Clinico-Epidemiological Characteristics of Patients With Inflammatory Bowel Disease in Egypt: A Nationwide Multicenter Study.

Background and Aims: Ulcerative colitis (UC) and Crohn's disease (CD) are the most common types of Inflammatory bowel disease (IBD), with variable responses to traditional therapies and unpredicted prognosis. In Egypt and most developing countries, the lack of recent epidemiological and prognostic data adversely affects management strategies. We collected and analyzed data of patients with IBD from multiple centers across Egypt to evaluate patients' clinical and epidemiological characteristics. Methods: This retrospective multicenter study included patients diagnosed with IBD between May 2018 and August 2021, at 14 tertiary gastroenterology units across Egypt. Record analysis addressed a combination of clinico-epidemiological characteristics, biochemical tests, stool markers, endoscopic features, histological information, and different lines for IBD treatment. Results: We identified 1104 patients with an established diagnosis of IBD; 81% of them had UC, and 19% showed CD. The mean age of onset was 35.1 ± 12.5 years ranging from 5 to 88 years, the mean duration of illness at inclusion was 13.6 ± 16.7 years, gender distribution was almost equal with a significant male dominance (60.4%, p = 0.003) among patients with CD, 57% were living in rural areas, and 70.5% were from Delta and Coastal areas. Two hundred nineteen patients (19.8%) displayed comorbid conditions, primarily associated with CD. The most frequent complaints were diarrhea (73.2%), rectal bleeding (54.6%) that was significantly higher among patients with UC (64%, p < 0.001), and 46.8% with abdominal pain (more often with CD: 71%, p < 0.001). Conventional therapy was effective in treating 94.7% of patients. The main lesion in patients with CD was ileal (47.8%); patients with UC mainly exhibited proctosigmoiditis (28.4%). Dysplasia was detected in 7.2% of patients, mainly subjects with UC. Conclusions: To our knowledge, our effort is the first and largest cohort of Egyptian patients with IBD to describe clinical and epidemiological characteristics, and diagnostic and management approaches. More extensive prospective studies are still needed to fully characterize disease distribution, environmental factors, and pathological features of the disease.

STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening.

INTRODUCTION: Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening. METHODS: A single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications. RESULTS: No statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group. CONCLUSION: The STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI). LEVEL OF EVIDENCE: Level III, Therapeutic study.

Humerus Lengthening: A Comparison of the Internal Lengthening Nail to External Fixation.

Introduction: Magnetic internal lengthening nails (MILNs) have been used for humeral lengthening to avoid complications associated with external fixation. Purpose/Questions: We compared the 1-year Disabilities of the Arm, Shoulder and Hand (DASH) score, adjacent joint range of motion (ROM), bone healing index (BHI), length achieved, distraction rate, and complications when lengthening the humerus using MILN vs using external fixation. Methods: We conducted a retrospective cohort study of 18 patients (22 humeri) from January 2001 to March 2020 divided into 2 groups, the MILN group (7 patients, 7 humeri) and the mono-lateral fixator group (11 patients, 15 humeri). Results: The MILN group showed larger improvement of DASH scores (average 26.8 and 8 for MILN and fixator groups, respectively), less loss of elbow ROM (average 5° and 7° for MILN and fixator groups, respectively), and shorter time to full recovery of elbow ROM (average 39 days and 122 days for MILN and fixator groups, respectively). In the MILN group, there was slower distraction rate (average 0.66 mm/day and 0.86 mm/day for MILN and fixator groups, respectively), less lengthening achieved (average 5.2 cm and 7 cm for MILN and fixator group, respectively), and a lower lengthening percentage (average 19% and 41% for MILN and fixator group, respectively). Bone healing index (BHI) of 0.94 and 0.99 months/cm for the MILN and the fixator groups were similar. Conclusion: Humeral lengthening using the MILN allowed for early full recovery of joint ROM with comparable functional and radiographic outcomes compared with using external fixators.

Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome.

INTRODUCTION: The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow. METHODS: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion. RESULTS: At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°. CONCLUSION: A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Locking versus non-locking plates in fixation of extra-articular distal humerus fracture: a randomized controlled study.

