ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5351-5355
The Efficacy of Transobturator Tape (TOT) in Treatment of Mixed Urinary
Incontinence in Females
Amr Mohammed Elsadek Nowier, Mohammed Kandil Abd-Elfattah,
Ahmed Alsaghir Atallah Soliman*
Urology Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Ahmed Alsaghir Atallah Soliman, E-mail: drahmedatalla2014@gmail.com
ABSTRACT
Background: mixed urinary incontinence (MUI) is defined as the complaint of involuntary loss of urine,
associated with urgency and also with effort. Urodynamic studies (UDS) are widely considered the gold
standard investigation for determining the type of incontinence.
Aim of the Work: It evaluates the safety and efficacy of transobturator tape (TOT) procedure in treatment of
women with mixed urinary incontinence.
Patients and Methods: this study was carried out at Ain Shams Urology Department and National institute of
urology and nephrology in the period from October 2017 to may 2018. This Study included 20 female patients
with MUI who failed to respond to medical treatment and other forms of conservative methods. Post operative
evaluation was carried out at 2 weeks, 3, and 6 months following operation.
Results: Our study showed statistically significant cure rate for urge component 12 cases (60%), and also
significant cure rate for stress component 17 cases (85%), no statistically significant difference in the cure rate
depending on the age factor by dividing the patients into two groups group below forty (11 cases) and group
above forty (9 cases).
Conclusion: our study showed statistically significant cure rate for urge component 12 cases (60%), and also
significant cure rate for stress component 17 cases (85%). The limitations in our study were small number of
patients and short time of postoperative follow-up. We advocate that the TOT procedure should always be tried in
the management of mixed urinary incontinence in female population as it is an effective and simple procedure.
Keywords: Transobturator Tape, Mixed Urinary Incontinence, Urodynamic studies
INTRODUCTION
women with MUI is relatively more difficult, as it
Mixed urinary incontinence (MUI) is
involves addressing both the SUI and overactive
defined as the complaint of involuntary loss of urine,
bladder
(OAB)
symptoms.
Conservative
associated with urgency and also with effort or
management is usually the first line, including
physical exertion or on sneezing or coughing (1).
pelvic floor muscle training, bladder retraining, and
MUI is common, with an estimated prevalence of
pharmacological treatment. If the above fails,
30% of all women with urinary incontinence (2).
surgery for SUI may be contemplated in women
Women with MUI are twice as likely to be bothered
with predominant SUI symptoms; a number of
by their symptoms as compared to those with SUI
options are usually discussed with the patient
alone (3). Urodynamic studies (UDS) are widely
including MUS. Transobturator tension-free vaginal
considered the gold standard investigation for
tapes (TO-TVT) have been described in 2001 and
determining the type of incontinence. UDS findings
2003 (6) and have rapidly gained wide popularity
provide valuable information for the confirmation or
among surgeons due to the avoidance of the blind
rejection of the clinical diagnosis and play a crucial
retro-pubic pathway. It was also hypothesized that
role in the determination of the therapeutic strategy
TO-TVT could be preferred in women with MUI
(4). Women with both stress and urgency urinary
compared to retro-pubic tension-free vaginal tapes
incontinence can be challenging to manage. It is
(RP-TVT) due to the more horizontal position of the
important to determine which component is more
tape and consequently, less postoperative OAB
bothersome as it will help in directing treatment.
symptoms (3). In a recent systematic review and
UDS are frequently advocated prior to surgery in
meta-analysis Jain et al. (7) examined the
patients with MUI, as leakage with stress and
effectiveness of MUS in women with MUI. The
urgency often coexists. In patients without detrusor
authors showed that MUS is associated with
overactivity there is some limited data suggesting
reasonable overall subjective cure rates (56.4%) in
they have a higher chance of resolution of their
women with MUI. However, the cure rate for the
urgency symptoms after a sling than those with
urge component (30% to 85 %) was lower than that
urodynamic detrusor overactivity. In patients with a
for the stress component (85% to 97%).
predominant stress component, the midurethral sling
AIM OF THE WORK
(MUS) has been shown to improve urgency and
The aim of the present study is to evaluate
urge urinary incontinence (UUI) (5). Management of
the safety and efficacy of TOT procedure in
5351
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5356-5361
Correlation between Clinical and Urodynamic Improvement in Patients with
Overactive Bladder Syndrome on Anticholinergic Drugs
Mahmoud Ezzat Ibrahim, Ahmed Mohamed Tawfeek, Sherief Saad Mohamed *
Urology Department, Faculty of Medicine, Ain Shams University
*Corresponding Author: Sherief Saad Mohamed; Email:ahsd0307@gmail.com
ABSTRACT
Background: the International Continence Society (ICS) defined overactive bladder syndrome (OAB) as
urinary urgency with or without urge incontinence, often accompanied by frequency and nocturia in absence of
infection. Urinary urgency is the complaint of a sudden compelling desire to void which is difficult to defer
with patients often suffering from anxiety due to fear of leakage. Urge urinary incontinence is defined as
involuntary leakage of urine, accompanied or immediately preceded by urgency. Overactive bladder syndrome
is a symptomatic diagnosis. On the other hand, detrusor overactivity (DO) is an urodynamic finding,
characterized by involuntary detrusor contractions during the filling phase, which may be spontaneous or
provoked. These terms aren't interchangeable, as overactive bladder syndrome patients may not have detrusor
activity on urodynamic testing.
Aim of the Work: to determine the relation between clinical improvement and urodynamic based
improvement in patients with overactive bladder syndrome receiving anticholinergic drugs.
Patients and Methods: this study included thirty eight patients, who presented to the Outpatient Urology
Clinic at Ahmed Maher Teaching Hospital with symptoms of OAB syndrome. This study design was
prospective. Patients clinical histories were taken, they were examined thoroughly, and completed an IPSS
questionnaire. This was followed by a urinalysis, free uroflowmetry and a pelvi-abdominal ultrasound.
Results: this study included thirty eight patients who were divided into two groups. Group A included twenty
one patients, fifteen females and six males with mean age of 48.2 years old (21-60), who did not have detrusor
overactivity in the first urodynamic study. On the other hand, group B included seventeen patients, ten females
and seven males with mean age of 43.7 years old (18-58), who had detrusor overactivity in the initial
urodynamic study. Patients in both groups received Solifenacin 10 mg once daily for twelve weeks before
completing another IPSS questionnaire and undergoing a follow up urodynamic study.
Conclusion: in this study, we concluded that there was strong correlation between urodynamic and clinical
improvement in OAB patients after Solifenacin treatment as patients who were improved urodynamicaly reported
improvement of their symptoms while those with poor urodynamic response reported that their symptoms were
either the same as before treatment or worse. We also concluded that Solifenacin 10 mg once daily led to significant
improvement in IPSS results of OAB patients with significant increase in volume to first desire and maximum
cystometric capacity.
Keywords: Urodynamic Improvement, Overactive Bladder Syndrome, Anticholinergic Drugs.
INTRODUCTION
Overactive Bladder Evaluation (NOBLE) program
The International Continence Society
was developed to estimate the prevalence of OAB
(ICS) defined overactive bladder syndrome
and its burden in the United States, assess the
(OAB) as urinary urgency with or without urge
influence of sex on OAB and its symptoms and
incontinence, often accompanied by frequency
determine the impact of OAB on quality of life,
and nocturia in absence of infection. Urinary
sleep, and general mental health. 5,204
urgency is the complaint of a sudden compelling
participants completed the study that showed an
desire to void which is difficult to defer with
overall OAB prevalence of ~16% with no
patients often suffering from anxiety due to fear
significant differences between the two sexes.
of leakage. Urge urinary incontinence is defined
(16% in men, 16.9% in women) [3] . The study
as involuntary leakage of urine, accompanied or
demonstrated that OAB without urge incontinence
immediately preceded by urgency [1]. Overactive
(OAB dry) was more common in men than in
bladder syndrome is a symptomatic diagnosis. On
women. OAB with urge incontinence (OAB wet)
the other hand, detrusor overactivity (DO) is an
increased with age in both sexes, increasing from
urodynamic finding, characterized by involuntary
2% to 19% in women after the age of 44 years and
detrusor contractions during the filling phase,
from 0.3% to 9% in men with a marked increase
which may be spontaneous or provoked. These
after 64 years. While the prevalence of OAB with
terms aren't interchangeable, as overactive bladder
and without urge incontinence in women was
syndrome patients may not have detrusor activity
similar (9.3% and 7.6%), in men the prevalence of
on urodynamic testing [2]. The National
OAB wet (2.6%) was much lower than the
prevalence of OAB dry (13.4%) [3]. The difference
5356
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5362-5366
Recent Advances in Management of Postoperative Vomiting for Laparoscopic
Bariatric Surgeries
Alaa Abbass Moustafa, Mohammed Abd El Monem Marzouk, Mina Ezzat Almaz Nesem *
General Surgery Department, Faculty of Medicine, Ain Shams University
* Corresponding Author: Mina Ezzat Almaz Nesem, E-mail: minaezat91@gmail.com
ABSTRACT
Background and Objectives: obesity continues to be a leading public health concern associated with many
comorbidities that significantly decrease life expectancy. Surgery remains the only effective treatment
modality for morbid obesity, resulting in long-term weight loss and sustained improvement in weight-related
comorbidities. Vomiting is considered as a possible postoperative complication in all bariatric procedures.
Anastomotic leak is one of the most serious complications following bariatric laparoscopic Roux-en-Y gastric
bypass (LRYGB), and associated with high morbidity rates and prolonged hospital stay. Timely management
is of utmost importance for the clinical outcome. This study evaluated the approach to suspected leakage in a
high-volume bariatric surgery unit.
