The Interaction Between Angiotensin Converting The Egyptian Journal of Hospital Medicine Vol. ,1: 2-17

Rec . Nov. 2000
I.S.S.N: 12084

The Interaction Between Angiotensin Converting
Enzyme Inhibitor (Captopril) and Heat Stress
in The Male Albino rats.
2-Tissue Analysis

Eman G.E. Helal1, Samir A.M. Zaahkouk2,
Talaat E.I. Abd-Rabo3 and Somaia Z.A. Rashed4.

1Al-Azhar University for girls, Faculty of Science, Zoology Department
2Al-Azhar University, Faculty of Science, Zoology Department
3Tanta University, Faculty of Science, Zoology Department

Daily exposure to heat stress causes sustained elevation of blood pressure in rats.
It is known that the renin-angiotensin system is activated during episodes of behavioral
stress, and the purpose of this work was to assess the action of captopril in the
development of stress induced hypertension in rats.
Animals were divided into four groups. The first group served as a control,
while the other groups were subjected to heat stress of 40C and high hamidity of 80%
for 10 successive days. The second group was served as heat stress, while the third and
the fourth groups were received low and high doses of captopril (0.7 & 1.4 mg/kg.
b.wt., respectively). After 10 days of treatment, half of animals from each group were
decapitated and brain, liver, muscle, heart and kidney were separated and analysed. The
other half of animals were left for another 10 days without any additional treatment for
recovery.The results revealed a significant decrease in total protein of liver, heart,
kidney, total lipids of heart, muscle and brain and total cholesterol of liver. On the other
hand, insignificant change was noticed in muscle and brain total protein. Similarly, AST
and ALT activities were also within the normal values for all the organs
examined.Results exhibited that renin-angiotensin system may be important in the
development of stress-induced hypertension in rats.

and therfore the urgency of instituting
Hypertension has become a
the rapidincrease in proportion to the
relatively common problem in recent

years and it is often of long duration
magnitude of blood pressure elevation.
and refractory to standard antihype -
In fact, hyperten -sion is usually a
rtensive therapy. Epidemiologic studies
symptomatic until over end organ
indicate that the risks of damage to
damage is imminent or has already
kidney, heart, and brain are directly
related to the extent of blood pressure
enzyme (ACE) inhibitors is popular in
elevation. Even mild hypertension in
the treatment of hypertension. Captopril
young or middle-aged adults increases
is one of them and it has been shown to
the risk of eventual and organ damage.
be effective in lowering blood pressure
The risk
in hypertensive patients. Laderle (1985)
considered that captopril may have

Full Paper (vol.1 paper# 1)

Abstract The Egyptian Journal of Hospital Medicine Vol. 18 ­ 32.
Rec . Nov. 2000
I.S.S.N: 12084

Two-Dimensional and Three-Dimensional Ultrasonography
In assessment of Fetal Malformations: Routine versus Selective Use
Nahed H.Mohamed and Samia A. Sioudi
Obstetrics and Gynecology Department, Faculty of
Medicinal- Azhar University

Objective: This study was conducted trying to answer the question whether three-
dimensional ultrasound imaging should be used routinely for prenatal screening of
congenital malformations or only used selectively for specific high risk women for
congenital malformations.
Subjects & Methods: This study included 1000 pregnant women between 14 and 32
weeks gestation, Routine ultrasound examination was done during antenatal care of 500
pregnant women with no history of risk factors of congenital malformation, their ages
were < 35 y (group 1). Selective ultrasound examination was indicated for screening of
500 pregnant women with history of one or more risk factors for getting malformed
babies (group 2). Serial ultrasound examinations were done for assessment of fetal
organs, first using transabdominal traditional 2-D ultrasound imaging, then 3-D
ultrasound examinations using the same machine.
Results: On routine antenatal examinations of group (1) there was no significant
difference in detection of congenital malformations between 2-D and 3-D ultrasound
examinations (0.2 % and 0.6 % respectively, P > 0.05). On the other hand, there was no
significant difference between selective 2-D and 3-D ultrasound examinations of high-
risk group (11) (0.8 % and 1.4 % respectively, P > 0.05). There was no significant
difference between routine and selective ultrasound use for detection of congenital
malformations (P> 0.05). Three-dimensional ultrasound provided the same informations
as 2-D ultrasound imaging in 33.33% (1/3 diagnosed anomalies) of group (1) and
57.14% (4/7 anomalies) of group (11). Whereas it was more accurate in diagnosis of
fetal anomalies than 2-D imaging in 66.66% (2/3 anomalies) of group (1) and
42.85%(3/7 anomalies) of group (2.).These results were not statistically significant
Conclusion: Many fetal malformations could be diagnosed by traditional 2-D
ultrasonography, yet in some cases limitations do exist. Therefore, a high degree of
expertise and training is needed. Traditional 2-D ultrasonography was used routinely
early and late in pregnancy for other obstetric indications. We do not support the routine
use of 3-D ultrasonography during antenatal assessment of the pregnant women . The
adjunctive use of 3-D ultrasonographic imaging system with the 2-D imaging in
selective cases can greatly increase diagnostic accuracy of congenital malformation. On
the other hand, It is equally important to weigh the human costs against the benefit.