INTRODUCTION: Studies have shown that the use of nonlocking (reconstruction) plates in fixing distal humerus fractures may not yield stable fixation which therefore requires long immobilization and suboptimal functional results. There are reports showing that locking plates are biomechanically superior to nonlocking plates. The aim of this study was to compare elbow functional outcomes between locking and nonlocking plates in fixation of distal humerus fractures. METHODS: A single-centre, randomized control study was conducted at an academic level 1 trauma centre. A total of 60 patients with type 13-A fracture (AO/OTA classification) were randomized into two equal groups, locking plates group, and nonlocking plates group. The primary outcome measure was the Mayo elbow performance score (MEPS) at one year. Secondary outcomes measures were elbow flexion/extension arc, union, operative time, and complications (e.g., infection, heterotrophic ossification). RESULTS: The Mayo Elbow Performance Score (MEPS) at one year was 88 ± 10.1 in locking plates group and 75.8 ± 12.8 in nonlocking plates group. The difference was found to be statically significant (P value = 0.01). Elbow flexion/extension arc of motion at one year was 116° ± 15° in locking plates group and 113° ± 28° in nonlocking plates. The difference was not found to be statistically significant (P value = 0.17). CONCLUSION: Both implants yield similar results, with locking plates showing slightly better clinical scores.

Calcaneal lengthening for the pes planovalgus foot deformity in children with cerebral palsy.

PURPOSE: The objective of this study was to evaluate the operative management of pes planovalgus deformity in ambulatory cerebral palsy (CP) children by calcaneal lengthening osteotomy described by Evans. METHOD: Fifteen children (10 girls and 5 boys) with average age 11 years 6 months (range, 8 years 4 months-14 years 6 months) with 22 feet with pes planovalgus (PPV) deformity were included in this study. Clinical evaluation was made according to Dogan's scale and graded as perfect, good, fair and poor. Preoperative and postoperative radiological assessment of anteroposterior talo-first metatarsal angle (AP-T1MT), anteroposterior talo-calcaneal angle (AP-TC), laterl Talo-first metatarsal angle (Lat. T1MT), lateral Talo-calcaneal angle (Lat. TC), and lateral Calcaneal pitch angle (Lat. CP) had been done for all feet. All feet were corrected with the modification of the calcaneal lengthening osteotomy described by Mosca. RESULT: Clinical results were perfect in 18 feet (82%), good in 2 feet (9%) and fair in 2 feet (9%). Radiological results showed improvement in 20 feet, while 2 feet showed no improvement. The improvement was significant in Lat. T1MT (P < 0.001), AP-T1MT (P < 0.05)., AP-TC and Lat. CP (P < 0.001, <0.001 respectively) whereas it was insignificant in Lat. TC (P > 0.05). CONCLUSION: The results of the present study showed that the procedure reliably relieves pain in PPV foot in CP children and proved effective in addressing all components of the deformity in both hindfoot and forefoot clinically and Radiologically.

Hybrid fixation for adolescent both-bones diaphyseal forearm fractures: Preliminary results of a prospective cohort study.

INTRODUCTION: Both-bone forearm fractures account for 3.4% of all pediatric fractures and 26% of all pediatric upper extremity fractures. Although non-operative management remains a feasible treatment option for children older than 10 years, they have a higher incidence for malunion due to their limited bone remodelling potential. Therefore, surgical intervention could be advocated for this age group, however the optimal method of surgical fixation in this age group remains controversial.Authors wanted to evaluate hybrid fixation (plating of ulna & elastic nail for radius) of adolescent both-bone forearm fractures in a large single-institution cohort of patients. METHODS: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from February 2016 to February 2019.A total of 60 patients (age 10-16 years) with both-bones forearm fracture were enrolled. Patients were assessed radiographically for union as well as clinically using the "Outcome Grading System" developed by Martus et al. for functional assessment of surgical management of pediatric forearm fractures using forearm rotation range of motion & complications rate. RESULTS: At final follow up for each patient (24 months) Union was achieved in all cases. Delayed union occurred in 4 patients (2 radii & 2 ulnae) with no case of combined radius & ulnar delayed union. At final follow up, the mean supination range was 81.27° ± 4.1°, while the mean pronation range was 68.17° ± 3.03°. The "Outcome Grading System" results were: 48 cases (80%) scored excellent, 10 cases (16.7%) scored good & 2 cases (3.3%) scored fair. CONCLUSION: Hybrid fixation method in adolescent both-bones forearm fracture could be a viable option in managing these injuries & may reduce the problem of ulnar non-union encountered when using elastic stable intramedullary nail (ESIN) in that age group. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty.

