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   2017| April-June  | Volume 30 | Issue 2  
    Online since September 25, 2017

 
 
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ORIGINAL ARTICLES
The role of progesterone in comparison with calcium channel blockers in the prevention of preterm birth in women with a short cervix
Mohamed M Fahmy, Alaa M Abdelgayed, Ragab M Dawood, Eman S Abdelaty
April-June 2017, 30(2):333-337
DOI:10.4103/1110-2098.215447  
Objective: The objective of this study was to compare between vaginal progesterone and calcium channel blockers(CCBs) in the prevention of preterm labor in patients with a short cervix. Background Preterm birth(PTB) is defined by the WHO as onset of labor before 37 completed weeks of gestation. The incidence of PTB is variably reported between 5 and 11% of all births, and its prevention continues to remain elusive, with many reports indicating an increase in the prevalence of PTB over recent years. Patients and methods One hundred fifty pregnant women were arranged in three groups: placebo group; the CCB group, in which patients received nifedipine 20mg four times daily; and the progesterone group, in which patients received 200mg of micronized vaginal progesterone daily. Results There were statistically significant differences between progesterone and CCB regarding the prevention of PTB and treatment of PTB, with a P value of 0.000; a higher number of women experienced improvement in the progesterone group, with 60% of women having no PTB and only 6% having very early pretermbirth. Conclusion Vaginal progesterone was better than nifedipine in the prevention and treatment of PTB in women with a short cervix.
  283 63 -
Comparative study using cyclosporine A 0.05% eye drops, autologous serum 20% eye drops, and combined use of cyclosporine A 0.05% eye drops and autologous serum 20% eye drops in the treatment of moderate to severe dry eye
Mohammad A Al-Sayed Ahmad Kasper, Hassan G Farahat, Osama A Al-Morsy, Ahmad A Alhagaa
April-June 2017, 30(2):525-531
DOI:10.4103/1110-2098.215461  
Objectives A comparative study was carried out between the cyclosporine A 0.05%, the autologous serum, and combined therapy of both in the treatment of moderate to severe dry eye. Background Dry eye disease is a common and often underdiagnosed condition. Patients and methods A prospective interventional case study was carried out on 30patients attending the ophthalmology outpatient clinic of Menoufia University; these patients were subdivided as follows: groupA received topical autologous serum 20% four times daily for 2months, groupB received cyclosporine A emulsion 0.05% twice daily for 2months, and groupC received topical cyclosporine A emulsion 0.05% two times daily and topical autologous serum 20% four times daily for 2months. The three groups received nonpreserved tears up to five times daily, to be followed 1month after stoppage of treatment, except for nonpreserved tears(Refresh Plus). All patients were subjected to a full assessment of history, slit-lamp examination, lissamine green staining of the ocular surface, the tear break-up time test, Schirmer's test, and conjunctival impression cytology before treatment, at 1 and 2months after treatment, and then 1month after stoppage of treatment. The results obtained were subjected to a statistical analysis. Results In our study, we found that autologous serum eye drops had a more delayed onset of action, but more sustained action; topical cyclosporine A had a rapid onset of action, but regression occurred soon after stoppage of treatment. Both autologous serum and cyclosporine 0.05% had additive effects with a rapid sustained action. Conclusion Combined topical cyclosporine A emulsion 0.05% and autologous serum eye drops 20% are effective in the treatment of dry eye cases through their combined anti-inflammatory and epitheliotropic effects. Therefore, we recommend the use of combined autologous serum 20% and cyclosporine 0.05% in the treatment of severe dry eye.
  277 23 -
The role of sildenafil citrate(viagra) suppositorieson endometrial response(thickness and mean resistance index of endometrial spiral artery) in cases of unexplained infertility
Shahinaz El-Shourbagy, Ahmed M. E. Ossman, Ashraf El-Mohamady
April-June 2017, 30(2):343-349
DOI:10.4103/1110-2098.215451  
Objective The oblective of this study was to evaluate the endometrial response of women with unexplained infertility after treatmentwithsildenafil citrate(viagra) suppositories. Background Unexplained infertility refers to failure to conceive in a couple with no definitive cause. Endometrial thickness(ED TH) and perfusion may have an important contribution to etiopathogenesis of unexplained infertility. Patients and methods A total of 50 women with unexplained primary infertility were treated with 25mg of sildenafil citrate suppositories four times per day for 7days starting from the fifth day of the menstrual cycle for three cycles. Ultrasonographic measurement of ED TH and the mean resistance index(RI) values of endometrial spiral artery(SA) assessed by transvaginal color-pulsed Doppler ultrasound were measured in women with unexplained infertility before and after sildenafil citrate treatment and compared with an equal number of a fertile control group receiving no treatment. The conception rate and pregnancy outcome were recorded in the two groups. Results Women with unexplained infertility in the present study had a significantly thinner endometrium and a higher SA-RI(6.52+0.77; 1.00+0.23mm, respectively), meaning lower peri-implantation blood flow compared with fertile controls(11.98+1.23; 0.58+0.06mm, respectively). Sildenafil citrate-treated women showed a statistically significant increase in ED TH(8.87+0.56mm; P <0.001) and a significant decrease in the mean SA-RI(0.61+0.07; P <0.001), yielding a better conception rate. Conclusion Treatment with viagra suppositories enhances endometrial blood flow by decreasing the SA-RI and consequently improves endometrial growth and receptivity in cases of unexplained infertility, thus yielding a better conception rate.
  242 52 -
Multiple ultrasonographic parameters and fetal fibronectin measurement for prediction of preterm labor at risk
Ahmed N Eissa, Osama A El Kilani, Ahmed M Amer
April-June 2017, 30(2):338-342
DOI:10.4103/1110-2098.215445  
Objective The present study was conducted to evaluate cervical length measurement, placental score, and amniotic fluid volume by ultrasound, and the level of fetal fibronectin(FFN) between 24 and 34weeks of gestation as predictors of preterm labor. Background Spontaneous preterm birth continues to be the major contributor to perinatal morbidity and mortality. Early detection of preterm labor is difficult because initial symptoms and signs are often mild and may occur in normal pregnancy. The traditional criteria for preterm labor(persistent contractions accompanied by progressive cervical dilatation and effacement) are most accurate. Other means have been thought to detect preterm labor early. These include ultrasound examination of the cervix to measure the cervical length, measurement of amniotic fluid index, and detection of FFN in the cervicovaginal sample. Patients and methods This study was carried out on 80 pregnant women attending the antenatal care clinic of Kafr El-Dwar General Hospital from July 2014 to April 2015. The patients were divided into two groups: group one(50cases), which included patients who have no history of unexplained preterm labor, and group two(30cases), which included patients who have a history of unexplained preterm labor. Patients were followed up for the occurrence of preterm labor pain. Full complete history was taken from all cases, and then general examination was done for them. FFN testing and transabdominal and transvaginal ultrasound examination between 24 and 34weeks of gestation with assessment of cervical length, fetal viability, number, fetal biometry(biparietal diameter, femur length, abdominal circumference), placenta(score, site, and maturity), and amniotic fluid(amount and turbidity) were performed. Results The results of this study revealed that the risk of preterm delivery(PTD) is inversely correlated with cervical length. Routine transvaginal scan of the cervix performed between 24 and 34weeks helped to identify patients at risk of PTD; women with oligohydramnios are found to be liable to develop preterm labor. Assay of FFN in cervicovaginal secretions has proven to be a valuable test in the prediction of spontaneous PTD. Conclusion The first step in the prevention of preterm labor is early identification of women at risk for preterm birth by the use of ultrasonography to detect cervical length and amniotic fluid volume and by the detection of FFN in cervicovaginal secretion.
  227 50 -
Hyoscine butylbromide for shortening of the first stage of labor in primigravid women
Mohamed A Kandil, Tarek M Sayyed, Ehab M El-Mallah, Mohamed A Rezk, Hasnaa M Zidan
April-June 2017, 30(2):350-355
DOI:10.4103/1110-2098.215455  
Objectives The aim of this work was to study the efficacy of hyoscine butylbromide(HBB) for shortening of the first stage of labor in primigravid women. Background Prolonged labor is one of the most important risk factors for perinatal compromise and, if caused by obstructed labor, it carries the risk for uterine rupture, postpartum hemorrhage, puerperal sepsis, and maternal death. Patients and methods The study was a randomized, double-blinded, controlled trial. One hundred and ten primigravid term pregnant women in spontaneous labor received either HBB or a placebo intramuscularly once the women entered the active phase of labor. The primary outcome measured was the duration of the first stage of labor. Secondary outcomes were the duration of the second and third stages of labor, blood loss at delivery, rate of cesarean section, and Apgar scores for the neonates. Results A total of 110 women yielded data for analysis. Of them, 55 women received HBB and 55 received placebo. The mean duration of the first stage in the study group was 208.16±17.24min, compared with 258.16±15.27min in the control group; there was a highly significant statistical difference(P=0.00). There were no significant changes in the duration of the second stages of labor(P=0.09). There were no significant changes in the duration of the third stages of labor (P=0.16). There were no significant statistical differences in blood loss or Apgar scores. There was no significant statistical difference in the cesarean section rate or instrumental delivery. Conclusion HBB is effective in significantly reducing the duration of the first stage of labor and is not associated with any apparent short-term adverse outcomes in the mother or neonate.
  81 29 -
Improving esthetic outcome of facial scars by fat grafting
Fouad Ghareeb, Dalia M Elsakka, Yahia Alkhateep, Hossam M Zayed
April-June 2017, 30(2):412-419
DOI:10.4103/mmj.mmj_718_16  
Objective The aim of this study was to evaluate the effects of different techniques of fat grafting on improving the esthetic outcome of facial scars. Background Control of facial scarring is one of the most difficult challenges in surgical practice, and represents a difficult therapeutic problem facing plastic surgeons to achieve good results. To date, no gold standard exists for the treatment of scar tissue. Autologous fat grafting has been introduced as a promising treatment option for scar tissue-related symptoms. However, the scientific evidence for its effectiveness remains unclear. Patients and methods This study was conducted on 30patients with obvious facial scars. Patients' age ranged from 8 to 48years. Patients were selected randomly to be treated with fat grafting. The abdomen and thigh were the most commonly chosen donor sites. Fat was processed to be injected at the dermohypodermal junction(microfat grafting) or intradermal injection(nanofat grafting) was used. Results Fat grafting proved to have a significant role in scar remodeling. This was measured clinically by the Vancouver Scar Scale. Regarding patient satisfaction with cosmetic appearance, 15cases were evaluated as excellent, eight cases were evaluated as good, and five cases were evaluated as fair. Conclusion Autologous fat grafting has a significant role in facial scar remodeling and provides a beneficial effect on facial scar tissue and scar-related conditions with not only esthetic results but also functional results. Significant improvement in scar appearance, skin characteristics, and restoration of volume and three-dimensional contour is reported.
