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Table of Contents
July-September 2016
Volume 29 | Issue 3
Page Nos. 469-764
Online since Monday, January 23, 2017
Accessed 185,485 times.
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REVIEW ARTICLES
Update of pathogenesis and management of nasal polyposis
p. 469
Omer El Banhawy, Rashid Al Abri, Yasser Khalil, Ibrahim Abdul Shafy, Fawzy Fayaz
DOI
:10.4103/1110-2098.198570
Objectives
The goal of this article is to review important and recent findings relating to the pathogenesis and management of nasal polyposis (NP). The rationale for a disease classification based on histopathological characteristics and current concepts in therapeutic approach toward managing the condition are summarized.
Data sources
The data sources are PubMed systemic reviews and all materials on the internet from 2004 to 2014.
Study selection
The initial search presented 6692 articles, of which 40 met the inclusion criteria: systemic review, clinical trial types II and III, meta-analysis, published in English language, published in peer-reviewed journals, and focusing on epidemiology, pathogenesis, and management of NP.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included ethical approval, eligibility criteria specified, appropriate controls, and adequate information.
Data synthesis
Recommendations received were revised for the strength of evidence and strength of recommendation then available data were tabulated.
Findings
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a predominantly inflammatory disease associated with dysregulated interaction between sinus epithelium and the innate lymphoid system. Recent research suggests that chronic rhinosinusitis is neither an eosinophilic nor a neutrophilic disorder. The goal in CRSwNP/ eosinophilic chronic rhinosinusitis is to create a wide postsurgical corridor rather than simple polypectomy for effective delivery of topical anti-inflammatory therapy.
Conclusion
New classification of CRSwNP based on the endotyping characters will facilitate the development of managements and establish genetic associations, demonstrate biomarkers for disease subgroups, and test novel therapeutic targets until the question of NP control has been answered.
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Nutritional support in critically ill adult patients
p. 478
Ayman A Radi, Alaa Eldin A Aiad, Enas A Soliman, Ahmed M Ragab
DOI
:10.4103/1110-2098.198655
Objective
The aim of this study was to conduct a review of nutritional support in critically ill adult patients.
Data analysis
Data source: medical textbooks, medical journals, and medical websites with recent research studies having the keyword nutritional support in the title of the paper were searched. Study selection: systemic reviews that addressed nutritional support and studies that addressed support in critically ill adult patients were selected. Data extraction: a special search was conducted at midline with the keywords nutritional and support in the title of the paper, and suitable studies meeting the criteria were extracted and their quality and validity assessed. Data synthesis: each study was reviewed independently. The data were translated into the language most comfortable for the researcher and arranged in topics throughout the article.
Recent findings
Early nutritional support (within 48 h) is advocated in critically ill patients. The normal policy is to start with enteral nutrition (EN). If not feasible or not able to provide complete nutrition, parenteral nutrition is started to supplement EN. The caloric balance can be maintained by providing 25-35 kcal/kg/day. Nutrition should be personalized for each patient taking into consideration the state of disease and the present nutritional status of the patient. The patient's nutritional adequacy and possible side effects should be assessed regularly.
Conclusion
Early EN has been suggested to be beneficial in the critically ill. But depending on the enteral route alone might lead to underfeeding. Therefore, many patients may need a combination of EN and parenteral nutrition, adjusted as tolerance to EN increases.
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A rationale approach to perioperative fluid therapy in adult patients
p. 487
Safaa Helal, Nagwa Daha, Sherif Zalat, Zeinab Zahran
DOI
:10.4103/1110-2098.198659
Objective
The aim of this study was to focus on the main fluid compartments of the body, and their relative volumes, the differences in their composition, and how these factors affect water and electrolyte balances within the body. In addition, the study aimed to highlight the different types of fluids that can be used for maintenance, replacement, and resuscitation in special situations and outline the latest British guidelines on adult perioperative fluid therapy.
Data summary
Fluid and electrolyte disturbances are extremely common in the perioperative period. Large amounts of intravenous fluids are frequently required to correct fluid deficits and compensate for blood loss during surgery. Major disturbances in fluid and electrolyte balance can rapidly alter cardiovascular, neurological, and neuromuscular functions. In this review, we summarize a clear understanding of normal water and electrolyte physiology, body's fluid compartments and common water and electrolyte derangements, their treatment, and anesthetic implications, which are essential parts of perioperative care and the management of perioperative hemodynamic instability.
Conclusion
Perioperative fluid therapy plays an important role in maintaining hemodynamic stability before, during, and after operation, as well as in preventing electrolyte disturbance. Although it saves life if used cautiously, it can also cause many adverse effects if used without understanding its physiology and how to be used in different situations.
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Laparoscopic management of complications in cases of ventriculoperitoneal shunt
p. 495
Tamer A Sultan, Ahmed G El Tatawy, Mohammed A. A. Ali
DOI
:10.4103/1110-2098.198660
Objective
The objective of this study was to assess the value of laparoscopy in the management of the complications that occur after the insertion of the ventriculoperitoneal shunt (VPS).
Materials and methods
Data were obtained from Medline databases (PubMed, Medscape, ScienceDirect), EMF-Portal, and all materials available in the internet from 2014 to 2015. The initial search presented 48 articles, of which 24 met the inclusion criteria. The articles studied the role of laparoscopy in the management of the complications after the insertion of the VPS and different case studies about the role of laparoscopy. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethics approval was gained, eligibility criteria was specified, appropriate controls, and adequate information and defined assessment measures. The study was conducted on 20 patients who were already diagnosed with abdominal complications after previous insertion of VPS. In our study, with regard to the sex, there were 11 male and nine female patients. Age ranged from 29 days to 43 years, and there were 14 children and six adults. All of our 20 patients were examined using abdomen ultrasound (US): 12 of them had positive US findings and the remaining eight cases had no US findings. In our study, the 20 patients with abdominal complications were submitted to laparoscopy as a management tool, and we examined whether the role of laparoscopy was beneficial or not.
Results
A total of 24 potentially relevant publications were included. The studies revealed the experimental trials on using abdominal laparoscopy to deal with the abdominal complications after the insertion of the VPS.
Conclusion
We found that laparoscopy is a useful modality for the treatment of intra-abdominal complications of VPS such as adhesions and pseudocyst. It is effective, and it avoids multiple laparotomies and its attendant complications and future adhesions.
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ORIGINAL ARTICLES
Pediatric myringoplasty: surgical outcomes of postauricular temporalis fascia graft versus permeatal tragal perichondrial graft in the management of tympanic membrane perforations
p. 499
Ibrahim A Abdelshafy, Attallah H Hassan
DOI
:10.4103/1110-2098.198661
Objective
The aim of this study was to investigate the difference in success rate between temporalis fascia graft and tragal perichondrial graft among pediatric patients undergoing tympanoplasty type 1 for chronic suppurative otitis media with dry central perforation.
Background
Chronic otitis media surgery is the most common procedure in otology in developing countries. Many surgical options with graft materials are used for closure of the tympanic membrane perforations.
Patients and methods
This is a prospective randomized comparative study including 54 pediatric patients (56 ears), between 8 and 18 years of age, with tympanic membrane perforation. Patients were randomly divided into two groups: group A included 30 ears of 28 patients who were subjected to postaural temporalis fascia graft myringoplasty and group B included 26 ears of 26 patients who were subjected to permeatal tragal perichondrial graft myringoplasty. Closure of the perforation within 1 year postoperatively and improvement in hearing with air-bone gap on pure tone audiogram less than 10 dB were considered as success criteria. Sex, age, site and size of perforation, and status of contralateral ear were studied.
Results
The overall success of tympanic membrane perforation closure was 86.7% in group A and 88.4% in group B, with no statistically significant difference between the two groups. No difference was found as regards sex and site of perforation between the two groups. However, bilateral ear affection and the size of perforation had a significant difference in overall success. Moreover, no significant audiological difference was found between the two groups, but the overall improvement was significant.
Conclusion
Tympanoplasty type 1 (myringoplasty) is an appropriate technique for repairing tympanic membrane perforation in pediatric patients. Both postaural temporalis fascia graft and permeatal tragal perichondrial graft are effective, with no significant difference between the two techniques. Bilateral affection of the ears and size of perforation should be considered as determinant factors for success.
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Microdebrider-assisted turbinoplasty against submucosal cauterization in inferior turbinate hypertrophy
p. 504
Ahmed Ragab, Omar Elbanhawy, Ahmed Khashba, Ayman Ali, Mahmoud AbdelAziz
DOI
:10.4103/1110-2098.198688
Objective
This study was carried out to compare postoperative outcomes between microdebrider-assisted turbinoplasty and submucosal cauterization (diathermy) in the treatment of chronic inferior turbinate hypertrophy using subjective and objective criteria.
Background
Chronic nasal obstruction is one of the most common symptoms in otorhinolaryngology, and hypertrophy of the inferior turbinates is the most frequent etiology.
Patients and methods
This prospective study was carried out over 25 patients with nasal obstruction and hypertrophied turbinate mucosa refractory to medical treatment. All patients enrolled in the present prospective randomized study were subjected to microdebrider-assisted turbinoplasty on the right side (group A operation) and a submucosal cauterization on the left side (group B operation). Postoperative changes in the degree of nasal obstruction, nasal discharge, and crustations were evaluated at 1 week, 1 month, and 6 months by nasal endoscopy. The patient satisfaction score was evaluated at 6 months postoperatively. Rhinomanometric measurement was also performed preoperatively and at 6 months postoperatively for objective comparison.
Results
Microdebrider-assisted turbinoplasty was statistically better in comparison with submucosal cauterization regarding postoperative nasal obstruction at 1 month (
P
= 0.025) and 6 months (
P
= 0.049), nasal crustations at 1 month (
P
= 0.004) and 6 months (
P
= 0.017), postoperative patient satisfaction at 6 months (
P
= 0.042), and rhinomanometric measurement at 6 months (
P
= 0.001). There was improvement of nasal discharge and headache with no statistically significant difference between both groups (
P
≥ 0.05).
Conclusion
Microdebrider-assisted turbinoplasty is more effective and satisfactory than submucosal cauterization in relieving nasal obstruction subjectively and objectively.
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Comparative study between different surgical treatment modalities of refractory chronic rhinosinusitis in children
p. 510
Ahmed Ragab, Adel Tharwat, Heba Abo El-Naga, Reda Omar
DOI
:10.4103/1110-2098.198689
Objectives
The aim of the present study is to compare randomly the effect (symptoms and CT improvement according to results of the postoperative mean differences of total CT Lund Mackay score) of adenoidectomy, adenoidectomy with middle meatus (MM) wash, and adenoidectomy with endoscopic sinus surgery (ESS) in the treatment of chronic rhinosinusitis in children.
Background
Rhinosinusitis is a common disease observed in pediatric patients. Different modalities of treatment can be used in the management of chronic rhinosinusitis, but the best plan to treat the disease is not known.
Materials and methods
Fifty-five patients were enrolled randomly in three treatment groups: group I (adenoidectomy), group II (adenoidectomy with MM wash), and group III (ESS and adenoidectomy). Patients were assessed preoperatively and 6 months postoperatively regarding visual analogue scale for sinonasal symptoms and CT Lund-Mackay score.