BACKGROUND: Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, patient-reported outcomes and joint range of motion (ROM) after ankle distraction are described. MATERIALS AND METHODS: Thirty-two patients (mean age 49 years) who underwent ankle distraction had pre-operative and one-year postoperative MRIs, which were graded using a modified whole-organ magnetic resonance imaging score (WORMS). Ankle joint space and ROM were measured. A non-validated three-item questionnaire was administered to assess functional outcomes. RESULTS: Although the anterior quadrant of the ankle showed a trend to improvement in cartilage morphology on the postoperative MRI, the WORMS did not demonstrate a significant difference in any of its subcategories. While reduction in joint osteophytes was observed and maintained short term, this was mainly due to resection intraoperatively. X-rays revealed a significant increase in joint space, and there was a significant increase in ankle dorsiflexion. Eight-seven percent of the patients were satisfied with their functional outcome. CONCLUSION: At short-term follow-up, MRI scores after ankle distraction arthroplasty did not demonstrate significant improvement despite positive changes on X-ray and improved clinical outcomes and ankle ROM. Further study on larger patient numbers with longer follow-up is required. LEVEL OF EVIDENCE: IV, Case Series. HOW TO CITE THIS ARTICLE: Haleem AM, Galal S, Nwawka OK, et al. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. Strategies Trauma Limb Reconstr 2020;15(3):157-162.

The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method).

INTRODUCTION: Femoral lengthening with or along intramedullary (IM) nails will occur along the axis of the nail coincident with the anatomical axis of the bone. In the femur particularly, such lengthening often creates lateral mechanical axis deviation as the knee is driven medially. In cases where shortening is associated with frontal plane deformity the surgeon needs to correct the deformity intra-operatively, however, subsequent lengthening along the anatomical axis will create deformity. Thus, planning for lengthening of the femur with or along IM nails, whether shortening is associated with frontal plane deformity or not, requires a completely different planning strategy. The author questioned if a resolution anatomical axis can be identified and used for planning when lengthening the femur along or with IM nails while still applying the same classic CORA deformity analysis method. METHODS: In a prospective study, the author included eight patients who needed femoral lengthening, five with associated frontal plane deformity and three without. The author identified a method to determine the trajectory of the nail in the lower femoral segment. It was done by calculating the angle enclosed between this resolution anatomical axis and the mechanical axis, also known as the anatomical-mechanical angle. RESULTS: This new method has proven to be effective in achieving normal alignment after lengthening is completed. CONCLUSION: The Resolution Axis Method is a new and alternative method providing a solution for planning when lengthening the femur along the anatomical axis using an IM nail, whether a deformity is present or not.

Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures.

OBJECTIVES: The best fixation method for open tibial fractures has long been a matter of debate, many studies have recommended the use of intramedullary nails over external fixation for treating such fractures, recent studies also showed favorable results for the use of plates in managing open tibial fractures. However, there are very few (if any) reports in the literature comparing the use of minimally invasive plate osteosynthesis to reamed intramedullary nails in the fixation of open tibial fractures. The aim of this study was to compare the safety & efficiency of minimally invasive plate osteosynthesis to reamed intramedullary nails in treating open tibial shaft fractures. DESIGN: A single-center, parallel group, prospective, randomized study. SETTING: Academic Level 1 Trauma Center, during the period from October 2014 to December 2016. PATIENTS: A total of 60 patients with open tibial fractures were randomized to reamed intra-medullary nails (R-IMN) (group A) or minimally invasive plate osteosynthesis (MIPO) (group B). OUTCOME MEASUREMENT: Patients were assessed for union (clinical & radiographic) & complications (e.g.; non-union, infection). RESULTS: No statistically significant differences were found between the 2 methods in term of the incidence of infection or non-union. Time to full union was shorter for the R-IMN group when compared to that of the MIPO group & that was found to be statistically significant. CONCLUSION: MIPO technique has equal safety to R-IMN technique in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures, as both techniques have similar rate of infection & non-union. These findings suggest that the MIPO technique can be considered a valid treatment alternative for such fractures. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient-reported outcome.