Patients and Methods: the study has been conducted on 100 Patients with morbid obesity. Observational
checklist including: Age at the time of operation, body mass index (BMI), preoperative gastroesophageal
reflux disease (GERD) and newly developed postoperative upper gastrointestinal symptoms. Invasive
manoeuvres as gastrographin swallow and meal, virtual gastroscopy and upper gastroIntestinal endoscopy
were done upon patients who developed post-operative vomiting after LBS for two months. Go to:
Results: 100 Patients who underwent LBS included 85% women, 42 ± 10 years old, body mass index 43,8 ±
5,4 kg/m2, sleeve gastrectomy 71%, minigastric bypass surgery 24%, Roux-en-Y gastric bypass 5%. During
the first 48 post-operative hours, 39% of patients developed postoperative vomiting which was controlled with
medical treatment (Aprepitant). 4% of them suffered from recurrent episodes of vomiting over a period of two
months were surgically complicated (stenosis, kinking, or obstruction). Endoscopic treatment was successful
for 3 of the 4 patients (75%) after balloon dilatation or insertion of a stent. One of the 4 patients (25%)
required conversion to Roux-en-Y gastric bypass.
Conclusion: post-operative vomiting after Laparoscopic Bariatric Surgeries (LBS) is a common complication
which responds well to centrally acting antiemetic (Aprepitant) during the first 48 post-operative hours. While
invasive maneuvers (Balloon dilatation or insertion of a stent) or even surgical correction might be needed.
Keywords: Laparoscopic Bariatric Surgeries, Obesity, Vomiting, Aprepitant.
INTRODUCTION
pre-mature deaths. It increases the likehood for the
Obesity continues to be a leading public
development of diabetes, hypertension and NASH.
health concern associated with many comorbidities
The American Heart Association identified obesity
that significantly decrease life expectancy. Surgery
as an independent risk factor for the development
remains the only effective treatment modality for
of coronary heart disease. In order to minimize
morbid obesity, resulting in long-term weight loss
post-surgical cardiovascular risk, surgical weight
and sustained improvement in weight-related
loss may become a more frequently utilized option
comorbidities (1). Bariatric operations are either:
to address obesity. (1). In the malabsorptive type of
restrictive, limiting the amount of food ingested
surgery as Rou-en-Y gastric bypass, there is
(e.g.; adjustable gastric banding and sleeve
surgical connection (anastomosis) between the
gastrectomy), malabsorptive, limiting the amount
stomach and bowel, or between two parts of the
of nutrients absorbed (e.g.; Biliopancreatic
bowel. The surgeon attempts to create a water-tight
diversion), or a combination of both (e.g.; Roux-
connection by connecting the two organs with
en-Y Gastric bypass surgery) (2). Bariatric surgery
either staples or sutures, either of which actually
had tremendous growth since its initial sporadic
makes a hole in the bowel wall. The surgeon will
introduction in 1954 with a more than 20-fold
rely on the body's natural healing abilities and its
increase in the number of procedures performed
ability to create a seal, like a self-sealing tire, to
over the last decade (3). Individuals with BMI 40
succeed with the surgery. If that seal fails to form
kg/m2 and those with BMI > 35 kg/m2 with
for any reason, fluid from within the
obesity-related comorbidities who failed diet,
gastrointestinal tract can leak into the sterile
exercise, and drug therapy, should be considered
abdominal cavity and give rise to infection and
for bariatric surgery (4). The rising prevalence of
abscess formation. Leakage of an anastomosis can
overweight and obesity in several countries has
occur in about 2% of Roux-en-Y gastric bypass and
been described as a global pandemic. Obesity can
less than 1% in mini gastric bypass (5). As the
be considered like the driving force towards the
anastomosis heals, it forms scar tissue, which
5362
Received:21/6/2018 Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5367-5370
The Crosstalk between Interferon and Transforming Growth Factor Beta
Signaling Pathways in Hepatitis C Patients
Noha Mohamed Hany M. Elzeiny*, Abd-El-Rahman M. A. Hammouda, Enas Samir Nabih 1,
Sherif Monier Mohamed 2
Medical Biochemistry and Molecular Biology Department 1, Internal Medicine and Gastroenterology Department 2,
Faculty of Medicine, Ain Shams University
*Corresponding Author: Noha Mohamed Hany M. Elzeiny, Email: Nohaelzeiny@gmail.com, Mobile: 01092286565
ABSTRACT
Background: there is an increasing interest in using microRNAs (miRNAs) as biomarkers in liver disease.
Diagnostic biomarkers in hepatitis C serve as a great benefit for the early treatment of HCV. Aim of the
Work: the aim of this study was to evaluate the expression of miRNA-16 in Egyptian patients infected with
HCV and their relation to different biochemical and clinicopathological parameters. Patients and Methods:
twenty-five subjects were chosen, 16 HCV infected and 9 healthy controls. Collection, processing and storage
of serum for evaluation of miRNA16 using RT-qPCR was done. We evaluated the power of miRNA as a
diagnostic tool using ROC curve analysis. The prognostic significance of the investigated parameters in HCV
patients was explored. Results: there is a highly significant difference of miRNA 16 expression between HCV
patients and healthy controls. miRNA 16 has great sensitivity and specificity for differentiating between
patients with HCV and healthy controls. Conclusion: miRNA 16 can be used as a potential diagnostic biomarker
for HCV. In addition, it could be used for staging of the disease.
Keywords: HCV, miRNA, miRNA 16.
INTRODUCTION
infected with HCV and their relation to different
Hepatitis C virus (HCV) infection is by far
biochemical and clinicopathological parameters.
considered one of the main reasons of chronic liver
PATIENTS AND METHODS
disease throughout the world. The extended effect of
HCV infection ranges from minimal change to
Enrollment of patients: we recruited
extensive fibrosis, cirrhosis, liver cell failure with
patients infected with hepatitis C virus (HCV patients,
the risk of progression to hepatocellular carcinoma
n = 16) and individuals (controls, n = 9) who were
(HCC) (1). HCV genotype 4 infection is common in
matched with patients for age and gender as possible
the Middle East and Africa, especially northern and
in the study. he Ethics Committee of Ain Shams
sub-Saharan area. According to recent estimates
Faculty of Medicine, Egypt, approved all procedures
10.4 million patients are positive for HCV genotype
involving human material, and all patients signed an
4 accounting for 13% of all HCV infections
informed consent. From November 2016 to June
worldwide. In Egypt alone, 15% of the Egyptians
2017, a total of 25 participants were enrolled into the
are sero-positive, 93% of which are infected with
study (Internal Medicine Department, Faculty of
genotype 4 (2). MicroRNAs (miRNAs) are small
Medicine, Ain Shams University) including 16
non-coding RNAs that affect the function a wide
patients with HCV infection and 9 healthy controls
variety of other genes by inhibiting the translation of
recruited from interested hospital employees who
their complementary mRNAs. Some miRNAs play
were excluded from the diagnosis of hepatitis B virus
an important role in immunity against viral
(HBV), HCV, and HCC. We excluded any patient
infection. Changes in the levels of hepatic miRNAs
with acute infections, clinically detected jaundice,
have been reported in many liver diseases as HCC
symptoms of liver cell failure, HBV and HCC. Male
and liver fibrosis (3). The miRNA16 family consists
and female participants were included with an age
of miRNA15a, 15b, and 16. Downregulation of
range of 2040 years (median, 35 years). Clinical
miRNA15a and miRNA 16 is a valuable predictor
characteristics of patients were retrieved from the
of HCC spread and patient survival (4). Moreover,
clinical records available and were assessed
the expression levels of miRNA 16 are significantly
retrospectively (Table 2). In addition, the
high in HCV infected patients and in hepatic fibrosis
clinicopathologic parameters were collected such as
(5, 6). In this study, we tested the hypothesis that
gender, smoking, HBV surface antigen, HCV
miRNA 16 is upregulated in HCV patients in
antibodies, and serum alpha fetoprotein (AFP) and
comparison to healthy controls.
performed ultrasound. Samples collection and
processing: five milliliters of venous blood were
AIM OF THE WORK
drawn and collected in a serum separator tube
The aim of this study was to evaluate the
centrifuged at 3,000 rpm for 10 min, and the serum
expression of miRNA-16 in Egyptian patients
was separated, aliquoted, and stored immediately at -
80°C. Extraction of total RNA, including miRNA:
5367
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5371-5374
Knowledge and Awareness of Diabetic Foot Complications in Diabetic Patients
Sarah Naif Aldawish, Ahmad Hassan Alsomali, Abeer Jalawi alotaibi , Abdulwhab Abdulhaq Alkhars
Almaarefa University, Saudi Arabia
*Corresponding author: Sarah Naif Aldawish, E-mail: sara-naif1993@hotmail.com
ABSTRACT
Background: diabetic foot problems are common throughout the world, resulting in major economic
consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic
origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in
the prevalence of type 2 diabetes.
Aim of the Work: to assess the level of awareness of Diabetic foot disease amongst patients with type 2
diabetes mellitus aim. To measure the knowledge of diabetic about sign and symptoms of diabetic foot. To
measure the knowledge of risk factors of diabetic foot in diabetic patients.
Patients and Methods: this is a questionnaire-based cross-sectional study enrolling a total of 100 randomly
selected diabetic foot Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis
was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DF were calculated as
absolute frequencies and were reported as overall percentages.
Results: a number of 99 participants with type 2 Diabetes Mellitus participated in the study, 91% of the
participants were either overweight or obese, 92% of participants had concomitant hypertension, (57.5%),
dyslipidemia and (26.7%) eye problems. Also 76% of the specimen reported altered sensation in their lower
limbs, and 90% reported having no previous diabetic foot disease education. Only 22.2% of participants
reported having examined their feet, but only when they experienced a problem. A number of participants
achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI)
4.24.7) and practice (mean 11.09, s.d. 2.233, CI 10.811.5) on diabetic foot care (DFC). Those who had a
higher level of education and who were less than 65 years old had a significantly better score for previous foot
care education (p <0.05).
Conclusion: The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To
minimize the burden of DFD, improved screening and prevention programs as well as patient education should be
provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and
identifying the at-risk foot.
Keywords: Diabetes, diabetic foot, type-II diabetes, sequella.
