Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Approaches to develop PLGA based in situ gelling system with low initial burst

In situ gelling systems have gained much interest owing to their successful application in the preparation of controlled drug delivery and tissue engineering. The commonly used polymer for these systems is the biocompatible and biodegradable polymer of Poly [lactic-co-glycolic acid] [PLGA] that is available in the market as implants, microparticles and in situ implant. A polymeric solution is prepared by mixing the polymer with a biocompatible solvent which may be water miscible such as N-methyl pyrrolidone [NMP], 2-pyrrolidone and Dimethyl sulfoxide [DMSO] or partially water miscible solvents such as triacetin, benzyl benzoate, ethyl acetate, triethyl citrate and benzyl alcohol. Upon injection of this polymeric solution into buffer or physiological fluid, the system solidifies and the administered drug releases in a controlled manner. The major drawback of these systems is their high initial burst that characterized by release of a noticeable amount of the administered drug during the first release stage that usually results in drug toxicity and tissue irritation. This review focuses on presenting the different strategies utilized to decrease the initial burst from PLGA in situ gelling system

efficacy of ranibizumab in the treatment of macular edema secondary to central retinal vein occlusion [CRVO]

Purpose: To evaluate the effect of 3 consecutive intravitreal injections of ranibizumab [Lucentis] on visual acuity [VA] and central macular thickness [CMT] for central retinal vein occlusion [CRVO] induced macular edema. Study design: Our study was a prospective interventional case series

Patients and Methods: Twenty eyes of 19 consecutive patients diagnosed as CRVO-related macular edema [eight perfused, twelve ischemic CRVO] treated with 3 monthly intravitreal injections of ranibizumab at presentation as a monotherapy. Follow up visits were scheduled on the first, third and sixth months post-injections. Main outcome measures included mean changes in BCVA and CMI as measured by OCT

Results: The mean time from diagnosis until injection was 20 days. The mean BCVA of 0.03 +/- 0.03 [2/60] at baseline improved to a mean BCVA of 0.07 +/- 0.02 [5/60] six months after the last injection [final outcome], which was statistically significant [p<0.05] .Eleven eyes showed improved visual acuity [ 55%], 8 eyes [40%] had a stable visual acuity and 1 eye [5%] had worse visual acuity compared with baseline. A mean CMT of 679 um +/- 198 at baseline was improved to a mean CMT of 411 um +/- 158 six months after the last injection [final outcome], which was statistically significant [p<0.001]. The improvement in BCVA was superior in perfused CRVO compared to ischemic CRVO No ocular or systemic side-effects were noted

Conclusion: Intravitreal injection of ranibizurnab has shown promising results in VA improvement and decrease in CMT in patients with macular edema associated with CRVO especially the perfused form. However, long term results need to be further investigated

Evaluation of notch and hypoxia signaling pathways in chemically induced hepatocelluar carcinoma in rats

Hepatocellular carcinoma [HCC] is a common worldwide malignancy. Notch signaling pathway contributes to the genesis of diverse cancers, however, its role in HCC is unclear. Hypoxia is a common feature of HCC. Signal integration between Nothc and hypoxia may be involved in HCC. The aim of this study was to evaluate the expression of some Notch pathway genes, in addition to hypoxia inducible factor-1 alpha [HIF-l alpha] during rat hepatocellular carcinogenesis. The study aimed also, to identify any crosstalk between Notch signaling and hypoxia throughout hepatocellular oncogenesis in rats. Hepatocellular carcinogenesis was chemically induced in rats. Tissue specimens were examined histopathologically and classified into early preneoplastic group, advanced preneoplastic group, and control group. The expression of Notch-l, Dll-4, and HIF-l alpha was evaluated in tissue samples by total RNA extraction and RT-PCR. The expression of target genes were significantly increased in the diseased group. There was a significant correlation between the expression of Notch-l, Dll4, and HIF-l alpha. These results indicate that overexpression of Notch-l, Dll-4, and HIF-l alpha may be associated with the malignant transformation of hepatocytes with a possible Notch-hypoxia cross talk during hepatocellular oncogenecity