Screening for fetal abnormalities has
Ultrasound is the chief method for
become one of the most profile health
detecting fetal malformations. In this
care issues of modern obstetrics.
context, Merz et al.(1995) reported that

Full Paper (vol.1 paper# 2)

Introduction The Egyptian Journal of Hospital Medicine Vol. 1, 33-47
I.S.S.N: 12084
Rec . Nov. 2000

Human Parvovirus B19, Cytomegalovirus Infections and Thyroid
Autoimmunity in Women with Recurrent First Trimester Abortion

Azza H. El-Salakawy¹, Nahed H. Mohammed ², Olfat G. Shaker ³
and Ehab Ragaa Abdoul Raouf 4

¹ Microbiology Department Faculty of Medicine ( Girls ), Al- Azhar University,
2Obstetrics and Gynecology Department, Faculty of Medicine (Girls), Al- Azhar University,
³Medical Biochemistry Department, Faculty of Medicine, Cairo University,
4 Human Genetic Department, National Research Center

OBJECTIVE: The goal of this study was to modify and optimize the screening and diagnostic
procedures of unexplained recurrent abortion. Antithyroid antibodies, parvovirus B19 (B19V)
and cytomegalovirus (CMV) infections, which were usually overlooked in clinical practice of
handling cases of recurrent abortion, were studied to evaluate their role in the pathogenesis of
recurrent first trimester abortion. Also , we tried to elucidate the importance of detection of
these agents and whether it should be routine prenatal investigations of women with
unexplained recurrent abortion.
STUDY DESIGN: sixty women with unexplained recurrent first trimester abortion were the
study group and thirty term healthy pregnant women, were selected as a control. Placental and
fetal tissues were analyzed for B19V and CMV deoxyribonucleic acids using nested polymerase
chain reaction (PCR) assay. Also sera were analyzed for T3, T4 and TSH levels, the presence of
antithyroid antibodies (thyroglobulin and thyroid peroxidase), CMV specific IgM antibodies
and parvovirus B19-DNA by dot blot hybridization assay.
RESULTS: Parvovirus B19-DNA was demonstrated in nearly one third of the aborted
products (19/60 - 31.67 %) and 6.67% of the placentas of the control group, that represent
highly significant difference (P <0.001). Whereas, serum samples of the two groups were
negative for parvovirus B19 viral DNA by dot blot hybridization. Cytomegalovirus ­ DNA was
demonstrated in 7/60 aborted tissues (11.67 %) and one placenta of the controls (3.33 %), that
represent non significant changes (P > 0.05). In contrast, only 5 aborting women (8.33 %) and a
woman of the control group (3.33%) were CMV-IgM seropositive, that also represent non
significant changes (P > 0.05). Antithyroglobulin antibody levels were significantly higher in
aborting women (7/60) than control (P < 0.05), whereas there was no significant changes in
antithyroid peroxidase antibody levels between the two groups. Nine aborting women (15%)
were seropositive for one or both of the thyroid autoantibodies compared with two (6.67%) of
the control group, that represent non significant changes (P>0.05). We did not find any
significant relation between thyroid autoimmunity and viral infections (B19V & CMV) in
women with unexplained recurrent first trimester miscarriage.
CONCLUSION: Parvovirus B19 infection was found to be an important pathogenic agent in
recurrent first trimester abortion. It is essential to investigate for B19Vinfection among pregnant
women with recurrent abortion. This significant finding demonstrates the usefulness of a
sensitive molecular tool, PCR assay of viral DNA to aid in the diagnosis. However, testing for
cytomegalovirus infection and antithyroid antibodies are not essential as routine prenatal
investigations and should be restricted to certain patients with unexplained recurrent pregnancy


