Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children: Predictors of successful outcome.

INTRODUCTION AND OBJECTIVES: Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi <2 cm, the success rate after the first session is low. This is in contrast to other minimally invasive procedures like percutanous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), which have higher rates of success. Therefore, the present study sought to identify predictors of success after one session of ESWL. PATIENTS AND METHODS: A prospective study including 100 children with renal stone burden <2 cm who underwent ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention. RESULTS: Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1 mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P < 0.001). CONCLUSION: Patient's age was an important predictor for response after ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group.

Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study.

OBJECTIVE: Peeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. PATIENTS AND METHODS: Between September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. RESULTS: The median age of the children was 2.5 years (range 0.5-12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered. CONCLUSION: Open and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group.

Prevalence of hydatid cysts in slaughtered animals in Sirte, Libya.

The prevalence of cystic echinococcosis was studied among the livestock slaughtered in abattoir of Sirte, Libya during the period July 2004 to May 2005. The overall infection rate of 4.9% in sheep, 2.4% in goats, 2.7% in camels and 15% in cattle were observed. The increase in prevalence with age of the animals was statistically significant in the four species. In female goats, examined infection was higher in the male. Liver had higher hydatid cysts than lungs in sheep, goat while infected lungs had higher in camel.

Functional characterization of Fospeg, and its impact on cell cycle upon PDT of Huh7 hepatocellular carcinoma cell model.

BACKGROUND: Although several treatment options are available for hepatocellular carcinoma (HCC), their application is mostly restricted to early diagnosed cases or includes liver transplantation, which is rarely available due to donor scarcity. The attractiveness of PDT as a cancer treatment does not only come from its minimal invasiveness, but also from the high selectivity due to tumor localization that can be applied. Precise focusing of light on tumor lesions will result in tumor-specific PDT activation. Novel photosensitizers can be applied in such low concentrations that cells not subjected to irradiation remain healthy. The lethal effect and mechanism of death induction of the photosensitizer Fospeg has never been studied on hepatocellular carcinoma. The aim of the present study is to functionally analyze the impact of PDT on Huh-7 HCC cell line, as well as to analyze its impact on cell cycle protein expression. METHODS: Cellular viability, and proliferation assays were conducted via MTT and BrdU assay, respectively. Transfected cell models of Huh7 with different constructs harboring cell cycle genes and downstream reporter luciferase gene were generated. RESULTS: Our results show a statistically significant decrease in both viability and proliferation of Huh-7 cells following PDT, while maintaining Fospeg and laser concentrations far below toxic levels. Proliferative cell cycle genes show a tendency of inhibition, while p53 levels show a significant increase following PDT. CONCLUSION: Fospeg-mediated PDT is a promising strategy for treatment of hepatocellular carcinoma and needs to be further explored in vivo.

Reconstruction of long anterior urethral strictures by dorsally quilted penile skin flap.

Objective. To present the results of reconstruction of long (>5 cm), penile, bulbar, and bulbopenile urethral strictures by penile skin flap as dorsal onlay in one-stage procedure. Patients and Methods. Between January, 1998 and December, 2004, 18 patients (aged from 28-65 years) presented with long urethral strictures, 5.6-13.2 cm (penile in 6, bulbar in 2 and combined in 10 cases), those were repaired utilizing long penile skin flaps placed as dorsal onlay flap in one stage (Orandi flap 6 cm in 6 cases, circular flaps 7-10 cm in 8, and spiral flaps 10-15 cm in 4). Followup of all patients after reconstruction included urine flow rate at weekly intervals, RUG at 6-12 weeks, and urethrocystoscopy at 12 and 18 months. Results. The urethral patency was achieved in 77% of patients. The complications were fistula in one patient (5.5%), restricture occurred in 3 patients (16.6%) that required visual internal urethrotomy and two patients (11%) showed curvature on erection that dose not interfere with sexual intercourse. Diverticulum (penile urethra) was seen in one patient (5.5%) containing stones and was excised surgically. There was penile skin loss in 3 patients (16.6%). All patients completed at least one-year followup period. Conclusion. Free penile skin flaps offer good results (functional and cosmetic) in long penile and/or bulbar urethral strictures. Meticulously fashioned longitudinal, circular or spiral penile skin flaps could bridge urethral defects up to 15 cm long.

HPTLC densitometric analysis of arbutin in bulk drug and methanolic extracts of Arctostaphylos uva-ursi.

A high-performance thin layer chromatographic densitometric method for the analysis of arbutin was developed and validated in the present investigation. Arbutin was separated on aluminium-backed silica gel 60 F(254) plates with methanol : chloroform (3:7)% (v/v) as the mobile phase. This system was found to give a compact spot of arbutin at a retention factor (R(f)) value of 0.32 ± 0.02. The limit of detection and limit of quantification were found to be 35.42 and 106.26 ng/spot, respectively. The proposed method with a high degree of precision and accuracy was employed for the analysis of arbutin in the bulk drug and methanolic extract of Arctostaphylos uva-ursi.

Plasma levels of adrenomedullin and atrial natriuretic peptide in patients with congestive heart failure of various etiologies.