  87 19 -
Impact of vacuum-assisted closuredevice in the treatment of sternal wound infection
Awatef Farghaly, Amr Allama, Medhat Nashy, Khaled A Sha'aban
April-June 2017, 30(2):405-411
DOI:10.4103/1110-2098.215471  
Objective The aimof this study was to evaluate the effectiveness and clinical outcome of vacuum-assisted closure(VAC) therapy in the treatment of sternal wound infection(SWI) as either a sole therapy or as a bridge for other reconstructive procedures. Background VAC therapy is a novel treatment employed to aid wound healing in different areas of the body and recently also in SWI after cardiac surgeries. Patients and methods Our study is a prospective nonrandomized study conducted on 30patients who developed either superficial or deep SWI after cardiac surgeries. These patients were undergoing VAC therapy as a sole therapy or as a bridge for other reconstructive procedures. Results The mean duration of VAC therapy was 12.7(range: 4–27) days. The mean length of hospital stay was 27(range 14–65) days.Twenty-nine(95%) patients were treated successfully. Hospital mortality occurred in one(3.33%) patient because of septic shock and multiple organ failure. At the end of VAC therapy, the mean reduction in wound size was 34.3%. The mean granulation tissue formation was 64%. VAC therapy was used as definitive therapy in 63.33% and as a bridge to conventional methods in 33.3% of cases. Conclusion VAC is a safe, reliable, and relatively new option for the treatment of devastating SWI after cardiac surgery. It is important to find a strategy that may be used as a 'standard VAC therapy approach' if identified in the future. Finally, we conclude that VAC therapy should be considered as a first-line treatment for most SWI.
  59 42 -
Comparisonbetweenfasting and nonfasting lipid profile in patients receiving treatment with statin therapy
Walaa F Abdel-Aziza, Ghada M Soltana, Ahmed M Ahmed Amer
April-June 2017, 30(2):614-618
DOI:10.4103/1110-2098.215443  
Objectives The aim of this study was to assess the effect of ordinary meal on the lipid profileofpatients receiving statin therapy. Background The lipid profile is an essential investigation for the patient who comes to cardiology outpatient clinic. Numerous guidelines recommend sampling in the fasting state for cardiovascular risk assessment. Fasting for 12–14h is not only cumbersome and unpleasant for patients, but may result in limited compliance to disease monitoring and treatment. Patients and methods This study was performed on 100patients with dyslipidemia receiving statin therapy whose doses had not changed for 2 or more months(group I), and 100patients with dyslipidemia not receiving statin therapy(group II). Lipid profile was determined for fasting and postprandial statuses. Results The lipid profile parameters in both groups in fasting and postprandial statuses were compared. In group I, the mean fasting serum triglyceride level was 176.21mg/dl and mean postprandial serum triglyceride level was 213.49mg/dl(P=0.0001); the mean fasting low-density lipoprotein(LDL) level was 161.19mg/dl and mean postprandial LDL was 159.25mg/dl (P=0.184). In group II, the mean fasting serum triglyceride level was 231.06mg/dl and mean postprandial triglyceride level was 284.60mg/dl(P=0.005); the mean fasting LDL was 185.18mg/dl and mean postprandial LDL was 181.32mg/dl(P=0.871). Conclusion Finally, from this study we found that there is no significant clinical difference between fasting and nonfasting levels of total cholesterol, high-density lipoprotein, and LDL. Thus, we can use the nonfasting tests to follow-up the dyslipidemic patients.
  78 21 -
Meanplatelet volume and serum uric acid in neonatal sepsis
Ghada M El-Mashad, Hanan M El-Sayed, Mohamed S Rizk, Sally M El-Hefnawy, Tamer W El-Zayat
April-June 2017, 30(2):581-587
DOI:10.4103/mmj.mmj_608_16  
Objectives The aim of this article was to determine the role of mean platelet volume(MPV) and uric acid(UA) level in the diagnosis of neonatal sepsis. Background MPV is a measure of platelet volume; larger platelets have more granules. It reveals the presence of inflammatory burden and disease activity in many diseases. UA is one of the most important antioxidants in human biological fluids and is responsible for neutralizing more than 50% of the free radicals in human blood. For this reason, it was thought that the antioxidant effects of UA could increase the life expectancy and/or reduce the incidence of malignancy. Patients and methods This study was conducted on 80 newborns divided into two groups: group1 included 40 newborns diagnosed with neonatal sepsis and group2 included 40 healthy newborns assigned as controls. All patients in the study were subjected to adequate assessment of history, full clinical examination, complete blood count including MPV, C-reactive protein, blood culture, and serum UA level at the time of diagnosis of sepsis. Results Septic neonates showed statistically higher values of MPV and statistically lower levels of serum UA. Area under curve values for MPV and UA were 0.65.4(P=0.01) and 0.69(P=0.001), respectively. The diagnostic cut-off values of MPV and UA for neonatal sepsis were 7.85 fl and 5.8mg/dl, respectively. Conclusion MPV and UA should be assessed in the early diagnosis of neonatal sepsis.
  66 27 -
Study of Apa-I vitamin D receptor gene polymorphism in patients with hepatocellular carcinoma
Rawhia H El-Edel, Mohamed S Mostafa, Belal A Montaser, Yasmen A El-Hag Ali
April-June 2017, 30(2):619-625
DOI:10.4103/mmj.mmj_673_16  
Objective The aim of this study is to study vitamin D receptor(VDR) Apa-I gene polymorphism in patients with hepatocellular carcinoma(HCC) infected with chronic hepatitis C. Background HCC is a global problem. In Egypt, it is one of the major health problems facing the health authorities. Several major risk factors of HCC have been identified, including chronic infection of hepatitis B virus and hepatitis C virus. Nevertheless, only a fraction of infected patients develop HCC during their lifetime suggesting that genetic factors might modulate HCC development. Consequently, identification of additional genetic factors affecting transcription of specific regulatory genes could help to select high-risk populations. Patients and methods This study was conducted on 120patients between February 2015 and February 2016:40patients with HCC and 40patients with liver cirrhosis without any radiological evidence of HCC, who presented to the Hepatology Department, National Liver Institute, Menoufia University, along with 40 age-matched and sex-matched healthy controls. Vitamin D receptor Apa-I gene polymorphism was determined by PCR-restriction fragment length polymorphism. Results Our study revealed significant statistical difference between patients with HCC and those with liver cirrhosis also between patients with HCC and control group regarding VDR gene Apa-I polymorphism. In HCC group, there was also significant statistical difference between the studied Apa-I VDR genotypes and α-fetoprotein, tumor size, and serum albumin. Conclusion VDR Apa-I gene polymorphism could be associated with increased risk of HCC development in chronic hepatitis C virus-infected patients.
  59 22 -
Percutaneous nephrolithotomyversusextracorporeal shock wave lithotripsy for moderate-sized kidney stones
Khaled M Aboelkher, Osama A Abd-Elgawad, Tarek M Abd-Elbaky, Eid A Elsherif
April-June 2017, 30(2):372-377
DOI:10.4103/1110-2098.215462  
Objective The aim of this study was to evaluate the effectiveness of extracorporeal shock wave lithotripsy(ESWL) with that of percutaneous nephrolithotomy(PCNL) for managing moderate-sized kidney stones measuring between 100 and 300 mm2 in area. Background Shock wave lithotripsy(SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10mm in diameter, whereas stones that are larger than 20mm are best managed with PCNL. The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy, and PCNL outcomes for intermediate-sized upper-tract calculi(100–300 mm2). Patients and methods This study was conducted at the Urology Department, Menoufia Teaching Hospital, Menoufia University, between December 2013 and February 2015. It study included all patients with moderate-sized renal calculi(range: 1–3cm) who were planned for management of renal calculi either with PCNL or with ESWL. Patient data were taken as follows:(a) preoperatively, clinical assessment and laboratory investigations;(b) during surgery; and(c) postoperatively, complications and residual stone. Results This study included 70patients with nonstaghorn calculi with an area between 100 and 300mm. Thirty patients underwent PCNL and 40 underwent ESWL; 49(70%) patients were male and 21(30%) were female; 29(41.4%) patients had right-sided stones and 41(58.5%) had left sided stones. The mean age of the patients was 34.1years and the average BMI was 29.0 kg/m2. The mean operative time in our study was 2.36±0.8h. Conclusion This study demonstrates that PCNL and up to two SWL treatments are safe and comparably effective in treating patients with intermediate-sized upper-urinary-tract stones between 100 and 300 mm2 in area.
  69 11 -
Prevalence of endometriosis in unexplained infertility and chronic pelvic pain in women attending Menoufia University Hospital
Mohamed S Gad, Alaa M Abdel-Gayed, Ragab M Dawoud, Ahmed F Amer
April-June 2017, 30(2):356-360
DOI:10.4103/mmj.mmj_415_16  
Objective The aim of the present work was to evaluate pelvic endometriosis among women with unexplained infertility and chronic pelvic pain attending Menoufia University Hospital and subjected to diagnostic laparoscopy. Background Pelvic endometriosis is a common, frequently underestimated health problem in Egypt. It is correlated with patient's age less than 30years and low parity. Patients and methods This was a prospective clinical observational study that included 50patients with unexplained infertility and 50patients with chronic pelvic pain who underwent diagnostic laparoscopy at the gynecologic Endoscopy Units, Menoufia University Hospital, from June 2014 to December 2015 to diagnose pelvic endometriosis as an etiologic factor with correlation of the different patient characteristics and the risk for endometriosis. Results Endometriosis was diagnosed by means of laparoscopy in 33patients included in this study, of which 21cases were confirmed by means of histopathological examination. There was a significant association with dysmenorrhea(P<0.02), prior pelvic surgery(P<0.03), and Cancer Antigen-125 measured using mini VIDAS(P<0.001) level in positive cases. Conclusion Endometriosis should be suspected in infertile women and patients with pelvic pain, especially those with prior pelvic surgery. Dysmenorrhea is the most leading symptom indicating endometriosis. Laparoscopy with histopathologic examination is considered the most accurate for diagnosing endometriosis.