INTRODUCTION
knowledge of diabetic about sign and symptoms of
Diabetic foot disorders (DFD) one of the
diabetic foot, and to measure the knowledge of risk
common chronic complications of diabetes, which
factors of diabetic foot in diabetic patient's5.
may lead to major and minor limb loss1. More than
AIM OF THE WORK
50% of lower limb amputations are performed on
1- To assess the level of awareness of Diabetic foot
diabetic patients around 3970 in KSA2. It is
disease amongst patients with type 2 diabetes
estimated that 90% of the total diabetic patient end
mellitus aim.
up with amputation. Diabetic foot complications are
contributing to both mortality and morbidity among
2- To measure the knowledge of diabetic about sign
the diabetic population leading to substantial
and symptoms of diabetic foot.
physical, physiological and financial burden for the
3- To measure the knowledge of risk factors of
patients and community at large3. Moreover,
diabetic foot in diabetic patients.
diabetic foot infections are a well-recognized risk
PATIENTS AND METHODS
factor for hospitalization and amputation4.
According to a recent meta-analysis, one in every 30
Population research and sampling: Based
hospitalized patients at any given time is affected by
on a cross-sectional study of enrollment a total of 100
a diabetic foot infection. Additionally, patients with
diabetic patients on June 2018 randomly selected in
diabetes who develop an infection have been
Saudi Arabia to ensure diversity in age group and
reported to have a 155-fold increased risk of
educational stages. Statistical analysis: Data was
amputation compared to those who do not. This
entered and analyzed using Microsoft Excel 2016
study aimed to determine the risk factors of
(Microsoft Corporation, Seattle, WA, USA).
complication of diabetes in lower limb to assess the
level of awareness of Diabetic foot disease amongst
patients with diabetes mellitus aim. To measure the
5371
Received:2/6/2018
Accepted:11/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5375-5384
Correlation between Central Venous Pressure and the Diameter of Inferior Vena
Cava by using Ultrasonography for the Assessment of the Fluid Status in
Intensive Care Unit Patients
Mostafa Ibrahim Mostafa Shalaby*; Hussein Montasser Roshdy**; Wael Mohamed Elmahdy*; Anas
Ezzat Fathy El Mezayen*
Departments of Anesthesia and Intensive Care Unit* and Diagnostic Radiology**,
Faculty of Medicine Al Azhar University
Corresponding Author: Anas Ezzat Fathy El Mezayen, Mobile: 01009836758; Email: anasezzat1990@gmail.com
ABSTRACT
Background: decisions regarding fluid therapy, whether in the operating theatre, intensive care unit,
emergency department, are among the most challenging and important tasks that clinicians face on a daily
basis. Specifically, almost all clinicians would agree that both hypovolaemia and volume overload increase the
morbidity and mortality of patients. The therapeutic goal of fluid administration is to increase preload, or the
stressed venous volume, leading to an increased stroke volume and cardiac output. However, studies of
patients with acute illness or hypotensive patients in the intensive care unit consistently demonstrate that
approximately 50% of fluid boluses fail to achieve the intended effect of increasing cardiac output. Aim of the
Work: this study was done to evaluate the correlation between central venous pressure (CVP) measurements
and ultrasound measurements of the inferior vena cava diameter, and collapsibility index. The secondary aim
was to evaluate the value of ultrasound as a noninvasive tool in assessment of intravascular volume status and
fluid responsiveness in critically ill intensive care unit patients. Patients and Methods: after obtaining the
approval of the Al-Azhar University Ethical Committee and written informed consent, 50 patients aged 30-60
years of either sex, ASA I-III admitted in the ICU of Al-Azhar teaching hospitals who had a functioning
central venous catheter inserted for any clinical indication, were involved in this single blinded correlational
study. Hemodynamic parameters were monitored continuously including heart rate and non-invasive mean
arterial blood pressure. CVP measurements were taken with the patient in the supine position. Clinical
assessment was done for signs of hypovolemia like hypotension, tachycardia, prolongation of capillary refill:
>3 seconds, acidosis, increased serum lactate more than 2 mmol/L or loss of skin turgor. Results: in our study,
there was a significant correlation between CVP and the two studied ultrasound parameters, IVC CI and
IVCdmax. Analysis of the receiver operating characteristic curve ROC showed that inferior vena cava
collapsibility index (IVC CI) had the most favorable performance of the two ultrasound parameters in
predicting CVP < 10 cm H2O. As regards prediction of fluid responsiveness, analysis of the ROC showed a
better diagnostic accuracy of IVC collapsibility index and IVC diameter for predicting fluid responsiveness.
Conclusion: ultrasound of the inferior vena cava may be used as a feasible non-invasive, rapid and simple adjuvant
method to assess the intravascular volume and guide fluid responsiveness in critically ill intensive care unit patients,
inferior vena cava collapsibility index may be used to predict low central venous pressure and predict fluid
responsiveness.
Keywords: Central venous pressure, diameter of inferior vena cava
INTRODUCTION
catheter is contraindicated in certain situation as any
Fluid management in the intensive care
coagulation disorders, infection over the insertion
plays a vital role in the outcome of the patient.
site etc. There have been reports of many
Hypovolemia with inappropriate use of vasopressors
complications with a central venous catheter e.g.
to maintain the blood pressure reduces the organ
infections, accidental arterial puncture, hematoma,
perfusion leading to ischemia. On the other hand
hemothorax,
pneumothorax,
air
embolism,
fluid overload causes cellular swelling and
dysrhythmias. (3) Recently the ultrasound guided
congestion of lungs thereby increasing morbidity
measurement of the IVC diameter and its changes
and mortality. (1) Central venous catheters have a
with respiration have been used to calculate the fluid
wide variety of uses such as hemodynamic
status of a patient. It is a safe technique and it is also
monitoring, drug administration, total parenteral
relatively cheap. It can be used as an alternative to
nutrition, trans-venous pacemaker placement,
central venous catheterization to assess the volume
pulmonary artery catheterization, etcetera. The
status of patients. It is a dynamic measure of
central venous pressure is a static measure of
intravascular volume status, as it reflects the volume
volume. (2) The method has been followed widely to
changes that take place with respiration.(4) The IVC
assess the volume status and thereby treating the
adjusts to the body's volume status by changing its
patient accordingly. Insertion of central venous
diameter depending on the total body fluid volume.
The caval opening increases in size during
5375
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5385-5390
Comparison between the effect of Two Regimens for Hepatitis C Treatment
(Qurevo and Ribavirin) and (Sofosbuvir, Daclatsvir and Ribavirin) on Patients
above and below the Age of 60 Years
Mahmoud Abd El Majeed Othman, Motaz Mohamed Saied Abd EL Mawjood, Mohamed Osama Aly
Aly, Aya Ahmed Morsy El Ghamry
Department of Internal Medicine, Faculty of Medicine, AinShams University
Corresponding author: Aya Ahmed Morsy El Ghamry, E-mail: drayaahmed@yahoo.com, Mobile: 01008602806.
ABSTRACT
Background: the goal of antiviral treatment is to prevent complications of the disease, mainly cirrhosis and
HCC. New therapy options, known as direct acting antiviral (DAA) regimens, offer the promise of increased
success rates complimented by shorter treatment durations, improve side effect profiles, and simplified
treatment monitoring.
Aim of the Work: to compare between the effect of oral antiviral treatment especially (Quervo and Ribavirin)
and (Sofosbuvir, Daclatasvir and Ribavirin) between elderly patients above 60 years and young people below
this age as regard: Response to treatment, Development of complication.
Patients and Methods: the study was conducted on 100 Egyptian patients they were divided into 2 groups
each one received one of the two treatment regimens then each group divided into 2 subgroups, subgroup A
include patients below 60 years and subgroup B include patients above 60 years. The selected patients were
subjected to History taking, Complete physical examination, Pelviabdominal ultrasound, Laboratory
investigations: complete blood count, bilirubin and liver enzymes before and after treatment, INR, creatinine,
albumin, HBs Ag, HIV antibodies and Alpha feto proteins, HCV RNA.
Results: there is no significant difference between two treatment regimens. Both regimens show cure rate
about 94%, 96% achieved SVR with (sofosbuvir daclatasvir and ribavirin regimen), (quervo and ribavirin
regimen) respectively. Both regimens are effective in elderly patients above 60 years as young patients below
this age in both regimens, response of treatment in both regimens in elderly patients above 60 years is 96%.
Gender doesn't affect treatment outcome. Anemia develop in 34% of patients receiving sofosbuvir, daclatasvir
and ribavirin regimen, and in 58% of patients receiving quervo and ribavirin regimen. Females developed
anemia more frequent than males in both regimens. Both regimens developed hepatobiliary complication,
12%, 18% developed hyperbilirubinemia with (sofosbuvir daclatasvir and ribavirin regimen), (quervo and
ribavirin regimen) respectively.
Conclusion: treatment with (sofosbuvir daclatasvir and ribavirin regimen) or (quervo and ribavirin regimen) is
highly effective with little differences between them; also age and gender have no role in achieving SVR.
Complications such as anemia and hyperbilirubinemia occur in treatment with both regimens and more frequent
with (quervo and ribavirin regimen).
Keywords: Sofosbuvir, Daclatasvir, Quervo, Ribavirin, SVR
INTRODUCTION
treatment of persons infected with genotype 4 HCV
(4)
Left untreated, chronic HCV infection can
. Sofosbuvir has shown a good safety profile in
cause liver cirrhosis, liver failure and HCC. Of those
clinical trials; an overall improved tolerability was
with chronic HCV infection, the risk of cirrhosis of
seen with sofosbuvir compared to interferon based
the liver is 15-30% within 20 years (1). The risk of
regimens (5).
