate therapeutic modality for infertile women with endometrial hyperplasia

To evaluate the impact of oral letrozole therapy for 3-months on infertile patients with pathologically confirmed endometrial hyperplasia [EH]. The study comprised 17 infertile patients with EH. All patients underwent full clinical examination, transvaginal ultrasonography [TVU] to determine endometrial thickness [ET] and estimation of serum E2 levels. All patients were prescribed letrozole 2.5 mg tablets once daily for 3 months and underwent endometrial biopsy at end of treatment. The study outcome was defined as regression of EH to histologically normal endometrium at end of treatment. At the end of the 3-months treatment period, all patients showed significant reduction of preliminary endometrial thickness and decrease of serum E2 levels. All cases with simple EH without atypia [n=10] showed good response with a mean regression rate of ET of 70.2%, while was 59.3% in cases of complex EH without atypia [n=5] and 53% in cases of complex EH with atypia [n=2]. The overall pathological success rate was 88.2%; 100% in simple EH without atypia, 80% in complex EH without atypia and 50% in EH with atypia. For EH without Atypia in infertile patients oral letrozole therapy for 3-months resulted in high regression rate of endometrium and high pathological success rate. However, further large scale studies with dosage modification are needed to determine its true efficacy in EH with atypia in infertile patients

lipoprotein lipase hind III polymorphism and the susceptibility to hypertension

Lipoprotein lipase [LPL] enzyme plays a central role in lipid metabolism. The primary function of LPL enzyme is the hydrolysis of the core triglycerides of circulating chylomicron and very low density lipoprotein [VLDL]. It releases monoglycerides and free fatty acids, which are taken up by skeletal muscle or adipose tissue. The present work aimed to study the association of the common variant of LPL HindlII [H+] and hypertension. Hindlll [+] variant allele of LPL were determined by polymerase chain reaction restriction fragment length polymorphism [PCR-RFLP] assay in 150 hypertensive patients and 150 normotensive as a control group. Serum lipoproteins were also observed in both groups. Allele frequencies were H+ = 0.733 and H- = 0.267 for LPL Hindlll in the hypertension group compared to H+ = 0.683 and H- = 0.317 in the control group. Individuals with homozygous [H+/+] genotype were at higher risk of developing hypertension compared to the [H-/-] genotype [Odds Ratio OR = 2.13, 95% Confidence Interval CI = 0.937-4.8]. Serum TG level were also higher in the individuals with [H+/+] genotype compared to the [H-/-] genotype, while HDL showed negative correlation with the presence of [H+/+] genotype. It can be concluded that the LPL Hindlll [H+] variant of LPL may influence the blood lipid metabolism and increase risk for hypertension

Cerebral metabolites concentrations determined by quantitative proton MR spectroscopy in patients of intracerebral haematomas

This study was made to investigate serial metabolic changes in frontal lobes of patients with deep intracerebral hemorrhage [ICH] to found any correlation between N-acetylaspartate [NAA] and degree of motor impairment or clinical outcome. Forty three patients with deep ICH were examined with proton magnetic resonance spectroscopy by multivoxel method [voxel=10 X 10 X 20 mm; 64 voxels]. NAA/creatine ratios in the white matter of the primary motor and premotor areas on both sides were measured sequentially: within 48 hours, at 2 weeks, and 1 month after onset using National Institutes of Health Stroke Scale We found, in the primary motor area on the affected side, the NAA/ creatine ratio decreased sequentially. At 48 hours and 2 weeks after onset, a negative correlation was detected between NAA/creatine and hematoma volume, but there was no correlation 1 month later. At 2 weeks, NAA/ creatine correlated negatively with motor impairment. In conclusions, there is delayed gradual reduction of NAA/creatine ratio in the frontal lobes correlating with motor deficit and clinical outcome after deep ICH

Water quality in selected parts of the distribytion system in Kafr El Sheikh Governorate