  43 20 -
Knowledge and attitude of family physicians, pediatricians, and otolaryngologists as regards pediatric acute bacterial rhinosinsuitis guidelines in Menoufia
Ahmed A Ragab, Hala M Shaheen, Heba A Salman
April-June 2017, 30(2):602-606
DOI:10.4103/1110-2098.215456  
Objectives The aim of this study was to assess the knowledge and the attitude of family physicians, pediatricians, and otolaryngologists as regards different guidelines of acute bacterial rhinosinusitis(ABRS) management in children and causes of nonadherence to them. Background Clinical practice guidelines have been promoted as a strategy to improve the quality of patient care. However, more efforts had been expended on creating guidelines rather than on implementing them. Methods The study was a cross-sectional one. The study sample included physicians from different specialities dealing with cases of ABRS. The sample included participants from different departments(family medicine, pediatrics, and otolaryngology) from the list of attendees of related conferences. They were selected using systematic random techniques. Every third person from the list was selected. The study included 67 family physicians, 23 otolaryngologists, and 28 pediatricians. They were evaluated using a predesigned questionnaire, which included items related to diagnosis, investigations, and treatment modalities. According to their response they were classified as follows: well adherent and poorly adherent. Results The study revealed that there was no difference between different specialties as regards adherence to guidelines. Age and qualifications did not affect their adherence. Family physicians and pediatricians showed greater adherence to Infectious Disease Society of America guideline and otolaryngologists showed greater adherence to Canadian. The main causes of nonadherence were the delay in renewing guidelines and ambiguous recommendations. Conclusion The overall knowledge and attitude as regards guidelines of ABRS between different specialties was poor. Age and qualifications did not affect the adherence to guidelines. The main causes of nonadherence were lack of applicability and ambiguous recommendations.
  51 11 -
Serum ferritin and its usefulness in detecting iron deficiency anaemia among children with protein energy malnutrition: a case–control study in North Central Nigeria
Aishat O Saka, Isaac A Ojuawo, Mohammed J Saka, Lukman Olatunbosun, Abayomi Biliaminu
April-June 2017, 30(2):575-580
DOI:10.4103/1110-2098.215463  
Objectives The aim of this study was to assess the value of serum ferritin among protein energy malnutrition(PEM) patients with iron deficiency. Background Iron deficiency is the most common micronutrient deficiency seen in PEM and a common cause of morbidity and mortality in this condition. Patients and methods This was a case–control study in which participants were children diagnosed with PEM and controls were children with normal nutrition. Ninety consented participants and controls participated in the study with informed consent obtained from caregivers. Full blood count and examination of a peripheral blood smear, as well as serum ferritin concentration, was analysed by enzyme-linked immunosorbentassay. Data entry and analysis were carried out with a micro-computer using the SPSS, version16, software packages. Results The mean age of the children with PEM was 22.7±14.4months. In the participants, prevalence of iron deficiency was 24.4%, whereas that of iron deficiency anaemia was 16.6%. Mean serum ferritin levels were significantly higher in the controls compared with participants(P=0.000). The sensitivity and specificity of serum ferritin was 100.0%(95% confidence interval), and the likelihood ratio was 0.00(95% confidence interval). Conclusion Patients with PEM were found to have high prevalence of iron deficiency anaemia and low serum ferritin levels. The sensitivity and specificity of serum ferritin levels were found to be high among PEM patients with iron deficiency anaemia.
  45 14 -
Laparoscopic versus open pyeloplasty in the management of ureteropelvic junction obstruction
Mohamed Badreldin, Tarek M Abdel Elbaky, Mohamed M Abdallah, Atef Badawy
April-June 2017, 30(2):361-366
DOI:10.4103/1110-2098.215467  
Objectives This study aimed to compare the results and outcome of laparoscopic versus open pyeloplasty in the management of ureteropelvic junction obstruction. Background Since the first successful open pyeloplasty in 1891 by Kuster, many approaches for ureteropelvic junction obstruction correction has been developed. Successful laparoscopic pyeloplasty was initially introduced by Schuessler in 1993. Laparoscopic pyeloplasty has decreased morbidity of flank incision and shorter hospital stay with excellent surgical outcomes. Materials and methods This study was conducted as a prospective nonrandomized study at the urology department, faculty of medicine, Menoufia University, Egypt. A total of 30 patients were included and divided into two groups. The first group included 21 patients who underwent open pyeloplasty between May 2010 and June 2013. The second group included nine patients who underwent laparoscopic pyeloplasty between June 2010 and May 2013. Preoperative, intraoperative, and postoperative variables and outcome were evaluated. Results Demographic data for patients in the two groups were similar. There were 21 patients (eight male and 13 female patients) in the open group, with a mean age of 23 ± 5.5 (17–38), versus nine patients (four male and five female patients) in the laproscopic group, with a mean age of 23 ± 3.8 (18–27). Compared with the open group, the laparoscopic group had prolonged operative time (251 ± 55.7 vs. 129 ± 20.7). The mean follow-up period was 18.5 versus 18.8 for the open group and the laparoscopic group, respectively. During the 3-month follow-up period, postoperative glomerular filtration rate% and postoperative T1/2 per minutes were comparable in both groups, without statistical difference; they were 33 ± 11.8 and 12 ± 8.7 versus 35 ±11.7 versus 16 ± 14.5 for the open group and the laparoscopic group, respectively. Conclusion Perioperative complications, hospital stay, and success rate are comparable between open and laparoscopic pyeloplasty, with prolonged operative time for the laparoscopic group and larger morphine equivalent dose for the open group.
  44 13 -
Wies procedureversusJones procedure in the surgical correction of acquired lower eyelid involutional entropion
Hoda M Kamel El-Sobky, Sameh S Mandour, Mona M Mohammed Allam
April-June 2017, 30(2):507-511
DOI:10.4103/1110-2098.215452  
Objective The aim of this study was to compare the effect of Wies procedure withthatof Jones procedure in the primary repair of lower eyelid involutional entropion. Background Involutional entropion(senile entropion) is a general instability of the lid structures with age with inward rotation of the eyelid margin. The eyelashes rub against the inferior cornea and bulbar conjunctiva causing irritation. This finally leads to impaired optical function of the ocular surface. Different methods have been described aiming at treating one or several of the etiological factors of the involutional entropion. Patients and methods In the current comparative prospective study, 30patients(31 eyelids) with senile lower eyelid involutional entropion without horizontal eyelid laxity were selected and divided into two groups. Group 'A' included 16 eyelids of 15patients that were corrected using Wies procedure and group 'B' included 15 eyelids of 15patients that were corrected using Jones procedure. Results In the group subjected to Wies procedure, during the follow-up period(6months), 12(85.7%) cases were successful, two cases were missed from follow-up, and two(14.3%) cases were unsuccessful(undercorrection in one case and recurrence in the other). However, in the group subjected to Jones procedure, 14(93.3%) cases were successful and only one(6.7%) case was unsuccessful(overcorrection occurred). In the Wies group, nine(64.3%) cases showed cosmetically accepted results and five(35.7%) did not. However, in the Jones group, 12(80%) cases showed cosmetically accepted results and three(20%) cases did not(P=0.03). In the Wies group, eight(57.1%) patients were satisfied and six(42.9%) were not. However, in the Jones group, 13(86.7%) patients were satisfied and two(13.3%) were not(P=0.55). Conclusion Jones procedure is more likely successful, cosmetically acceptable, and satisfactory to the patients compared with Wies procedure.
  46 11 -
A comparativestudybetween lateral internal sphincterotomy(an alternative approach) and fissurectomy in the surgical management of chronic idiopathic anal fissure
Olfat El-Sibai, Ahmed Sabri, Ahmed E Ahmed Omara
April-June 2017, 30(2):383-387
DOI:10.4103/1110-2098.215440  
Objectives The objective of this study was to evaluate andcomparethe effectiveness of lateral internal sphincterotomy(LIS, an alternative approach) versus fissurectomy in the surgical management of chronic idiopathic anal fissure. Background LIS(an alternative approach) versus fissurectomy in the management of chronic anal fissure is presented and its potential advantages are described. Patients and methods This is a prospective randomized study including 40patients presenting with chronic anal fissure (>2months). The patients were distributed randomly between two equal groups: groupA underwent LIS(an alternative approach), and groupB underwent fissurectomy. Both groups were evaluated for postoperative pain, postoperative fissure healing, and postoperative complications. Results All patients in groupA were pain-free and without bleeding within 1week, whereas 65% in groupB were pain-free in the same period. Urinary retention was noted in one patient(5%) in groupA, whereas it was noted in two patients(10%) in groupB. Incontinence to flatus was noted in two patients(10%) in groupA, whereas it was noted in three patients(15%) in groupB. There was one patient(5%) with fissure recurrence in groupB but none in the LIS group. No patient in either group was affected with anal stenosis or perianal infections. All wounds healed within 4weeks in groupA, whereas 85% healed within the same period in groupB. Conclusion In the surgical treatment of chronic anal fissure not responding to conservative management, LIS may be the better treatment and, perhaps, the preferable surgical technique with fewer total complications(P<0.005).
  39 14 -
Management of conjunctival lesions
Abd El-Rahman E Sarhan, Ghada Z Rajab, Manar F Dawoud
April-June 2017, 30(2):466-474
DOI:10.4103/1110-2098.215449  
Objective The aim of this study was todetect, diagnose, and treat the different conjunctival lesions over a period of 1year. Background The conjunctiva is the site of expression of many lesions either benign or malignant and are worthy of study. Patients and methods The study was conducted on patients attending the Outpatient Clinic of Ophthalmology in Menoufia University Hospital. It was conducted on 159patients with conjunctival lesions. Cases were examined and managed and the data were analyzed. Results The study included 159cases. Overall, 100cases(62.9%) were male and 59cases(37.1%) were female. As regards age, 129cases(81%) were adult(mean age: 56±19.5) and30cases(19%) were children(mean age 11±6.5). Benign conjunctival lesions were the most common and represented 155cases(97.5%). The most common lesions were benign pigmented conjunctival lesions(41cases, 25.8%). The second most frequent lesions were pterygia(40cases, 25.2%). Pingueculae were the third most common conjunctival lesions(30cases, 18.9%). The remaining lesions included allergic conjunctival masses(16cases, 10%), epibulbar choriostomas(12cases, 7.6%), pyogenic granuloma(eight cases, 5%), orbital fat herniation(four cases, 2.5%), cystic lesions(four cases, 2.5%), and ocular surface squamous neoplasia(four cases, 2.5%). Conjunctival lesions among children(in the decreasing order of frequency) included conjunctival choriostomas(12cases, 30%), conjunctival nevi(11cases, 27.5%), allergic conjunctival lesions(eight cases, 20%), congenital melanosis(six cases, 15%), conjunctival Tenon's cyst(two cases, 5%), and one case of pyogenic granuloma(2.5%). Conclusion Benign conjunctival lesions are the most frequent, although some tumors may hide systemic association or malignant tumor. Hence, any suspicious conjunctival lesion should be excised carefully and sent for histopathological analysis and close follow-up is recommended.