HCC in persons with cirrhosis is approximately 2-4%
AIM OF THE WORK
per year (2). Elderly patients with chronic HCV
To compare between the effect of oral
infection have been an understudied population due
antiviral treatment especially (Quervo and
to several factors. These factors include exclusion of
Ribavirin) and (Sofosbuvir, Daclatasvir and
subject older than 65 years of age in several clinical
Ribavirin) between elderly patients above 60 years
trials, reluctance to treat HCV infection in elderly due
and young people below this age as regard:
to fear of dealing with more HCV therapy related
Response
to
treatment,
Development
of
adverse effects, co morbidities and risk factors of
complication.
aging such as decreased glomerular filteration rate
that may cause more severe hemolytic anemia with
PATIENTS AND METHODS
ribavirin and interactions of interferon and ribavirin
This is a case control study that was
with several potential geriatric drugs (3). Paritaprevir,
conducted on 100 Egyptian patients, 50 patients
a protease inhibitor boosted with ritonavir, and
received (Sofosbuvir, Daclatasvir and Ribavirin)
ombitasvir, an NS5A inhibitor, are effective for the
and other 50 patients received (Quervo and
5385
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5391-5395
Study of Vitamin D Level in Cirrhotic HCV Patients before and after
Transplantation
Amira Ahmed Salem, Wael Ahmed Yousry, Ghada Abd El-Rahman Ahmed, Hussein Salah Eldin
Ibrahim Omar*
Internal Medicine Department, Faculty of Medicine, Ain Shams University
* Corresponding Author: Hussein Salah Eldin Ibrahim Omar, E-mail: hussein.salaheldin@yahoo.com, Tel: 01224348761
ABSTRACT
Background: chronic hepatitis C is a common condition. Transfusion of blood or blood-related products was
one of the main routes of HCV transmission. Furthermore, nosocomial infections represent a key source of
infection, particularly in some of the high-prevalence countries (such as Egypt, Pakistan and Eastern Europe).
In general, prevalence increases with increasing age until peak prevalence at 5564 years in most regions. At
least six HCV genotypes are known, Genotype 4 frequency is the highest from Central Africa to the Middle
East. Worldwide people infected with HCV are at an increased risk of developing serious hepatic
complications including cirrhosis and hepatocellular carcinoma.
Aim of the Work: the aim of this work is to study vitamin D level in post HCV liver cirrhosis patients before
and six months after liver transplantation in addition to chronic HCV patients without cirrhosis.
Patients and Methods: this prospective case control study was conducted on 25 patients. 15 of them with
liver cirrhosis due to chronic hepatitis C virus evaluated before and six months after liver transplantation in
addition to 10 chronic HCV patients without cirrhosis as control group. Liver cirrhosis or transplantation
patients were recruited from Ain Shams specialized hospital liver transplantation unit and chronic HCV
patients without cirrhosis were recruited from hepatology outpatient clinic of Ain Shams university hospital in
the period from February 2017 to November 2017. Symptoms suggestive of liver disease (e.g. jaundice,
bleeding tendency, increased abdominal girth).
Results: this study was conducted on 25 patients. 15 of them with liver cirrhosis due to chronic hepatitis C
virus evaluated before and six months after liver transplantation in addition to 10 chronic HCV patients
without cirrhosis as control group. Group I: Consists of 15 (60%) patients with post HCV liver cirrhosis before
liver transplantation. They were 13 males (86.6%) & 2 females (13.3%). Their mean age was 50.53 ± 4.52.
Group I: Consists of the same patients of group I evaluated six months post liver transplantation. Group III:
Consists of 10 (40%) patients with chronic HCV without cirrhosis. They were 6 males (60%) & 4 females
(40%). Their mean age was 53.0 ± 8.46.
Conclusion: this study concluded that vitamin D deficiency is prevalent among patients with liver cirrhosis. Liver
transplantation improves vitamin D level but not to the recommended normal level i.e. vitamin D deficiency or
insufficiency can persist after transplantation.
Keywords: Vitamin D level, Cirrhotic HCV Patients, Endoscopic Retrograde Cholangio Pancreatography.
INTRODUCTION
(4). Vitamin D has immunomodulatory effects with
Egypt has the highest prevalence rate of
direct actions at dendritic cells, monocytes,
hepatitis C virus (HCV) in the world, making it the
macrophages,
B-cell
and
T-cell
functions
most challenging public health problem facing the
considering that vitamin D and vitamin D receptors
country (1). Studies showed that 7% of the Egyptian
(VDR) are expressed by several cellular populations
population carry hepatitis C virus (HCV) RNA (2).
of the immune system such as T- helper 1(Th1) and
Liver cirrhosis occurs with untreated chronic
T- helper 2 (Th2) (4).
hepatitis C virus infection, patients with cirrhosis are
AIM OF THE WORK
susceptible to a variety of complications, and their
The aim of this work is to study vitamin D
life expectancy can be markedly reduced, especially
level in post HCV liver cirrhosis patients before and
in those with acute or chronic liver failures (3).
six months after liver transplantation in addition to
Vitamin D has been associated with chronic liver
chronic HCV patients without cirrhosis.
diseases and it has been reported that low vitamin D
status is a common feature in different types of liver
PATIENTS AND METHODS
diseases (4). According to recent studies , the
This prospective case control study was
prevalence of vitamin D insufficiency is higher in
conducted on 25 patients. 15 of them with liver
patients with chronic liver disease than in general
cirrhosis due to chronic hepatitis C virus evaluated
population ranging between 64 and 92 % and it has
before and six months after liver transplantation in
been also reported that incidence of vitamin D
addition to 10 chronic HCV patients without
deficiency increases as the liver disease progresses
cirrhosis as control group. Liver cirrhosis or
5391
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5396-5397
Thymopharyngeal Duct Cyst: A Form of Cervical Thymus
Reyof Saeed Alharthi 1, Alaa Bakheet A. Alzahrani 1, Sultanah Naser Alshreef 1 and
Bashaer Beshr Alnahdi 2.
1 Taif University, Taif City, Saudi Arabia.
2 King Abdullaziz University, Jeddah City, Saudi Arabia.
*Corresponding Author: Reyof Saeed Alharthi, E-mail: Reyofsaeedalharthi@gmail.com
ABSTRACT
Background: a rare case of a cystic thymopharyngeal duct presented as a rare case of the cervical thymus. The
embryology of normal cervical descent of the thymus is reviewed. The preoperative diagnosis of
thymopharyngeal duct cyst is rare to be established, however, histopathology is the definitive diagnosis.
Thymopharyngeal duct cysts are rare lesions commonly been one of differential diagnosis in childhood neck
masses.
Patients and Methods: asymptomatic thymopharyngeal duct cyst in a 7 years old boy caused by the remnants
of the thymopharyngeal duct. A consent form was taken from the parent. The study approved by the ethical
Committee of the Faculty of Medicine, Umm Al-Qura University that follows the international rules of
research. The study not sponsored by any agency.
Results: the patient undergoes surgery under general anesthesia followed by transverse incision, the cystic
lesion was found on the sternocleidomastoid muscle. There were no postoperative complications.
Histopathologic evaluation confirms the presence of thymopharyngeal duct cysts.
Conclusion: thymopharyngeal duct cysts can cause a diagnostic challenge to the surgeon evaluating of neck
swelling. Also its importance of considering thymopharyngeal duct cysts in the differential diagnosis of any child
who presents with a neck swelling.
Keywords: Thymopharyngeal cyst, Cystic lesion, Duct Cyst
INTRODUCTION
resonance imaging (MRI) of the neck mass. The
The thymic cyst is one of the rare
consent was obtained from the child's parent. The
differential diagnoses of neck masses in children and
MRI reported that a peripherally enhancing, multi-
the diagnosis mostly is postoperative based on the
septated, cystic lesion that arises from the superior
histopathology examination of the specimen. The
mediastinum and extended into the left sides of the
thymopharyngeal duct cyst in children are mainly in
neck, deep to the sternocleidomastoid muscles
the mediastinal but it could be founded at any level
(SCM), and anterior to the carotid sheaths. The left-
of the normal embryology of thymus from the angle
sided lesion was measured 10.5 cm in length. No
of the mandible to the superior mediastinum [1,2].
additional enhancing lesions were noted. The
The thymic embryological remnant usually presents
preoperative diagnosis was thymopharyngeal duct
as a case of cervical mass during childhood.
cyst. The patient undergoes surgery under general
Thymopharyngeal duct cyst is a cystic thymic
anesthesia followed by transverse incision, the cystic
remnant located from the lateral neck to the upper
lesion was found on the sternocleidomastoid muscle,
mediastinum into the thymus gland [3,4].
the cystic counted from the sternal notch and the
inferior edge end with the opening of the thoracic
PATIENTS AND METHODS
cavity, the total length was 14 cm, the specimen sent
A 7-year-old boy presented with gradual
to histopathological investigations thymopharyngeal
onset of enlargement, painless on the left neck mass.
duct cyst was the diagnosis. We closely observed the
There was no history of fever, night sweats, malaise,
patient for the next two months. During the follow-
dysphagia, wheezing or any difficulty in breathing.
up, there was no increase in swelling no pain or
He got an upper respiratory tract infection around 1
decreased range of motion. The patient informed that
week ago; he had no prior neck swelling or any
have be follow up sooner if the mass returns.
infection. otherwise, he was healthy. The patient was
up to date on all vaccinations. There was no family
DISCUSSION
history of congenital or acquired of the same illness.
Physical examination of the neck showed a mass on
The primordial thymus is created from
the left, which was firm in consistency not fluctuant,
ventral of the bilateral third pharyngeal pouches
not tender, or erythematous. He had a full neck range
during the 6th week of development. The conjugated
of motion. Based on these findings, we suspected he
inferior parathyroid from the dorsal wings of these
has cystic lesion but we couldn't give the definitive
pouches develops in association with thymic
diagnosis with this information alone, so hens we
primordium. The thymus glands elongate caudally
decided to perform a Contrast-enhanced magnetic
with medial direction, keeping a connection with the
pharynx through the epithelial tube which is known
5396
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5398-5402
The Role of Susceptibility Weighted Imaging (SWI) in Evaluation of Acute Stroke
Maha Abdelhamed El Nouby*, Eman Ahmed Fouad Darwish, Eman Ahmed Shawky Geneidi
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Maha Abdelhamed El Nouby, Mobile: +201272792124, E-mail: mahaelnoby@yahoo.com
ABSTRACT
Background and Objectives: SWI provides information about blood oxygenation levels in intracranial
vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information
about the degree of brain perfusion in arterialischemic stroke. We aimed to evaluate the influence of the SWI
venous signal pattern in predicting stroke evolution.