Drinking water safety is one of the most fundamental and critical responsibilities of public health authorities. There are several challenges facing water resources development in Egypt including upgrading water quality from current degradation. Sanitation service is inadequate in Kafr El-Sheikh's main cities and in the majority of the villages, and constitutes a major environmental concern for the whole Governorate, as it is for all over Egypt. The water quality in the distribution system itself may not be the same as the treated water entering the system. So, protecting and maintaining water distribution systems are crucial for ensuring high quality drinking water. This study is planned to perform a sanitary survey of a municipal water treatment plant and its distribution system in a rural area located in Kafr El-Sheikh Governorate and to examine their water quality as an example for the growing dependence on small water treatment plants in poviding quality water to rural areas and alleviae the burden of water borne diseases. The biological and physico-chemical parameters of 100 water samples from a Mutubis plant and its distribution system represented by tap water, and stored water [roof tanks and reservoirs] were examined using standard methods. El Khadra treatment plant is one of the 13 minor plants supplying the rural areas in Mutubis. It supplies 25 Ezbas covering a population of about 160,000 and produces 80 Liters/second. Transport and storage of water are common practice in this area using different unhygienic reservoirs. Moreover, 60% of the studied roof tanks had unsatisfactory sanitary score. Although most of physico-chemical parameters were in compliance with the Egyptian drinking water standards, approximately all biological parameters were violating the recommended limits. 67% of all water samples were contaminated with total coliform counts, but surprisingly fecal coliforms were detected only in roof water tanks. Moreover, Coagulase and DNase-positive Staphylococci were isolated from 18.75% of all water samples. Co-incidental occurrence of Cryptosporidium oocysts and Giardia lamblia cysts has been found in 19% of samples, while co-incidental absence of the two parasites has been found in 60% of samples. These results suggest a possibility of inadequate performance of the plant in addition to post-treatment contamination and possible risk of infection from these water supply sources. Regular monitoring and enhancement of microbial and physico-chemical parameters of water quality served by different water treatment plants till reaching the population are recommended to gauge their safety for human consumption

Elisa and pcr indiagnosis of toxoplasma gondiiin benha university hospitals

Generally speaking, congenital Toxoplasma gondii infection can lead toabortion or severe congenital disease in the newborn infant. The early di-agnosis of the mother or her baby particularly in pregnant women andnewborn babies pave the way to treatment and thus can minimize thecomplications. In this study, the PCR and IgM-ELISA were used to diag-nose active toxoplasmosis. The results revealed that PCR detected veryrecently infection [23/70 subjects] than IgM-ELISA [18/70 ones]. Howev-er, the use of both IgM-ELISA and PCR together improved the diagnosticsensitivity and specificity

Foley's catheter thermal endometrial ablation versus hysteroscopic rollerball endometrial ablation in treatment of dysfunctional menorrhagia

To compare the efficacy and safety of thermal endometrial ablation with the use of Foley's catheter with hysteroscopic rollerball endometrial ablation in the treatment of dysfunctional menorrhagia. A randomized clinical prospective comparative study. Benha University Hospital. The study included eighty patients with persistent dysfunctional menorrhagia not responding to medical treatment for whom follow up data were available for 12 months and fulfilled the inclusion criteria that were enrolled in the study. The patients were randomized into two equal groups of 40 patients each. Patients in the first group were treated by thermal ablation with the use of Foley's catheter, while those of the second group were treated by hysteroscopic rollerball ablation. Preliminary pelvic sonography, hysteroscopy and endometrial biopsy were performed to exclude intrauterine pathology. The procedure was done in the early follicular phase of menstrual cycle under general anesthesia. The main outcome measures included a 12 months follow up of menstrual blood loss and any adverse events. The twelve months follow up indicated that both techniques significantly reduced menstrual blood flow. Success rates, as reflected by percent of patients who returned to normal menstrual bleeing pattern or less were comparable being 80% for thermal balloon group and 85% for the rollerball group. The procedural time was reduced significantly in the uterine thermal balloon group [p < 0.05]. Intraoperative complications occurred in three [7.5%] of the hysteroscopic rollerball group, while no intraoperative complications occurred in the thermal balloon group. Thermal endometrial ablation with the use of Foley's catheter is a safe, simple, easy, cheap and mininally invasive procedure. It is effective as hysteroscopic rollerball ablation in treatment of dysfunctional menorrhagia, however long term follow up on large number of patients is requird for further assessment

Recent stents in patients of acute myocardial infarction clinically and angiographic results