Full Paper (vol.1 paper# 3)

Transvaginal Ultrasonographic Cervical Assessment as a Predictor The Egyptian Journal of Hospital Medicine Vol. 1, 48 -59,
I.S.S.N: 12084
Rec . Nov. 2000

Transvaginal Ultrasonographic Cervical Assessment as a Predictor
Of Successful Labor Induction
Nahed H. Mohamed, Naglaa H. Mohamed and Mahmoud A. Mansour*
Obstetrics and Gynecology Department, Faculty of Medicine for Girls, and
*Biochemistry Department, Faculty of Pharmacy
Al- Azhar University

OBJECTIVE: To assess cervical maturation before labor induction with measurements
obtained by transvaginal scans. Cervical length and detection rate of cervical gland area,
were compared with Bishop score and serum Prostaglandin E2 levels at term for
duration of labor, successful labor induction and mode of delivery.
STUDY DESIGN: Transvaginal scans were performed for detection of cervical gland
area and measurements of cervical length in 80 singleton pregnant women scheduled
for induction of labor at >37 weeks of gestation. Cervical ripening was assessed
simultaneously by Bishop score and preinduction serum prostaglandin E2 metabolite
was detected by ELISA technique. Results were compared against parity, gestational
age, and mode of delivery and induction-to-delivery interval.
RESULTS: Seventy percent of the studied women were delivered vaginally (46.7% of
nulliparous and 84 % of multiparous women). Women with cervical length <3.0 cm and
also women with higher PGE2 levels had shorter labors (P< 0.01) and were more likely
to be delivered vaginally (P< 0.05). Significant decrease in the detection rate of cervical
gland area in women who had shorter labors and were delivery vaginally (P<0.05) and
also in multiparous than nulliparous women (P < 0.01) . The mean serum PGE2 level
was significantly higher in multiparous than nulliparous women (P < 0.01). Women
with Bishop score > 4 also had shorter labors and were more likely to be delivered
vaginally (P< 0.05). Whereas, there was no significant difference in the mode of
delivery with Bishop score < 4 (P >0.05). Cervical length, detection rate of cervical
gland area serum PGE2 levels, and Bishop score showed linear correlation with
duration of labor (r =0.47 P< 0.05, r =0.58 P< 0.01, r = 0.67 P< 0.05 and r = 0.43, P
<0.01 respectively).
CONCLUSIONS: Ttransvaginal ultrasonographic cervical measurement is comparable
to Bishop score in assessing cervical ripeness for labor induction. Cervical measurement
parity and serum PGE2 were independent predictors of the mode of delivery. Whereas,
the mode of delivery cold not be predicted in women with Bishop score < 4.


Induction of labor in women with an
an important role in the control of
unripe cervix at term remains a
cervical ripening in human.
challenge for the obstetrician. It is one
Ellwood et al (1981) reported that
of the most common aspects of obstetric
practice, with 15% of all pregnant
women undergoing iinduction or
prostaglandins increases at term
augmentation of labor (Ventura et al,
followed by sharp increase at
1998). Prostaglandins undoubtly play
parturition and the amniotic fluid

Full Paper (vol.1 paper# 4)

Carbamate Toxicity and Protective effect of The Egyptian Journal of Hospital Medicine Vol., 1 : 60 - 77
I.S.S.N: 12084

Rec . Nov. 2000

Carbamate Toxicity and Protective effect of
vit. A and vit. E on some biochemical
aspects of male albino rats

Samir, A.M. Zaahkouk* ; Eman, G.E. Helal ,
Talaat E.I. Abd-Rabo* amd Somaia Z.A. Rashed**