Materials and Methods: a semiquantitative analysis of venous signal intensity on SWI and diffusion
characteristics on DTI was performed in 2o adult patients with acute stroke of MCA vascular territories. The
mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with
stroke progression on follow-up.
Results: we included 2O patients with a confirmed diagnosis of arterial ischemic stroke. Follow-up images
were available for. MCA stroke progression on follow-up was observed in 11/12 patient with DWI -SWI
mismatch. Initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch
showed a statistically significant association (P _ 0.00188) for infarct progression.
Conclusion: SWI-DWI mismatch predicts stroke progression in arterial ischemic stroke.
Keywords: stroke, MRI, Susceptibility weighted imaging (SWI), (PWI), DWI.
INTRODUCTION
flow
contribute
to
a
higher
level
of
A stroke is caused by the interruption of the
deoxyhemoglobin and vein dilatation, which
blood supply to the brain, usually because a blood
increases the conspicuity of vessels on SWI. As a
vessel bursts or is blocked by a clot. This cuts off the
result, SWI can show asymmetric prominent
supply of oxygen and nutrients, causing damage to
hypointense vessels potentially from different
the brain tissue (1). The effects of a stroke depend on
concentrations of deoxyhemoglobin between
which part of the brain is injured and how severely it
ischemic and normal brain areas. This potential
is affected. A very severe stroke can cause sudden
metabolic information on SWI may help to delineate
death, so predicting the risk of further infarct growth
penumbra without contrast agent administration (4).
in stroke patients is critical to therapeutic decision
Recently, a study on pediatric arterial ischemic
making (2). Contemporary therapy for acute ischemic
stroke has reported that SWI/DWI mismatch is
stroke is based on the concept of penumbra, which is
useful in detecting penumbra in middle cerebral
an area with reduced blood flow but not to such a
artery (MCA) infarct, thus predicting progression of
level that causes irreversible cell membrane failure.
infarction on follow-up images (5).
Although challenged by several limitations,
AIM OF THE WORK
mismatch between larger abnormal areas on MR
This study aims to assess the diagnostic
perfusion-weighted imaging (PWI) and smaller
value of SWI-DWI mismatch in detecting ischemic
restricted areas on diffusion-weighted imaging
penumbra, and predicting early infarct growth in
(DWI) is a widely accepted approach to detecting
patients with acute MCA territory ischemic stroke.
penumbra, predicting stroke evolution and
determining patients with the greatest potential to
PATIENTS AND METHODS
benefit from thrombolytic therapy. However, PWI
Patients: During a period of 8 months
requires administration of a contrast agent, which is
duration from October 2017, twenty patients were
contraindicated in a variety of clinical conditions,
enrolled in the study. All patients presented
such as renal insufficiency and previous reactions to
clinically with acute stroke. The study was
contrast agents (3). Susceptibility-weighted imaging
approved by the Ethics Board of Ain Shams
(SWI) which is a high-resolution, three-dimensional,
University and an informed written consent was
gradient-echo T2* MR technique with enhanced
taken from each participant in the study.
sensitivity for paramagnetic substances is a potential
Inclusion criteria: Patients with radiological
alternative for detecting ischemic penumbra and
evidence of acute non-lacunar ischemic infarct in
thus predicting infarct growth. In the ischemic brain,
the territory of the middle cerebral artery
the increased oxygen extraction fraction and slow
presenting within not less than 6 hours and not
5398
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5403-5408
Reliability of Diffusion Weighted MRI for the Diagnosis of Residual and
Recurrent Cholesteatoma
Medany Mahmoud Medany 1, Reda Mohammed Sabra 1, Ehab Kamal Hakim 1, Amr Mohammed
Ismaeel Sadawy 2, Ahmed Mohammed Medhat Elshafei 1*
Departments 1 Otorhinolaryngology and 2 Radiodiagnosis, Faculty of Medicine, Ain Shams University
*Corresponding Author: Ahmed Mohammed Medhat Elshafei, E-Mail: Ahmedmedhats2006@gmail.com
ABSTRACT
Background: olesteatoma is defined as the presence of collections of kertatinized squamous epithelium within
a sac in temporal bone & skull base, commonly involve the middle ear cavity & mastoid cavities. Congenital
cholesteatomas compose only 2% of middle ear cholesteatomas.
Aim of the Work: to evaluate the role of DWMRI in detecting residual and/or recurrent cholesteatoma and to
compare it to the intra-operative findings.
Patients and Methods: this study was conducted on patients with recurrent or residual cholesteatoma
suspected clinically or by CT examination at Ain Shams University hospitals or Hearing and Speech Institute.
The patients were referred from the department of Otolaryngology, Ain Shams University hospitals, Hearing
and Speech Institute and also from other private clinics.
Results: from the 30 cases we examined, 19 cases (63%) showed areas of DWI restriction within the middle
ear denoting primary or recurrent cholesteatoma. The smallest size of cholesteatoma detected was 4.5 mm. All
19 cases that showed evidence of recurrent cholesteatoma on MS-EPI DWI MRI images underwent second
look mastoid surgery will all cases (100%) showing intra-operative evidence of cholesteatoma. Of the 11 cases
that were negative for cholesteatoma on DWIs, 9 of these cases underwent second look mastoid surgery with 4
cases (44%) showing small cholesteatomas measuring less than 4 mm while the other 5 cases (56%).
Conclusion: DWI is a beneficial tool in the evaluation of recurrent cholesteatoma with excellent specificity that
reduces the need of second look surgeries in multiple cases.
Keywords: Diffusion Weighted MRI, Residual , Recurrent Cholesteatoma
INTRODUCTION
this disease, otomicroscopic evaluation is the
Cholesteatoma is defined as the presence of
principal diagnostic tool for acquired cholesteatoma,
collections of kertatinized squamous epithelium
an inflammatory polyp or granulation tissue might
within a sac in temporal bone & skull base,
be obscuring the vision on examination by, as
commonly involve the middle ear cavity & mastoid
recurrent or residual disease is mainly attributed to
cavities.It may be congenital or acquired. Congenital
hidden areas that cannot be seen using surgical
cholesteatomas compose only 2% of middle ear
microscope. otoendoscopic examination and
cholesteatomas
(1).
Cholesteatomas
involve
surgical exploration is other tools to be used for such
Prussak's space and progressively erodes the
cases (4). A cholesteatoma can only be eradicated
adjacent structures such as the scutum and the
from the temporal bone by surgical resection and is
ossicular chain. After growth, the cholesteatoma
usually managed with radical or modified radical
invades the antrum and the mastoid process, eroding
mastoidectomy. The choice of surgical approach
further structures of the middle ear such as the facial
depends upon the scoring of the anatomical
nerve canal, the tegmen tympani and the posterior
extentsion of the cholesteatoma into the middle ear
semicircular canal wall (2). It can erode and destroy
and mastoid cavity and the status of the ossicular
important structures with potential for causing
chain and tympanic membrane, selection of the
central nervous system (CNS) complications (eg,
optimal surgical approach results in complete
brain abscess, meningitis) makes it a potentially fatal
disease eradication. these procedures can be
lesion (3). It is usually diagnosed on basis of history,
classified into canal wall up and canal wall down
otoscopic examination with radiological and
procedures (5). The incidence of recurrence of the
audiological assessment. An understanding of the
chronic active disease vary from 3 to 18% of all
pathophysiology of aural cholesteatoma is
surgical procedures and the failure most importantly
important, due to it's destructive nature which is
attributed to residual or recurrent cholesteatoma
responsible for the morbidities associated with it's
with persistent suppuration of middle ear and
chronic nature. the lack of effective nonsurgical
mastoid (6). Recurrent disease or disease due to de-
management add importance to the understanding of
novo retraction (i.e. retraction pocket cholesteatoma)
5403
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5409-5415
Effect of Immediate versus Early Oral Hydration on Caesarean Section
Postoperative Outcomes: A Randomized Controlled Trial
Heba A. Ahmed*, Ahmed A. El-Shahawy, Hazem M. Sammour
Department of Obstetrics and Gynecology,Faculty of Medicine, Ain Shams University
*Corresponding author: Heba A. Ahmed; Email: a.h_hoba@hotmail.com
ABSTRACT
Background: caesarean sections performed every year are increasing in number dramatically all over the
world. So, it became very important to give more attention for their postoperative care.
Aim of the Work: to evaluate the effect of immediate oral hydration initiated within 2 hours after
uncomplicated caesarean section on the following post-operative outcomes: post-operative vomiting and
abdominal distention, post-operative nausea and abdominal pain, the return of intestinal movements, duration
of intravenous fluid administration, duration of hospital stay and participant satisfaction.
Patients and Methods: this randomized controlled study was conducted at Ain Shams University Maternity
Hospital. It was carried during the period from July 2016 to July 2017. 140 women, all of them underwent
uncomplicated cesarean section under regional anesthesia were randomly assigned into two groups. In the
immediate group: oral hydration was received in the first 2 hours postoperatively, and in the early group: oral
hydration was received after 8 hours postoperatively.
Results: all the results of the postoperative outcomes of both groups had non-significant differences except for
the psychological satisfaction which was significantly higher in the immediate group with a (p<0.001).
Conclusion: immediate oral hydration group showed non-significant differences comparing with early oral
hydration group regarding most of the postoperative outcomes, but the results were relatively better towards the
immediate group. Also, immediate hydration is significantly better than early hydration regarding psychological
satisfaction of women, allowing them to be more able to breastfeed their kids and to spend a less stressful time in
the hospital.