Results
There were no significant differences between the groups preoperatively (
P
> 0.05). All groups had postoperative improvement regarding visual analogue scale for sinonasal symptoms and CT Lund-Mackay score (
P
< 0.001). The mean differences between the preoperative and postoperative total visual analogue scale for sinonasal symptoms and CT Lund-Mackay scores were higher in group III than in group II (
P
= 0.04 and 0.05) and group I (
P
< 0.001 and
P
< 0.001), respectively. In addition, group II had better symptoms and CT scores than group I (
P
= 0.03 and 0.01).
Conclusion
ESS and adenoidectomy had better symptoms and CT results improvements than adenoidectomy with or without MM wash.
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Prophylactic steroids and/or antibiotics to reduce post-tonsillectomy morbidity: a double-blind placebo-controlled trial
p. 515
Elsayed M Abd Allah Rezk, Adel T Ataallah, Ahmed A Ragab, Ayman A Abd Fattah
DOI
:10.4103/1110-2098.198693
Objectives
The aim of this study was to evaluate the role of postoperative oral steroids (prednisolone) and/or antibiotic (amoxicillin and clavulanic acid) to reduce post-tonsillectomy (with or without adenoidectomy) morbidity.
Background
Tonsillectomy remains one of the most common surgical procedures performed worldwide. Mortality rates for the operation range from one in 10 000 to one in 35 000, with morbidity rates ranging from 1.5 to 14%. Consequently, antibiotics ± oral steroids are frequently prescribed in an effort to minimize complications such as pain, dehydration, secondary infection of the operative site, and haemorrhage.
Materials and methods
A total of 265 children subjected to tonsillectomy with or without adenoidectomy were randomly allocated into four groups. The patients were blinded to the postoperative medications that they received: group A, two placebo treatments for 5 days (75 patients); group B, postoperative antibiotic and placebo for 5 days (64 patients); group C, postoperative antibiotic and oral steroid for 5 days (61 patients); and group D, postoperative oral steroid and placebo for 5 days (65 patients). The postoperative recovery was assessed by completion of a questionnaire including the following parameters: pain degree, fever, nausea and vomiting, halitosis, pharyngeal bleeding, analgesic requirement, and the day of return to a normal diet.
Results
There were no significant differences between the four groups in terms of nausea and vomiting (
P
≥ 0.05), but there was a significant difference between the groups favoring group C in the mean pain score (
P
= 0.0001), paracetamol consumption (
P
< 0.0001), halitosis (
P
= 0.01), postoperative bleeding (
P
= 0.0007), time taken to return to normal diet (
P
< 0.0001), and fever on postoperative days from the third day (
P
= 0.0005), fourth day (
P
= 0.0001), fifth day (
P
< 0.0001), sixth day (
P
< 0.0001), to seventh day (
P
= 0.0002).
Conclusion
Combined prophylactic oral steroids (prednisolone) and antibiotic (amoxicillin and clavulanic acid) for 5 days after tonsillectomy can reduce the postoperative morbidity.
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Intrathecal versus intravenous dexmedetomidine in characteristics of bupivacaine spinal block in lower abdominal surgery
p. 523
Mohammed H Afifi, Ashraf M Mohammed, Sabry I Abdullah, Khaled E Ellisy
DOI
:10.4103/1110-2098.198694
Background
Dexmedetomidine was shown to improve bupivacaine spinal anesthesia.
Objective
The aim of this study was to compare between intrathecal and intravenous (i.v.) dexmedetomidine as an adjuvant to bupivacaine spinal anesthesia.
Patients and methods
Sixty ASA physical status I-II aged 20-60 years scheduled for lower abdominal surgery under spinal anesthesia were assigned randomly to two groups. The intrathecal group received intrathecal 15 mg hyperbaric bupivacaine with 5.0 μg dexmedetomidine, followed by an i.v. infusion of normal saline solution during surgery. The i.v. group received intrathecal hyperbaric bupivacaine 15 mg with 0.5 ml normal saline solution, followed by a loading dose of dexmedetomidine 0.5 μg/kg over 10 min and then a maintenance dose of 0.5 μg/kg/h during surgery. Assessment parameters were vital signs, spinal block, analgesia, sedation, and side effects.
Results
Blood pressure and heart rate values were lower in the i.v. group than in the intrathecal group. The intrathecal group had earlier sensory onset, higher peak sensory level, and prolonged sensory regression time to S1 dermatome (
P
< 0.001). The time to Bromage 3 motor block was comparable between both groups, but the regression time to Bromage 0 was prolonged in the intrathecal group (
P
< 0.001). The intrathecal group had a longer time to first analgesic request (
P
< 0.001) and less analgesic consumption than the i.v. group. The i.v. group had a higher intraoperative sedation level. The intrathecal group had fewer side effects than the i.v. group, but this was statistically insignificant.
Conclusion
As an adjuvant for spinal bupivacaine, intrathecal dexmedetomidine is superior to i.v. dexmedetomidine. It provides more stable hemodynamics, greater block augmentation, better analgesia, and fewer side effects including the intraoperative sedation score than the i.v. route.
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The effects of using pregabalin versus clonidine premedication in laparoscopic cholecystectomy
p. 530
Nadia M Bahgat, Sadik A Sadik, Wafiya R Mahdy, Osama A El-Sharkawy, Ahmed A Metwally, Maather K El-Shafey
DOI
:10.4103/1110-2098.198695
Objectives
The aim of this study was primarily to compare the efficacy of oral premedication with pregabalin versus clonidine on stress response and hemodynamic stability during laryngoscopy in adult patients undergoing elective laparoscopic cholecystectomies, and, second, to evaluate sedation, anxiety, and postoperative analgesic effects of both oral premedications.
Background
Laparoscopic cholecystectomy induces hemodynamic responses, which should be attenuated with appropriate premedication. Moreover, after laparoscopic cholecystectomy, patients report visceral pain and shoulder tip pain resulting from diaphragmatic irritation, which should be relieved with appropriate analgesics.
Patients and methods
Sixty adult patients aged 18-60 years with American Society of Anesthesiologist physical status I of both sexes scheduled for elective laparoscopic cholecystectomy were randomized to receive pregabalin 300 mg (group P), clonidine 200 μg (group C), or placebo (group O), given 90 min before surgery as oral premedication. Anesthetic technique was standardized and all groups were assessed for preoperative sedation level using the Ramsay Sedation Scale, along with changes in heart rate and mean arterial pressure, before premedication, before induction, after laryngoscopy, after creation of pneumoperitoneum, and after extubation. Intraoperative propofol, isoflurane, and opioid drug requirement and postoperative complications were recorded.
Results
Perioperative sedation levels were higher with pregabalin than with clonidine, without prolongation of recovery time. Statistically significant attenuation of mean arterial pressure and heart rate to laryngoscopy and laparoscopy was observed in the premedicated groups. The visual analogue scale scores of both the pregabalin and the clonidine group were significantly lower than that in the control group at 1, 4, and 8 h after surgery.
Conclusion
This study confirms that oral premedication with pregabalin 300 mg or clonidine 200 μg produces sedation and hemodynamic stability during laparoscopic cholecystectomy and a decrease in postoperative pain and analgesic consumption.
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Comparative study between the Karydakis technique and the Limberg flap in pilonidal sinus
p. 539
Samir M Kohla, Allaa A Alsesy, Tamer F Abd El-Aziz, Moharrem A Mohammed, Mahmoud A Abo Zaid
DOI
:10.4103/1110-2098.198696
Objective
A comparative study was carried out between the Karydakis technique and the Limberg flap in the management of sacrococcygeal pilonidal disease.
Background
Pilonidal sinus is a sinus tract that commonly contains hairs under the skin between the buttocks a short distance above the anus, but can occur elsewhere in the body. The best surgical technique for sacrococcygeal pilonidal disease is still controversial. The aim of this randomized prospective trial was to compare the results of both the Karydakis technique and the Limberg flap.
Patients and methods
This study included 13 patients with sacrococcygeal pilonidal sinus disease who were assigned randomly. Fifteen patients were subjected to the Karydakis technique and 15 patients received the Limberg flap.
Results
Our study showed that the time to removal of stitch in the Karydakis group was 12.26 ± 1.66, whereas in the Limberg group, it was 13.66 ± 1.29 (longer in group that received the Limberg flap;
P
= 0.016). The percentage of complete healing in the Karydakis group was 80%, whereas that in the Limberg group was 66.7% (no significant difference;
P
≥ 0.05). Postoperative wound breakdown in the Karydakis group was 13.3%, whereas that in the Limberg group was 26.7% (no significant difference;
P
≥ 0.05). Recurrence was 6.7% in the Karydakis group, whereas it was 6.7% in the Limberg group (no significant difference;
P
≥ 0.05). The time to return to work was 21.73 ± 6.49 in the Karydakis group, whereas in the Limberg group, it was 28.66 ± 7.50 (longer in the Limberg flap group;
P
= 0.012), and the duration of surgery in the Karydakis group was 37.73 ± 12.98, whereas that in the Limberg group was 61.60 ± 11.11 (longer in the Limberg flap group;
P
≤ 0.001).
Conclusion
The Karydakis flap procedure had many advantages over the Limberg flap for the treatment of uncomplicated pilonidal sinus because of its lower postoperative complication rate, time to removal of stitches, time to return to work, and duration of surgery. However, there was no difference between the two surgical procedures in terms of prevention of recurrence.
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Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma
p. 545
Alaa A Elsesi, Asem F Moustafa, Mostafa H Elmarakby
DOI
:10.4103/1110-2098.198697
Background
Serum CA19-9 is a tumor marker with high sensitivity to pancreatic cancer. It is considered an easy, cheap, fast, and noninvasive tool in the diagnosis and monitoring of cancer pancreas, which is one of the medical problems that has high morbidity and mortality rates.
Objective
The aim of this study was to evaluate the clinical value of serum CA19-9 levels in predicting the resectability of pancreatic carcinoma, provided the tumor is resectable on computer tomography basis.
Patients and methods
In this retrospective study, serum CA19-9 levels were evaluated in 48 patients with pancreatic cancer in whom there was a possibility of resection on the basis of imaging. The patients were presented and treated at Menoufia University Hospitals and Damanhour Oncology Center during the period from January 2012 to December 2014.
Results
Resectable pancreatic cancer was detected in 38 (79.2%) patients and unresectable pancreatic cancer was detected in 10 (20.8%) patients. CA19-9 gave positive results (>39 U/ml) in 43 (89.6%) patients. The cutoff value of CA19-9 was 439.15 U/ml.
Conclusion and recommendations
Preoperative CA19-9 serum level is a useful marker in further evaluating the resectability of pancreatic cancer. Significantly increased serum level of CA19-9 can be regarded as an ancillary parameter for unresectable pancreatic cancer. CA19-9 level in combination with computer tomography has higher sensitivity in the determination of the resectability of pancreatic cancer and thereby benefits in avoiding unnecessary laparotomy and prevents its morbidity.