Al-Azhar University for Girls, Faculty of Science, Zoology Department
Al-Azhar University, Faculty of Science, Zoology Department,
Tanta University, Faculty of Science, Zoology Department

The effect of daily oral administration of carbamate (1/10 L.D50) on rats for 30
successive days were studied. The male rats were divided into five groups (control,
control + oil, carbamate, carbamate + vit. A and carbamate + vit. E). Each group (except
control and control + oil) was daily administrated carbamate (0.012 mg/kg B.wt.). Two
groups of carbamate ­ intoxicated animals provided with vit. A (700 mg/kg.B.wt) or vit.
E (10 mg/kg.B.wt). Poisoning symptoms were recorded, e.g. unbalanse, diarrhea, have
poor health and posterior limbs rigidity. Haematological parameters showed a
significant decrease in red blood corpuscles (R.B.Cs), white blood corpuscles (W.B.Cs)
count, Haemoglobin concentration and haematocrit value in groups treated with
carbamate, and an improvement in these values was observed in groups treated with the
anti-oxidants (vit. A and vit. E). Total lipids cholesterol, total proteins, albumin,
glucose, LDH, AST, ALT, adrenaline and noradrenaline were measured in serum. Total
proteins, total lipids, of tissues (liver, heart, muscle and kidney) were investigated.
The present study declare that, carbamate induced a significant elevetion in serum
LDH, glucose. total lipids,cholesterol, AST, ALT, adrenaline and noradrenaline. On the
other hand, causes a significant reduction in total proteins and albumin.
The total lipids and total proteins of the tissue were recorded highly significant
decrease in the group treated with carbamate only. From another point of view,
antioxidant ameliorated the effect of carbamate on tissues. So, it is clear that
administration of vit. E or vit. A. reduced the effect of carbamate on biochemical
alteration to various extent. The antioxidant property of vitamin A and vitamin E seem
to be responsible for the observed protection against carbamate intoxication.


The environmental pollution is
pesticides, that may build up in the food
one of the most serious problems that
faces mankind in this century. There are
contamination of the environment (El-
many types of pollutants that interfere
Sebae, 1993).
with our-life
both directly
More than 30,000 metric tons
indirectly. Furthermore, potential future
formulated pesticides (carbamate) were
hazards to human health and wildlife
important and used annually in the
can be created by residues from some
density population area along the green
strip of land beside the river Nile and


Full Paper (vol.1 paper# 5)

The Egy ptian Journal of Hospital Medicine Vol., 1 : 78: 94
Rec . Nov. 2000
I.S.S.N: 12084

Changes In Some Haematological And Biochemical Parameters of
Albino Rats In Response to Low-energy Diet
By. Somaia Z. A. Rashed
Tanta University, Faculty of Science, Zoology Department


The effect of low-energy diet (Low protein or low fat-diet) was studied using
male albino rats. The experiment was expended to 45 days (30 days treatment and 15
days recovery period). Body weight gain or loss as well as blood samples for blood
picture (R.B.CS. W.B.CS count, Hb. concentration, Hct value and erythrocyte indices
such as MCV, MCH and MCHC) well recorded Biochemical examination for glucose
concentration, total protein, albumin, globulin and A/g ratio. Triglyceride level,
total cholesterol and LDL-cholesterol, and HDL-cholesterol level, in addition to
some hormones such as insulin, Testosterone and Leptin levels were examined at the
end of the treatment period and the recovery period. A significant decrease in body
weight gain percentage was observed in group fed low
protein or Low fat-diet and the body weight improved during and after the
recovery period. A significant decrease in R.B.CS, W.B.CS, count and Hb.
concentration, and Hct value in treatment period and improved during and after
recovery period. Total proteins, albumin and globulin were significantly affected by low
protein or low-fat diet treatment in comparison with the control group. These effects
were significantly counteracted by balanced diet. A significant decrease in triglyceride,
total cholesterol, LDL-cholesterol and HDL-cholesterol were observed in groups
received diet containing low-protein or low fat as compared with the control group. The
results of the present study showed a significant reduction in (Leptin, insulin and
testosterone) level after treatment for 30 days and recovery period for 15 days.