Conronary thrombosis plays a major role in the pathogenesis of acute myocardial infarction. Between December 1998 to November 2000. 57 patients with acute myocardial infarction who were admitted at coronary care unit [CCU] of Sayed Galal and Al Housein University Hospital were included in this study. The patients were divided into two groups: G1: they had primary PCI. G2: [25 patients] they had received streptokinase followed by percutaneaus coronary intervention [PCI] within 24hs after failed thrombolysis [Persistent chest pain and/or extension of ST segment elevation]. The primary goal of therapy for acute myocardial infarction is rapid, complete and sustained restoration of infarct related artery [IRA] blood flow. Both fibrinolytic and mechanical restoration of antegrade coronary blood flow in patients have been shown to improve left ventricular function, reduce infarct size and reduce mortality. Although intravenous fibrinolytic therapy is effective in improving outcome after myocardial infarction and can be administered early to a great proportion of patients than is possible with percutaneaus coronary intervention, its effectiveness profile is disappointing to most cardiologists. The advantages of PCI include immediate visual assessment of reperfusion success and identification of the entire coronary and ventricular anatomy. This assessment often obviate the need for noninvasive testing befor hospital discharge and can lead to an accelerated discharge and recovery of low risk patients. The benefit of primary angioplasty seems greatest in elderly and those with high risk characteristics. The presence of the platelet rich thrombus in acute myocardial infarction and the central role of platelet activation in stent thrombosis suggest a potentially, advantagious role for the new class glycoprotein Ilb; llla receptor antagonists during PCI. Stenting in acute MI and in thrombus containing lesion has become a feasible and safer procedure in an expert hands, with new devices, high pressure deployment and with the use of [GPIIbIIIa blockers

Antibodies to chlamydia trachohomatis heat shock protein 60 [chlamydial HSP 60] and chlamysia trachomatis major outer membrane proten [MOMP] in women with tubal factor infertility

Most of the acute infections of Chlamydia trachomatis are asymptomatic and are thus left untreated. In some women repeated or persistent C. trachomatis infection leads to scarring of the fallopian tube tissue and subsequent infertility because of occlusion of the tubes. Screening for C trachomatis specific antibodies is mandatory in. diagnosing asymptomatic tubal factor infertility [TFI], particularly because it has been shown that C trachomatis is rarely isolated from the upper genital tract and clinical diagnosis requires invasive procedures not routinely available in general practice. C. trachomatis has immunodominant proteins such as major outer membrane protein [MOMP] and Chlamydial heat shock protein6o [chlamydial hsp60] that most of the host's immune response is directed at. The aim of the present study was to evaluate the association between, antibodies to C. trachomatis-specific IgG and chlamydial hsp60 in women with TFI. This study was done on 45 women diagnosed as having TFI by means of hysterosalpingogram [HSG] and laparoscopy, and 31 wives of male factor infertility patients with documented patent tubes by hysterosalpingogram, as a control group. Their age ranged from 19 to 35 years. Antibodies to C. trachomatis-specific IgG were more prevalent in younger women [<25 years old] than older women [>25 years old]. 77% versus 47% in TFI group, and 37% versus 27% in control group. Antibodies to C. trachomatis specific IgG were present in 29 [64%] of 45 women with tubal infertility compared with 10 [32%] of 31 control women. The difference was statistically significant [P=0, 0019]. antibodies to chlamydial hsp60 were significantly higher in TFI patients [28 of 45; 62%] than controls [6 of 31; 20%]. The difference was satistica1ly significant [P 0, 0002], Using the Spearman rank order correlation test, the antibodies chlamydial hsp6o had a highly significant correlation to C. trachomatis specific IgG antibodies in TFI patients [rs 0.53, P<0.001] and in controls [rs= 0.54, P<0.001]. In conclusion, Antibodies to chlamydial hsp60 and C. trachomatis-specific IgG are strongly associated with TFI a when used in combination at initial infertility evaluation, they would provide a rapid non-interventive means of diagnosing tubal factor infertility

Spontaneous reduction of intussusception: avoiding unnecessary surgery

The aim of this work was to study cases of spontaneous reduction of intussusception and their implication on the management and outcome. We routinely use ultrasound for diagnosis and hydrostatic reduction of intussusception with saline enema. The study included 16 patients who were admitted to the Pediatric Surgical Center, Faculty of Medicine, University of Alexandria during the period between January 1996 and October 2000 with the diagnosis of intussusception. They fulfilled the study criteria of spontaneous reduction. Details of the clinical picture were compared with the standard cases of intussusception together with correlation with ultrasound features before and after reduction. All cases were examined on admission and diagnosis of intussusception was confirmed by finding the characteristic target sign on ultrasound. During the period of preparation for hydrostatic reduction or during transport from another center, 12 cases showed evidence of spontaneous reduction, which was confirmed by ultrasound and observation. Hydrostatic reduction was attempted in 4 cases. Four cases showed faint target sign on ultrasound after trial of reduction and were considered questionable. Surgical exploration was performed and showed a reduced intussusception. Spontaneous reduction of intussusception is a possible though rare fate of childhood intussusception. It must be borne in mind to avoid unnecessary surgery in this peculiar subset of patients. The pseudotarget sign on ultrasound can be present for a short period after successful reduction of intussusception and is probably due to residual edema. Awareness, short period of observation and repeating sonography examination after 2 hours will avoid confusion in these cases