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The anterior rectus abdominis sheath flap for fascial closure in burst abdomen and midline incisional hernia
p. 549
Soliman A El Shakhs, Ahmed M Fawzy, Bahaa A Mashaal
DOI
:10.4103/1110-2098.198698
Objectives
The aim of this study is to evaluate the effect of using the anterior rectus abdominis sheath flap in the repair of burst abdomen and midline incisional hernia.
Background
Complex abdominal wall hernias can be challenging for the reconstructive surgeon. The use of autologous tissue is preferable when possible. This repair entails a single fascial incision releasing the anterior rectus sheath as a turnover flap for abdominal wall reconstruction. This allows large defects to be closed with autologous tissue alone in a two-layer fascial repair in a vest-over-pants manner in a simple, straightforward surgical approach.
Materials and methods
Thirty participants requiring open abdominal management over a 26-month period were reviewed who underwent the anterior rectus abdominis sheath flap which released by lateral incision that meeting in midline as open book closing the defect ± the mesh. Hospital and office-based charts were reviewed.
Results
Thirty patients included in this study have risk factors such as anaemia (14:46.7%), malnutrition (11:36.7%), smoking (17:56.7%), obesity (16:53.3%), malignancy (17:56.7%), diabetes (8:26.7%) and chest complications (chronic obstructive pulmonary disease) (12:40%), with the cause of primary lesion divided into intestinal obstruction (6:20%), gastrointestinal tract malignancy (10:33.34%), miscellaneous (gynaecological and urological) (7:23.33%) and traumatic laparatomy (7:23.33%). Postoperative complications were wound infection (6:20%), seroma (5:16.6%), skin necrosis (3:10%), recurrence (1:3.3%), haematoma (1:3.3%) and no fistula. The average length of follow-up was 6-26 months.
Conclusion
The use of the anterior rectus abdominis sheath flap is an important technique for fascial closure in burst abdomen and midline incisional hernia; it is a simple and natural technique and provides a fascial closure with low recurrence and acceptable complications.
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Management of isolated calf vein thrombosis
p. 554
Hatem A Saleh, Nehad Abdo Zied, Mohammed S Shalan
DOI
:10.4103/1110-2098.198699
Objective
The aim of the present study was to evaluate a protocol for managing isolated calf vein thrombosis.
Background
Deep vein thrombosis (DVT), which is common among the general population, can lead to fatal pulmonary embolism; therefore, its early diagnosis is essential. A recent study revealed that the reason for 10% of mortality in general hospitals in the UK was pulmonary embolism.
Patients and methods
Forty patients with isolated calf vein thrombosis were categorized into two groups: group A, which included 20 patients with provoked isolated calf vein thrombosis; and group B, which included 20 patients with unprovoked isolated calf vein thrombosis.
Results
In the provoked group, 16 patients had satisfactory resolution after 10 days of therapy (80%), four patients had no resolution (20%), and no patient had progression to the popliteal vein. On the other hand, in the unprovoked group, 14 patients had satisfactory resolution (70%), four patients had no resolution (20%), and two patients had progression to the popliteal vein (10%) (
P
= 0.34). Sixteen patients in the provoked group had no recurrence at the end of 3 months (80%), three patients had recurrence of the calf thrombosis (15%), and one patient had progression to the popliteal vein (5%), whereas in the unprovoked group, 14 patients had no recurrence (70%), four patients had recurrence of calf thrombosis (20%), and two patients had progression to the popliteal vein (10%) (
P
= 0.74).
Conclusion
Provoked calf vein thrombosis can be treated with low molecular weight heparin (LMWH) for 10 days and then the duplex should be repeated after 10 days. If there is no progression to thrombus, anticoagulation therapy is stopped and the patient is asked to use elastic stockings. Unprovoked calf vein thrombosis can be treated with LMWH for 10 days, and if there is no propagation to the thrombus, we can put the patients on low intensity warfarin dose regimen - for example, 1-2 mg to adjust INR in the range 1-1.9.
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Role of ankle peak systolic velocity in predicting healing of diabetic foot lesions
p. 559
Ahmed M Hosny, Nhad A Ahmed Zeed, Tawfik A Eldeen Tawfik
DOI
:10.4103/1110-2098.198709
Objective
The aim of the present study was to determine whether ankle peak systolic velocity (APSV) can predict healing of diabetic foot lesions.
Background
Problems associated with the diabetic foot are prevalent worldwide. Diabetic foot lesions contribute significantly toward the morbidity and mortality of patients with diabetes mellitus. This study was carried out to evaluate the APSV as a predictor of healing in diabetic foot lesions.
Patients and methods
Diabetic patients referred to the General Surgery Department of Menoufia University were included in the study. Patients were included if they had foot lesions, such as ulcers, gangrene, or tissue necrosis, and had no palpable pedal pulses. End points were healed, healing, and nonhealing or amputation. In total, 50 diabetic foot patients were included in the study. All of them were subjected to the following: an assessment of full history; physical examination, including foot examination through peripheral pulses including Doppler examination, measurement of APSV, and ankle-brachial index; and routine investigations.
Results
Twenty-four patients reached the end point of adequate healing or complete healing. On the other hand, 26 patients had nonhealing lesions. The APSV was significantly higher in patients with healed or healing lesions compared with the patients with nonhealed lesions: 57.8 ± 12.72 versus 24.9 ± 9.55 cm/s (
P
< 0.001). At a cut-off point of 40 cm/s, the APSV showed a sensitivity of 90.91%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 92.3%, with a diagnostic accuracy of 97.4% in predicting the healing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 23.4 ± 6.5 versus 58.8 ± 12.3 cm/s (
P
< 0.001).
Conclusion
APSV could predict the healing of diabetic foot lesions with a high degree of accuracy in this group of patients.
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Fistulectomy versus fistulotomy in the management of simple perianal fistula
p. 564
Olfat I Elsebai, Alaa A Elsesy, Mohammed S Ammar, Ahmed M Khatan
DOI
:10.4103/1110-2098.198710
Objective
The objective of this research was to study the functional and clinical outcomes of fistulectomy versus fistulotomy in the treatment of simple perianal fistula.
Background
Anal fistula has been known as a common surgical ailment for over two and a half millennia. Current management remains dependent on surgeon preference between options such as fistulotomy and fistulectomy.
Patients and methods
This is a prospective clinical study that included 30 patients suffering from simple perianal fistula; patients were divided into two groups each containing 15 patients: group A was managed by fistulectomy and group B was managed by fistulotomy. Both groups were evaluated according to the operative time, postoperative pain, time of wound healing, postoperative complication, incontinence, and recurrence.
Results
There was a significant decrease in the operative time in group B compared with group A (
P
< 0.05), there was a significant decrease in postoperative pain in group B compared with group A (
P
< 0.05), and there was a significant decrease in the time needed for wound healing in group B compared with group A (
P
< 0.05). There was no significant difference in postoperative complications, incontinence, and recurrence between the two groups (
P
> 0.05).
Conclusion
Fistulotomy is a simple and effective method for the treatment of simple perianal fistula, as it has shorter operating time with less postoperative pain and less time needed for wound healing compared with fistulectomy, with the same incidence of postoperative complications, incontinence, and recurrence as fistulectomy.
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Extent of division of the internal anal sphincter in chronic anal fissure
p. 570
Samir M. H. Kohla, Ahmed Fawzy, Ahmed S Goda
DOI
:10.4103/1110-2098.198712
Objective
The aim of this study was to compare the results of lateral internal anal sphincterotomy up to the dentate line or up to the apex of the anal fissure.
Background
Troublesome fecal incontinence following a lateral internal sphincterotomy is often attributed to faulty surgical technique. However, it may be associated with coexisting occult sphincter defects. Whether continence is related to the extent of sphincterotomy remains debatable.
Patients and methods
This prospective randomized study included 48 patients suffering from chronic anal fissures in the period between October 2013 and March 2015. They were admitted to the Department of Surgery of Menoufia University and Al-Helal insurance hospitals. This study included 24 patients who underwent traditional lateral internal sphincterotomy (up to the dentate line) and 24 patients who underwent conservative lateral internal anal sphincterotomy (up to the height of the fissure apex or just below it). All patients were evaluated with respect to operative time and postoperative complications. The results were documented and statistically analyzed.
Results
The mean time required for relief of pain postoperatively after conventional lateral sphincterotomy (LS) operation was 2.1 ± 2.6 days and that after conservative LS was 3.7 ± 3.5 days. Early transient incontinence was reported in 9/24 (37.5%) patients in the conventional LS group and 2/24 (4.2%) patients in the conservative LS group. Wounds healed within 6 weeks in 16/24 (66.7%) patients of the conventional LS group and in 22/24 (95.8%) patients of the conservative LS group.
Conclusion
On the basis of this study, we conclude that the conservative LS operation has several advantages over the conventional LS operation in the treatment of chronic anal fissures.
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Shoelace darn repair versus mesh repair hernioplasty in treating midline abdominal incisional hernia
p. 575
Samir M Kohla, Hossam A El-Fol, Ahmed S El-Gammal, Ayman M Al-Ebiary
DOI
:10.4103/1110-2098.198714
Objective
The objective of this study was to compare the efficiency and safety between the use of shoelace darn repair and the use of mesh repair in the management of midline abdominal incisional hernia.
Background
Midline abdominal incisional hernia is a complication caused by surgical wounds after different surgical procedures. Management of midline abdominal incisional hernia is performed through different surgical approaches.
Patients and methods
This was a 1-year, prospective, randomized study including 40 patients with midline abdominal incisional hernia. The patients were divided into two equal groups - group I (20 patients) repaired by shoelace darn repair and group II (20 patients) repaired using a polypropylene mesh. Both groups were evaluated for incidence of infection, hematoma formation, seroma formation, and recurrence for 12 months.
Results
Wound hematoma was found in one patient (5%) from group I and in one patient from group II (5%); there were no statistically significant differences between the two groups with regard to hematoma (
P
= 0.987). Similarly, seroma was found in one patient (5%) from group I and in one patient from group II (5%); there were no statistically significant differences between the two groups with regard to seroma (
P
= 0.987). Three patients (15%) from group I had recurrence of hernia, whereas two from group II had recurrence of hernia (10%), and statistical analysis proved that there was no significant difference between the two groups with regard to hernial recurrence (
P
= 0.637). One patient (5%) from group I complained of postoperative chronic pain, whereas two from group II (10%) complained of postoperative pain, and statistical analysis proved that there was no significant difference between the two groups with regard to postoperative chronic pain (
P
= 0.553). Wound infection was found in one patient (5%) from group I and in three patients from group II (15%), and statistical analysis proved that there was no significant difference between the two groups with regard to wound infection (
P
= 0.602).
Conclusion
From the present study, we concluded that shoelace darn repair is a better option for managing midline abdominal incisional hernias.
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The assessment of the clinical applications of propeller flaps of the lower leg
p. 580
Tarek F Kishk, Ahmed M Elbarah, Yasser M Elsheikh, Waleed S Abd El Sadek
DOI
:10.4103/1110-2098.198717
Objective
The aim of the present study was to assess the clinical applications of the various propeller perforator flaps for the leg in an attempt to evaluate the results and propose an algorithm for the management of various defects of the lower-third of the leg.