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Intraocular lens master optical biometry versusconventionalultrasound biometry in intraocular lens power calculations in highly myopic eyes
Hassan G El Din Farahat, Khaled E Said Ahmed, Hatem M Gad Marey, Mohammed A Fouad
April-June 2017, 30(2):485-491
DOI:10.4103/1110-2098.215434  
Objective The aim of this study wastocompare the accuracy of optical biometry and applanation ultrasound measurement of the preoperative intraocular lens(IOL) power calculation formulas(Haigis, SRK/T, and Hoffer Q) of highly myopic eye. Background Implantation of an IOL is the cornerstone in modern day cataract surgery, which is no longer used for just visual rehabilitation but has also become a form of refractive surgery in which the final refractive result can define visual outcome. Accurate biometry necessitates proper axial lens measurements. Patients and methods This study included 60 eyes of 52patients(nine cases of bilateral and 42cases of unilateral cataract)[27female(45%) and 33male(55%)] with extreme myopia and axial lengths longer than 26.0mm with cataract as the only ocular pathology. Patients were divided into two groups. Group1(the optical biometry group) included 30patients and group2(the A-scan ultrasound group) included 30patients. Eyeswith significant cataract suitable for phacoemulsification and primary in-bag implantation of posterior chamber IOL were included. All patients underwent clear corneal phacoemulsification by the same surgeon and implantation of the one-piece soft hydrophobic acrylic IOL(EYECRYL-600L) IOL(power range−5.0.0 to+15.0 D). Results This study was carried out on 60 eyes of 52 highly myopic patients presenting with cataract. Patients were divided into two groups: group1, which included 30 eyes that underwent optical biometry using Zeiss 5000 IOL Master, and group2, which included 30 eyes that underwent A-scan ultrasound biometry using Sonomed PAC SCAN 300 AP. Conclusion Haigis formula with the Zeiss IOL Master using partial coherence interferometry gives significantly better IOL power prediction in highly myopic eyes with cataract compared with US biometry.
  41 11 -
BRIEF COMMUNICATION
Scope of genetic counseling in reducing the magnitude ofhereditary disorders: developing nations' perspective
Shrivastava Saurabh RamBihariLal, Shrivastava Prateek Saurabh, Ramasamy Jegadeesh
April-June 2017, 30(2):633-635
DOI:10.4103/1110-2098.215468  
Genetic counseling is defined as a process of communication and education, which addresses concerns relating to the development and/or transmission of a hereditary disorder. Despite the proven utility of genetic counseling in improving the clinical outcome and quality-of-life of people, its overall contribution in the health sector has remained far from expected. Recognizing the scope of genetic counseling, the need of the hour is to deliver easily accessible and quality-assured genetic counseling services to the entire population. In conclusion, global expansion of genetic counseling services is the need of the hour, to have a significant impact on the patient-related clinical outcomes and on the psychosocial concerns of the family members.
  39 10 -
ORIGINAL ARTICLES
Diagnosis ofacute appendicitis in low Alvarado score
Samir M Kohla, Ayman A Omar, Tamer A Sultan, Ahmed F Elnakoury
April-June 2017, 30(2):388-392
DOI:10.4103/1110-2098.215441  
Objective The aim of this study was to evaluate the efficacy of computed tomography(CT) and ultrasound(US) in the diagnosis of appendicitis in low Alvarado score. Background Diagnosis of acute appendicitis is sometimes difficult. Equivocal cases usually require in-patient observation and multiple laboratory and imaging investigations. The combination of the clinical scoring system and advanced imaging has been deeply influential in clinical practice. Patients and methods Thirty patients with low Alvarado score below 8 and above 3 were included. US was performed for all patients and CT was performed for patients who had a negative result on US. All specimens of appendectomies were sent for histopathological examination and then their results were compared with the results of US and CT. Results The results of this study showed that US had a sensitivity of 72.7%, specificity of 94.7%, and accuracy of 86.7%. The sensitivity, specificity, and accuracy of CT were 100%. Negative appendectomy rate was 15.38%. Conclusion The patients with an intermediate Alvarado score(4–7) are the typical group for whom operative decision is difficult. Imaging studies(either US or CT) are useful adjunct to physical and laboratory findings in these patients by decreasing hospital stay and negative appendectomy rate.
  35 14 -
Evaluation of direct visual internal urethrotomy in the management of anterior urethral strictures
Alaa El Deen M El Mahdy, Tarek M Abdelbaky, Mohamed A Selim, Ibrahim M Gomaa
April-June 2017, 30(2):367-371
DOI:10.4103/1110-2098.215438  
Objectives The aim of the present study was to evaluate the outcome of direct vision internal urethrotomy (DVIU) in the management of patients with anterior urethral stricture. Background DVIU is a simple and popular treatment for male urethral stricture; however, the long-term stricture-free rate is modest even after only a single procedure. Therefore, identifying patients at risk for recurrence after DVIU is crucial. There is a paucity of research regarding factors predicting failure after DVIU, notably with no standardized definition of failure. Patients and methods We reviewed the charts and retrospectively analyzed the records of 103 male patients who underwent DVIU for anterior urethral stricture disease at Menoufia University Hospital between June 2014 and June 2015. The patients' demographics and stricture characteristics were analyzed. Procedure failure was defined as the need for regular urethral dilatation, redo DVIU, or urethroplasty. In addition, predictors of failure were analyzed. Results Successful outcome had occurred in 51 patients. The site of stricture was bulbar in 72.5% of them, whereas it was bulbopenile in 23.5% and penile in 4% of them. Stricture length was less than 1 cm in 51% of them, whereas it was 1–2 cm in 49% of them. Conclusion Patients with urethral stricture who are ideal candidates for initial treatment with DVIU tend to have a single, short (≤1 cm) bulbar stricture and no extensive spongiofibrosis surrounding the stricture. Repeated DVIU should be considered only in patients who are poor surgical candidates and not because of the convenience of performing a simple procedure.
  36 12 -
Comparison of results of primary total hip replacement in diabetic and nondiabetic patients
Elsayed M Zaky, Osama G Ahmed, Hossam M Abdella
April-June 2017, 30(2):450-455
DOI:10.4103/1110-2098.215457  
Objective The aim of this study was to compare the results of total hip arthroplasty in diabetic and nondiabetic patients. Background Total hip arthroplasty is considered one of the most successful and effective surgical procedures performed in the world. The increase in the numbers of patients undergoing hip arthroplasty coincides with the incidence of increased prevalence of diabetes over the last two decades. The diabetic population undergoing arthroplasty is very poorly reported in comparison with the nondiabetic population due to the adverse outcomes of diabetes. Materials and methods All 40patients received cemented primary total hip replacement for the treatment of osteoarthritis and were divided into two groups: a diabetic group, which included 20patients, and the nondiabetic group, which included 20patients. The functional outcome was evaluated according to the modified Harris Hip Score in all patients, and complications(e.g.,superficial wound problems, deep infection, periprosthetic fracture, loosening, and osteolysis) were recorded in both groups. Results Patients with diabetes mellitus required longer hospital stay and increased overall cost. Moreover, the need for postoperative blood transfusion was higher in the diabetic group. The diabetic group showed a higher number of complications in comparison with the nondiabetic group, although it was statistically nonsignificant. The study showed the negative impact of body weight on the functional outcome in both groups. Conclusion Diabetic patients undergoing arthroplasty are the high-risk group and they required close monitoring of blood glucose level during the perioperative period, as diabetic patients had a higher rate of postoperative complications and required longer hospital stay and had increased total cost in comparison with the nondiabetic group.
  43 5 -
Effectof Nd: YAG laser capsulotomy size on visual outcomes of the eye, intraocular pressure, and macular thickness
Abd El-Khalik I El-Saadani, Osama A El-Morsy, Khaled A Shahata El-Sayed
April-June 2017, 30(2):512-516
DOI:10.4103/1110-2098.215453  
Objective The objective of this study was to show the effect of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy size on visual outcomes of the eye, intraocular pressure(IOP), and macular thickness. Background Although Nd:YAG laser capsulotomy has been found to be safe and effective, events such as retinal detachment, cystoid macular edema, and rise in IOP tend to occur after Nd:YAG laser capsulotomy. Materials and methods A total of 56 eyes of 56patients were enrolled in this prospective comparative study with posterior capsular opacification following uncomplicated cataract surgery with posterior chamber intraocular lens implantation. All patients were examined before Nd:YAG laser capsulotomy and 1, 4, and 12weeks after Nd:YAG laser capsulotomy for best-corrected visual acuity(VA), IOP, and foveal thickness. Patients were divided into two groups based on the postoperative capsulotomy size: group1, capsulotomy size less than 3.9mm; group2, capsulotomy size equal to or larger than 3.9mm. Results We found significant improvement in VA in both groups, with no significant effect of capsulotomy size on the improvement in VA. IOP increased 1week postoperatively in both groups, but IOP rise in group2 was higher than in group1; both groups had increased central foveal thickness at 1week postoperatively. The degree of foveal thickening was similar in both groups. Conclusion Patients who underwent a larger capsulotomy size have more elevation in IOP. Rise in central foveal thickness was similar in large and small capsulotomy groups, and the improvement in VA was not affected by the capsulotomy size.