There is a widespread interest in
and arteriosclerosis, but the low fat diet
dietary protein or fat effect on various
causes reduction of serum total lipids
aspects of protein and lipid metabolism
Also there is a widespread agreement
and problems relating to hepatic and
that consumption of food low in protein
cardiovascular disease. Some problems
or low in fat resulted in substantial
can develop at the extremes either low
weight loss. The elegant model of Flatt
fat or low protein intakes. Excess fat
(1987) predicts that low protein or low
causes elevation of serum lipids and
fat diet should induce weight loss. Long
thus an increased risk of heart disease
term trials of low-fat or low protein


Full Paper (vol.1 paper# 6)

Detection of Hepatitis C Virus (HCV) RNA among Young The Egyptian Journal of Hospital Medicine Vol. 1, 95 - 102,
I.S.S.N: 12084
Rec . Nov. 2000

Detection of Hepatitis C Virus (HCV) RNA among Young
Adult Drug Users

Azza H. El. Salakawy
Department of Microbiology, Faculty of Medicine for
Girls, Al-Azhar University

A study to determine the frequency and potential risk factors of hepatitis C virus
(HCV) infection was carried out on 33 serum samples from drug users; admitted to
hospital for treatment. Sera were screened for HCV antibodies (anti-HCV) using
enzyme-linked immunosorbent assay (ELISA). Anti-HCV antibodies were detected in
11/33 (33.3%) of drug users versus 2/30 (6.7%) of volunteer blood donors (control
group), which represent statistically significant changes (p < 0.001). HCV-RNA was
detected by one step nested reverse transcription polymerase chain reaction (RT-PCR).
HCV-RNA was detected in 7/11 (63.6%) of seropositive drug users, all of them were
injection drug users.
There was significant association of HCV infection with age and injection drug
use (p < 0.05). However, there was no significant relation between the duration of drug
abuse and HCV infection. From these findings, I conclude that HCV infections are
common among injection drug users probably due to the intravenous use of drugs.


An estimated 170 million people
In Egypt, there is high prevalence
worldwide have hepatitis C virus
of hepatitis C virus, where 10% - 20%
(HCV) infection (WHO, 1997). HCV is
of the general population is infected
(Kamel et al 1992; Darwish et al,
transmitted acute hepatitis (Choo et al.,
1993). As in other regions of the world,
1989). It is an enveloped positive ­
in Egypt some HCV infections are
stranded RNA virus in the family
caused by transfusions (Khalifa et al,
Flaviviridae, its genome consists of ~
1993; Abdel­Wahab et al, 1994),
9.600 nucleotides which encodes of >
injection drug use (Bassily et al., 1995),
3.000 amino acids that is processed into
perinatal expossure (kumar et al,1997)
structural (S) and nonstructural (NS)
and percutaneous medical procedures
proteins (Kolykhalov et al., 1997). It is
(both traditional and non traditional).
an important cause of chronic hepatitis
HCV is widely spread among
and may eventually cause progressive
injecting drug users (IDUs) (van den
liver disease, cirrhosis, and liver cancer
Hoek et al., 1990; Thomas et al,
(Alter et al, 1992; Tong et al, 1995).
1997).The most common mode of HCV

Full Paper (vol.1 paper# 7)

The Interaction between Converting The Egyptian Journal of Hospital Medicine Vol. ,1: 103 - 113

Rec . Nov. 2000
I.S.S.N: 12084

Effect of Some Food Colorants (Synthetic and
Natural products) of Young Albino Rats

I- Liver and Kidney Functions

Eman G. E. Helal(1) Samir A.M.Zaahkouk(2)
and Hamdy A. Mekkawy(3).


Zoology Department, Faculty of Science for Girls, Al - Azhar University
, Nasr City, Cairo.

Zoology Department, Faculty of Science, Al - Azhar University, Nasr City, Cairo.