Background
The ideal method for the soft-tissue reconstruction of the leg should be reliable, relatively easy to perform, offer viable tissues similar in skin texture and thickness to the lost ones (replace like with like), leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. The perforator-based propeller flaps have all these advantages.
Patients and methods
This study included 34 patients who presented with moderate-sized leg defects from August 2013 to June 2015. Out of the 34 patients, 24 were males and 10 were females. Their ages varied from 5 to 50 years with an average age of 27 years. There were 19 posterior tibial artery perforator flaps. There were 12 flaps based on perforators of the peroneal artery. Lastly, there were three anterior tibial artery perforator flaps. Duplex ultrasonography was carried out for 25 patients preoperatively.
Results
All flaps were based on a single perforator except three cases in which the flaps were based on two adjacent perforators. Fourteen of the flaps were proximally based and 20 were distally based. All flaps were designed as propeller flaps and were rotated from 70° to 180°. The donor site was closed by using split-thickness grafts in all except three cases in which the donor site was closed primarily. Out of the 19 flaps of the posterior tibial artery, 11 (57.5%) healed uneventfully and eight (42.5%) cases were complicated. Out of the 12 peroneal artery propeller flaps, nine (75%) flaps healed uneventfully and three (25%) cases were complicated. Lastly, out of the three cases of the anterior tibial artery propeller flaps, one (33%) healed uneventfully and two (66%) were complicated.
Conclusion
Propeller flaps based on perforator vessels are raising interest in the reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows the reconstruction of soft-tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of propeller perforator flaps in the treatment of various lower-leg defects.
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The visual outcome and complications in deep anterior lamellar keratoplasty for keratoconus
p. 587
Saber H El Sayed, Mahmoud M Ismail, Motaz F El Sawy, Ahmed A El Hagaa, Mohammed S Abdel Aziz
DOI
:10.4103/1110-2098.198718
Objective
The aim of this study was to evaluate visual outcomes and complications of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in patients with keratoconus.
Background
Keratoconus is a bilateral noninflammatory corneal thinning disorder leading to protrusion, distortion, and scarring of the cornea. Treatment options are glasses, hard contact lenses, cross-linking, intracorneal segment insertion, refractive surgery, or keratoplasty. DALK can be a better choice to manage cases of moderate and some cases of severe keratoconus without deep scarring and severe thinning.
Participants and methods
This interventional study was carried out on 47 eyes of 46 patients who presented with moderate to advanced keratoconus for DALK from December 2012 to June 2014 with a mean follow-up of 12 months. The best spectacle-corrected visual acuity, the refractive status, and intraoperative and postoperative complications were evaluated.
Results
Thirty-seven procedures (78.7%) were completed with big-bubble formation, and six patients (12.8%) required manual intrastromal dissection. Intraoperative microperforations occurred in four cases (8.5%). The mean preoperative uncorrected visual acuity was 0.036 ± 0.017 and the final best spectacle-corrected visual acuity at 1 year had a mean value of 0.38 (
P
< 0.001). The postoperative mean spherical equivalent refractive error and astigmatism were − 4.9 ± 2.6 and − 3.9 ± 1.6 D, respectively. Main complications encountered included loosening of the stitches in 11 cases (23.4%), vascularization of the stitches in three cases (6.4%), double anterior chamber in two cases (4.3%), Urrets-Zavalia syndrome in one case (2.1%), stromal rejection in one case (2.1%), and suture abscess in one case (2.1%).
Conclusion
DALK using the big-bubble technique appears to be a safe and effective procedure in patients with keratoconus. Postoperative myopic astigmatism is observed in most of the cases.
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Study of relation between serum lipids and loss of vision in patients with diabetic retinopathy
p. 593
Hoda M Kamel Elsobky, Nermeen M Badawi, Ahmed A El-Hagaa, Walid E Nasef
DOI
:10.4103/1110-2098.198721
Objectives
The aim of this study was to evaluate the association of serum lipids with vision loss in diabetic retinopathy (DR) patients and the effect of lipid-lowering agents.
Background
Elevated serum lipids such as total cholesterol and triglycerides lead to vision deterioration through affection of retina in diabetic patients.
Patients and methods
Forty type 2 diabetic patients were evaluated for serum lipids, diabetic retinopathy (DR) and macular oedema from January 2013 to September 2013 in Menoufia University Hospital, Menoufia, Egypt. Antilipid therapy was administered to hyperlipidaemic patients with DR or macular oedema for 9 months and re-evaluated.
Results
Of the 40 diabetic patients, 65% were male and 35% were female, and the mean age was 50.5 years (range = 20-80 years). An overall 75% of patients had DR and 25% of patients did not have DR. Various grades of clinically significant macular oedema (CSME) were detected in 42.5% of diabetic patients. Duration of diabetes ranged from 5 to 25 years. Dyslipidaemia was found in 70% of DR patients. Of the 25 dyslipidaemic patients, 12 patients (48%) had CSME. Total cholesterol, low-density lipoprotein, very-low-density lipoprotein and triglyceride level were elevated in DR and CSME. Hard exudate was present in 70% of DR patients with total cholesterol level above 230 mg/dl, and was present in 80% of DR patients with the ratio of total cholesterol level to high-density lipoprotein above 4.5. Retinal hard exudate decreased after antilipid therapy.
Conclusion
Dyslipidaemia is associated with an increased risk of development and progression of retinopathy and maculopathy in diabetic patients.
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Use of ultrasonic pachymetry to compare the changes in postoperative corneal thickness in extracapsular cataract extraction and in phacoemulsification
p. 597
Mayada H Shebl, Ahmed A El-Hagaa, Mostafa K Nassar
DOI
:10.4103/1110-2098.198725
Objective
The aim of the present study was to evaluate and compare the changes in corneal thickness after extracapsular cataract extraction (ECCE) and phacoemulsification using ultrasonic pachymetry.
Background
During cataract surgery, several mechanisms may lead to corneal endothelial injury and consequent edema. Ultrasonic pachymetry is the gold standard technique to evaluate corneal thickness changes following different types of cataract surgeries.
Patients and methods
Of the 50 patients included, 25 patients underwent phacoemulsification (group 1) and 25 patients underwent ECCE (group 2). The inclusion criteria were corneal clarity, absence of lens subluxation, axial lengths of 21-24 mm, and fully dilatable pupils. The exclusion criteria were pre-existing corneal disease, lens subluxation, pseudo-exfoliation syndrome, coexisting eye disease, or a complicated cataract surgery. Corneal pachymetry was carried out preoperatively and on postoperative days 1, 7, 14, and 21.
Results
The mean preoperative central corneal thickness (CCT) was 546.64 ± 49.95 in group 1 and 537.12 ± 41.01 in group 2 (
P
> 0.05). The postoperative day 1 CCT was 627.52 ± 66.93 in group 1 and 682.88 ± 68.85 in group 2 (
P
< 0.05). The postoperative week 1 CCT was 558.92 ± 52.97 in group 1 and 602.68 ± 71.50 in group 2 (
P
< 0.05). The postoperative week 2 CCT was 548.36 ± 51.99 in group 1 and 585.96 ± 49.37 in group 2 (
P
< 0.05). The postoperative week 3 CCT was 547.56 ± 50.01 in group 1 and 538.20 ± 41.13 in group 2 (
P
> 0.05).
Conclusion
Ultrasonic pachymeter is a reliable instrument that can be used to obtain rapid, accurate, and reproducible measurements of corneal thickness. In short-term follow up, the postoperative corneal edema after phacoemulsification cataract surgery offers faster recovery compared with that after ECCE.
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Topical amphotericin B versus subconjunctival fluconazole injection in the management of fungal keratitis
p. 601
Saber H El-Sayed, Fareed M Wagdy, Ahmed A El-Hagaa, Eman F Mottawea
DOI
:10.4103/1110-2098.198726
Objectives
The aim of this study was to compare the use of topical amphotericin B (0.5 mg/ml) eye drops with the use of subconjunctival injection of fluconazole (2 mg/ml) in dealing with cases of fungal keratitis.
Background
Fungal keratitis is considered one of the serious ocular infections that lead to ocular morbidity and visual loss, especially in developing countries.
Materials and methods
This study was carried out on 50 eyes of 50 patients with resistant corneal ulcers attending Menoufia University Hospital outpatient clinic between July 2012 and February 2014.
Results
Group 1 included 25 cases treated with topical amphotericin B; the study revealed healing of corneal ulcers in six cases (24%), and 19 cases (76%) developed complications. Group 2 included 25 cases treated with subconjunctival fluconazole injection; the study revealed statistically significant result (
P
< 0.01) of healing of corneal ulcers in 23 cases (92%), and in two cases (8%) complications developed.
Conclusion and recommendations
Fungal keratitis has proven to be a continually challenging ocular disease for patients, providers, and society. The most common etiologic agents have been identified to be diabetes and plant ocular trauma. Our study states that the administration of a subconjunctival injection of fluconazole was more effective compared with the administration of topical amphotericin B eye drops, as evidenced by the healing of the fungal corneal ulcer and shorter duration of healing.
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The effect of smoking on choroidal thickness measured by optical coherence tomography
p. 606
Abdel Rahman Elsebaey Sarhan, Sameh Mohamed Elgouhary, Asmaa Mohamed Ibrahim, Al-Shimaa Hussein Maklad
DOI
:10.4103/1110-2098.198727
Objective
The objective of this study was to investigate the effect of smoking on choroidal thickness using the enhanced-depth imaging mode of Spectralis Heidelberg optical coherence tomography (OCT).
Background
Cigarette smoking is an important risk factor for the development of systemic vascular disease and ocular vascular disease. The effect of smoking on the retina and deeper retinal tissues is now a topic of great interest besides being a risk factor for ocular vascular disease. Recently, optical coherence tomography has been shown to be effective in evaluating the choroidal thickness.
Patients and methods
The right eyes of 100 participants (50 healthy smokers and 50 healthy nonsmokers) were included in this study. We measured the choroidal thicknesses of the never-smoking individuals as a control group. The choroidal thicknesses of the smoking participants were measured at 1 and 8 h after smoking. Choroidal thickness measurements were taken at the fovea and at five more points, which are located at, respectively, 500 μm nasal to the fovea, 1000 μm nasal to the fovea, 500 μm temporal to the fovea, 1000 μm temporal to the fovea, and 1500 μm temporal to the fovea.
Results
A significant difference was found for the choroidal thickness, as the choroidal thickness was decreased after 1 h in comparison of smokers and nonsmokers, and there was an increase in choroidal thickness after 8 h in smokers compared with nonsmokers at all measurements points.
Conclusion
Smoking caused an acutely significant decrease in choroidal thickness that returned to increase after 8 h. The choroidal thickness significantly differs between the healthy young smokers and nonsmokers.
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Phacoemulsification by using the quick-chop and the divide and conquer techniques: a prospective comparative study
p. 612
Hoda M. K. El-Sobky, Faried M. W. Faried, Mohamed G. A. Hassan
DOI
:10.4103/1110-2098.198741
Objective
The aim of the present study was to show the differences between the quick-chop and the divide and conquer techniques regarding phacoemulsification time and the operative effect on corneal endothelium.
Background
Phacoemulsification techniques continue to evolve with the goal of providing safer and more effective methods of cataract extraction.
