Juxta-renal varicocelectomy for recurrent varicocele following retroperitoneal operation.

Two patients with recurrent painful left varicocele following retroperitoneal varicocelectomy were subjected to juxta-renal varicocelectomy by a transverse supraumbilical incision. Ligature of the testicular vein was carried out just below the renal vein. Minute periarterial veins were disrupted by desheathing the testicular artery. Both patients were cured of their varicocele as judged by scrotal ultrasonography and by color duplex ultrasonography. Average follow-up period was 5 months.

'Squeeze delivery' excision of subcutaneous lipoma related to anatomic site.

A small cosmetic incision followed by 'squeeze delivery' was attempted for 190 lipomas in 116 patients. This technique was successful without resort to widening of the incision or using scissor dissection in 87 lipomas (46 per cent). Success was not related to size but to the site of the lipoma. The success rate was 100 per cent for excision of lipomas in the forearm and leg.

The storage effects of calcium-fortified orange juice concentrate in different packaging materials.

Orange juice concentrate has been fortified with calcium in order to fulfil part of the recommended daily allowance of calcium and to overcome the problem of the shortage of milk and dairy products in Egypt. The loss of quality of calcium-fortified and unfortified orange juice concentrate was evaluated in three different packaging materials and when stored for ten weeks at room temperature. The results showed that vitamin C content decreased during storage for both the fortified and the unfortified samples. The trend of ascorbic acid breakdown was similar in all packaging treatments. The total titratable acidity declined during storage period; however, the decline was higher in the unfortified sample than in the fortified one. Also, the pH values increased along with the storage period. The results illustrated that the color values of both the fortified and unfortified diluted orange juice concentrate changed little at the end of the storage period. However, the samples packaged in low density polyethylene bags had the higher orange in the color values R and Y. The changes in the iron content for both samples was negligible during the storage period. However, a very slight change in the calcium content (4.5% and 4%) was observed after ten weeks of storage for both the unfortified and the fortified samples respectively. The acceptability of fortified orange juice rated higher than the unfortified one. The panelists' evaluation values were affected by the packaging treatment and storage time. The samples packaged in low density polyethylene bags had a higher level of decline of the panelists' evaluations than the ones packaged in laminated pouches or cans, while the latter had a lower level of decline.

Treatment of human scabies by sulfur and permethrin.

Scabies is one of the most important prevalent contagious disease caused by itch mite "Sarcoptes scabiei." Many effective scabiecides have been suggested and tried. They differ in their side effects since they are applied on diseased skin sometimes all over the body. In this paper, sixteen parasitologically proved human scabies were successfully treated by 5% sulfur precipitate and 2.5% permethrin. Application of sulfur for one week or 2 applications of permethrin followed by a third one a week later proved to be safe and effective. The one week course of sulfur and the third application of permethrin acts against any emerging immature stages of the mite.

Serum immunoglobulin and complement values in scabietic patients.

Immunity entails all the forces concerned with recognition, specific reaction and removal of foreign bodies after they again access into the body of the host. The immune system interacts with genetics and infectious agents as well as with metabolic, endocrine and environmental factors. The serum immunoglobulins (G.M.A. & E.) and complement (C3 and C4) were estimated in sixteen parasitologically proven patients with scabies. The causative agent was Sarcoptes scabiei. The results showed a high significant increase in the mean average of IgG., IgM. and in particular IgE pretreatment than in patients three months after treatment and in patients after treatment than in controls. On the other hand, there was a significant decrease in the mean average in the mean average of IgA after treatment was insignificant compared with controls. The C3 and C4 showed no significant changes in the mean average in the patients before or after treatment compared with controls. The changes in the IgG., IgM. and in particular IgE. may be specific reaction to the parasite or a non specific one to the dead parasite or its faeces or even to a secondary infection developed. On the other hand, the decrease in the IgA. may be due to the mite or its products which interfere with its synthesis. It is concluded that scabies is associated with a humoral immunological response against the mite infestation.

Clinical and parasitological aspects on human scabies in Qualyobia Governorate, Egypt.

In the last decade, human scabies caused by Sarcoptes scabiei and other non human strains is one of the most common contagious parasitic disease. Over a period of one year (June 1991--May 1992), a total of 200 scabietic patients were diagnosed in the outpatients' clinic of Dermatology and Venereology, Benha University Hospitals. They were 120 females and 80 males (sex ratio = 1.5:1). Their ages ranged between three months up to 70 years old. Most of the patients were parasitologically positive (160 or 80%). The most common signs and symptoms were itching, skin burrows, scratch markings, papules and pustules. Regional lymphadenitis was sometimes present as well as fever in patients with secondary bacterial infection. The most affected sites were the abdomen (100%), followed by the buttocks (81.3%), the thigh (50%), legs (50%) and the arms and web spaces (62.5%). The male external genitalia was infested in 60% and the female breast was infested in 72.7%. The sex and site distribution of the infestations were attributed to the risk factor of exposure to infestation. The patients were successfully treated with 5% sulfur precipitate and 2-5% permethrin. The whole results were discussed on the light of the previous work.