The National Center For Social and Criminological Research,
Zamalek P. O., P. C. 11561, Cairo, Egypt

Food colorants are used all over the world in great amount. However, their use in food
is still controversial. It causes and will cause severe tension to the consumers as the
sensitivity of people increases to general health.
This work was carried out to study and compare between the possible toxic effect of
some natural (tumeric, carmine and chlorophyll) and synthetic (fast green, annatto and
sunset-yellow), food colorants on liver and kidney function of young male albino rats.
Such effect might explain hyperactivity of children that was claimed associated with
consumption of food colorants.
The study revealed that administration of both natural and synthetic food colorants
(permitted dose) significantly increases serum AST and serum urea. All colorants with
the exception of sun-set yellow significantly increase serum total bilirubin. While,
chlorophyll, fast-green and sun-set yellow were significantly increase serum ALT.
Some of the colorants used have a retard destructive effect on some vital organ
functions, which extends even after the recovery period. Therefore, large quantities and
/or long periods of colorants administration should not be used as additive in man's diet
or as a drink. Hence, these colorants should restrictly be used in nutritional therapy. And
more caring must be done prevent our children to eat or drink these colorants with much
amounts or for long period.


Material of natural origin have been
materials, mostly plant derived, could
used to provide colour in foods, drugs
be used to enhance the appearance of
and cosmetics for the thousands of
foods and thus tumeric, paprika and
saffron were used for more than just
compounds and plants were probably
their flavouring properties. In the
among the first materials used for
nineteenth century, synthetic organic
cosmetic purposes ( Gount et al. , 1972)
dyes were developed to provide a more
Later, it was discovered that certain
economical and extensive array of

Full Paper (vol.1 paper# 8)

Immunological Assessment of addicts The Egyptian Journal of Hospital Medicine Vol. 1, 114 -128

I.S.S.N: 12084
Rec . Nov. 2000

Immunological Assessment of addicts

Nadia Gamal El-Din Zaki(1) ,Kouka Saad Eldin Abdel-Wahab (2)
Azza Hassan El-Salakawy,(2) Enas Ibrahim El-Gaafarawi(1)
and Maha Hassan Shokair (3)
(1)The National Center for Social and Criminological Research.
(2) Microbiology Dept.,Faculty of Medicine for Girls, Al-Azhar University.
(3) Immunogenetics and Organ Transplantation Unit, Ain Shams Specialised Hospital.


The aim of this study is to investigate some aspects of immunologic response
among Egyptian addicts. The study was conducted on 33 drug addicts who were
admitted to hospital for treatment. They were males with age range (19-30; mean 24.73
years). They were followed up at 2-weeks intervals for one month. Blood samples from
18 addicts and 10 non-drug-user control blood donors were evaluated for some
lymphocyte immunophenotypic markers by flow cytometric analysis. Addicts showed
significantly (P < 0.001) decreased percentages of both T-helper (CD4+) and T-
cytotoxic (CD8+) compared with controls. There was also significant (P < 0.05)
reduction of CD4+/CD8+ lymphocyte ratio. Sera from all addicts, whether on hospital
admission or follow-up samples were subjected to the following investigations. Some
blood-borne viral infections were investigated; hepatitis B surface antigen (HBsAg) was
present in 1/33 (3%) addicts. Hepatitis C virus antibodies (anti-HCV) were detected in
11/33 (33.3%) addicts versus 1/10 (10%) of controls. Human immunodeficiency virus
antibodies (anti-HIV) were present in one serum out of 33 (3%) addicts. Reactivation of
cytomegalovirus (CMV) latent infection was assessed by detection of anti-CMV IgM in
1/33 (3%) of addicts on hospital admission, which persisted during the first two weeks,
then disappeared on the 4th week. Antibody activity as neutralizing antibodies to
polioviruses 1,2 and 3 were tested in cell culture, the antibody titer was higher in
follow-up samples than on the time of hospital admission. Antistreptolysin O (ASO)
was detected in serum of one addict (3%) on hospital admission and in another addict 2-
weeks later which indicated streptococcal infection. The acute inflammation phase C-
reactive protein (CRP) was high in 7/33 (21.2%), 3/33 (9.1%) and 1/33 (3%) upon
hospital admission, 2-weeks and 4-weeks, after cessation of drug use respectively.
There are considerable evidences which
Hilburger, 1998). The opiate drugs of
suggest that drug addiction has an effect
abuse are immunosuppressive, both in
on the humoral immunity and cell
humans and in experimental laboratory
mediated immunity which decreases
animals (Eisenstein et al., 1996). For
host resistance to infection. (Donahoe et
example, morphine treatment results in
al., 1987, Eisenstien et al., 1996).
the suppression of phagocytosis by
Opiates have been shown to produce
macrophages (Rojavin et al., 1993) and
profound effects on the immune system
polymorphnuclear cells (Pacifici et al.,
(Arora et al., 1990; Eisenstein and
1994), as well as inhibition of