Patients and methods
Fifty eyes of 49 patients were enrolled in this prospective comparative study. All eyes had nuclear cataracts of grades I-IV according to the Lens Opacities Classification System III. This study involved two groups, each having an equal number of eyes (25). The technique used for group A was the quick-chop phacoemulsification, and for group B it was the divide and conquer phacoemulsification. Preoperative and postoperative assessments included best corrected visual acuity, intraocular pressure, slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density was measured preoperatively and 3 months postoperatively. All surgeries were carried out at Menoufia University Hospital between March 2013 and October 2014 using the Geuder Megatron G.
Results
In the quick-chop group, the mean equivalent ultrasound time was 12.6 s and endothelial cell loss 3 months postoperatively was 7.44%. In the divide and conquer group, the mean equivalent ultrasound time was 19.99 s and the mean endothelial cell loss 3 months postoperatively was 8.72%.
Conclusion
The quick-chop phacoemulsification technique consumes less time than does the divide and conquer technique, with statistically significant differences. The quick-chop technique also has a lesser impact on the corneal endothelium than does the divide and conquer technique, with statistically insignificant difference.
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Evaluation of combined corneal cross-linking with LASIK in risky patients
p. 616
Abdel Rahman E Sarhan, Ghada Z Elabedin, Wesam S Elsayed
DOI
:10.4103/1110-2098.198742
Objective
The aim of this study was to evaluate the efficacy and safety of ultraviolet A irradiation cross-linking on completion of laser-assisted in-situ keratomileusis (LASIK) in risky patients to avoid post-LASIK ectasia.
Background
Patients with thinner-than-normal corneas, irregular corneal astigmatism, asymmetry on corneal topography, against-the-rule astigmatism, or steeper-than-normal corneas have higher risk of development of post-LASIK ectasia which need improvement in surgical interference.
Materials and methods
Forty-eight eyes of 30 myopic patients presented for LASIK at Al-Fardous Eye and Dental Hospital, Zagazig, Egypt, between September 2013 and August 2014. The study group comprised risky patients with corneal thickness of at least 480 μm and postoperative residual stromal thickness of at least 300 μm. After reflecting the flap, 0.1% riboflavin sodium phosphate solution was applied on the bare stromal bed and left to be soaked in for 60 s, and then the patient was positioned with the ultraviolet light (typically 365-370 μm).
Results
The study proved that there was an improvement in mean spherical error from −4.05 ± 1.19 preoperatively to −0.98 ± 0.12 on the second day postoperatively, and it improved to −0.59 ± 0.49, −0.49 ± 0.39, and −0.39 ± 0.36 at 1, 3, and 6 months postoperatively, respectively. These results showed a statistically highly significant difference (
P
< 0.001). Visual acuity improved from 0.828 ± 0.33 best-corrected visual acuity preoperatively to 0.881 ± 0.11, 0.894 ± 0.21, 0.9 ± 0.22, and 0.913 ± 0.22 at second day postoperatively, and 1, 3, and 6 months postoperatively, respectively. However, the improvement did not show a statistically significant difference (
P
> 0.05) because we compared the results with the preoperative best-corrected visual acuity.
Conclusion
Application of riboflavin with ultraviolet after LASIK in risky patients improves refractive errors (spherical and cylindrical errors) and prevents post-LASIK corneal ectasia.
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Phacoemulsification, topography guided
p. 623
Saber H El-Sayed, Ghada Z El.Abedin Rajab, Sabry A. S. El-Banna
DOI
:10.4103/1110-2098.198743
Objectives
The aim of this study was to evaluate the astigmatic correcting effect of paired opposite clear corneal incisions (OCCIs) on steep axis in cataract patients with preoperative regular astigmatism undergoing phacoemulsification.
Background
Phacoemulsification in the era of refractive surgery is hitting new frontiers through the correction of preoperative astigmatism at the same time of cataract surgery.
Materials and methods
A total of 80 eyes of 80 patients were enrolled in this prospective study. All eyes had cataract, which necessitated undergoing phacoemulsification. Each patient underwent phacoemulsification surgery combined with OCCIs, to correct preoperative astigmatism. All patients were scheduled to postoperative visits at 1 week, 1, 2, and 3 months postoperatively. Corneal topography was performed at each visit.
Results
Our patients revealed a decrease in preoperative astigmatism throughout the follow-up period. The decrease in the mean astigmatism values was 1.56 ± 0.73 D. This was a statistically significant result (
P
< 0.05). However, the decrease was most evident in patients with vertical or oblique axes astigmatism, and least evident in patients with horizontal axis astigmatism.
Conclusion
OCCIs are innovative on-axis technique for correcting astigmatism at the time of cataract surgery. This is advantageous due to the simplicity of the technique and nearly avoidable complications.
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Divide and conquer versus chopping in phacoemulsification: study of the operation events and early results
p. 627
Hassan G El-Din Farahat, Nermin M Badawy, Faried M Wagdy Faried, Yousef H. M. Ibrahim Mansour
DOI
:10.4103/1110-2098.198744
Objectives
The aim of the study is to evaluate the efficacy and safety of the divide-and-conquer technique versus chopping technique in phacoemulsification.
Background
Kelman in 1967 introduced ultrasonic phacoemulsification for cataract removal, aiming to find a safer and more effective way of removing the lens. At present, phacoemulsification is the procedure of choice for cataract extraction for most ophthalmologists.
Materials and methods
This prospective study included 30 eyes of 30 patients attending the outpatient clinic of Menoufia Ophthalmic Department. Patients aged 40-60 years old with senile cataract nuclear grades from 2 to 4 underwent detailed history taking, full ophthalmic examination, A-B scan ultrasonography, corneal pachymetry and endothelial cell density measurements, and nuclear grading. All patients were operated by the same surgeon using Geuder megatron s3 machine.
Results
There was statistically significant endothelial cell loss (ECL) following all studied techniques 3 months postoperatively (12.4 and 10.5% in groups I and II, respectively). There was no significant difference between all studied groups. The nuclear grade and absolute phaco time had positive correlation with higher ECL, whereas age, sex, and axial length did not affect ECL. A significant increase in the central corneal thickness (CCT) was observed at the immediate postoperative week among the two studied groups (14 and 10.5%, respectively). There was no statistically significant difference between the two groups. The postoperative CCT pachymetry values were returned to near preoperative values at 3 months postoperatively.
Conclusion
Significant and equal ECLs occur after the two studied techniques. Absolute phaco time and nuclear grade have a positive correlation with higher ECL. Age, sex, and axial length do not affect ECL. CCT increases significantly and equally postoperatively following the two techniques.
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Assessment of diabetic macular edema by fundus autofluorescence and optical coherence tomography
p. 632
Khaled E. El-Kotb Said Ahmad, Asmaa M Ahmad Ibrahim, Yasmeen A Abd El-Razag El-Ghazaly
DOI
:10.4103/1110-2098.198745
Objectives
The objective of this study was to evaluate the role of fundus autofluorescence (FAF) in the diagnosis of diabetic macular edema (DME) and to compare it with optical coherence tomography findings.
Background
FAF imaging is a new technology that can be used to characterize eyes with macular disease. Specific FAF patterns observed in patients with DME seem to correlate with various optical coherence tomography patterns rather than with visual acuity.
Patients and methods
This study included a total of 51 eyes (26 right and 25 left eyes) of 27 patients (12 male and 15 female) with a mean age of 56.5 years. Main outcome measurements included best corrected visual acuity (BCVA), central macular thickness (CMT), the integrity of photoreceptors inner/outer segment junction (IS/OS), and the presence or absence of increased FAF (iFAF) at the foveola.
Results
Among the 51 eyes, 37 (72.5%) eyes had no FAF, eight (15.7%) eyes had single-spot iFAF, and six (11.8%) eyes had multispot iFAF; only three (5.8%) eyes of 51 eyes showed the presence of iFAF at the foveola. There was a significant association between grades of FAF regarding intact IS/OS layer (
P
= 0.003) and significant association between grades of FAF regarding partly interrupted IS/OS layer (
P
= 0.04). There was a significant association between grades of FAF and the mean CMT (
P
= 0.002). There was a nonsignificant association between grades of FAF and the mean values of BCVA (
P
= 0.27), and there was a highly significant positive correlation between BCVA and CMT (
P
< 0.001).
Conclusion
FAF might reflect the damage of the retina and had a relationship with the integrity of photoreceptors, as well as CMT, which gives new insight into the evaluation of DME, but it cannot reflect the severity of DME and cannot help us to evaluate the visual function of the patients.
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Fibrin glue and fascia lata graft for management of cerebrospinal fluid leakage after cranial surgery, preliminary results
p. 637
Ahmed Sh. Ammar
DOI
:10.4103/1110-2098.198746
Objective
The purpose of this study is to evaluate the efficacy of fibrin glue and fascia lata graft as a substitute for dural repair in postoperative cerebrospinal fluid (CSF) leak after cranial surgery.
Background
Postoperative CSF leakage is a common complication after many cranial and spinal operations. Several methods are used for repair of dural tears to stop CSF leak; one of these methods is to use fibrin glue with autologous graft - for example, fascia lata - for repair.
Materials and methods
A total of 12 cases with postoperative CSF leak after cranial surgery were observed and managed in the period from June 2010 to December 2012. In all, four cases were meningiomas and eight cases were gliomas. Male-to-female ratio was 5 : 7 and mean age was 56.8 years. All cases underwent secondary surgery to manage the CSF leak by fascia lata graft and fibrin glue. Mean duration of follow-up was 9.8 months (range 6-20 months). Computed tomography brain with and without contrast was performed to determine the presence of CSF leaks between 2 weeks and 3 months after surgery.
Results
No CSF fistula was found in all patients. No adverse effects or complications such as wound infection or neurological impairment were encountered postoperatively. Follow-up computed tomography brain revealed no evidence of CSF leakage.
Conclusion
The use of fascia lata graft and fibrin glue is a useful and effective method in controlling CSF leakage after cranial surgery.
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The role of instrumented fusion in the management of recurrent lumbar disc herniation
p. 642
Mohamed S Elsanafiry, Adel Hanafy, Ahmed Azab, Ahmed Sh. Ammar, Alaa A Elsesy
DOI
:10.4103/1110-2098.198747
Objective
The aim of the present study was to compare the clinical outcome of discectomy alone with discectomy and fusion in the treatment of recurrent lumbar disc herniation.
Background
Lumbar disc herniation is one of the most common spinal conditions and causes widespread medical problems. The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disc herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion.
Patients and methods
Fifty patients (35 M, 15 F) with an average age of 45.9 years (range: 31-60 years) were retrospectively and prospectively evaluated. All patients underwent discectomy (
n
= 22) or discectomy and fusion (transpedicular screws with or without interbody fusion) at Menoufia University Hospitals, from January 2011 to April 2014 (minimum 12-month follow-up). The clinical and radiographic results were compared between the two groups. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index.
Results
In comparison with the discectomy group, the discectomy and fusion had significantly lesser VAS (leg pain), VAS (back pain), and lesser Oswestry disability index during the follow-up period postoperatively. Complications included cases of seven small dural tear in the discectomy group. There were four cases of dural tear and two cases of superficial wound infection in the discectomy and fusion group. One case of hardware failure was observed in the discectomy and fusion group.