Corrective spinal osteotomy for kyphotic deformity

We present sixteen cases of spinal kyphosis treated by a closing-wedge posterior vertebral osteotomy with partial corpectomy at the apex of the deformity followed by posterior stabilization and fusion. The deformity was caused by a congenital anomaly in 6 cases; infection in 7 cases; and ankylosing spondylitis in 3 cases. The indication for surgery was to correct a deformity, which interfered with sitting balance, disturbed respiration, caused abdominal discomfort and/or impeded forward sight vision ahead to the horizon. The average correction was 38 degrees [22-65 degrees] with a mean loss of correction of 3.9 degrees [0-12 degrees]. The average operating time was 195 minutes and blood loss was 1750cc. The osteotomy corrected the deformity in all the cases sufficiently to alleviate the pre-existing symptoms and improve their posture. There were no fatal complications. Implant failure was seen in 2 cases in the form of screws loosening. One deep seated infection required removal of the implant, and two cases had superficial infection controlled by local debridement and parentral antibiotics

Renaissance of small diameter partial portacaval shunt: experience, outcome and survival in Egyptian schistosomal portal hypertensive bleeders

The objective of this work was to evaluate specifically the surgical experience, portal haemodynamics, clinical outcome and survival in Egyptian schistosomal portal hypertensive bleeders after the small diameter partial portacaval shunts [SDPPCS]. This prospective study included fifty-six patients out of two hundred and fifty-four patients with schistosomal hepatic fibrosis, portal hypertension, and splenomegaly and complicated by bleeding oesophageal varices. All patients belonged to class A or B of Pugh modification of Child-Turcotte classification of cirrhosis. All patients were studied preoperatively with endoscopy and color duplex. All patients showed a preoperative haemodynamics pattern with hepatopedal flow. The fifty-six patients were prepared for elective small diameter partial portacaval shunt, SDPPCS, using the 8 mm, non-compressible polytetrafluoroethylene [PTFE] graft, Gore-Tex, W. L. Gore and Associates, Inc., Elkton, Md.].Postoperative duplex study was repeated one month, six months, and one year after operation. The portal flow cephalad and caudal to shunt site were measured, shunt patency was directly visualized, and flow in IVC cephalic to shunt in the intrahepatic portion was measured. Postoperative endoscopic evaluation, every three months during the first year, then every six months afterwards, to assess the downgrading of varices. One-three years of follow-up were the time allowed before reporting the final results. The episodes of variceal bleeding, ascites and encephalopathy were recorded for all patients. Twenty-one cases [37.5%] belonged to child s class A, and thirty-five cases [62.5%] were class B. SDPPCS was abandoned in 5/56 [8.9%]. Causes of operative failure in graft replacement were: adhesions due to previous cholecystectomy in 1/56 [1.8%], very thin walled PV in 1/56 [1.8%], very small PV < 10 mm in 3/56 [5.35%], extensive collaterals around the PV in 2/56 [3.58%], and medially displaced PV with inability to dissect a sufficient segment in 1/56 [1.8%]. Complications: were in the form of PV thrombosis in 1/56 [1.8%], IVC thrombosis in 1/56 [1.8%], shunt thrombosis in 2/56 [3.58%], and transected CBD in 1/56 [1.8%]. SDPPCS permitted sufficient volume of prograde flow of portal blood to the liver leading to maintenance of liver functions and low incidence of encephalopathy. SDPPCS resulted in progressive diminution of the size and grade of esophageal and gastric varices, as well as, disappearance of risk signs, thus guarding against rebleeding. There was statistically significant difference in downgrading of esophageal and gastric varices and improvement of gastropathy. SDPPCS resulted in improvement in hematological abnormalities with significant increase of blood elements, especially for thrombocytopenia. SDPPCS resulted in significant decrease in splenic size and splenic congestion. There was no operative mortality. Survival after SDPPCS was 91.07%. Shunt was patent in 49/51 patients [96%]. Three patients [5.357%] complained of mild encephalopathy after SDPPCS. Small diameter partial portacaval shunt [SDPPCS], using 8 mm PTFE graft, is feasible technically and is effective in controlling bleeding esophageal bleeding with preservation of a prograde hepatic portal flow, that preclude encephalopathy, in Egyptian schistosomal portal hypertensive bleeders. It could be considered as an alternative to difficult cases meant for DSRS, or shunt procedures in splenectomized patients