  36 12 -
Comparisonbetweencorneal biomechanics and HbA1c levels in healthy individuals and type2 diabetic patients
Hesham M Elmazara, Sameh S Mandour, Mahmoud E El Bahnasy
April-June 2017, 30(2):517-524
DOI:10.4103/1110-2098.215460  
Objectives The aim of this study was to evaluate the corneal biomechanical properties using the ocular response analyzer(ORA) in type2 diabetic patients. Background The ORA isadevice developed in recent years and reveals the biomechanical properties of the cornea. It reflects certain biomechanical properties of the cornea, such as corneal hysteresis and corneal resistance factor. Patients and methods A total of150eyes of 75patients were enrolled in a cross-sectional prospective comparative study from May 2015 to May 2016. Patients were divided into three equal groups. ORA and HbA1c evaluation were carried out for all patients. Results The corneal hysteresis of the study groups ranged from 5.5 to 9.8mmHg for the control group (groupA), and it ranged from 6.00 to 11.4mmHg for the diabetic group(groupB), whereas it ranged from 9.5 to 15.20 in the diabetic group(groupC). The corneal resistance factor of the study groups ranged from 5.8 to 10.00mmHg for the control group(groupA), from 6.2 to 12.00mmHg for the diabetic group(groupB), and from 8.90 to 16.10mmHg for the diabetic group(groupC). The Goldmann-correlated intraocular pressure of our study groups ranged from 10 to 30mmHg for the control group(groupA), from 10 to 22mmHg for the diabetic group(groupB), and from 10.5 to 26.00mmHg for the diabetic group(groupC). The corneal-compensated intraocular pressure of the study groups ranged from 10.8 to 25mmHg for the control group(groupA), from 11.2 to 30mmHg for the diabetic group(groupB), and from 10.00 to 28.00mmHg for the diabetic group(groupC). Conclusion The corneal biomechanics in diabetic groups are significantly higher than those in the control group.
  36 9 -
The effectofperitoneal lavage with a mixture of lincomycin–gentamicin on postoperative infection in cases of colorectal cancer surgery
Alaa Abd A Elsisy, Mahmoud G Hagag, Marwan M Ewida
April-June 2017, 30(2):393-399
DOI:10.4103/1110-2098.215454  
Objective The aim of this work was to evaluate the effect of the use of antibiotic solution formed of lincomycin and gentamycin in normal saline in decreasing the risk for postoperative infection in cases of colorectal cancer. Background Infection after colon cancer operations is still the most common and the most serious complication, with an incidence of more than 30%. Patients and methods This study was carried out on 40 randomly allocated patients with resectable colon and rectal cancer. Group1 included patients who underwent intra-abdominal lavage with normal saline, followed by a second lavage with a gentamicin–lincomycin solution, and group2 included those who underwent lavage with normal saline. Results There was a significant difference between groups as regards the presence of postoperative wound sepsis. Isolated organisms were mainly gram negative in both groups. In group1, the isolated organism was Pseudomonas. In group2, three cases were diagnosed with Escherichia coli and two cases for each of Pseudomonas, Klebsiella, and Enterobacter. Intraoperative abscess was diagnosed in three cases, two in group2 and the remaining one in group1. There was no significant difference between groups as regards the presence of intra-abdominal abscess. Conclusion Antibiotic lavage of the peritoneum is associated with a lower incidence of intra-abdominal abscesses and wound infection. A normal saline lavage did not significantly reduce the number of positive cultures, in contrast to an antibiotic one(gentamicin–lincoamycin), which resulted in negative cultures in 90% of the cases.
  29 12 -
Positivefocused assessment sonography as an indication for laparotomy in hemodynamically unstable blunt traumatized patient
Ashraf A Zieneldin, Tarek M Rageh, Sameh M Azab, Noha A Elgndy
April-June 2017, 30(2):400-404
DOI:10.4103/1110-2098.215459  
Objective The aim of this studywasto evaluate the results of focused assessment with sonography for trauma (FAST) in hemodynamically unstable blunt traumatized patients and to determine its role in the diagnostic evaluation of these patients. Background The emergency physician faces significant clinical uncertainty when a multiple trauma patient arrives in the emergency department. Patients are assessed, and their treatment priorities are established in the primary survey. FAST is an important skill during trauma resuscitation. The use of point-of-care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Menoufia university hospitals. Patients and methods This study was conducted on 50patients with blunt abdominal trauma, either a localized trauma to the abdomen or a polytrauma with a blunt mechanism. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. Results There were a total of 50cases, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6 and 100%, respectively. The negative predictive value was 92%, whereas the positive predictive value was 100%. The overall accuracy was 96%. Conclusion FAST with presence of free fluid intraperitoneal without reference to the amont is useful as the initial diagnostic tool for abdominal trauma to detect intra-abdominal fluid in hemodynamically unstable patients. FAST performed by clinicians detects intraperitoneal fluid with a high degree of accuracy. All FAST examinations are valuable tests when positive. However, ultrasound examination is operator dependent, and FAST scan has its own limitations. For negative FAST scan cases, we recommend a period of monitoring, serial FAST scans, or further investigations, such as computed tomography scan.
  27 14 1
Evaluation of hook plate for fixation of displaced lateral third fractures of the clavicle
Adham E Mousa, Ahmad I Zayda, Ayman M Ebied
April-June 2017, 30(2):425-433
DOI:10.4103/1110-2098.215439  
Objectives The aim of this study was to assess the effectiveness of open reduction and internal fixation of Neer typeII unstable lateral third clavicle fractures using the clavicle hook plate(HP). Background In the last decade, the clavicle HP has been in use. Reports about this plate have showed a high success rate in terms of union. However, there is still concern as regards rate of mid-term complications, particularly the involvement of the acromioclavicular joint(ACJ). Patients and methods To evaluate the results and mid-term effects in use of this plate, we performed a prospective analysis with a mean follow-up of 17months(1.45years) of 20 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle HP. Results Short-term functional results in all patients were good to excellent. All but one (95%) patient had a united fracture. Five (25%) patients developed impingement symptoms, and in two (10%) patients fsubacromial osteolysis was found. These findings resolved after plate removal. Twenty patients were evaluated at a fixed initial follow-up visit, 3months postoperatively, and re-evaluated at a mean follow-up period of 1.45years. The final Constant Shoulder score mean was 95.5 and the disabilities of the arm, shoulder and hand score (DASH) mean was 3.54 preoperatively compared with 92.9 and 4.26, respectively, before plate removal (P=0.000). One(5%) patient developed ACJ arthrosis, which was symptomatic. Two (10%) patients had extra-articular ossifications, of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis, and development of ACJ arthrosis or extra-articular ossifications. Conclusion The clavicle HP is a good primary treatment option for acute displaced lateral clavicle fracture with few complications. At mid-term, the results are excellent, and no long-term complications can be attributed to the use of the plate.
  33 8 -
Umbilicalcord S100B protein in neonatal hypoxic–ischemic encephalopathy
Ghada M El-Meshad, Dalia M El-Lahoney, Naglaa F Barseem, Mohammed A Helwa, Amr A.H. Elsisy
April-June 2017, 30(2):588-594
DOI:10.4103/mmj.mmj_655_16  
Objective The aim of this study was to highlight the importance of cord blood S100B protein in the diagnosis of neonatal hypoxic–ischemic encephalopathy and determination of its severity. Background S100B is a calcium-binding protein and is a major component of the cytosol in various cell types. The S100B exerts significant influence on cellular metabolism, Ca2+homeostasis, cytoskeletal modification, cell proliferation, and cell differentiation. The presence of S100B in the cerebrospinal fluid, serum, and amniotic fluid above threshold levels is used for diagnostic/prognostic purposes. Patients and methods This study included 30 asphyxiated newborns and 23 weight and gestational age-matched healthy neonates as controls. Immediately after birth, blood samples were collected from all neonates and values of S100B protein were determined using enzyme-linked immunosorbent assay technique. Results The mean serum level of S100B protein was significantly higher in the asphyxiated group than in the control group with a significant correlation between increased S100B protein level and severity of hypoxic–ischemic insult among patients. We found that at the cutoff level for serum S100B protein of 0.44μg/l, the sensitivity was 97%, specificity was 91%, and accuracy of predicting neonatal asphyxia was 94%, with a positive predictive value of 94% and a negative predictive value of 95%. Conclusion It was concluded that S100B protein in the umbilical cord blood is a useful marker for early detection of neonatal hypoxic–ischemic encephalopathy in the full-term neonate and also in determining the grade of hypoxia.
  27 14 -
Quality of life in patients with erectile dysfunction in Shebin El Kom District
Taghreed M Farahat, Alaa H Maraee, Nagwa N Hegazy, Ibrahim A Ismail
April-June 2017, 30(2):607-613
DOI:10.4103/mmj.mmj_474_16  
Objective This study aimed to assess the risk factors for erectile dysfunction(ED) and the sociodemographic characteristics of patients with ED in Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital. Background ED is a common disorder that affects the quality of life(QoL) of millions of people worldwide. Numerous factors can disrupt erectile function–for example, age, smoking, cardiovascular disease, and diabetes mellitus(DM). Patients and methods This was a cross-sectional study that was conducted on 169patients with ED from Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital during the period 1December 2015 to 31May2016. Information on sociodemographic data, risk factors for ED, and effect of ED on QoL was collected using self-administered questionnaires: a sociodemographic questionnaire, the International Index of Erectile Dysfunction(IIEF) questionnaire, a risk factors questionnaire, and the shorter version of the World Health Organization Quality of Life questionnaire. Results The main sociodemographic characteristics affecting ED were age of the patient(P=0.001) and age of the patient's wife(P=0.0001). The main risk factors for ED were lifestyle risk factors such as smoking (P=0.000) and obesity(P=0.005), medical conditions such as DM(P=0.0001), hypertension (P=0.0002), heart disease(P=0.019), dyslipidemia(P=0.013), lower urinary tract symptoms (P=0.005), and hypogonadism(P=0.004), intake of drugs (β-blockers (P = 0.000), insulin (P = 0.016), psychiatric drugs (P = 0.006), and silymarin (P = 0.001)), and penile and pelvis injury(P=0.032). Pychogenic factor was present in most cases of ED. In patients with ED other domains of IIEF, including orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction(89.7%) were reduced. Also ED negatively affected all domains of QoL. Conclusion According to our results, the main risk factors are aging, cardiovascular disease, DM, dyslipidemia, lifestyle issues(such as smoking and obesity), penile or pelvic injury, and side effects from medication. ED has a significant negative impact on other domains of IIEF and on the QoL.