Conclusion
In cases of recurrent lumbar disc herniation, the clinical outcome is better when the patients were operated by using discectomy and fusion rather than using discectomy alone.
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Vertical thoracotomy versus conventional posterolateral thoracotomy
p. 646
Ahmed L Dokhan, Alaa A ElSesy, Medhat R Nashy, Ahmed H Onsi
DOI
:10.4103/1110-2098.198748
Objective
The aim of the study was to evaluate the use of vertical thoracotomy as a thoracic approach.
Background
A carefully planned thoracic incision should provide effortless and excellent exposure, preservation of the underlying anatomy and function, and a cosmetically acceptable result.
Materials and methods
We conducted a prospective, cohort study in which 30 consecutive patients were exposed to two types of thoracotomies performed by the surgeons of the cardiothoracic surgery Department in Menoufia University Hospital from October 2012 to October 2014. The patients were classified randomly into two groups: group A (
n
= 15) in which vertical thoracotomy was performed and group B (
n
= 15) in which standard posterolateral thoracotomy was performed. Operative data were collected from all patients in both groups as regards indication of operation, type of operation, intraoperative complications such as bleeding, need of extension of the incision, total operative time, and time of opening and closure of the thoracotomy.
Results
Results showed that vertical thoracotomy can be used for a wide range of procedures in different age groups and in both sexes. Shoulder joint movement was significantly better when vertical thoracotomy was used (
P
= 0.044), and cosmetic results are better.
Conclusion
Vertical thoracotomy offers specific advantages of minimum trauma and maximum preservation of chest wall function with a cosmetically acceptable scar.
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Brachiobasili carteriovenous fistula: a primary angioaccess for regular hemodialysis
p. 651
Hatem A Elazeem Saleh, Ahmed Hossny, Ehab Kandeel
DOI
:10.4103/1110-2098.198749
Objective
The aim of the present study was to examine the use of brachiobasilic arteriovenous fistula (BBAVF) as a primary angioaccess for regular hemodialysis in patients having metabolic syndrome in comparison with distal forearm radiocephalic arteriovenous fistula (RCAVF).
Patients and methods
Sixty patients recently diagnosed with end-stage renal disease fulfilling the inclusion criteria for this study were selected from a total of 638 patients referred from the nephrologists clinic to the vascular clinic at Gamal Abdel-Nasser Hospital and Shebin El-Koum Hospital. The patients were randomly divided into two groups, the RCAVF group, which included 30 patients, and the BBAVF group, which also included 30 patients. All patients suffered from metabolic syndrome. Metabolic syndrome was defined as the presence of three or more of the following: blood pressure greater than 130/90 mmHg; triglycerides greater than 150 mg/dl; high-density lipoprotein less than 50 mg/dl for women and less than 40 mg/dl for men; BMI greater than 30 kg/m
2
; or fasting blood glucose greater than 110 mg/dl.
Results
The patency rate after 1 year in BBAVF group was 27 (90.0%), and nine (30.0%) in the RCAVF group. Primary access failure in the BBAVF group was 6.7%, and 3.3% in the RCAVF group. Moreover, secondary access failure in the BBAVF group was 10%, and 70% in the RCAVF group. The number of metabolic syndrome criteria and incidence of angioaccess failure showed significantly low patency of RCAVF in patients fulfilling the fourth and fifth criteria for the metabolic syndrome.
Conclusion
BBAVF was found to have higher patency in comparison with RCAVF in metabolic syndrome patients with end-stage renal disease. However, establishing BBAVF as the first choice in metabolic syndrome patients needs further studies in the future.
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The optimum duration of treatment for first time lower limb proximal deep vein thrombosis
p. 657
Hatem A Saleh, Asem F Mostafa, Mostafa I Saad
DOI
:10.4103/1110-2098.198750
Objective
The aim of this study was to define the optimum duration required for treatment of first time proximal lower limb deep vein thrombosis (DVT).
Background
DVT refers to the formation of one or more blood clots in one of the body's deep veins, most commonly in the lower limbs (proximal lower limb veins such as iliac, femoral or popliteal veins and distal lower limb veins such as calf veins). The optimal duration of treatment for first time proximal DVT is still controversial. The aim of this study was to define the optimal duration required for the treatment of first time proximal lower limb DVT.
Materials and methods
We reviewed papers on the optimal duration required for treatment of first time proximal lower limb DVT from Medline databases (Pub Med, Medscape, and ScienceDirect) and also from materials available in the Internet. We used optimal duration/treatment/first time proximal lower limb DVT as searching terms. The search was performed in the electronic databases from 2000 to 2014.
Conclusion
Three months of therapy is an efficient and a safe method for the treatment of first attack of proximal lower limb DVT and thus there is no need for extending the duration of therapy.
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Surgical aortic valve replacement for severe stenosis with low ejection fraction and low transvalvular gradient
p. 662
Ahmed L Dokhan, Mohamed M Gomaa, Montaser E Abd El-Aziz, Mohamed G Hagag
DOI
:10.4103/1110-2098.198751
Objectives
Evaluation of early outcomes of surgical aortic valve replacement (AVR) for patients with isolated severe aortic stenosis (AS) associated with left ventricular (LV) dysfunction and low transvalvular gradient.
Background
AS is the most common valvular heart disease in elderly people, with an incidence of 2-7% in the population above 65 years. Sudden death may be the first presentation for severe AS. AVR is the effective treatment for AS. Benefits versus mortality of surgical AVR is still controversial in patients who presented with severe AS associated with LV dysfunction and low gradient.
Materials and methods
Between October 2012 and January 2015, this multicenter prospective observational study included 20 consecutive patients who presented with isolated severe AS (valve area <1 cm
2
), associated with LV dysfunction (ejection fraction <40%), and a low mean gradient (<40 mmHg). All patients underwent conventional surgical AVR using cardiopulmonary bypass. LV function improvement was evaluated, 6 months postoperatively for all survivors, by transthoracic Echo.
Results
Our study included 14 male and six female patients with a mean age of 64.75 years and a mean EUROSCORE II of 1.62. All participants underwent conventional AVR with a cardiopulmonary bypass mean time of 113.3 min and a mean cross-clamp time of 69.6 min. The postoperative course involved a mean ICU stay of 3.6 days but, unfortunately, with two (10%) cases requiring reopening and mortality occurring in two (10%) cases. Among the 18 survivors, we detect statistically significant improvements in LV dimensions and systolic function in the postoperative follow-up Echo after 6 months.
Conclusion
Despite the high mortality rate (10%), surgical AVR is still the gold standard management for severe AS even in the risky subgroup of patients with LV dysfunction and low gradient, due to its effect in the LV function improvement.
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The short-term outcome of redo-mitral valve surgery: emergency versus elective
p. 668
Ahmed L Dokhan, Ali H Taher, Islam M Ibrahim, Ayman M Asfour
DOI
:10.4103/1110-2098.198752
Objectives
The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement as emergency cases against elective cases.
Background
Patients with mechanical prosthetic heart valves are at risk of reoperation. The reported risk of mortality may be as low as 5.4-11% for elective reoperation, but as high as 38-61.5% for emergency procedures.
Patients and methods
Forty patients who had undergone previous mitral valve replacement were admitted for redo-mitral valve replacement during the period between May 2011 and May 2013 at the National Heart Institute. They were divided into two groups: group A: 20 patients were admitted from the ER as emergency cases; group B: 20 patients were admitted from outpatient clinics as elective cases. A mechanical valve was inserted with horizontal mattress pledgeted nonabsorbable sutures. Sutures were placed from left atrium to left ventricle. Tricuspid valve incompetence, if present, was corrected by tricuspid valve repair (De-Vega suture).
Results
The hospital mortality was 20%. There was no effect regarding age, sex, cardiac rhythm, number of previous operations, type of the previous prosthesis, and interval from last implantation. Taking into consideration that mortality was higher in the emergency group, the New York Heart Association (NYHA) functional class, left ventricular end systolic diameter, left ventricular end diastolic diameter, redo-cardiac surgery sternotomy, and adhesiolysis carry a significant risk of catastrophic bleeding, especially with the rush accompanying hemodynamic instability. Infective cardiac tamponade, permanent pacemaker, residual infective endocarditis, the need for dialysis, and cerebrovascular accidents were not statistically significant.
Conclusion
When significant valve dysfunction is first noted, reoperation should be undertaken to minimize the operative risk to avoid mortality and postoperative morbidities.
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Evaluation of early outcomes after mitral replacement in rheumatic heart patients with pulmonary hypertension
p. 674
Ahmed L Dokhan, Mohamed E Abd El-Raouf, Islam M Ibrahim, Mohammed G Abdellatif
DOI
:10.4103/1110-2098.198753
Objectives
To evaluate and compare the early hemodynamic results and echocardiographic data after rheumatic mitral valve replacement (MVR) in patients with mild and severe pulmonary hypertension (PH).
Background
Development of PH in association with valvular dysfunction is a marker of advanced disease. Some authors have reported no greater risk in patients with severe PH compared with those with a mild degree of PH, whereas others reported that severe PH is associated with a greater operative risk and a poorer long-term prognosis. It is desirable to reassess the outcome in these patients with newer anesthetic agents, improved valve prostheses, myocardial protection, and postoperative care.
Patients and methods
Between September 2013 and May 2015, this multicenter prospective observational study included 40 patients who presented with rheumatic mitral stenosis indicated for elective MVR divided into two equal groups: group A, with a mean pulmonary artery pressure (mPAP) equal to 26-40 mmHg, and group B, with mPAP more than 55 mmHg. All patients underwent conventional surgical MVR using cardiopulmonary bypass. Early hemodynamic improvement was observed with follow-up transthoracic echo performed 1 week and 3 months postoperatively
Results
Our study included 17 male and 23 female patients with a mean age of 32.40 years; all of them underwent conventional MVR with cardiopulmonary bypass. Throughout our study, we detected a statistically significant difference between both groups regarding the duration of postoperative mechanical ventilation and improvement in mPAP in both groups. There was a single case of morbidity in group B with no cases of mortality for 3 months postoperatively in both groups.
Conclusion
MVR is safe and effective even in patients with severe PH.
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Management of segmental tibial fractures by an Ilizarov external fixator
p. 680
Taher Abdelsatar, Mohammad Elsawy, Ahmad Zayda, Ahmad Samy
DOI
:10.4103/1110-2098.198754
Objectives
This study aimed to evaluate the treatment of patients with segmental tibial fractures using an Ilizarov external fixator.
Background
Segmental fractures of the tibial shaft often occur after a high-energy direct trauma with consecutive severe soft-tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed, and therefore operative treatment is demanding.
Materials and methods
This prospective study included 30 patients with segmental tibial fractures. All were fixed by an Ilizarov external fixator.
Results
The bone results were excellent in 15 patients (50%), good in six patients (20%), fair in seven patients (23.4%), and poor in two patients (6.6%). The functional results were excellent in 15 patients (50%), good in 10 patients (33.4%), fair in three patients (10%), and poor in two patients (6.6%).
Conclusion
Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method allows for control of complications by decreasing the need for new operations even in the presence of infection.