Sclerotherapy versus surgery in the treatment of varicocele: a randomized study

To evaluate the differences between surgical and seminological results observed in two groups of patients with primary varicocele who underwent, respectively, open surgery or antegrade sclerotherapy. From Jan. 2005 to Jan. 2006, we recruited 60 patients with left sided varicocele for this study. Before treatment all patients were evaluated by a physical examination, color Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography and semen analysis. These patients were randomized to two groups; group A: 30 patients [open surgery] and B: 30 patients [antegrade sclerotherapy]. At the current follow up, it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis. A satisfactory significant improvement of the rate of fast progressive spermatozoa and reduction in immotile spermatozoa in those patients who underwent sclerotherapy compared to the patients who underwent open surgery. The outcomes of all other parameters [number and morphology] are fully comparable. Operating time is decidedly shorter for antegrade sclerotherapy, but there are no significant differences in terms of early or late postoperative complications. Our results demonstrate that sclerotherapy combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility

Prediction of visual acuity improvement after intravitreal, triamcinolone acetonide injection in cases of diffuse diabetic macular edema

This study aims at identifying which factors affect the visual improvement following intravitreal triamcinolone acetonide [IVTA] injections. This is important in order to avoid injection of cases with expected poor improvement. 62 eyes with diffuse- diabetic macular edema of 48 patients were received IVTA injections of 4 mg. Visual acuity assessment, Fluorescein angiography and measurements of macular thickness by Optical Coherent Tomography [OCT] were done before and 3 months after injection. The data are collected and statistically analyzed. Visual improvement was found to he affected by the pre- injection macular thickness, macular ischemia, duration of visual loss, previous laser treatment. Age of the patient did not show significant influence on the degree of improvement of vision. The effect of IVTA can be expected by meticulous preoperative assessment. This is important in order to avoid useless injections

Total cystopericystectomy versus traditional cyst evacuation for treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. Surgery is the recommended treatment for hepatic hydatid cysts. The purpose of this study is to evaluate the technique of cystopericystectomy for treatment of hydatid cysts of the liver comparing it with the traditional surgical technique of cyst evacuation. Twenty six patients [26] admitted with hydatid disease of the liver in Assiut University Hospital from January 2004 to April 2007. All patients were randomized into two groups, group I [13 patients] were managed by total cystopericystestomy and group II [13 patients] managed by conservative technique of cyst evacuation. History, clinical examination chest X-ray abdominal ultrasonography and computed tomography were performed. All patients were treated with oral albendazole dose for two months after surgery. Blood transfusion hospital stay, post-operative complications, and any evidence of hydatid recurrence were recorded. Surgery was performed on 26 patients with liver hydatid disease [14 men and 12 women] with a mean age of 40.2 years [range 21-73 years]. The mean diameter of the cyst was 6.6cm [range 5-11cm]. Blood transfusion was required in 5 patients in the group of cystopericystectomy and in 2 patients of traditional technique of cyst evacuation. The mean hospital stay was 6.1 days in cystopericystectomy group and 8.2 days in the traditional technique of cyst evacuation. During the follow up period which extended up two years postoperatively, no mortality was verified, the incidence of postoperative complications was 7.6% in the group randomized to cystopericystectomy and it was 23.07% in the group randomized to cyst evacuation. Recurrence of hydatid disease was observed in one patient 7.6% in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy group. Surgical treatment of hepatic hydatid disease by total cystopericystectomy combined with medical therapy with albendazole is a valuable alternative to the more conservative technique of cyst evacuation with a lower incidence of morbidity and recurrence

use of progressive tension sutures in abdominoplasty for fewer complications and a speedy recovery