INTRODUCTION: The 5th metacarpal fractures accounts for 38% of all hand fractures given that the neck is the weakest point in metacarpals, so neck fracture is the most common metacarpal fracture. Surgical fixation is also advocated for such fractures to prevent mal-rotation of the little finger which will lead to fingers overlap in a clenched fist. Various methods are available for fixation of such fractures, like intramedullary & transverse pinning. There are very few reports in the literature comparing both techniques. Authors wanted to compare outcomes and complications of transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures. METHODS: A single-center, parallel group, prospective, randomized study was conducted at an academic Level 1 Trauma Center from October 2014 to December 2016. A total of 80 patients with 5th metacarpal's neck fractures were randomized to pinning using either transverse pinning (group A) or intramedullary pinning (group B). Patients were assessed clinically on range of motion, patient-reported outcome using the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire & radiographically. Two blinded observers assessed outcomes. RESULTS: At final follow up for each patient (12 months) the statistically significant differences were observed in operative time, the transverse pinning group showed shorter operative time, as well as complication rate as complications were observed only in intramedullary pinning group. No differences were found in range of motion or the Quick-DASH score. CONCLUSION: Both techniques are equally safe and effective treatment option for 5th metacarpal's neck fractures. The only difference was shorter operative time & less incidence of complications in transverse pinning group. LEVEL OF EVIDENCE: Level II, Therapeutic study.

Non-parallel screw fixation for femoral neck fractures in young adults.

INTRODUCTION: Current literature shows divergence of views regarding screws positioning in femoral neck fractures fixation. The goal of this study is to evaluate the efficiency of divergent screw fixation for fracture neck of femur (NOF). METHODS: The study was conducted at an academic Level 1 Trauma Center. This is a retrospective study conducted from October 2013 to October 2016. The study included 41 patients (33 males, 8 females) suffering from fracture NOF who were fixed using BDSF technique (26 within 24 h. & 15 after 24 h.). The average age was 41.5 y (23-49 y). According to Garden classification; 17 patients (41.5%) were type 4, 24 patients (58.5%) were type 3. According to Pauwel's classification; 8 cases (19.5%) were type III, 25 cases (61%) were type II & 8 cases (19.5%) were Type I. Thirty-six cases (88%) were trans-cervical, 4 Sub-capital (9.5%) and 1 (2.5%) Basi-cervical. Six patients had comminution at the fracture site. We evaluated radiographic outcomes of union, femoral neck shortening, screws back-out & femoral head avascular necrosis (AVN). We also evaluated functional outcome using the Harris hip score. Follow-up was 24 months on average (ranging from 20 to 29 months). RESULTS: One patient was lost during the follow up, the remaining 40 cases gave the following results regarding union: 38 united (within 3-4 months), 2 patients were un-united & one of them developed AVN. Twenty-seven patients (71%) had femoral neck shortening <5 mm, 8 patients (21%) had shortening 5-10 & 3 patients (8%) had shortening >10 mm. Shortening was on average 3 mm (0-15). Screws back-out distance was on average 4 mm (0 to16). Patients with mild femoral neck shortening had Harris hip score of 96 on average (92-100), those with moderate shortening had a score of 75 on average (72-79), those with severe shortening had a score of 62 on average (56-68). CONCLUSION: The Authors believes this method provides better union rate & less incidence of femoral neck shortening than that of the conventional inverted triangle screws configuration reported in literature. However multi-center studies & long term follow-up is needed to fully evaluate this method.