  29 11 -
Nodal ratio and number ofdissected nodes in breast cancer patients with inadequate axillary dissection
Naser M Abd El-Bary, Eman A Tawfik, Ashraf E Abd El-Ghany, Ehab A Shaltout, Ahmed A Hussein
April-June 2017, 30(2):564-571
DOI:10.4103/1110-2098.215466  
Objective The aim of this study was to evaluate the prognostic significance and to define the optimal cutoff points of nodal ratio and number of dissected nodes in node-positive and node-negative breast cancer patients, respectively, who underwent inadequate axillary lymph node dissection(ALND). Background The absolute number of involved axillary lymph nodes(LNs) is considered the most important prognostic factor in breast cancer. Over the last decade, several studies indicated that the lymph node ratio(LNR) might predict outcome better than the number of positive LNs. Patients and methods This retrospective study included 200 women with invasive breast cancer. GroupI included node-positive cases with inadequate ALND; groupII included node-positive cases with adequate ALND; groupIII included node-negative cases with inadequate ALND; and groupIV included node-negative cases with adequate ALND. Receiver operating characteristic curve was used to identify cutoff points of LNR in each of the node-positive groups, and number of dissected nodes in node-negative patients, classifying the patients into low-risk and high-risk groups. Results Optimal LNR cutoff points classifying node-positive patients into low-risk and high-risk groups were 0.44 for groupI and 0.40 for groupII with statistically significant differences in disease-free and overall survival. There were no statistically significant survival differences between groupsIII and IV. The cutoff point of six dissected nodes classified the node-negative patients into low-risk and high-risk groups with statistically significant differences in disease-free and overall survival. Conclusion LNR could be incorporated into the staging of breast cancer patients, especially those with inadequate axillary dissection. LNR cutoff points of 0.44 and 0.40 can be used to classify node-positive patients with inadequate and adequate axillary dissection, respectively, into low-risk and high-risk groups. For node-negative patients, oncologists can be satisfied with a number of dissected nodes as low as seven axillary LNs.
  31 8 -
Matrix metalloproteinase-1polymorphismin hepatocellular carcinoma patients with hepatitis C or B
Gehan K El Saeed, Belal A. E. Montaser, Abdel M Aoda, Omnia S. N. Ahmed
April-June 2017, 30(2):626-632
DOI:10.4103/mmj.mmj_728_16  
Objective The aim of this work was to study the relationship between matrix metalloproteinase-1(MMP-1) −16071G/2G gene polymorphism and hepatocellular carcinoma(HCC) in patients infected with hepatitis B or C viruses. Background MMP-1, an interstitial collagenase, plays an important role in the breakdown of extracellular matrix. It has been demonstrated that the overexpression of this enzyme is associated with tumor initiation, invasion, and metastasis. The−1607 single guanine(1G)-to-2G polymorphism(reference single-nucleotide polymorphism 1799750) in the MMP-1 promoter region creates an E26(Ets)-binding site and results in transcriptional upregulation. Therefore, the MMP-1 polymorphism may influence an individual's susceptibility to the development of certain tumors such as HCC. Patients and methods This study was carried out on 100 participants; 40 of them were patients with HCC infected with hepatitis C virus, 20 of them were patients with HCC infected with hepatitis B virus, and the remaining 40 were age-matched and sex-matched healthyvolunteers. All participants were subjected to full history taking, laboratory investigations including liver profile, α-fetoprotein, and prothrombin induced by vitamin K absence II, and determination of MMP-1−16071G/2G polymorphism by PCR–restriction fragment length polymorphism assay. Results The MMP-1−1607 genotype distribution among HCC patients was significantly different from that in healthy controls(P<0.001). Compared with the wild-type1G/1G genotype, the variant 1G/2G and 2G/2G genotypes and the 2G allele were associated with risk for HCC(P<0.001). The 1G/2G genotype was associated with large tumor size. The 1G/2G and 2G/2G genotypes were associated with Child–Pugh B and C. The 1G/2G genotype was associated with advanced tumor stage and the 2G/2G genotype was associated with metastatic tumor stage. Conclusion The results suggest that the MMP-1−16071G/2G polymorphism is associated with an increased risk for HCC.
  31 8 -
Ultrasound-guided transversus abdominis plane block for lower abdominal surgeries: bupivacaine alone or combined with fentanyl or epinephrine
Ahmed A. R. Metwally, Khalid M Abo-El-Enin, Sabry I Abd Allah, Nevin M Soliman, Walid A Abo-Omar
April-June 2017, 30(2):538-543
DOI:10.4103/1110-2098.215478  
Objective The objective of this study was to evaluate the effects of adding fentanyl or epinephrine to bupivacaine in ultrasound-guided transversus abdominis plane(TAP) block for lower abdominal surgeries. These effects include quality and duration of the analgesia and opioid consumption. Background TAP block provides analgesia to the anterior abdominal wall. Many adjuvants were used to improve the quality and duration of analgesia in various nerve blocks. Patients and methods Fifty-six adult patients undergoing elective lower abdominal surgeries under general anesthesia received TAP block with 20ml of local anesthetic mixture bilaterally and were randomly allocated according to the local anesthetic mixture into three groups: groupB(bupivacaine), groupBE(bupivacaine+epinephrine), and groupBF(bupivacaine+fentanyl). The primary outcomes were postoperative pain(evaluated by time to first analgesia request and visual analog scale) and opioid consumption(intraoperative fentanyl and morphine in 24h postoperatively). The secondary outcomes were effect on hemodynamics, time of extubation, and side effects. Results Time to first analgesia request was longer in groupBF, postoperative visual analog scale was lower in groupBF after 4h, the use of intraoperative fentanyl was lower in groupBF, and morphine consumption 24h postoperatively was lower in groupBF. Time of extubation was shorter in groupBF, and intraoperative mean arterial pressure decreased at 30min in groupB and groupBF. Conclusion The addition of fentanyl to the local anesthetic in ultrasound-guided TAP block prolongs the analgesia, lowers postoperative pain, and decreases the opioid consumption. Adding epinephrine prevents reduction of mean arterial pressure without additional effects on the block characteristics.
  24 15 -
Studying the 'cocktail party problem' usingsubjective and neurophysiologic measures
Abd El Hai R El-Assy, Trandil H Elmahallawy, Enaas A Kolkaila, Rasha M. K. M. Mesrigah
April-June 2017, 30(2):456-465
DOI:10.4103/1110-2098.215446  
Objective We aimed to study the effect of background noise on speech auditory evoked responses in both normal-hearing(NH) individuals and those with sensorineural hearing loss(SNHL) and correlate these neurophysiological results with subjective measures. Background Understanding speech in noisy situations is one of the most complex activities encountered in everyday life. It is dependent on cognitive factors and sound processing at peripheral, subcortical, and cortical levels. These make perception of speech in noise one of the most complex aspects of human communication. Patients and methods Fifty NH individuals and 40 individuals with mild-to-moderate SNHL were subjected to the Speech, Spatial, and Qualities of Hearing Scale questionnaire, the speech perception in noise test, speech auditory brainstem response, and cortical auditory evoked responses using speech syllable/da/in quiet condition and at three different signal-to-noise ratios(SNRs) (+10, 0, and−10). Results Speech auditory brainstem response results in NH participants showed delayed latencies of both transients(waves V, A, C, and O) and frequency-following response with reduction in amplitudes of onset(V and A) and F wave only in noisy relative to quiet condition, whereas in SNHL delayed latencies and decreased amplitudes of both transients and fractional flow reserve (FFR) were observed. The effect of noise can be seen in all waves of cortical auditory evoked responses–that is, with decreasing SNR response, latency increased and response amplitude decreased in both SNHL and NH. Conclusion Background noise affects both transients and sustained components of speech in NH and SNHL. P1, N1, P2, and N2 components are all affected by SNR, despite their distinct neural generators; this raises the possibility that the effects demonstrated here are reflective of subcortical processing that is propagated to higher levels of the auditory system. cocktail party, speech auditory brainstem response, speech-in-noise perception
  26 10 -
Treatment of distal femoral fractures in adults using the less invasive stabilization system
Mahmoud M Hadhoud, Yasser S Hannout, Abd El-Hamid S Abd El-Hamid Rageh
April-June 2017, 30(2):434-441
DOI:10.4103/1110-2098.215473  
Objective The aim of this studywas to assess clinical outcomes and complications in 20 adult patients with distal femoral fractures treated with the less invasive stabilization system(LISS). Background LISS distal femur has been the treatment of choice for distal femoral fractures when operative treatment is needed. However, LISS of comminuted distal femoral fracture is a challenging operation, which requires surgical experience and meticulous attention to soft tissue. The LISS is an emerging procedure for the treatment of distal femoral fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods This prospective study included 20 adult patients between 45 and 72years of age(mean age: 58.45years) suffering from fractures of the distal femur who were treated with the LISS at El-Menoufiya University Hospital from September 2014 to September 2015. Among the patients, eight were male and 12 were female. Results The patients were followed up for a mean of 5.6months, ranging from 4 to 6months. Radiographically, all fractures except two healed in good alignment. Solid union took place from 8 to 14weeks, with a mean of 12weeks. There were no intraoperative complications, including neurologic or vascular injury, and two patients developed superficial wound infection postoperatively. Conclusion It was found that the LISS is an adequate technique for the treatment of distal femoral fractures in adult patients when surgical stabilization is indicated. This simple minimally invasive technique provides stable fixation, with minimal blood loss, minimal soft tissue stripping at the fracture site, and bone union in most of the studied cases.
  24 9 -
Respiratory and auditory disorders in a ceramic manufacturing factory(Queisna City, Menoufia Governorate)
Gaafar M Abdel Rasoul, Safaa Badr, Heba K Allam, Hala M. M. Gabr, Amira M Abdel Monaem
April-June 2017, 30(2):595-601
DOI:10.4103/1110-2098.215470  
Objectives The aim of this study was to evaluate respiratory and auditory disorders among workers in a ceramic manufacturing factory and their relationship with workplace environment in the same factory. Background The ceramic industry is one of the most hazardous industries to the respiratory system. In addition, disorders due to occupational exposure to noise are possible. Participants and methods A cross-sectional, comparative study was carried out on 138 workers in a ceramic manufacturing factory and 138 nonoccupationally exposed participants(control group). An environmental study for total, respirable, and differential dusts and noise was carried out. Spirometric measurements, audiometric assessment, and plain chest radiography were applied. Results The mean value of respirable dust level, free crystalline silica concentration, and noise levels were higher than international permissible levels. Ceramic manufacturing factory workers had a higher significant prevalence of respiratory and auditory manifestations as well as deteriorated spirometric measurements, abnormal audiometric assessment, and abnormal radiological findings. Conclusion Exposure to free crystalline silica concentrations more than permissible levels results in abnormal spirometric measurements and abnormal radiological findings. Continuous exposure to noise levels more than 90 dBA leads to abnormalities in audiogram in the form of threshold shifting and V-dip depression. Regular use of good-quality personal protective equipment, especially masks and ear muffs, and periodic medical examination are highly recommended.