Study of penile sensitity in patients with primary premature ejaculation

We have evaluated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this disorder and whether there is a sensory difference among these patients Penile biothesiometry was performed in 78 patients with primary premature ejaculation and in 20 men with normal satisfactory ejaculation as a control group. Both patients and control men selected from the same age group [30-40 years]. Vibratory thresholds were recorded at the glans penis and both lateral aspects of mid penile shaft. Vibratory thresholds of the three location sites [glans penis and right and left mid penile shaft] in the patients group were significantly lower than those in the normal control group, Based on the glanular vibratory threshold, the patients were classified into three subgroups. The average of thresholds of the three location sites was used as an indicator for the penile sensitivity as a whole in each patient and it was termed by us as penile sensitivity index [PSI]. significant differences in PSI were detected between the three subgroups of patients. Patients with primary premature ejaculation have penile hypersensitivity with different grades. This may provide further implications for an organic basis of primary premature ejaculation. Penile sensitivity index [PSI] may provide a quantitative evaluation of premature ejaculation and may aid in the selection of therapy and evaluation of its outcome

comparison between the effects of miniplat fixation and other methods of fixation of displaced subcondylar fractures on dog temporomandibular joint [radiographical and histological study]

However, management of displaced condylar fractures is still controversial as it may be managed by MMF, transosseous wiring and miniplates. The present study was performed to evaluate the histological and radiographic changes of the TMJ area after inducing displaced subcondylar fracture in dogs through preauricular approach and fixation. The animals were divided into three groups [A,B and C]. In group A: the ftactured segments were reduced and MMF was applied for 7 days. In group B: the fractured segments were reduced and fixed by interosseous wiring. In group C. displaced condylar process was reduced and a titanium miniplate was introduced to fix the fracture. Each group was subdivided into two subgroups according to the sacrification date [45 and 90 days after surgery]. Results indicated that the TMJ exerted variable histologic and radiographic responses in different groups at the various sacrification dates indicating the various effects of each technique on the joint and the miniplate fixation in cases of displaced subcondylar fracture gave the most favorable results. Consequently, it is the technique of choice for such cases

Cardiovascular and haemodynamic changes in healthy and cardiac patient undergoing dental extraction

A clinical study was performed to investigate the role of Midazolam as sedative agent on the possible incidence of ischemic changes which occur during dental extraction for ambulatory patients receiving local anaesthesia and also to identify which group of cardiac patients is mostly at risk during minor oral surgical procedures. Forty patients aged between 20- 50 year represent the materials of this work, of the forty patients, ten healthy patients act as a control group. The thirty patients had a cardiac disease. All patient were monitored for recording [HR], [SBP], [DBP] and [MAP] by automatic non invasive blood pressure monitor. Midazolam 1 mg was given IV. to all patients and the previous parameters were recorded after 5 minutes, at 1 and 5 minutes post injection of local anaesthetic [Mepicaine] and at 1 and 5 minutes after tooth extraction. The threshold for myocardial ischemia used in this study includes RPP values more than 12.000 and PRQ values less than 1.0. Sedation produced significant decrease in the RPP values in all groups [P < 0.05]. Whereas, it produced insignificant change in PRQ values. This beneficial effect of sedation would be recommended for cardiac patients, especially hypertensive patients who have more risk than the other patients to develop myocardial ischemia during dental extraction under local anaesthesia

Effects of meniscrectomy on temporomandibular joint structure in dogs

Although the value of meniscectomy has been recently questioned the operation has been indicated in certain types of temporom and ibular joint diseases. This study aimed to evaluate roentgenographically and histologically the changes following unilateral meniscectomy in dogs. The results indicated that the operated as well as the unoperated sides demonstrated degenerative changes including flattening, resorption, erosion and osteophytes formation on the articular surfaces