Dynamic locked plating for fixation of distal femur fractures using near- cortical over-drilling: Preliminary results of a prospective observational study.

INTRODUCTION: Nonunion after locked plating of distal femur fractures is not uncommon. Authors wanted to assess if "Dynamic" locked plating using near-cortex over-Drilling technique would provide a mechanical environment the promotes callus formation, thereby avoiding non-union encountered when applying locked plates with the conventional method. METHODS: This study was conducted at an academic Level 1 Trauma Center. This is a prospective study conducted from November 2015 to November 2016. Follow-up was 10 months on average (ranging from 8 to 12 months). The study included 20 patients with 20 fractures (13 males, 7 females). The average patients' age was 41.2 years (18-64 years). According to the Müller AO classification of distal femur fractures (33A-C) there were 15 cases with extra-articular fractures (AO 33A), 5 patients with intra-articular fractures (AO 33C). Dynamic Locked plating using near-cortical over-drilling technique was done for all patients. Two blinded observers assessed callus score on 6-week radiographs using a 4-point ordinal scale. A 2-tailed t-test. Two-way mixed intra-class correlation testing was performed to determine reliability of the callus measurements by the 2 observers. RESULTS: All patients achieved union, time to union was 13.4 weeks on average (range form 8-24 weeks). Delayed union was observed in 2 patients. The average callus score for fractures was 1.8 (SD 0.6). All fractures united in alignment except 1 fracture which united in valgus malalignment, the deformity was appreciated in the postoperative radiographs. No wound related complications, no loss of reduction, no catastrophic implant failure or screw breakage were detected. CONCLUSION: Dynamic locked plating using near-cortex over-drilling is a simple technique that uses standard locked plates that promotes callus formation when used for fixing distal femur fractures.

Toll Like Receptor 3 Polymorphisms in Hepatitis B Virus Infection.

Hepatitis B virus (HBV) is the one of the major causes of chronic liver disease. Individuals exposed to HBV show wide spectrum outcomes including immunized persons, asymptomatic carrier, chronic active hepatitis, cirrhosis and HCC. The outcome of HBV infection and the severity of associated liver diseases are determined by the nature and strength of host immune responses against the virus. There is accumulating evidence that the innate branch of the host immune system plays an important role in the control of HBV infection. Various components including toll-like receptor (TLR) contribute to this nonspecific innate immune response .TLR3 play an important role in innate immune response against viral pathogens. Single nucleotide polymorphisms (SNPs) in the TLR3 could be considered as factors for the susceptibility to viral pathogens including HBV. This study aimed to investigate the distribution of six SNPs of the TLR3 gene in patients infected with HBV and to determine the relation between these SNPs and the clearance of hepatitis B virus. These SNPs were tested by direct sequencing. Three groups were investigated: chronic HBV carrier (25 patients), chronic active HBV carrier (16 patients) and 13 persons who were previously exposed to HBV and became immunized. These 3 groups were examined for six SNPs (rs5743311, rs5743312, rs5743313, rs5743314, rs5743315, and rs78726532). The analysis showed high frequencies of GCTCCA haplotype and CCA haplotype in the immunized group when compared to chronic hepatitis B groups (P < 0.05). These findings indicate that genetic variations in the TLR3 gene could affect the outcome of HBV infection.

Percutaneous multiplanar subtrochanteric osteotomy with external fixation for developmental coxa vara (preliminary results).