  24 9 -
Opticalcoherence tomography versus perimetry in follow-up of glaucoma
Mostafa K Nassar, Faried M Wagdy, Ahmed H Taha
April-June 2017, 30(2):475-479
DOI:10.4103/1110-2098.215430  
Objective The objective of this study was to evaluate the ability of optical coherence tomography(OCT) to detect glaucoma in its early stages and follow-up progression of the disease compared with visual field(VF) examination aiming for better control of the disease and decreasing the incidence of morbidity(blindness) resulting from this disease. Background Primary open angle glaucoma is the leading cause of irreversible world blindness. VF deficits are thought to be the functional expression of ganglion cell losses. OCT provides high-resolution images that allow in-vivo measurements of the retinal nerve fiber layer in cross-section. Patients and methods Twenty eyes diagnosed with primary open angle glaucoma were included in the study. All patients were subjected to complete ocular examination, VF examination by standard automated perimetry(SAP), and OCT assessment of the retinal nerve fiber layer in the primary visit. Follow-up periods were 3 and 6months by SAP and OCT assessment of the retinal nerve fiber. Results The follow-up period was 6months. SAP was nearly similar to OCT in detecting progression: eight(40%) eyes compared with 10(50%) eyes by OCT. OCT was better because of its ability to detect early any progression before functional affection, but the difference between them is not significant. Conclusion OCT was able to detect more progression compared with VF. In addition, it detected progression earlier compared with VF. OCT proved the ability to detect any structural changes before corresponding functional defects can be detected.
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Evaluationof the corneal endothelium by specular microscopy in torsional phacoemulsification versus longitudinal phacoemulsification
Mostafa K Nassar, Osama A Al-Morsi, Alaa M Abdel-Gayd, Salah M Helmy
April-June 2017, 30(2):492-495
DOI:10.4103/1110-2098.215435  
Objective The objective of this study was to compare the effect of cataract extraction by torsional and longitudinal phacoemulsification on the integrity of the corneal endothelium. Background Endothelial cell loss remains a well-known, undesirable side effect of cataract surgery. Torsional phaco has a lower mean needle time, less chatter, and improved followability compared with longitudinal phaco. Patients and methods This is a prospective randomized study for comparative analysis of corneal endothelial modifications(central cell density and cell loss) following torsional versus longitudinal phaco. Atotal of 50 eyes included had nuclear cataract grade3. Divide-and-conquer technique was used for surgeries using Infiniti, Ozil Technology phacomachine. Cases were distributed randomly into two groups: groupI included 25 eyes for which torsional phaco surgery was performed, and groupII included 25 eyes for which longitudinal phaco surgery was performed. Results In groupI, the P value that expresses the change between preoperative and postoperative endothelial counts was 0.001, which is statistically significant(P<0.05), and in groupII the P value that expresses the change between preoperative and postoperative endothelial counts was also 0.001, which is statistically significant(P<0.05). On comparing two groups regarding the percentage of endothelial loss, the P value was 0.159, which shows no statistically significant difference(P>0.05) between the two groups. Conclusion There was no significant difference on comparing the two types of phacoemulsification, as regards the postoperative corneal endothelial cell loss and best-corrected visual acuity.
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Subfoveal choroidal thickness by enhanced depth imaging optical coherence tomography in typeII diabetes mellitus
Hatem M Marey, Sameh M Elgouhary, Ahmed A Gad El Rab
April-June 2017, 30(2):532-537
DOI:10.4103/1110-2098.215464  
Objectives To evaluate the subfoveal choroidal thickness(ChT) in typeII diabetes mellitus(DM) using enhanced depth imaging optical coherence tomography(EDI-OCT). Background Diabetic retinopathy(DR) is because of hemodynamic abnormalities. The choroid provides oxygen and nutrients to the outer retina. EDI-OCT can image the choroid invivo. Patients and methods A prospective clinical randomized study was carried out focusing on 100 eyes of 100patients divided into two groups: groupA included 50 eyes of 50 diabetic patients with typeII DM (20–50years) and groupB included 50 eyes of 50 age-matched normal healthy controls with no sex or laterality specification. The subfoveal ChT, using EDI-OCT, was measured from the posterior edge of retinal pigment epithelium to the choroioscleral junction. Results The mean age of the patients was 42±7 and 39±9years in groupA and B, respectively. The mean DM duration in groupA was 7.96±3.9years. Subfoveal ChT was found to be 291±42μm in groupA[275.31±31μm for no apparent retinopathy(no DR), 298±42μm for nonproliferative diabetic retinopathy, 309±58μm for proliferative diabetic retinopathy, 277±29μm for diabetic macular edema(DME) absent, and 306±47μm for DME present], whereas it was 284±54μm in groupB. There was a statistically significant positive correlation between subfoveal ChT and DM duration(P=0.00). Conclusion Subfoveal ChT was found to be correlated with the stage of DR. Progressive thickening of the choroid with the progression of DR and/or the development of DME may reflect the concurrent progression of diabetic choroidopathy.
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Surgical management of nonmelanomatous malignant cutaneous lesions of the face
Soliman A El-Shakhs, Ibrahim M Zeitoun, Yasser M El-Sheikh, Ahmed S El-Gammal, Mahmoud A. E. Oda
April-June 2017, 30(2):378-382
DOI:10.4103/1110-2098.215433  
Objective The aimof the present study was to evaluate the esthetic and functional outcomes after surgical excision of nonmelanomatous malignant lesions of the face, followed by a suitable tool of reconstruction. Background Neoplasm of the skin is found most often on the face. Cosmetically, the face is the most important anatomic area for most patients. Because of this, malignant tumors of the facial skin pose a great challenge in treatment, prohibiting compromises between oncologically responsible surgery and functional and cosmetic outcomes. Patients and methods This prospective study included 25patients, all of them suffering from nonmelanomatous skin cancer and managed at Menoufia University Hospitals and Damanhur Oncology Center by different modalities of reconstruction during the period from April 2012 to December 2014. The appropriate technique was selected for every patient, taking in consideration the location and size of the lesion. Results Eighteen cases had reconstructive procedures with local flaps only, five cases had more combined reconstructive tools in the form of local flaps(rotational flaps) plus split-thickness graft to close the secondary defect, and two cases required reconstruction with a full-thickness graft. Conclusion Our experience showed that the postoperative defects gave the best cosmetic results when reconstructed by using a nearby tissue, fulfilling all patient and surgeon expectations with a minimum rate of morbidity. Clear guidelines and a multidisciplinary approach for the treatment of skin cancer are important to ensure that patients receive optimal care with satisfactory end results for tumor control as well as reconstructive esthetic outcome.
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Lessinvasive stabilization system versus open reduction and internal fixation of closed proximal tibial fractures in adults
Mohammed S. A. El-Hamid Arafa, Ahmad F Shams El-Din, Hesham M El-Mowafy
April-June 2017, 30(2):442-449
DOI:10.4103/1110-2098.215437  
Objective The aim of this study was to compare the clinical and radiological outcome between less invasive stabilization system(LISS) and open reduction with internal fixation(ORIF) for the treatment of extra-articular proximal tibia fractures through the lateral approach. Background Proximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. However, it is associated with problems, especially overlying skin conditions, delayed recovery, and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods Thirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into two groups. GroupI(n=15) patients were treated with LISS and groupII(n=15) with ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6months. Results In eachgroup, 12patients showed union, two patients showed nonunion, and one patient showed delayed union. The mean operative time in LISS patients was 79.3min, whereas in ORIF patients it was 122min. All patients of the LISS group were exposed to radiation, whereas only 40% of patients in the ORIF group were exposed to radiation. The mean time of union in LISS patients was 10.87weeks. However, in ORIF patients, the mean time of union was 21.13weeks. There was no significant difference between the two groups as regards the postoperative complications. Functional outcome was satisfactory in both groups. Conclusion LISS achieves comparable results with ORIF in extra-articular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection.
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Different modalities of aortic root reconstruction with aortic valve-sparing techniques in ascending aortic aneurysms
Ahmed L Dokhan, Said A Badr, Islam M Ibrahim, Ahmed S Hussien Mostafa
April-June 2017, 30(2):420-424
DOI:10.4103/1110-2098.215469  
Objectives The aim of the study was to study the different types of valve-sparing aortic root reconstruction techniques to assess the short-term results with respect to improvement of patient's functional status, left ventricular dimensions and functions, and durability of competent aortic valve and to detect predictors of failure of aortic repair. Background The focus on valve-sparing operations and the concomitant re-evaluation of the functional anatomy of the aortic root have demonstrated that aortic root deformation often coexists with architecturally and morphologically normal valve leaflets. Thus, sparing and realigning the leaflets and reconstructing the aortic root have the potential for avoiding prosthetic valve disease. Materials and methods This was a prospective analytical study conducted on 50 consecutive patients with aortic root aneurysm and dissection associated with significant aortic regurgitation. These patients were operated upon using aortic valve reimplantation technique and studied for aortic valve competence. Results Follow-up echocardiography was performed within 30 days postoperative, after 6 months, 1 year, and then yearly. Moderate aortic incompetence was found in four patients (P = 0.001) at 1 year, with 100% freedom from reintervention for valve-related problems. Conclusion Valve-sparing aortic root reimplantation (Tirone-David technique) is effective in correcting aortic insufficiency due to aortic root diseases, with good results with respect to durability of aortic repair.
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Optical coherence tomography and fundus autofluorescence findings in areas of geographic atrophy owing to age-related macular degeneration
Hoda M Kamel El-Sobky, Nermeen M Badawi, Sally A Mohamed Elnaghy
April-June 2017, 30(2):480-484
DOI:10.4103/mmj.mmj_116_16  
Objective To evaluate the optical coherence tomography(OCT) and fundus autofluorescence(FAF) findings in cases of geographic atrophy owing to age-related macular degeneration(AMD). Background Old patients who have dry-typeAMD were included. Patients and methods This study was conducted on 30 eyes to assess OCT and FAF findings in cases of geographic atrophy owing to AMD. Results The study provedthrough OCT findings that retinal pigment epithelium atrophy was present in all patients(100%). Drusen were present in 28patients(93.3%). Back scatter was present in all patients(100%). Retinal anatomy alteration was present in all patients(100%). Posteriorvitreous detachment was present in nine patients(30%). FAF findings were the margins of geographic atrophy. There was one eye with no areas of increased FAF(3.3%), 18 eyes were diffuse(60%), eight eyes were banded(26.7%), three eyes were focal(10%), and patchy type was not found(0%). In the current study, 14(46.7%) had well-defined edges, whereas 16 eyes(53.3%) had ill-defined edges. Moreover, 15 eyes(50%) were found to have unifocal decreased FAF, whereas15 eyes(50%) were found to have multifocal decreased FAF. In addition, 12 eyes(40%) had irregular shape, whereas 11 eyes(36.7%) had circular shape and seven eyes(23.3%) had oval shape. In the current study, the size of areas of decreased FAF was compared with the optic disc diameter of the same affected eye, and this area ranged from 0.5 to 4 disc diameters, with a median of 2.31±0.96 disc diameters. Conclusion OCT and FAF are complementary in identifying, examining, and managing geographic atrophy owing to AMD. The advantages of OCT over FAF are that it allows quantitative and qualitative analysis of geographic atrophy lesions, allowing better structural identification of the lesion.