OBJECTIVE: The aim of this study was to evaluate the plasma levels of the adrenomedullin (ADM) and atrial natriuretic peptide (ANP) in adult and pediatric patients with congestive heart failure (CHF) of various etiologies and to investigate their relations with haemodynamic variables e.g. echocardiographic left ventricular ejection fraction (LVEF) and fractional shortening (FS). SUBJECTS AND METHODS: The study was made in 38 adult and 21 pediatric patients with CHF of various etiologies and compared with 15 adult and 10 pediatric normal healthy controls. Patients with CHF were classified according to the New York Heart Association (NYHA) functional classification into grades II to IV in adult patients and into grade IV in all pediatric patients. ADM and ANP plasma levels were determined prior to the treatment with enzyme immunoassay. RESULTS: A statistically significant difference in the plasma levels of ADM and ANP were found between pediatrics and adult patients and corresponding healthy controls. Their levels were progressively increased with severity of NYHA class in adult patients. We found a significant positive correlation between plasma levels of each of ADM and ANP and pulse rate, systolic and diastolic blood pressure; and a significant negative correlation between their plasma levels and echocardiographic LVEF and FS. A significant positive correlation between plasma levels of ADM and ANP in both pediatrics and adult patients were also found. CONCLUSION: Plasma levels of ADM and ANP increased in adult and pediatric patients with CHF irrespective of the cause. They were positively correlated with each other and negatively correlated with LVEF and FS. These findings might have important clinical implications in that a noninvasive blood test may be used to identify high-risk subjects for HF for more invasive procedures.

Phenolic constituents of Ononis vaginalis roots.

The ether soluble fraction of the roots of Ononis vaginalis Vahl. Symb. afforded three new compounds: 3-hydroxy-4,9-dimethoxycoumestan, maginaldehyde [2-(4-hydroxy-2-methoxyphenyl)-5,6-dimethoxy-3-benzofuran-carboxaldehyde] and 5,7,4'-trihydroxy-4-styrylcoumarin. In addition, four known pterocarpans; 3,4,9-trimethoxypterocarpan, maackiain, medicarpin and trifolirhizin were also isolated. The styrylcoumarin derivative showed significant antiviral activity against Herpes simplex type 1 and weak cytotoxicity.

Two bioactive saponins from Albizia subdimidiata from the Suriname rainforest.

Bioassay-guided fractionation of a methanol extract of Albizia subdimidiata using the engineered yeast strains 1138, 1140, 1353, and Sc7 of Saccharomyces cerevisiae as the bioassay tool resulted in the isolation of the two active saponins 1 and 2; one of these, albiziatrioside A (1), is described for the first time. The structures of 1 and 2 were established on the basis of HRMS, 1D and 2D NMR spectral data, and GC--MS analysis of the sugar units. Both isolated compounds showed significant cytotoxicity against the A2780 cell line.

Bioactive saponins from Swartzia schomburgkii from the suriname rainforest.

Bioassay-guided fractionation of the MeOH extract of Swartzia schomburgkii using the engineered yeast strains 1138, 1140, and 1353 as the bioassay tool resulted in the isolation of five active (2, 4-7) and three inactive (1, 3, 8) saponins. Saponins 4 and 6 are previously unreported. The structures of all of the saponins were established based on 1D and 2D NMR spectral analysis, on acid and alkaline hydrolysis followed by TLC and GC-MS, and by comparison with literature data for known compounds. Three of the isolated compounds (4-6) showed weak cytotoxicity against the M-109 cell line.

Study of surfactant level in cases of primary atrophic rhinitis.

The surfactant system of the nose was examined biochemically in control cases and compared to cases of primary atrophic rhinitis. The study group included 25 cases with primary atrophic rhinitis compared to 10 normal volunteers. Biochemical analysis of the nasal aspirate in these cases revealed the presence of phospholipids constituting surfactant with phosphatidylcholine constituting 75.35 per cent of the total phospholipids. Biochemical analysis of the nasal aspirate in cases with primary atrophic rhinitis revealed a significant decrease in the total phospholipids compared to normal cases and also a significant change in the phospholipid profile. Thus significant biochemical changes in the surfactant system of the nose is an evident and early finding in cases of primary atrophic rhinitis. This suggests a possible role for surfactant deficiency in the aetiopathogenesis of cases of primary atrophic rhinitis.

Synthesis and biological evaluation of analogues of cryptolepine, an alkaloid isolated from the Suriname rainforest.

Bioassay-guided fractionation of an extract of a mixture of Microphilis guyanensis and Genipa americanacollected in the rainforest of Suriname yielded the known alkaloid cryptolepine (2) as the major active compound in a yeast bioassay for potential DNA-damaging agents; the same compound was later reisolated from M. guyanensis. The structure of cryptolepine was identified unambiguously by spectral data and by its total synthesis. Several cryptolepine derivatives (3-29, 32-41) were synthesized based on modifications of the C-2, N-5, N-10, and C-11 positions. Two cryptolepine dimers (30, 31) were also prepared. The structure modifications did not result in compounds with a higher potency than the parent compound cryptolepine in the yeast assay system, although some derivatives did show significant activity. Selected compounds (6, 7, 17, 22, 23, 26, and 27) were also tested for cytotoxicity in mammalian cell culture, and two compounds showed significant cytotoxic activity.