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The role of the Ilizarov fixator in management of tibial defect
p. 685
Mahmoud M Hadhoud, Ahmad I Zayda, Mohamed F Abdel Baky
DOI
:10.4103/1110-2098.198755
Objectives
The objective of this study was to evaluate the results of the Ilizarov technique in the treatment of tibial defect.
Background
The incidence of tibial defect is increasing continuously in our country as a result of high-energy trauma, debridement of osteomyelitis, tumor resection, or congenital anomalies. Sometimes the defects are associated with major soft-tissue injuries that limit the functional outcome independent of the actual bone loss.
Materials and methods
This work was a prospective study of 30 patients with tibial defect treated by Ilizarov external fixator. All patients were evaluated both clinically and radiologically through routine follow-up visits, and all items of information concerning each patient were collected and recorded using the patient information sheet, and data were tabulated and evaluated.
Results
In this study of 30 patients with tibial bone defect treated with Ilizarov external fixator, the results were five excellent patients, 19 good patients, four fair patients, and two poor patients (
P
< 0.05).
Conclusion
Treatment of tibial defect with Ilizarov yields satisfactory results.
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Evaluation of treatment of distal tibial fractures using the minimally invasive percutaneous plate osteosynthesis technique
p. 691
Hassan A Neinaa, Yasser S Hannout, Ayman A Mohammed Abdel Wahab
DOI
:10.4103/1110-2098.198756
Objectives
The goal of this study was to report and evaluate the treatment of distal tibial fractures using the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique.
Background
MIPPO has been used for the management of fractures since a long period of time. Good fixation, mild blood loss, and early mobilization are always the main advantages of this technique. Other advantages include the following: it is simple, quick, and causes minimal surgical trauma.
Materials and methods
From August 2013 to January 2015, 20 (13 male and seven female) patients with a mean age of 49.5 years suffering from type A distal tibial fracture were treated in the Orthopedic Department, El-Menoufiya University Hospital, and Mansoura New General Hospital with medial distal locked plate using the MIPPO technique and early mobilization.
Results
Fracture union was achieved within 16-23 weeks. In 16 cases union was achieved within 16-20 weeks and was delayed in three cases and achieved within 23 (mean: 19.2) weeks. There was only one case in which nonunion occurred.
Conclusion
The MIPPO technique is effective in achieving union and excellent functional outcome in metaphyseal distal tibial fractures.
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Comparison between results of management of recent intra-articular fractures of distal end radius by percutaneous pinning and volar locked plate
p. 698
Hesham Ghoneem, Ahmed Zayda, Mohamed O Mostafa
DOI
:10.4103/1110-2098.198780
Introduction
Distal radius fractures are considered the most common fractures in orthopedic practice. There are many different fracture patterns and injuries associated with articular cartilage and neighboring soft tissue that are found in different patient populations. Fractures of the distal radius are caused by high-energy trauma in young patients and by low-energy trauma in the elderly. Disruption of the ligaments and the displacement of the carpus and/or the triangular fibrocartilage complex will equally influence the functional outcome. Many methods have been established for the treatment of fractures of the distal radius. The main principle is to obtain anatomical reduction with rigid fixation to allow early mobilization. Comparison between the results of closed reduction and internal fixation by percutaneous Kirschner wires and open reduction and internal fixation (ORIF) by self-locked plates and screws in the treatment of recent intra-articular distal radial fractures was made in 30 patients in El-Menoufia University Hospital during a 33-month period.
Objectives
This study compared clinical outcomes and complications in patients with recent intra-articular distal radius fractures treated using two methods of fixation: percutaneous pinning and self-locked plating.
Background
While selecting treatment, a technique that makes alignment of articular surfaces a priority and restores more normal joint mechanics should be used. Closed reduction and percutaneous pinning is a good option, which preserves soft tissue as it is a minimal invasive procedure. On the other hand, open reduction and self-locked plate fixation is a unique option in supporting articular surface and preventing its collapse.
Materials and methods
Thirty patients were analyzed and divided into two groups. Patients in group A (
n
= 17) were treated with percutaneous pinning and patients in group B (
n
= 13) were treated with ORIF by self-locked plating. The major characteristics of the two groups in terms of age, sex, mode of injury, fracture location, and associated injuries were similar.
Results
Primary union was achieved in all patients. The mean time to union was similar in the two groups. The mean operation time in the percutaneous pinning group (25 min) was shorter than that in the ORIF group (80 min). There were complications in four cases (13.33%). One case was treated by self-locked plates and screws and had extensor tendon irritation (3.33%). Three cases that were treated by percutaneous pinning had complications; one case had pin-tract infection (3.33%), one case had loss of reduction and complex regional pain syndrome (3.33%), and one case had pin-tract granuloma (3.33%). Functional outcome was satisfactory in both groups.
Conclusion
Percutaneous pinning technique achieves comparable results with the ORIF by self-locked plating method in intra-articular distal radial fractures. Percutaneous pinning reduces operation time and soft-tissue dissection. Self-locked plating reduces collapse and loss of reduction rates.
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Relationship between
Helicobacter pylori
infection and pre-eclampsia complicated by intrauterine growth restriction
p. 705
Ayman A Shabana, Zakaria F Sanad, Osama A Alkelany, Nabih I El Khouly, Mostafa M Hussain
DOI
:10.4103/1110-2098.198786
Objectives
The objective of this study was to evaluate the association of
Helicobacter pylori
stool antigen (HPSA) with pre-eclampsia (PE) complicated by intrauterine growth restriction (IUGR).
Background
PE is a severe hypertensive pregnancy-related disorder that affects 5-8% of women worldwide, thus representing the main cause of fetomaternal mortality and morbidity; it is often associated with fetal growth restriction (IUGR), which is defined as failure of the fetus to achieve its genetically determined growth potential.
Materials and methods
This is a prospective study for 100 pregnant women divided into two groups: 50 pregnant women with a diagnosis of PE with IUGR and 50 women with uneventful pregnancies (control); maternal stool samples were collected from all patients between 34 and 38 weeks of gestation, and HPSA was measured using monoclonal antibody test, which is an immunochromatographic assay that uses antibody-coated colloidal gold.
Results
A significantly higher percentage of women who were positive for HPSA were found among PE cases complicated by IUGR (76%) compared with uneventful pregnancies (32%) (
P
< 0.001).
Conclusion
HPSA has a direct role in the etiopathogenesis of PE complicated by IUGR.
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Clinico-epidemiological features of premenstrual syndrome among Egyptian women
p. 710
Zakaria F Sanad, Osama Al-Kelany, Amal Salama, Mona M Awad
DOI
:10.4103/1110-2098.198787
Objectives
The aim of the present study was to examine the clinical physical, behavioral, and social effects of premenstrual syndrome and premenstrual dysphoric disorder among Egyptian women that affect their quality of life because of the impact symptoms these have on their activities of daily life.
Background
Premenstrual syndrome has been prevalent among women all over the world since the 19
th
century, affecting their quality of life.
Data sources
Medline databases (Pubmed, Medscape) and all articles are available on the internet from 2000 to 2014.
Conclusion
Premenstrual syndrome is a common cyclic disorder of young and middle-aged women characterized by emotional and physical symptoms that consistently occur during the luteal phase of the menstrual cycle. Women with more severe affective symptoms are classified as having premenstrual dysphoric disorder. In women with moderate symptoms, treatment includes both medication and lifestyle modifications. Dietary supplements, such as calcium and evening primrose oil, may offer modest benefit.
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Comparison of 1% lidocaine paracervical block and NSAIDs in reducing pain during intrauterine device insertion
p. 713
Mohamed M Fahmy, Nabih I El Khouly, Ragab M Dawood, Mohamed H Radwan
DOI
:10.4103/1110-2098.198788
Objectives
Pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of 1% lidocaine paracervical block for pain relief with IUD insertion compared with NSAIDs.
Background
The IUD provides long-term, reversible contraception equal in efficacy to tubal sterilization. The IUD is one of the safest, least expensive, and most effective contraceptive methods available. The IUD is often an excellent choice for women who do not anticipate future pregnancies but wish not to be sterilized.
Patients and methods
We performed a randomized clinical controlled trial of women undergoing IUD insertion. Participants were randomly assigned to receive either 10 ml of 1% lidocaine paracervical block or oral naproxen or placebo tablets before IUD insertion. Pain scores were measured using a 10-point visual analogue scale at various time points of procedure (speculum placement, tenaculum placement, during IUD insertion, and 15 min after the procedure).
Results
Of the 150 participants randomized, 50 women received the paracervical block, 50 women received NSAIDs, and 50 women received placebo tablets before IUD insertion. Groups were similar in age, parity, ethnicity, education, and complications. Pain scores were similar among the three groups at tenaculum placement (mean ± SD = 4.84 ± 1.39, 4.76 ± 1.28, and 4.70 ± 1.21, respectively;
P
= 0.938) as well as during insertion (mean ± SD = 5.30 ± 1.61, 4.90 ± 1.24, and 5.16 ± 1.20, respectively;
P
= 0.460). These results did not differ during speculum placement and after procedure.
Conclusion
1% lidocaine paracervical block, as well as NSAIDs, before IUD insertion does not decrease pain scores.
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Value of transvaginal cervical ultrasonographic assessment and bacterial vaginosis in prediction of preterm birth
p. 717
Mohamed M Fahmy, Sherief M.S. Abd El Salam, Mohamed A Emarah, Abeer A El Sobky
DOI
:10.4103/1110-2098.198789
Objective
The objective of this study was to determine the diagnostic value of cervical length (CL) measurement, in the second trimester of pregnancy, and the impact of bacterial vaginosis (BV) as a preterm labor (PTL) predictor.
Background
Preterm birth is the leading direct cause of neonatal death and morbidity, and it imposes large costs to the healthcare system. Early detection of pregnant women at risk of PTL will help reduce the occurrence of prematurity-related mortality and morbidity. Cervical insufficiency and BV are two items that have been recently known to have an essential role in preterm delivery. They can be diagnosed using safe, simple, and reliable methods.
Patients and methods
This is a prospective cohort study that included 580 pregnant women with uncomplicated singleton pregnancy between 20 and 22 weeks of gestation to assess CL, which was measured by a transvaginal probe immediately after collecting a vaginal swab for the diagnosis of BV by Amsel's criteria. CL) less than 30 mm was considered a short cervix and suggested cervical insufficiency. The vaginal swab fulfilled three out of four Amsel's criteria and was considered positive for BV. Patients were followed up until delivery.
Results
Our final analysis was based on the results of 500 participants. The incidence of PTL was 100 out of 500 (20%). The incidence of PTL in women who had BV was 52 out of 100 (52%), which is statistically significant. The incidence of PTL in cases with short CL less than and equal to 30 mm was 39 out of 100 (39%), whereas the incidence of short cervix cases in full term was three out of 400 (0.8%), which was statistically significant. The incidence of PTL was 16% for cases with BV and short CL, whereas there were no cases for full-term labor, which is statistically significant (
P
< 0.001).
Conclusion
The assessment of CL by transvaginal ultrasound and detection of BV during pregnancy have significant value in prediction of PTL.