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Theapplication of ultrasound, atypical muscle fibers around the roots of the interscalene brachial plexus, and effects on the interscalene nerve block
Mamdouh S Lotfy, Ashraf Moustafa, Thomas Grau, Heba Aboheeba
April-June 2017, 30(2):544-547
DOI:10.4103/1110-2098.215444  
Objectives The purpose of this study was to estimate the ability of ultrasound(US) to identify the presence of atypical muscle fibers around the roots of the interscalene brachial plexus and their relevance to the performance of continuous interscalene nerve block. Background Ultrasonography is a very effective technique for detecting the altered anatomy within the interscalene area and it helps to avoid complications like intraneural and intravascular injections. Methods This study included 215patients who received a US-guided interscalene brachial plexus catheter and underwent general anesthesia for shoulder surgery. All patients were examined using US for detection of atypical muscle fibers around the roots of the interscalene brachial plexus and for evaluating pain on the Numerical Rating Scale in the postoperative days. Results The presence of muscle bridges around the roots of the interscalene brachial plexus did not show any statistically significant differences in Numerical Rating Scale pain scores at rest and during movement on the second and third postoperative days. Conclusion US is a very effective technique for detecting the altered anatomy and increases the efficacy of the interscalene nerve block.
  18 6 -
Post-LASIK biometry methods in myopes(comparative study)
Saber H Elsayed, Abd El-Rahman E Sarhan, Moataz F Elsawy, Ahmed M Nadi Kamal Selim
April-June 2017, 30(2):496-501
DOI:10.4103/1110-2098.215436  
Objective This study aimed to find a practical accurate method to overcome the errors of intraocular lenses(IOLs) power calculation in patients undergoing cataract extraction and IOL implantation following previous laser-assisted in-situ keratomileusis(LASIK). Background Biometry for patients who had undergone LASIK. Patients and methods This study was carried out on 100 eyes to find a practical accurate method to overcome the errors of IOL power calculation in patients undergoing cataract extraction and IOL implantation following previous LASIK. Results Shammas no history method showed an average error(+0.46±0.69 D), with 84% of cases within±0.5 D and 92% within±1 D. Rosa no history method showed an average error (0.7±1.31 D), with 16% of cases within±0.5 D and 64% within±1 D. Ferrara no history method showed an average error (1.78±1.15 D), with 20% of cases within±0.5 D and 32% within ±1 D. Haigis-L no history method showed an average error(−0.48±1.25 D), with 56% of cases within±0.5 D and 68% within±1 D. Conclusion Shammas method was the most accurate method, followed by the Haigis-L method, the Rosa method, with more dioptric errors, and finally the Ferrara method, with the largest dioptric error.
  17 6 -
Comparison of fasica lata and prolene suture in frontalis suspension surgery: frontalis muscle suspension
Hassan G Farahat, Nermeen M Badawi, Sameh S Mandour, Sara A Nage
April-June 2017, 30(2):502-506
DOI:10.4103/1110-2098.215450  
Objectives The aim of the study was to compare prolene suture, polytetrafluoroethylene sheet, and fascia lata for frontalis suspension surgery in the treatment of congenital ptosis with poor levator function. Background Eyelid frontalis suspension surgery is a common operative procedure used to correct severe blepharoptosis in eyes with poor levator muscle function. The main indication for frontalis suspension surgery is severe blepharoptosis secondary to myogenic, neurogenic, mechanical, and traumatic disorders. Patients and methods Eyelids were divided into three groups. In groupI(20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using autogenous fascia lata. In groupII(20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using a ribbon of 0.3mm Gore-tex sheet. In groupIII(20 eyelids), the upper-eyelid tarsus was suspended to the frontalis muscle using prolene suture. Follow-up of eyelid level and reporting of postoperative complications and incidence of recurrence were done. Results At 12months postoperatively(end of the follow-up period), there was no statistically significant difference between groupI and groupII regarding eyelid level. Fascia lata-related complications were detected in three eyelids of groupI. Gore-tex-related complications were detected in five eyelids of groupII. Prolene-related complications were detected in eight eyelids of groupIII. There was no statistically significant difference in complications between the three groups. The recurrence rate was 5%(one of 20 eyelids) in groupI, 10%(two of 20 eyelids) in groupII, and 40%(eight of 20 eyelids) in groupIII. The difference in recurrence rates was statistically nonsignificant. Conclusion Fascia lata is a good sling material, followed by Gore-tex sheet. Prolene suture has many complications and is associated with a high rate of recurrence.
  17 6 -
Is there a seasonal distributionof acute appendicitis in Iraqi children?
Mahmood D Al-Mendalawi, Maha A Lattuf
April-June 2017, 30(2):572-574
DOI:10.4103/1110-2098.215442  
Objective The aim of this study was to define the seasonal distribution of acute appendicitis(AA) in Iraqi children, if any, test the significant effect of age and sex on this distribution, and compare our results with those reported previously. Background AA is one of the most common causes of abdominal pain and indication for emergency abdominal surgery in children. The few anecdotal published studies have shown variable association of seasonality with AA in children. Patients and methods We carried out a retrospective study on 1091 pediatric appendectomies at Children's Welfare Teaching Hospital in Baghdad between 2009 and 2014. Data of age, sex, and monthly and seasonal distribution were obtained from medical files. Descriptive statistics and the c2-test were used to describe and analyze data, respectively. Results The highest rates(30.7 and 30.4%, respectively) were found in the winter and summer months, whereas the lowest rates(20.6 and 18.2%, respectively) were found in the spring and fall. Seasonality was not statistically associated with age(P=0.120) or sex(P=0.251). Conclusion The results indicate a seasonality of AA in the population studied. Pediatricians and pediatric surgeons should take into account this seasonality when evaluating children with acute abdominal pain. Further large-scale multicenter studies are recommended to confirm our observation.
  12 10 -
The outcome ofearlydecompressive craniectomy of rapidly evolving cerebral parenchymatous mass lesion: vascular or trauma
Mohammud A Mohammud Salim, Shawky S Gad, Adel M Hanafy, Hossam A Elnoamany, Hazem M Negm
April-June 2017, 30(2):548-554
DOI:10.4103/1110-2098.215431  
Objectives The objective of this study was to determine the outcome of early decompressive craniectomy(DC) in cases of increasing(evolving) parenchymatous swelling due to trauma or massive middle cerebral artery(MCA) infarction. Background Intracranial hypertension is a major cause of secondary brain injury and often follows trauma or MCA infarction. Because intracranial pressure(ICP) varies with changes in the volume of the intracranial contents, we can increase cranial volume by removing the skull and opening the dura. The underlying brain can then swell under the relatively distensible skin. The use of DC to control increased ICP. Materials and Methods The study was a retrospective study conducted in Menoufia University, Neurosurgery Department, on patients admitted in a period of 2years, in case of severe rapidly increasing brain swelling due to trauma or MCA infarction managed by DC. The patients were assessed by clinical examination of preoperative and postoperative Glasgow Coma Scale(GCS) and pupillary reaction, as well as immediate computed tomography brain and 24h postoperative computed tomography brain. The patients were assessed according the Glasgow Outcome Scale. Results A total of 20cases were managed by DC. The data collected from 20cases in this study were evaluated. The mechanism of injury was road traffic accident in 11cases, MCA infarction in six cases and fall in three cases. All cases of bilaterally reactive pupil were clinically improved, and only one case of unilaterally reactive pupil was improved after DC. All cases with moderate GCS clinically improved after DC, and 23%(3/13) of cases with severe GCS affection were improved clinically. According to Glasgow Outcome Scale, the patients were assessed as follows: gradeV as good recovery, three(15%) cases; gradeIV as moderate disability, six(30%) cases; and gradeI as death, 11(55%) cases. Conclusion DC operation is the ideal solution for the management of increased ICP known by radiological improvement under the good circumstances of early intervention.
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Evaluation ofclinicaland surgical outcomes of management of pathological fractures of the dorsolumbar spine
Esam E Saleh, Ahmad M Gamal El-Den Azab, Saeed E Abd El-Rahman Al-Emam, Mahmoud G Hagag, Ashraf A Zaki Abd Al Karim
April-June 2017, 30(2):555-563
DOI:10.4103/1110-2098.215448  
Objectives The aim of this study was to evaluate the clinical and surgical outcomes of management of pathological dorsal and lumbar spine fractures. Background Pathological fractures are fractures that occur in diseased bone. Bone can be weakened by cancer, infection, or the natural aging process. In the spine, this usually occurs in the cancellous vertebral body, leading to vertebral compression fractures that can cause pain, neural compromise, and deformity. Patients and methods A retrospective study was carried out on 50patients who underwent surgical treatment for pathological fractures in the dorsal and lumbar spine. The patients were divided into three groups according to the underlying disease causing the fracture: groupA(21patients) included patients with osteoporotic fractures; groupB(18patients) included patients with neoplastic fractures; and groupC(11patients) included patients with pathological fractures due to infection. Preoperative history taking, full clinical examination, and laboratory and radiological investigations were performed for all patients. Preoperative functional assessment was performed using the Karnofsky scale, the American Spinal Injury Association scale, and the visual analog scale of pain and compared with postoperative values after 3, 6, and 12months. Results Postoperative functional evaluations showed improvement in all patients with recent neurological deficit(P=0.003, 0.016, and 0.001 in groupsA, B, and C, respectively). Significant improvement of pain in neurologically intact patients who underwent vertebral augmentations was observed(P=0.000, 0.00, and 0.03 in groupsA, B, and C, respectively). Conclusion In patients with pathological dorsal and lumbar spine fracture having neurological deficits or spinal canal compromise, the main treatment is spinal decompression and stable fusion. In the absence of neurological compromise or instability, vertebral augmentation is effective for the management of painful vertebral fractures.
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