Abdominoplasty is one of the commonest plastic surgery procedures done worldwide, however, it is plagued by a number of local complications including; hematoma and seroma formation, flap necrosis and hypertrophic scars. To avoid these complications, suction drainage and limitation of postoperative ambulation are widely used by most surgeons. The use of progressive tension sutures [PTS] has been introduced in plastic surgery in various operations to ease the advancement of various skin flaps. The basic concept of their use in abdominoplasty is to control redrapping of the abdominal flap eliminating dead space and nullifying the need for drains. It also avoids tension on the terminal suture lines by dividing flap tension over many successive points thus minimizing the possibility of flap edge necrosis and allowing early postoperative ambulation. Progressive tension sutures were used in 15 cases. No drains were used and early ambulation was allowed in all cases. The incidence of complications was very low [0. 13%], minimal seroma was encountered in one case [6.65%] and was managed conservatively and superficial flap necrosis in another case [6.65%] which was managed by repeated dressings. The average duration of operation was 2.4 hours and the average postoperative hospital stay was 2.6 days. These results suggest that the use of progressive tension sutures in abdominoplasty reduces the risk of local complications, ease the early postoperative period without adding significant operative time or hospital stay

prevalence of hepatopulmonary syndrome in cirrhotic patients due to hepatitis C

Hepatopulmonary syndrome is defined as the triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. It complicates a substantial percent of cirrhotic patients and has an impact on survival. Hepatitis C virus is the most common cause of cirrhosis in Egypt. The aim of this study: was to explore the prevalence of hepatopulmonary syndrome in HCV- induced cirrhotic patients and the risk factors associated with it. Patients and Thirty HCV- induced cirrhotic patients were studied. They underwent careful history taking, through clinical examination, chest X-ray,a complete blood count, prothrombin time, serum albumin, bilirubin, hepatitis markers, abdominal ultrasound, upper gastrointestinal endoscopy, arterial blood gases and transthoracic contrast echocardiography. Results' Four patients [13.3%] were found to have HPS. Patients with Hepatopulmonary syndrome had significantly higher Child-Pugh score compared with patients without Hepatopulmonary syndrome. The prevalence of HPS was significantly higher in ChildPugh class C compared with Child-Pugh A. Hepatopulmonary syndrome was not uncommon in HCV- induced cirrhotic patients [13.3. [% The study showed a significant correlation between the severity of liver disease and Hepatopulmonary syndrome

Postpartum involutional hypomastia: management by augmentation mammaplasty with submuscular textured saline-filled implants

One of the most common indications for augmentation mammaplasty is postpartum involutional hypomastia, with or without a varying degree of ptosis. The goal is to achieve a good and lasting aesthetically pleasing result, to preserve nipple sensation, and to avoid the most distressing and difficult to remedy complication capsular contracture around the implant, To achieve these goals, several factors should be taken into consideration; the biochemical nature of the implant, the surface of implant envelope, the plane of implantation, the use of povidone-iodine irrigation, the use of postoperative compression and the prevention of early hematoma formation and infection. 20 cases of postpartum involutional hypomastia were managed by submuscular implantation of textured saline filled implant. The aesthetic result was satisfactory in 95% of cases, Inframammary approach allowed adequate medial pectoral fibre release in 39 sides [97.5%] with only one case needing correction of unilateral implant migration by adhesive strapping. The nipple sensation was preserved in all cases. There were no incidents of capsular contracture or - late implant failure over a 1-year follow up period The results suggest that the use of the submuscular plane, the textured surface and the saline filled nature of the implant greatly minimizes the risk of capsular contracture development and that the use of inframammary approach makes operation easier, allowing adequate pocket dissection and muscle medial release and under vision Hemostasis. it also allows preservation of lateral thoracic nerve responsible for nipple sensation