Keywords: Immediate/Early Oral Hydration, Cesarean Section, Postoperative Outcomes, Vomiting, Nausea
INTRODUCTION
However, this belief changed because the duration of
Caesarean sections performed every year are
surgery became shorter, the regional anesthesia
increasing in number dramatically all over the world.
became more available, and intestinal manipulation
So, it became very important to give more attention for
during surgery became minimal. All these factors
their postoperative care (1). Return of intestinal
provided the chance for early oral intake before bowel
movement and passage of flatus are considered
movements return (2). Several studies were done to
important factors affecting the duration of
compare between different regimens of postoperative
postoperative hospital stay in addition to other factors
hydration and feeding (2). Many of which were done on
like the used anesthesia, wound healing, and
the effect of early hydration after caesarean section, but
breastfeeding (2). The traditional approach of giving the
less studies were done on the effect of immediate
patient nothing orally postoperatively till bowel
hydration. Therefore, early oral hydration especially
function returns (in the form of bowel movement or
immediate supply of oral fluids after caesarean sections
passage of flatus) followed by slow feeding is now
needs further studying. Also, its impact on
challenged and became controversial (3). The
postoperative recovery and duration of stay in hospital
importance of early feeding postoperatively depends
needs to be studied widely as well. (2) Moreover, early
on that food intake is able to stimulate a reflex causing
oral hydration after caesarean section might be
a coordinated propulsive activity and increasing the
beneficial in many ways, it may facilitate early return
secretion of gastrointestinal hormones. These effects
of intestinal movements and reduces the risk of
cause an overall positive effect on intestinal movement
hospital infections, leading to early hospital discharge
(2)
decreasing the duration of postoperative ileus (4). Early
. It also may decrease the cost of hospital stay as it
feeding also may be associated with reduced depletion
decreases the duration of intravenous fluid
of protein stores and improvement in wound healing
administration with less use of cannulae (3). There is
with a faster recovery (5). There was a belief that
also a proof of its association with breastfeeding
postoperative oral intake without return of intestinal
success and less suffering of the patient from thirst and
movements may cause nausea, vomiting, and
hunger (6), early postoperative nutrition also leads to a
abdominal distention leading to wound breakdown.
better wound healing and a better muscle function with
5409
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5416-5420
Prevalence and Determinant Factors of Chronic Calculous Cholecystitis among
Senile Population Arar, KSA
Maha Mukhlef R Alanazi 1, Abdalla Mohamed Bakr Ali 2, Waad Salamah Alaleimi 1, Asem Matrouk Z
Alrowaili 1, Sultan Majed M Alshammari 1, Saud Rteamy R Alanazi 1, Abrar Asaad M Alanazi 1, Waad Alazri
S Alanazi 1, Jawaher Naif M Althayidi 1, Alaa Ali S Alanazi 1, Zain Amer L Alruwily 1, Dnya Saleh Affat
Alanaziy 1, Zaid Qati F Alshammari 1, Mashail Rasheed M Alshammari 1, Fatimah Awadh A Alrasheedi 1
1 Faculty of Medicine, Northern Border University, KSA, 2 Faculty of Medicine, Sohag University, Egypt
*Corresponding Author: Maha Mukhlef R Alanazi, E-mail: apdo3332008@gmail.com
ABSTRACT
Background: chronic calculous cholecystitis is an inflammatory disease which affects the gallbladder wall
and causes motoric-tonic dysfunctions of the biliary system accompanied by gallstones in the lumen of the
gallbladder and biliary pain. Among aging study groups, the prevalence of gallstone disease is likely to
increase.
Aim of the Work: to determine the prevalence and determinant factors of chronic calculous cholecystitis
among senile population in Arar, KSA.
Patients and Methods: the present cross sectional community based study was conducted in Arar city,
Northern Border Province, KSA on 217 adult people aged 50 years and more. Data were collected through
personal interviews with the study population and filling the questionnaire which guided us to the data of
socio-demographic status, smoking, chronic diseases, already previously diagnosed with chronic calculous
cholecystitis, after ensuring the diagnosis by reviewing the accompanied health reports and/or prescriptions
and asking the accompanied caregivers about the case.
Results: the mean age of the participants (± SD) was 69.9 (±9.3) years; male to female ratio was 43.8 to 56.2.
The overall prevalence rate of chronic calculus cholecystitis found in this study was 6.9%. There was a
relationship between chronic calculus cholecystitis and age group, sex, DM, BMI group, Thyroid disease and
Hypertension. The prevalence of chronic calculus cholecystitis was more in females compared to males (9.0%
vs. 4.2%).
Conclusion: female gender, diabetes and obesity are significantly associated factors in the development of
gallstones. Thus, understanding the gallstones pathogenesis would result in life style modifications and weight loss
which would decrease the rates of the disease.
Keywords: Chronic Calculous Cholecystitis, Prevalence, Determinants, Senile Population, Arar, KSA
INTRODUCTION
gallstones in the gallbladder lumen, and reveals as
Calculous cholecystitis is a hepato-biliary
biliary pain [9]. The risk of developing gallstone disease
system disease caused by cholesterol and/or bilirubin
and its complications increases with age. Among aging
metabolic disorder. It is characterized by the formation
study groups, the prevalence of gallstone disease is
of gallbladder and/or biliary tract stones [1]. It is the
more likely to increase. The health of the gallstone
most common type of cholecystitis as gallstones are
patients is improving secondary to the improvement of
highly prevalent, but most (80%) are asymptomatic [2].
the diagnostic and therapeutic technologies [10]. In the
Gallstones prevalence is associated with geographical
study of González et al. who thought that the different
and ethnic variations [3]. In the study of Bateson[4], it
therapeutic methods that are at present in use, should
was estimated that up to 28% and 42% of senile British
be applied to this group, and whether surgical or long-
men and women, respectively, aged 8089 years have
term medical treatment should be applied, it was found
gallstones. Of these, 30% are symptomatic, and are
that elderly patients can undergo surgery in selected
seen by surgeons around the country [4]. However, it is
cases with an acceptable mortality rate and high
less prevalent in China, Japan and Egypt, compared to
morbidity. Surgery is recommended with those of a
Western communities [5, 6,7]. In Saudi Arabia, gallstones
lesser age, not always possible as many of them lacked
prevalence is not well defined, and more studies need
prior symptoms [11]. As this field is not well studied in
to be done throughout the country. However, recent
Northern Saudi Arabia, this study was carried aiming
studies indicated high prevalence and incidence [8]. The
at determining the prevalence and determinant factors
chronic type of calculous cholecystitis affects the
of chronic calculus cholecystitis among elderly in Arar
gallbladder wall and causes motoric-tonic dysfunctions
city, the capital of the Northern area of Saudi Arabia.
of the biliary system, accompanied by presence of
5416
Received:3/6/2018
Accepted:12/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5421-5426
Bronchial Asthma among Medical students in Saudi Arabia
Aishah Mohammad Alkhaldi 1, Mohammed Ali Almesned 2, Fawziah Abdulrahman Roublah 3, Ahmad
Mohedeen Aldawalibi 4, Talal Mohammed Saeed Alshahrani 5, Azzam Arshad Shaikh 6, Khalid Jubran Idris 6
1 Faculty of Medicine, Northern Border University, 2 Faculty of Medicine, Qaseeim University, 3 Faculty of Medicine,
King Abdul-Aziz University, 4 Faculty of Medicine, King Saud University, 5 Faculty of Medicine, King khalid University,
6 Faculty of Medicine, Umm Al-Qura University.
*Corresponding Author: Aishah Mohammad Alkhaldi, E-mail:
ABSTRACT
Background: bronchial asthma is a common chronic respiratory disease affecting adolescents and young
adults nationality and worldwide and its prevalence has increased in developed and developing countries over
the last three decades.
Aim of the Work: to establish the prevalence of bronchial asthma among medical students in Saudi Arabia
and the relationship between asthma and some associated risk factors.
Patients and Methods: a descriptive cross-sectional study. Data were collected from randomly selected
undergraduate medical students of 6 universities, during the academic year 2017-2018. A predesigned
questionnaire was disseminated to the targeted population to complete it.
Results: the prevalence of physician-diagnosed bronchial asthma in our participants was 19.2%. Males
reported insignificant higher prevalence of bronchial asthma compared to females (P= 0.195). Bronchial
asthma was significantly associated with skin allergy 32.9% (P= 0.001), allergic rhinitis 61.6% (P=0.001), hay
fever 12.3 %( P=0.001) and obesity 28.8% (P0.009). While it was insignificantly associated with smoking
(P=0.428), passive smoking (P=0.561), diabetes (P=0.254) and performing muscular exercise (P=0.322).
Precipitating factors to bronchospasm was dust in 43.8%, certain foods in 1.4%, hot weather in 2.7% and
multiple factors in 52.1%. Herbal treatment was tried in 34.2%; desensitization in 6.8% and 68.5% needed
emergency treatment. Response to medical treatment was good in 89.1% of cases.
Conclusion: the prevalence of physician-diagnosed bronchial asthma in our participants was 19.2%. Males reported
insignificant higher prevalence of bronchial asthma than females. Bronchial asthma was significantly associated
with skin allergy, allergic rhinitis, hay fever and obesity. While it was insignificantly associated with active smoking
or passive smoking.
Keywords: Prevalence, Physician-diagnosed asthma, associated symptoms, medical students, Saudi Arabia.