Two indigenous cases of cutaneous leishmaniasis in Qualyobia Governorate, Egypt.

This paper reports two indigenous cases of cutaneous leishmaniasis for the first time in Kafr Shokr, Qualyobia Governorate. One of the two cases was misdiagnosed as cutaneous tuberculosis (primary complex) and was kept on TB treatment, but with no clinical improvement. The two patients were successfully treated with sodium stibogluconate (pentostam).

Accuracy of ultrasound in the diagnosis of nonfunctioning kidneys.

The accuracy and reliability of ultrasound were assessed in 246 patients with 338 radiologically nonfunctioning renal units. The causes of nonfunction included hydronephrosis, pyonephrosis, renal parenchymal disease, renal agenesis, renal neoplasm and polycystic disease. Obstruction was proved in 158 patients, with an accuracy of 98.1 per cent. Retrograde pyelography was avoided. The diagnosis of a small end stage kidney was correct in 42 patients. In 9 patients with a unilateral nonfunctioning kidney less than 9 cm. long a thin coarsely textured cortex with dilatation of 1 or more calices was found. To our knowledge the presence of dilated calices in a small kidney, suggestive of chronic pyelonephritic changes, has not been described previously by ultrasound. Nonvisualization occurred in 16 cases (4.7 per cent) despite the anatomical presence of a kidney. An advanced degree of pyonephrosis with thick inspissated pus sometimes may mimic the ultrasonic appearance of a renal neoplasm.

Ultrasonography and amoebic liver abscesses.

Twenty-four patients were admitted to Kasr-El-Aini Hospital with suspected diagnoses of amoebic liver abscesses. The patients underwent clinical examinations, stool specimen analyses for cysts and trophozoites of Entamoeba histolytica, radiologic examinations, and routine liver function tests. In one patient, a liver scintiscan was obtained. Ultrasonographic examination was performed on all patients using the gray scale imaging technique. In 20 patients, the diagnoses of amoebic liver abscesses were demonstrated by ultrasonographic examination. In 19 patients, amoebic liver abscesses were verified by aspiration biopsies (95%), and one patient had a false-positive result. This false-positive result was due to a degenerated hepatoma, demonstrated by aspiration biopsy. Of the 19 patients, 12 patients (63.12%) had right lobe abscesses and seven (36.89%) had left lobe abscesses. The site, size and nature of the pus contained in the abscess could be determined by ultrasonographic examination and, therefore, helped in the management and technique of the aspiration biopsy. In addition, follow-up data could be more detailed using ultrasonographic examinations. Ultrasonographic examination is a noninvasive, safe, accurate, and rapid method of diagnosis, and is highly recommended as a routing procedure in all cases of suspected amoebic liver abscesses in the pre- and posttreatment stages of the disease. It is also recommended as an indicator of complete cure at follow-up examination.

Circumcaval ureter: a report of four cases in children with a review of the literature and a new classification.

4 cases of circumcaval ureter presenting in childhood are reported. A review of the literature reveals that most cases recieve attention only later in life at a time when ureteric changes are not so readily reversible. A study of the course of the ureter reveals that 2 forms can be distinguished: a common Type I with a slter reveals that 2 forms can be distinguished: a common Type I with a low loop and kinking of the proximal ureter producing obstruction and a rare Type II with a high loop where there is no kinking and no obstruction. Ureteric remodelling on the ordinary principles formulated for congenital obstructions can give good results.

The prognosis of pelviureteric obstruction in childhood: a review of 190 cases.

190 children with pelviureteric obstruction are reviewed. Their symptoms are analysed and the pre- and post-operative radiographic appearances are assessed. The results are very encouraging with a clinical improvement in the majority of patients, free ureteric drainage in almost all and an improvement in the calyceal pattern in 65.9%.

Urethral duplications in the male.

A classification of duplications of the male urethra has been presented together with our clinical experience. The commonest variety is epispadiac form which may be complete, incomplete or abortive. Less common are the hypospadiac forms and very much rarer are the spindle urethras where the bladder neck and also the distal urethra are single. The bifid urethra with pre-anal accessory track is relatively common but has often gone unrecognised.

Sexual function in hypospadiacs.

The sexual function of 82 patients treated for hypospadias was assessed. It was concluded that the sexual function in these patients was unsatisfactory only following incomplete or incorrect surgery. The aim of surgery should be to achieve a straight penis with an adequate urethral lumen and a urethral orifice situated at the tip of the glans. Proper assessment of chordee and meticulous care in surgical technique are the prerequisites for success. They are the only preventive measures of the physical, psychic, sexual and social handicaps to which hypospadiacs are subjected.