Developmental coxa vara (DCV) develops during early childhood between the age of independent walking and 6 years. The deformity includes a decrease in the neck-shaft angle and femoral retroversion. Recently, good results have been reported using external fixator systems for the correction of proximal femoral deformities secondary to slipped capital femoral epiphysis, Perthes' disease in children, and percutaneous proximal femoral osteotomy for coxa vara. This preliminary study was performed to evaluate the results of percutaneous subtrochanteric osteotomy in restoring the normal alignment and orientation (radiographic outcome), thereby restoring the normal mechanics of the hip joint, overcoming shortening of the limb, and re-establishing the length-tension relationship of the abductor muscles (functional outcome). During the period between January 2009 and January 2012, a prospective study was conducted involving 30 (33 hips) patients with DCV and a preoperative Hilgenreiner's epiphyseal angle of 60° or greater on coronal radiographs. Clinical and radiological (anteroposterior radiograph of the pelvis) evaluation of patients was carried out preoperatively and postoperatively until union was achieved and fixator removal was carried out, and then at 6 months and at the final follow-up, with a minimum of 12 and a maximum of 33 months after surgery and an average of 20.8 months. We used the technique described by Sabharwal and colleagues (2005) to perform an acute, opened wedge subtrochanteric valgus-flexion-derotation femoral osteotomy using a percutaneous multiple drill hole technique. A low-profile Ilizarov external fixator was applied in each case. The average operative time (including anesthesia time) was 74 (range 60-130) min. The average time spent in the external fixator until union was 11 (range 7-15) weeks. The average intraoperative blood loss was 35 (range 10-150) ml, and no patient developed hemodynamic instability or required any postoperative blood transfusion. The hospital stay averaged 1.2 (range 1-2) days. Hilgenreiner's epiphyseal angle preoperatively averaged 70.6° (ranging from 55° to 90°). At 6 months it averaged 40.6° (ranging from 15° to 60°). At final follow-up it averaged 41.16° (ranging from 15° to 60°). Percutaneous subtrochanteric osteotomy with external fixation appears safe and effective in treating multiplanar proximal femoral deformities associated with DCV in children. LEVEL OF EVIDENCE: Level IV.

External fixation of paediatric subtrochanteric fractures using calcar rather than neck pins.

UNLABELLED: Subtrochanteric femoral fractures in children are uncommon and have received limited attention in the literature. Its treatment is controversial, and different options are available: traction, spica casting, internal fixation and external fixation. The aim of this study is to present our results with external fixation of subtrochanteric femoral fractures in children using Ilizarov frame. Between January 2012 and January 2014, 14 patients with closed subtrochanteric femoral fractures were treated in Cairo University School of Medicine Teaching Hospital. The average age at the time of injury was 6.4 years (range 3.8-11.5 years). Pathological fractures and fractures associated with neuromuscular diseases were excluded from this study. Two patients were multiply injured with abdominal injuries (as ruptured spleen). In all cases, a low profile Ilizarov frame was inserted using two half pins inserted proximally from greater to lesser trochanters parallel to the hip joint orientation line (line between tip of greater trochanter and femoral head centre) and secured to an arch, and another three half pins were inserted distally perpendicular to the femoral shaft and secured to an arch that was connected by three rods to the proximal arch. No post-operative spica was used. Average follow-up was 18 months (range 12-36 months). All fractures united with anatomical alignment within an average of 8 weeks (range 6-12 weeks). There were no deep infections and no significant limb length discrepancies. At the latest follow-up, no patient had any restriction of activities. External fixation with a low profile Ilizarov frame appears as a good treatment option for subtrochanteric femoral fractures in children. LEVEL OF EVIDENCE: Level IV.

Diagnostic Role of RASSF1A and p16INK4a Promoter Gene Hypermethylation in Serum DNA of Lung Cancer Patients: Clinicopathological Significance.

The most common inactivation mechanism of tumor suppressor genes, RASSF1A and p16INK4a, in lung cancer is hypermethylation. We detected the methylation status of RASSF1A and p16INK4a in serum of lung cancer patients using methylation-specific PCR and analyzed their clinicopathological significance. Each of RASSF1A and p16INK4a hypermethylation was detected in 31.1% cancer patients but not in benign lung lesion patients. Hypermethylation was preferentially observed in small cell lung cancer (SCLC) for RASSF1A (50%), but not for p16INK4a. In non-small cell lung cancer (NSCLC), RASSF1A and p16INK4a hypermethylation were found in 27% and 37.8% respectively. Hypermethylation of RASSF1A was not correlated with clinicopathological character. While, p16INK4a hypermethylation was associated with age >60 years, smoking and squamous cell carcinoma (SCC) (P = 0.033), but not with gender and pathological stages of NSCLC. Sensitivity and specificity of each gene were 31.1% and 100% respectively and the sensitivity improved with evaluation of a combination of the two genes (55.6%). These findings suggest that serum RASSF1A and p16INK4a hypermethylation are promising diagnostic method for detection of lung cancer. As regard the clinicopathological characteristics, p16INK4a hypermethylation may provide a more specific approach than RASSF1A hypermethylation.