Full Paper (vol.1 paper# 9)

Has primary overlap replaced end-to-end repair for anal sphincter rupture during vaginal delivery The Egyptian Journal of Hospital Medicine Vol. 1, 129 -137 Dec.2000

I.S.S.N: 12084
Rec . Nov. 2000

Has primary overlap replaced end-to-end repair for anal sphincter
rupture during vaginal delivery?

Nagwa Abd El-Ghaffar Mohamed,
*Maha Abd El-Mongi Abd El-Rahman

Department of Obstetrics and Gynaecology, *Department of General Surgery
Faculty of Medicine for Girls Al-Azhar University, Cairo, Egypt.


Twenty primigravidae women were included in this study. Their age ranged from
(20-32) years. They were requiring primary repair for third degree tear occurring during
vaginal delivery. All repairs were performed immediately after obstetric disruption. A
ruptured internal sphincter was repaired separately and the torn ends of the external
sphincter were overlaped in 10 women and approximated as end-to-end in the other 10
women, and sutured with 3/0 polydioxanone sulphate sutures. Sixteen women were
followed up, and for all bowel function, clinical assessement, and anal endosonography
were performed at a mean of 120 days after delivary. Eleven percent had persistent
sonographic external sphincter defects with overlap, and 57% with end to end repair.
Also, we found similar percent of internal sphincter defects with overlap, and end-to-
end repair. There was no significant difference between the two techniques with regard
to the clinical outcome. Based on the preceding results it would appear that
sonographic image for external sphincter is better with overlap than end-to-end repair,
but we can not conclusively prove that overlap is superior to the end-to-end repair for
better clinical outcome obtained from both techniques.


Vaginal delivery is the major
in obstetric practice, including reduced
cause of anal incontinence in women(14).
ocular surveillance of perineum, lack of
Anal endosonography revealed occult
manual perineal protection, complicated
sphincter injury after vaginal delivery
birth positions, deficient support and
even in the absence of sphincter tears
assistance at delivery, are associated
diagnosed at birth(11). Sphincter rupture
with an increased risk of sphincter
is classified as a third degree tear when
lacerations. Nulliparity, instrumental
the fibers of the anal sphincter are torn,
delivery, high birth weight, shoulder
and fourth degree if in addition the anal
dystocia, fetal presentation, episiotomy
mucosa is breached(2). The incidence of
and epidural anaesthesia are also
anal sphincter rupture varies between
considered risk factors(9). Primary anal
0.5% and 2.5% in centres where
sphincter repair is generally performed
mediolateral episiotomy is practised,
by an obstetrician immediately after
compared with 7% in units performing
delivery using the technique of end-to-
a midline episiotomy(16). Modification
end approximation of the torn sphincter

Full Paper (vol.1 paper# 10)

Progress and Future challenges The Egyptian Journal of Hospital Medicine Vol. 1, 138 - 147
Rec . Nov. 2000
I.S.S.N: 12084

Experience of 20 years in Management of Medullohlastoma
( A long ­ term Retro spective study)
Dr. Alaa Abdel Hay (MD), Manal Moawad(MD)**
Hussein Boushnak (MD)*** and Hohamed Kabil*
*Neurosurgical, **Radiation Oncology and General Surgery. Departments, Faculty of
Medicine - Ain Shams University

Abstract :

Treatment for patients with newly diagnosed medulloblastoma includes surgical
resection followed by craniospinal radiotherapy. Adjuvant chemotherapy has been
shown to increase the cure rate with high risk or average risk disease and is now a
standard part of contemporary management (Gajjor et al., 99).