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Evaluation of second-look transurethral resection in the management of superficial bladder tumors
p. 722
Mohamed Badreldin, Tarek M. A. Baky, Shady M Salem, Mahmoud Mahdy
DOI
:10.4103/1110-2098.198790
Objectives
The aim of the present study was to evaluate the role of second-look transurethral resection of bladder tumors (TURBT) in the management of non-muscle-invasive bladder cancer (NMIBC).
Background
Bladder cancer is the ninth most common cancer diagnosis worldwide. Second-look TURBT ensures adequate evaluation of the muscularis propria while detecting and treating residual tumors.
Patients and methods
Thirty-one NMIBC patients underwent a second-look TURBT 2 weeks after the initial TURBT. The procedures carried out included reassessment of the bladder for the detection of residual lesions after initial resection, and the resection of the base of the previous resection site for restaging.
Results
Thirty-one NMIBC patients underwent second-look TURBT 2 weeks after the initial TURBT. Residual tumors were found in 28% of the patients with Ta tumors and 54.2% of the patients with T1 tumors (
P
= 0.445). The overall percent of residual tumors was 48.4% for all patients. Patients with Ta tumors had no upstaging to a higher stage or grade. On the other hand, in patients with T1 tumors we found that 50% of them were upstaged to T2. Thus, the overall upstaging to T2 was 38.7% of all NMIBC patients (
P
= 0.413).
Conclusion
Second-look TURBT is highly desirable in patients with high-grade T1 disease and large tumor size (>2-5 cm), especially if deep muscle is not found in the primary resection because of the significant risk for detecting muscle-invasive disease and missed residual tumors.
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Immunohistological study of the effect of extravirgin olive oil on aspartame-treated cerebellum of male albino rat
p. 728
Fatma Alzhraa F Abdel Baky
DOI
:10.4103/1110-2098.198791
Objective
The aim of this study was to determine the possible protective effects of extravirgin olive oil on aspartame (ASP)-treated rats, which causes cerebellar changes.
Background
ASP is found in many products and is used all over the world. It has been reported that the consumption of ASP could cause neurological and behavioral changes such as headache, insomnia, and seizures. This study discussed the possible protective effects of extravirgin olive oil on the cerebellum of rats previously treated with ASP.
Materials and methods
Thirty adult male albino rats were used in the present study. The animals were divided into three equal groups (10 rats in each). The first group served as the control group. In the second group, the rats were administered ASP at a dose of 75 mg/kg body weight daily for 3 months by using an intragastric tube. In the third group, the rats were administered olive oil in a dose of 0.5 mg/kg body weight, followed by ASP in the same dose as the rats in group 2 through the same route. In addition, cyclooxygenase-2 immunohistological and hematoxylin and eosin light microscopic, and morphometric analyses were carried out.
Results
In the ASP-treated group, disorganization of the three layers of the cerebellar cortex had occurred. ASP caused marked changes in the histological picture of the normal cerebellum, indicated by an increase in the number of vacuolated spaces, necrosis, and apoptosis in the three layers. Furthermore, there was a decrease in the mean value (±SD) of Purkinje cell count and the area of Purkinje cell layer in the ASP-treated group. The administration of extravirgin olive oil in conjunction with ASP resulted in significant improvement in the organization of cellular layers of the cerebellar cortex and ameliorated the effects of ASP on the cerebellum. There was a significant improvement in the morphometric results with the use of the oil.
Conclusion
Administration of extravirgin olive oil ameliorates the neuropathological changes caused by aspartame on cerebellum of albino rats.
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Directly observed therapy and repeat house-to-house visit: pincer movement for mass drug administration in West Bengal, India
p. 736
Dibakar Haldar, Aditya P Sarkar, Asit B Saren, Satabdi Mitra, Sumana Samanta, Arindam De, Gautam N Sarkar, Prabir Chakraborty
DOI
:10.4103/1110-2098.198792
Objective
The aim of this study was to assess the effect of directly observed therapy (DOT) on coverage, the compliance of mass drug administration (MDA), and to find out correlates of noncompliance.
Background
MDA for the elimination of lymphatic filariasis (LF) by 2015 in West Bengal (WB) has been criticized for undercoverage and mere distribution of antifilarial medicines for unsupervised consumption. To overcome these shortcomings, the government of WB adopted DOT for MDA.
Participants and methods
A cross-sectional survey was conducted in three villages of three blocks and two wards of one municipality of Bankura district, WB, India, selected randomly. Information was collected by interviewing inhabitants of randomly selected households.
Results
Overall, appropriate medicine distribution and consumption were 71.31 and 53.21%, respectively. Multivariate analysis revealed that medicine consumption was higher among the following: participants who belonged to the Hindu religion; people of poor socioeconomic status; those who were distributed medicine by a routine health worker acting as drug administrators;; those whose consumption was supervised and those who had complied to MDA previously. Almost three-fourth consumptions were unsupervised. 58.73% respondents knew about LF and 42% knew about transmission; 50.79% had heard about MDA and 39.68% stated that MDA is to avoid LF. Noncompliance to the distributed medicines might be due to lack of awareness about LF and MDA. The reasons for noncompliance were as follows: 'fear of adverse reaction' (63.72%), 'didn't know why to consume' (23.89%), and 'healthy' (20.35%) were causes of noncompliance.
Conclusion
Despite DOT and repeat house visit coverage of MDA, we fell short of target. Mass mobilization with effective supervision is the need of hour for universal coverage of MDA with supervised consumption of tablets.
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Mothers' perception toward neonatal jaundice in Kafr El-batanoon village, Menoufia, Egypt
p. 743
Dalia M Allahony, Nagwa N Hegazy, Zeinab A Kasemy, Eman M Bahgat
DOI
:10.4103/1110-2098.198793
Objectives
The aim of this study was to evaluate the knowledge, attitude, and practice of the mothers toward neonatal jaundice (NNJ).
Background
NNJ is a significant cause of neonatal morbidity worldwide and accounts for 75% of hospital readmissions in the first week of life. Severe NNJ can lead to irreversible brain damage or even death in otherwise healthy newborns. Because of early discharge of mothers from the hospitals, the responsibility of mothers in recognizing jaundice has increased. Mothers therefore play a vital role in the early identification and prevention of complication.
Materials and methods
This cross-sectional study was carried out on 265 mothers who attended Kafr El-batanoon primary health care for antenatal care or for their babies' vaccinations. The mothers were interviewed using a predesigned questionnaire to assess their knowledge, practice, and attitude toward NNJ. Data were analyzed using SPSS version 13.
Results
The results showed that only 18.9% of mothers had good knowledge about NNJ. Mother's knowledge was significantly influenced by their level of education, age, parity, and previous history. About 48.0% of participants had good attitude toward NNJ and its management. However, 95.8% of mothers expressed their willingness to seek medical advice if their babies develop NNJ; only 25.3% had a good practice and stated that they would seek medical attention within the first 24 h of jaundice, which was significantly influenced by their age, parity, occupation, and history.
Conclusion
Participants attending Kafr El-batanoon Unit had adequate idea about recognition of NNJ. However, their knowledge of causes, danger signs of complications, complications, and treatment were poor, with common misconceptions. Their attitude toward the management of NNJ was apparently positive, whereas practice was poor. Knowledge and practice of mothers were significantly influenced by their age, parity, and history of NNJ in previous babies. Therefore, it is recommended that healthcare providers should give more health education on NNJ to the mothers during antenatal care visits.
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Type II diabetic patients' satisfaction with the management plan in family health centers in Port Said city, Egypt
p. 749
Taghred M Farahat, Nagwa N Hegazy, Ahmed Ragheb, Wesam Yousef
DOI
:10.4103/1110-2098.198806
Objective
The aim of the study was to assess type II diabetic patients' satisfaction with the management plan in family health centers (FHCs) in Port Said city.
Background
Diabetes mellitus is a common and potentially disabling chronic disease, with increased risk for microvascular and macrovascular complications.
Patients and methods
A cross-sectional study was carried out on 150 participants after calculation of the sample size. All diabetic participants who were registered at all FHCs were interviewed using semistructured questionnaires to obtain sociodemographic characteristics and to assess type II diabetic patients' satisfaction toward counseling and treatment plans. This was followed by a review of the family health record. The responses from the questionnaires were collected, revised, tabulated, coded, and statistically analyzed.
Results
The study included 150 type II diabetic patients, aged 18-50 years. One-third (32.7%) of the respondents were unsatisfied with the management plan, whereas 67.3% were satisfied. The highest proportion of dissatisfaction was observed among patients with higher levels of education and low monthly income (
P
≤ 0.01). Unemployed patients expressed higher grades of satisfaction compared with employed patients. Patients without health insurance in other places had higher levels of satisfaction (
P
≤ 0.05).
Conclusion
This study concluded that 67.3% of type II diabetic patients were satisfied and 32.7% were not satisfied with the management plan in FHCs in Port Said city, Egypt.
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Respiratory and auditory health disorders among workers in a plastic factory (industrial zone, Queisna City, Menoufia Governorate)
p. 757
Gaafar M Abdel-Rasoul, Mahmoud E Abu-Salem, Hewaida M El Shazly, Heba K Allam, Eman A Salem, Asmaa A Ahmed
DOI
:10.4103/1110-2098.198804
Objective
The aim of the study was to investigate auditory and respiratory health disorders among Egyptian workers in a plastic industry as well as assess the workplace environment in the same factory.
Background
The common health hazards associated with plastic manufacturing processes include noise, and exposure to respirable airborne particulates, especially polyvinyl chloride (PVC) and styrene, that lead to occupationally induced hearing loss and chronic effects such as decreased pulmonary function and lung disease.
Participants and methods
A cross-sectional comparative study was carried out in 180 workers in a plastic factory in Queisna City, Menoufia Governorate, Egypt, and in 60 nonoccupationally exposed individuals, who served as the control group. An environmental study of dust, fumes, and noise levels was carried out. Spirometric measurements were taken and air conduction audiometric examination was performed.
Results
The mean values of PVC, styrene concentrations, and noise levels are higher than the national and international permissible levels. Plastic factory workers had a highly significant prevalence of chest and auditory manifestations as well as deteriorated spirometric measurements and abnormal audiometric findings.
Conclusion
Exposure to a high level of PVC, styrene, and noise is implicated in the increase in frequency of chest manifestations, early spirometric changes, and occupationally induced hearing loss. Use of an automated plastic grinding machine to decrease the exposure to dust as well as use of good-quality personal protective equipment, especially masks and ear mufflers, is recommended.
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CASE REPORT
Ptosis and ataxia complicating enteric encephalopathy in a child
p. 762
T Bindu Nair, KR Sanjeev, Dipti Kumar
DOI
:10.4103/1110-2098.198805
Ptosis, ataxia, and dysarthria presenting together are very rare neurological complications of enteric fever. We report a case of a 3-year-old boy with blood culture-proven enteric septicemia who developed these very rare neurological complications of enteric fever. After starting a course of intravenous antibiotics and steroids, he became afebrile and neurological symptoms abated with no residual effects after 4 weeks. This report is a further addition to all the published neuropsychiatric complications of enteric fever so far.
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© Menoufia Medical Journal | Published by
Wolters Kluwer Health
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Online since 31 Jan, 2014