Endoscopic removal of foreign bodies from the upper gastrointestinal tract: 5-year experience.

BACKGROUND: Foreign bodies (FBs) in the upper gastrointestinal tract are produced chiefly by accidental swallowing but rarely produce symptoms. Removal of FBs is not an infrequent challenge for upper gastrointestinal endoscopy. The aim of this study is to elicit our experience in a 5-year period in dealing with FBs in the upper gastrointestinal tract using upper endoscopy. METHODS: This retrospective study was conducted at Zagazig University Hospitals, Egypt, over a 5-year period. We reviewed all patients' files with full notations on age, sex, type of FB and its anatomical location, treatments, and outcomes (complications, success rates, and mortalities). Patients with incomplete files and those with FBs not identified at the endoscopic examination were excluded. RESULTS: A total of 45 patients were identified. Their ages ranged from 6 months to 102 years. Slight male predominance was noticed (53.3%). The most frequent presentation was a history of FB ingestion without any associated manifestations (44.4%). Coins were the most commonly encountered FBs (14/45). Esophagus was the most common site of trapping (27/45). The overall success rate was 95.6% (43/45). Upper endoscopy successfully resolved the problem by either FB removal (41/43) or dislodgment of the impacted fleshy meat to the stomach (2/43). Two cases were referred for surgical removal. The rate of complications was 6.7%. Furthermore, no mortalities due to FB ingestion or removal had been reported throughout the study. CONCLUSION: Our experience with FB removal emphasizes its importance and ease when performed by experienced hands, at well-equipped endoscopy units, and under conscious sedation in most cases, with high success rates and minor complications.

Single nucleotide polymorphism T869C of transforming growth factor-beta 1 gene and systemic lupus erythematosus: association with disease susceptibility and lupus nephritis.

Transforming growth factor ß1 (TGF-ß1) has a large role in the control of autoimmunity. Single nucleotide polymorphisms (SNP) in the promoter of TGF-ß1 cytokine gene are known to alter the production of this important cytokine. Decreased levels of TGF-ß1 may contribute to systemic lupus erythematosus (SLE) susceptibility, activity and organ damage. Lupus nephritis (LN) occurs in more than one-third of patients with SLE. In this study we measured serum levels of TGF-ß1 and assessed TGF-ß1 single nucloetide polymorphism (SNP) at codon 10 (T869C) in Egyptian SLE population in order to verify whether there is a relationship between this polymorphism, serum level of TGF-ß1, SLE susceptibility, clinical manifestations and lupus nephritis. We studied 56 consecutive SLE female patients and 40 healthy female volunteers as control group. Serum levels of TGF-ß1 were measured by enzyme-linked immunosorbent assay (ELISA) and the polymorphism of the TGF-ß1 gene, T869C was analyzed using the method of amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The genotype and allele frequencies of T869C of the TGF-ß1 gene did not differ between SLE patients and healthy controls. Serum levels of TGF-ß1 were significantly reduced in patients with SLE as compared with levels in healthy controls (P < 0.001). The genotype and allele frequencies of T869C of the TGF-ß1 gene did not differ between SLE patients with lupus nephritis (LN) and SLE patients without LN. Lower levels of TGF-ß1 were found in patients with LN than in patients without LN. TGF-ß1 was significantly decreased in TT group than in CC and TC groups (P < 0.001). No significant correlation was found between serum TGF-ß1 level, SLEDAI scores and clinical manifestations. In conclusion, these results suggest that T869C polymorphism of the TGF-ß1 gene is not associated with SLE disease susceptibility and specific clinical manifestations. However, this polymorphism may lead to the production of low serum level of TGF-ß1 especially with TT genotype and consequently plays an important role in the development of renal damage.