INTRODUCTION
Adolescents with asthma are at risk of significant
Bronchial Asthma is a chronic respiratory
morbidity and disability that affect their general
inflammatory disorder of the airways that is
health and will being [5]. In the Northern Borders
characterized by episodes or attacks of impaired
Region of Saudi Arabia, the prevalence of asthma
breathing, affecting up to 10% of adults and 30%
among adults 15 years was 6.45% according to
of children and adolescents [1]. The prevalence of
the national household survey in 2016 [6]. The
asthma has increased in developed and developing
prevalence of asthma in Saudi adults is under-
countries over the last few decades. Asthma is of
investigated. Saudi Initiative for Asthma did not
public health concern because it is a major cause
report the prevalence of asthma in adults, stating
of infirmity, and reduces the quality of life of
that there is a need to investigate asthma among
affected cases. Asthma nowadays is a focus of
the adult Saudi population [7]. Results from a
clinical research and public health programs as a
national Saudi household survey published in
common chronic disease causes considerable
2013, estimating the burden of chronic medical
morbidity and mortality [2]. Undiagnosed and
conditions including asthma among the Saudi
untreated asthma have a major impact on quality
population aged 15 years or older, indicated a
of life of the affected person as well as the
self-reported clinical diagnosis of asthma to be
families [3]. Compared to other chronic
4.05% [5]. A cross-sectional study was conducted
obstructive pulmonary disease like (COPD),
at Al-Baha University, AlBaha, Kingdom of Saudi
asthma does not result in death, but left untreated
Arabia to determine the prevalence of asthma
and incompliance to treatment can be fatal, and
symptoms and associated factors among medical
the WHO estimate that380,000 persons died due
students. It was found that, the prevalence of
to asthma in 2015 [3]. Asthma prevalence was
recurrent asthma symptoms was; shortness of
14.1% in the adolescent age group [4].
breath and cough in 31.3%, sleep interruption by
5421
Received:4/6/2018
Accepted:13/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5427-5432
Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy in
Uterine Tumors
Mohamad Fathy 1, Hamed Al-Azony 1, Ehab Hasanen 2, Nader Abd-Elhamid 1*
1 Surgical Oncology Unit and 2 Gynecology and Obstetrics Department
Faculty of Medicine, Al-Azhar University, Cairo
*Corresponding author: Nader Abd-Elhamid, E-mail: naderzaid1969@yahoo.com
ABSTRACT
Background: laparoscopic hysterectomy (LH) rates have increased but abdominal hysterectomy (AH) still
high and often the first choice for many surgeons even with most of studies reported that the minimal access
method offers significant patient benefit over open surgery.
Aim of the Work: we aimed to compare the outcome of total laparoscopic hysterectomy as regard the result
and safety compared to total open abdominal hysterectomy in cases of uterine tumors.
Patients and Methods: this prospective randomized controlled study performed on 25 patients who
underwent LH (group 1) compared to 25 patients who underwent AH (group 2). The mean age of the cases,
body mass index (BMI), duration of operation, estimated blood loss (EBL), rate of complications, post-
operative hospital stay and convalescence time were compared for two groups.
Results: LH was associated with a significantly longer operating time (139.96±22.66 minutes vs. 106.54±21.8
minutes P 0.001). As regard intraoperative complications and estimated blood loss there was no difference in
both groups. In LH group the pain score and analgesia requirements in post-operative period were
significantly less with fewer requiring opioid analgesia. There was a highly significant difference between
groups in postoperative wound infection which was higher in AH group. LH was also associated with a
significantly shorter inpatient hospital stay (2.22 days vs. 5.52 days P= 0.022) and earlier returned to normal
life (7.5 days vs. 20.6 days P<0.001).
Conclusion: total laparoscopic hysterectomy is safe and feasible procedure in treatment of uterine tumors with
accepted peri-operative morbidity and good improvement of quality of life post-operative.
Keywords: Total laparoscopic hysterectomy, total abdominal hysterectomy, uterine tumors, outcomes and
complications.
INTRODUCTION
laparoscopic hysterectomy (LH) in January, 1988.
Hysterectomy is one of the most common
The ligaments and uterine vessels were coagulated
gynecological procedures performed wide world.
with bipolar forceps and the vagina was closed
Approximately
600,000
hysterectomies
are
vaginally. The total operating time was 180 minutes
performed annually in the United States. Most
and the patient was discharged on the fourth
hysterectomies are performed for benign indications
postoperative day. Like other minimally invasive
(1). Hysterectomy can be performed abdominally,
surgeries laparoscopic hysterectomy have been
vaginally, laparoscopy or with robot-assisted. It can
clearly associated with lower morbidity as less blood
also be performed by combining two of these routes
loss, shorter hospital stay, speedier return to normal
(2). Choosing route of hysterectomy is influenced by
activities, and fewer abdominal wall infections when
many factors as shape and size of the uterus and
compared with open abdominal hysterectomies (6).
pelvis, surgical indications, presence or absence of
AIM OF THE WORK
adnexal pathology, extensive pelvic adhesive
The aim of this study is to compare the
disease, surgical risks, hospitalization and recovery
outcome of laparoscopic hysterectomy with open
length, hospital resources, and surgeon expertise are
abdominal hysterectomy in uterine tumors.
all weighed once hysterectomy is planned. Each
approach
carries
distinct
advantages
and
PATIENTS AND METHODS
disadvantages, discussed with the patient (3). Kurt
Study design: This is a prospective
Semm in Germany first described a technique for
randomized controlled study performed on fifty
laparoscopic assistance in vaginal hysterectomy in
patients recruited from those attending the
1984. The adnexa were separated laparoscopically in
outpatient surgical oncology department and
order to simplify vaginal hysterectomy this was later
obstetrics and gynecology department in Bab-
called laparoscopic assisted vaginal hysterectomy
ElSharia University Hospital, who were candidate
(LAVH) (4). Harry Reich (5) performed the first
for hysterectomy for uterine tumors during the
5427
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5433-5437
Posterior Corneal Astigmatism Changes in Cases with Keratoconus
Mohammed Elsaid AbdElaziz Mahmoud, Ismael Ebraheem Hamza, Ahmed Hassan Assaf,
Tamer Fahmy Eliwa*
Department of Ophthalmology, Faculty of medicine, Ain-Shams University
*Corresponding author: Mohammed Elsiad AbdElaziz, E-Mail: drmohammed1244@gmail.com, Mobile: 00201028518999
ABSTRACT
Background: keratoconus is bilateral (usually asymmetrical), progressive, non inflammatory, cone like
anterior protrusion of the cornea involving the central and the inferior para central areas that results in corneal
ectasia, astigmatism and diminution of vision. It usually seen after puberty, with incidence of 1 in 2000 of
general population, the major benefit of corneal tomography is the measurement of the posterior corneal
surface, because the posterior surface contributes minimally to the overall refractive power of the eye (due to
the minimal difference between the index of refraction of the cornea and aqueous) it was considered less
important both diagnostically and therapeutically. The posterior cornea, however, is an earlier indicator of
ectatic change or ectasia susceptibility.
Aim of the Work: to determine the changes of posterior corneal astigmatism in cases with keratoconus.
Patients and Methods: one hundred eyes of 50 patients were included in this retrospective, case control study
which adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committees of the
Ain Shams University Hospitals. All patients included in the study provided informed consent, these cases
were divided into: 1- Keratoconus group: comprised 50 eyes of 25 patients with keratoconus diagnosed on the
basis of clinical and topographic signs and 2- Control group comprised 50 eyes of 25 normal candidates for
refractive surgery.
Results: the mean magnitudes posterior corneal astigmatism(PCA) were approximately 1 D, and The PCA
values were significantly associated with the severity ofKeratoconus(KC), the posterior corneal surface was
more affected in the early stages of KC.
Conclusion: we found that the mean magnitudes PCA were approximately 1 D, and The PCA values were
significantly associated with the severity of KC, the posterior corneal surface was more affected in the early
stages of KC.
Keywords: Keratoconus, corneal tomography, posterior astigmatism, pentacam.
INTRODUCTION
detecting early keratoconus or keratoconussuspect(5).
Corneal topographers based on Placido disc
Koch and his colleagues(7) in 2012, found that
and
recent
elevation
based
tomography.
significant increase of posterior corneal astigmatism
Keratoconus is non inflammatory, ectatic corneal
(PCA)(0.86 ± 0.45 D) in patients with KC than
disorder characterized by progressive corneal
normal eyes (0.30 ± 0.15 D). In 2016, Naderan(8)and
thinning that results in corneal protrusion, irregular
his associates reported a strong correlation between
astigmatism, and decreased visual acuity(1). The
anterior corneal astigmatism (ACA) and posterior
incidence of keratoconus is about 1 of 2,000
corneal astigmatism (PCA) with severity of KC,
individuals with a higher incidence in refractive
More importantly ACA was more affected than
surgery candidates(2). Keratoconus starts posteriorly
PCA with an increase in the severity of KC. On the
with early change in posterior corneal curvature,
other hand, PCA was more affected than ACA in the
then progress to anterior corneal surface. So that
early stages of KC(1).
curvature changes on the anterior corneal surface
AIM OF THE WORK
might miss signs of early posterior corneal ectasia(3).
To determine the changes of posterior
The corneal posterior surface has been suggested to
corneal astigmatism in cases with keratoconus.
be useful and important clinical tool for keratoconus
detection and even for subclinical cases(3). Diagnosis
PATIENTS AND METHODS
of keratoconus has greatly improved from simple
One hundred eyes of 50 patients were
clinical diagnosis with the advent of better
included in this retrospective, case control study
diagnostic devices(4). Since slit lamp examinations
which adhered to the tenets of the Declaration of
cannot detect keratoconus in early stages, and visual
Helsinki and was approved by the Ethics
acuity may not be affected, corneal topography and
Committees of the Ain Shams University
tomography are the only reliable methods for
Hospitals. All patients included in the study
5433
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5438-5443
Anal Abscesses and Different Methods of its Surgical Management
Mana Ali Mueidh Al Hajlan, Mohammed Hundur Alasmari, Abdullah Salem Al Haider, Abdulaziz
Abdullah Alhazmi, Nasser Naji Mohsen Al harthi, Yaqoub Mubarak Ali Alhamami
Faculty of Medicine, Najran University, KSA
ABSTRACT
Background and Objectives: in this review wed discuss background of anal abscess and fistula, as well focused
on different surgical approaches for dealing with anal abscess, their effectiveness and difficulties after surgery.