Advance in surgery and radiotherapy techniques have improved results in the
last few decades (Paker 1999). These procedures have important early and long term
morbidity that must be weighted in order to offer the patient an acceptable risk-beniefit
The purpose of this study was to analyze the various clinical and prognostic features
which might affect the survival of medulloblastoma and to asses the response of patients
to treatment.

This study includes 288 patients with medulloblastoma who were treated in both
Neurosurgical and Radiation Oncology Departments during the period 1981 and 2000.

Statistical analysis has proven that the median survival was not affected
significantly by the sex or site of tumor but the most significant variables that affected
the median survival were the extent of surgery and stage of the tumor, age and
histopathology. Shunt operation reduces the incidence of post operative mortality


Medulloblastoma constitutes from
The prognosis for medullob -lastoma
10% to 20% of primary CNS tumors in
has improved remarkably in the past 40
children and about 40% of all posterior
years as a consequence of advances in
fossa tumors (Heideman et al., 1997).
radiotherapy (Brandes et al., 1999).
Surgical removal of the tumor is
In 1994, Carr et al., reported a trend
considered the first step of treatment to
of better survival in adult patients
establish definite diagnosis, releive the
treated with chemotherapy meanwhile
acute symptoms and reduces the bulk of
adjuvant chemotherapy was of value if
tumor (Brandes et al., 1999). Total or
given for patients with high risk of
near total resection exerts an important
recurrence (Brandes et al., 1999).
infleunce on recurrence of medullob -
Recently Millot et al., 1999,
lastoma (Bailey et al., 1995).
reported encouraging results with the

Full Paper (vol.1 paper# 11)

MULTIVARIATE ANALYSIS OF Bcl-2, APOPTOSIS, P53, AND HER-2/neu IN BREAST CANCER: A SHORT TERM FOLLOW UP The Egyptian Journal of Hospital Medicine Vol. 1, 148 - 163
I.S.S.N: 12084

Multivariate Analysis of Bcl-2, Apoptosis, P53, And Her-2/Neu In
Breast Cancer: A Short Term Follow Up

1o. El-Ahmady, 2e. El-Salahy3 M. Mahmoud, 4m. Abdel Wahab, 2s. Eissa
And A. Khalifa
1Biochemistry Dep., Ain Shams Faculty of Pharmacy,
2Biochemistry Dep., Ain Shams Faculty of Medicine,
3Biochemistry Dep., National Research, Dokki, Giza,
4Radiation Oncology Dep., Ain Shams Faculty of Medicine.


Background. Several molecular genetic alterations in breast cancer, including
aneuploidy, altered apoptosis, aberrant expression of p53, HER-2/neu and Bcl-2, have
been associated with poor prognosis in breast cancer patients. To determine the
importance of molecular-genetic factors relative to more traditional surgical- pathologic
prognostic factors, multivariate analysis was performed. Materials and Methods.
Ninety-four fresh tissue samples of primary breast carcinoma were studied with flow
cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and
PR) were measured in the cytosol fraction using Abbott ELISA assays, HER-2/neu was
determined in the membrane fraction and mutant p53 protein in the nuclear fraction,
both, by Oncogene Science ELIZA procedures. Bcl-2 and apoptosis (Cell death) were
measured in cell lysates by Oncogene Science & Boehringer Mannheim ELISA assays.
In addition, information regarding surgical-pathological features of the tumor was
obtained. Multivariate analysis using unconditional logistic regression model was done
to identify variables predictive of poor prognosis. Results. Using univariate analysis,
histological grade, tumor stage, lymph node status, HER-2/neu, and mutant p53, were
predictive of poor short-term prognosis. By multivariate analysis, tumor stage, lymph
node status, HER-2/neu were independent factors. Grade subgroup analysis versus time
of relapse, illustrated a predictive value of Bcl-2 in only low-grade tumors while
apoptosis was significant in high-grade type. Conclusion. Among a panel of molecular-
genetic factors investigated, HER-2/neu was the most strongly predictive of poor short-
term prognosis in breast cancer. Patients with HER-2/neu positive tumors can benefit
from Herceptin therapy.

Full Paper (vol.1 paper# 12)