Cardiac abnormalities associated with liver cirrhosis

The occurrence of unexpected deaths due to heart failure following liver transplantation and major surgery in cirrhocic patients and the studies that shown evidence of cardiac dysfunction in patients with cirrhosis have led to the introduction of the new clinical entity, [cirrhotic cardiomyopatby]. This study explores the cardiac abnormalities in cirrhotic patients and its correlation with aetiology and severity of cirrhosis and degree of portal hypertension. 40 cirrhocic patients with no history of cardiac disease and 20 age- and sex-matched healthy individuals were studied. They underwent: [1]Laboratory analysis: including liver function tests and hepatitis markers [2]Abdominal ultrasound [3]Upper gastrointestinal endoscopy [4] Trans-thoracic echocardiographic examination to assess left ventricular systolic and diastolic chamber dimensions, interventricular septal thickness, left ventricular posterior wall thickness and systolic and diastolic function. Cirrhotic patients had significantly increased interventricular septal thickness [P= 0.017] and Left atrial size [P= 0.03]. The ejection fraction was significantly higher in cirrhotic patients compared with the controls [P < 0.05]. The isovolumic relaxation time was significantly prolonged in cirrhotic patients [P= 0.04] and the deceleration time was significantly increased in cirrhotic patients [P< 0.05]. Cirrhotic patients with advanced liver disease [Child-Pugh class C] had a significantly smaller left ventricular diameter at the end of diastole compared with the controls [P= 0.03]. The E/A ratio was also significantly reduced in this group [P< 0.05]. The deceleration time was increased in all cirrhotic groups, and significantly so in the class C cirrhotic patients [P= 0.03]. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients. Cirrhosis is associated with changes in cardiac structure and function. There is thickening of interventricular septum and increased Left atrial size associated with diastolic dysfunction, as demonstrated by prolongation of the isovolumic relaxation time and increased the deceleration time. The ejection fraction was significantly higher in cirrhotic patients compared with the controls. The severity of liver disease is associated with more severe diastolic dysfunction. Child-Pugh class C cirrhotic patients had a significantly smaller left ventricular diameter at the end of diastole and the E/A ratio was also significantly reduced compared with the controls. The deceleration time was significantly increased in the class C cirrhotic patients compared with class A and B. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients

Intraoperative lymphatic mapping and sentinal node biopsy predicts axillary nodal involvement and avoids negative axillary dissections in [N0] breast cancer

The status of the axillary nodes is the strongest known prognostic variable in patients with breast cancer, and is routineely used in planning postoperative therapy. Conventional axillary dissection is limited by sampling error and potential morbidity With new wide scale regimens of screening and growing consensus of early diagnosis of breast cancer increasing numbers of negative axillary nodal dissections are encountered. Sentinel node biopsy techniques have revolutionized the management of axillary nodes. Accurate identification and focused histologic evaluation of the sentinel node allow accurate prediction of the status of other axillary nodes, thereby avoiding the morbidity and expense of a complete axillay dissection in node negative patients. In 26 cases of breast cancer, SLN intraoperative mapping was done following preoperative subcutaneous dye injection over breast mass. SLN detection success rate was 76.92%. Pathological examination of detected SLN[s] and comparison with the rest of axillary nodes revealed an accuracy rule of 90% in detection of axillury status with negative predictive value of 80%. With further evaluation and growing experience with the technique it can be a useful method to decide when to procced with formal axillary dissection in cases with no clinically detected nodes

Role of crystallin insolubilization in cataract formation

This work aimed to study the electrophoretic pattern of lens proteins and to study the pathological variation in lens protein in cataract to decide if cataract results from insolubilization of lens protein or due to appearance of a new type of protein. Also, decide if these changes in lens protein composition occur in equal proportion among various types of cataract. The results stated complete absence of crystallin in the water soluble moiety of both nuclear cataract and cortical cataract. There is an increase in proteins of high molecular weight and decrease in low molecular weight protein. Bs crystallin is incorporated into the high molecular weight aggregates of the water insoluble moiety of lens protein

Serum levels of some proteinase inhibitors in non-malignant and malignant liver diseases

The aim of this study was to investigate the levels of alpha-2-macroglobulin [alpha-2-M] and alpha-I-antitrypsin [alpha I AT] in non malignant and malignant liver diseases to be used as a biochemical marker of malignant transformation as well as to detect the degree of malignancy. Alpha-2-macroglobulin and alpha-I- antitrypsin levels were measured in serum by single radial immunodiffusion plates. The study showed a significant increase in alpha-I AT in non malignant liver diseases group, primary untreated liver cancer group and advanced liver cancer group when compared with that of the control group. Alpha-2 M showed a high significant increase only in advanced liver carcinoma with insignificant changes in other groups