DNA-damaging steroidal alkaloids from Eclipta alba from the suriname rainforest1.

Bioassay-guided fractionation of the MeOH extract of Eclipta alba using three yeast strains (1138, 1140, and 1353) resulted in the isolation of eight bioactive steroidal alkaloids (1-8), six of which are reported for the first time from nature. The major alkaloid was identified as (20S)(25S)-22,26-imino-cholesta-5,22(N)-dien-3beta-ol (verazine, 3), while the new alkaloids were identified as 20-epi-3-dehydroxy-3-oxo-5,6-dihydro-4,5-dehydroverazine (1), ecliptalbine [(20R)-20-pyridyl-cholesta-5-ene-3beta,23-diol] (4), (20R)-4beta-hydroxyverazine (5), 4beta-hydroxyverazine (6), (20R)-25beta-hydroxyverazine (7), and 25beta-hydroxyverazine (8). Ecliptalbine (4), in which the 22,26-imino ring of verazine was replaced by a 3-hydroxypyridine moiety, had comparable bioactivity to verazine in these assays, while a second alkaloid (8) showed good activity against Candida albicans. All the alkaloids showed weak cytotoxicity against the M-109 cell line.

Erythroxan diterpenes from Fagonia glutinosa.

Further investigation of the ether extract of the aerial parts of Fagonia glutinosa utilizing the brine shrimp bioassay resulted in the isolation of two new cytotoxic erythroxan diterpenes: 1 alpha, 10 alpha-epoxy-2-oxofagonene (1) and 1 beta, 10 beta-epoxy-2-oxofagonene (2). In addition, two inactive diterpenes, 2-oxofagonene (3) and its previously reported isomer 2-oxo-5-epi-fagonene (4), were also isolated.

Bioactive iridoids and a new lignan from Allamanda cathartica and Himatanthus fallax from the Suriname rainforest.

Bioassay-guided fractionation of the EtOAc extract of both Allamanda cathartica and Himatanthus fallax (Apocynaceae) using the Sc-7 yeast strain resulted in the isolation of the weakly cytotoxic isoplumericin and plumericin. In addition, the new lignan 7(R)-methoxy-8-epi-matairesional and three known compounds, plumieride, matairesinol, and pinoresinol, were isolated from H. fallax.

Inheritance of non-syndromal genetic deafness.

This study was carried out on 35 patients with undifferentiated genetic hearing loss attending the Human Genetics Clinic, Medical Research Institute, Alexandria University. Their ages ranged from three months to 25.5 years. Females were commonly affected than males. The high parental consanguinity (75%) with high inbreeding coefficient (0.04) declared the role played by consanguinity, which is an important risk factor, in the occurrence of the abnormality. The type of hearing loss in all patients is sensorineural. The diagnosis of deaf patients was done by means of pedigree analysis and audiometric criteria. They were classified according to their diagnosis into four cases with dominant inheritance, 21 cases having congenital deafness showed recessive inheritance with a recurrence risk of 0.277+/-(1.96) (0.10), one case with childhood deafness also showed recessive inheritance and one case with X-linked inheritance. Six cases were isolated cases, their mode of inheritance was indefinite except one case which may have suggested dominant inheritance. Two cases of ototoxicity in childhood also suggesting genetic causes were included. Genetic counselling was offered to the deaf parents to help the family to accept and adjust to the birth of a deaf child. The nature of the condition, prognosis and recurrence risk were explained to the parents.

Assessment of nutritional status of pediatric cancer patients.

The study was done to identify which parameters are most useful to be used for nutrition assessment in pediatric cancer patients. The study included 70 pediatric cancer patients (48 males and 22 females) age 4-10 years. Patients were classified into 3 groups based on type of cancer (Lymphoma, leukemia and rhabdomyosarcoma). The period of the study was divided into 3 stages according to treatment (initial, during and at the end of the 6 months period). The patients were subjected to nutrition assessment through using 24 hours dietary recall and anthropometric measurements. Also the relationship between nutrient intake and socioeconomic status of the patients was studied. The results showed positive between each of triceps skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC), height (Ht) and weight categories (as a percent of ideal body weight). These parameters can be used to assess nutritional status of pediatric cancer patients throughout the stages of treatment. The results of the 24 hours dietary recall showed a decrease in protein and caloric intake of all the patients by the end of the 6 months period. All the patients had low intake of vitamins A and C and calcium. A positive correlation was found between the intake of these 3 nutrients and socioeconomic level of the patients.

Lanigerol: a new antimicrobial icetexane diterpene from Salvia lanigera.

Roots of Salvia lanigera Poir. yielded a new icetexane [10,12-dihydroxy-9(10-->20)-abeo-8,11,13-abietatriene], named lanigerol, which had activity (MIC 1 mg/ml) against Gram-positive bacteria.