Patients and Methods: We conducted narrative review by searching published literatures in the following
databases: MEDLINE/PubMed, and Embase, for all studies concerning with types of Anal abscesses and
diagnosis in addition to surgical management approaches "June, 2018".
Results: Anorectal abscesses are one of the commonest anorectal problems encountered by surgeons. They are
usually cryptoglandular in origin and are associated with an anal fistula in 30% 70% of cases. When the
incriminating gland originates from the posterior midline and traverses the conjoint longitudinal muscle into
the deep postanal space, a deep postanal abscess results. Further extension of this infective process into the
unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. This type of abscess accounts for about
15% 20% of anorectal abscesses and its management remains challenging to surgeons.
Conclusion: Anorectal abscesses are common anorectal problems, early management is mandatory, almost always
require surgical drainage, even if they have spontaneously discharged.
Keywords: Anal abscesses, Surgery, perianal abscesses, postanal abscess, surgical management
INTRODUCTION
with anal abscess, their effectiveness and difficulties
A perianal abscess is defined as a local
encountered after surgery.
gathering of pus in the perianal tissues. It could
PATIENTS AND METHODS
prolong right into the ischiorectal fossa, on one or
both sides, ultimately develop a horse-shoe shaped
We conducted narrative review by
collection, or much less generally track up in the
searching published literature in the following
direction of and with the levator musculature [1], [2].
databases: MEDLINE/PubMed, and Embase, for
It is a usual problem contributing dramatically to the
all studies concerning with types of Anal abscesses
daily surgical work [3]. One of the most common
and
diagnosis
with surgical
management
aetiology is considered to be glandular infection
approaches "June, 2018". Reference lists of other
emerging from the anal crypts [1]. This could
relevant publications were screened to identify
describe why a proportion of perianal abscesses are
additional potentially relevant studies that were not
connected with fistulain-ano either from the start or
identified by the first method of literatures search.
as a later symptom in 26- 37% of the moment [2,3,4].
We restricted our search for only English published
Fistula-in-ano could increase possibility of abscess
articles with human subject.
recurrence which after that requires repeat drainage.
Despite having no recurring abscess, more
DISCUSSION
treatments might be required for fistula associated
In about third of patients, a fistula was
signs and symptoms such as discharge or perianal
discovered either at the time or subsequent to
soreness. For these reasons some surgeons have
abscess drainage [10,11]. Many fistulas develop on
taken into consideration primary fistula treatment at
the background of a pre-existing abscess [12]. They
the time of abscess drainage in order to reduce the
may additionally take place automatically and (less
demand for further surgery. The downside of this
frequently) in the context of inflammatory bowel
approach is that some fistulae could spontaneously
condition, tuberculosis, trauma, or as a problem of
settle with time and would have unnecessarily gone
neighborhood
operations
(such
as
through fistula surgery. Second of all fistula surgery
haemorrhoidectomy or episiotomy). There was no
in the presence of inflamed perianal tissues might
definitive means of avoiding or forecasting fistula
lead to damages to the anal sphincter and ensuing
occurrence or formation after abscess drainage. It
incontinence. In this review we discussed
was originally believed that discovery of enteric
background of anal abscess and fistula; as well we
organisms in the perianal abscess was related to an
focused on different surgical approaches for dealing
enhanced danger of succeeding fistula formation
[13] Nonetheless, a recent situation series of 164
5438
Received:6/6/2018
Accepted:15/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5444-5449
Evaluation of Stress Ulcer Prophylaxis Benefits and Outcomes: A Simple
Literature Review
Alghamdi, Mohammed Yaan Allah M 1, Abdulelah Hassan Alluhaybi 2, Abdullah Abdulaziz Alzahid 3,
Murad Abdullah Akkur 4, Mohammed Abdulaziz A Alshenaiber 5, Riyadh Othman Abdullah Shati 6, Wed
Ziyad Alnajjar 6, Sanaa Mahmoud Anbarserri 7, Reem Awad Alqahtani 8, Lamees Hassan Alzahrani 9
1- Al-Baha University, 2- Umm Al-Qura University, 3- Imam Abdulrahman Bin Faisal University, 4- Jazan University,
5- Misr University for Science and Technology, 6- King Abdulaziz University, 7- Taibah University,
8- King Khalid University, 9- Ibn Sina National College
E-mail:
ABSTRACT
Background: One of the commonest complications in critically ill patients is stress related mucosal disease
(SRMD). It can be associated with increase in the risk of development of overt gastrointestinal bleeding. As a
result, a lot of literatures have been done to evaluate the pathogenesis that stands behind it's development, and
assessment of the measures that can be used to lower the risk of it's 'occurrence.
Aim of the Work: In this review we aimed at discussing the pathogenesis that stands behind stress ulcer
development, Also, discussing the role of anta- acid as a prophylaxis against harms and benefits. In addition to
providing an intensive study that analyzed the recent literatures considered this field of study.
Methodology: A comprehensive search was done using biomedical databases; Medline, and Pubmed, for
studies concerned with assessment of stress ulcer prophylaxis. Keywords used in our search through the
databases were as; "stress ulcer", "stress ulcer prophylaxis", "stress ulcer in ICU patients".
Conclusion: Stress related mucosal disease is associated with increase in the risk of clinically overt gastrointestinal
bleeding. As a result, patients who require mechanically ventilation for more than 48 h and those with a manifest of
coagulopathy are highly recommended for having stress ulcer prophylaxis (SUP). Anta- acid such as Proton Pump
Inhibitors (PPIs) and histamine 2 receptor antagonists (H2RA) help in prevention of gastrointestinal bleeding, but
did not have any effect on mortality risk reduction. Still further prospective randomizes trials needs to be done to
evaluate our scientific research survey to guide the physicians in making a decision about the use of SUP in ICU
patients.
Keywords: Stress, Ulcer, Prophylaxis.
INTRODUCTION
The prevalence of overt bleeding depends on
Stress-related mucosal damage (SRMD) is a
depends on this condition is defined. According to
term used to describe an acute, erosive,
Cook et al.(3) overt gastrointestinal bleeding is
inflammatory insult to the upper gastrointestinal
defined as the presence of hematemesis, bloody
tract associated with critical illness(1). SRMD can
gastrointestinal aspirate or melena, while clinically
present as an asymptomatic superficial lesions found
significant bleeding is the association of overt
incidentally
during
endoscopy,
occult
gastrointestinal bleeding and either hemodynamic
gastrointestinal bleeding causing anemia, overt
compromise, or the requirement for blood
gastrointestinal bleeding and clinically significant
transfusion, or surgery (3) . According to the data
gastrointestinal bleeding. Stress ulcer described for
from earlier studies the prevalence of overt
the first time in 1969 when small focal lesions were
gastrointestinal bleeding is about 25 % of critically
found in mucosa of gastric fundus during post-
ill patients(4). Nowadays the condition is far more
mortem examinations in 7 (out of 150) critically ill
infrequent with the prevalence reported as between
patients2. Since that time, and as a result of the
0.6 and 4 % of patients (3, 4). The reduction in the
increase use of diagnostic endoscopy in the medical
incidence in more recent epidemiological studies
field, health care providers found that between 74
probably reflects an improvement in the overall
100 % of critically ill patients have stress-related
management of the critically ill patient, including a
mucosal erosions and subepithelial hemorrhage
focus on early aggressive resuscitation, attenuating
within 24 hours of admission. In most of time the
mucosal hypoperfusion, and an awareness of the
lesions are superficial and asymptomatic, but can
importance of early enteral nutrition(5).
extend into the submucosa and muscularis propria
METHODOLOGY
and erode significant vessels which will cause a
clinically overt and significant bleeding (figure 1).
Sample: We performed comprehensive
search using biomedical databases; Medline, and
5444
Received:5/6/2018
Accepted:14/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5450-5454
Prevalence of Right Ventricular Dysfunction in relation to Type of Vascular
Access in Chronic Hemodialysis Patients: Monocentric Study
Mohamed Osama Mahmoud, Bichari Walid Ahmed, Rezk Khaled Mohamed and
Abdel-Dayem Mohamed Mahmoud*
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Abdel-Dayem Mohamed Mahmoud, E-mail: mohamednephro9856@yahoo.com
ABSTRACT
Background: chronic renal failure (CRF) is associated with significantly increased morbidity and mortality.
Chronic renal failure affects almost every system of the body and results in various functional and structural
abnormalities. Life-sustaining haemodialysis (HD) requires durable vascular access (VA) to the circulatory system.
An arteriovenous fistula is currently considered the gold standard access for hemodialysis, as it has lower risk for
infection, lower tendency to thrombotic occlusion, greater blood flow, reduced treatment time and is less expensive
to maintain than alternative vascular access methodologies. Patients on hemodialysis have several risk factors for
developing PH: LV systolic and diastolic dysfunction, volume overload, endothelial dysfunction and sleep-
discorded breathing. Aim of the Work: The aim of the current study was the prevalence of right ventricular
dysfunction in relation to type of the vascular access in chronic hemodialysis patients. Patients and Methods: this
cross-sectional study was carried out on 100 subjects on regular hemodialysis more than six months duration, 62
males (62%) and 38 females (38%). The patients' age ranged between 24 and 76 years. They were selected from
dialysis unit in Aswan health insurance hospital. All patients were subjected to the following: full history taking and
clinical examination, vascular access examination (Types and patency), laboratory investigations. ECG for
arrhythmias "AF, PVCs, Ischemic changes, LVH" and Echo parameters findings "RT. Vent. Systolic pressure, Rt.
Vent. diastolic dysfunction, Rt. vent. dimensions, PHT & LVH). Results: percentage of right ventricular diastolic
dysfunction was higher in patients of A-V fistula [47.5%] than [42.4 %] in cases of A-V graft and [33.3%] in
patients with permanent catheter and there was significant statistical difference between right ventricular diastolic
dysfunction and types of vascular access (p=0.043). The percentage of Rt. Ventricular diastolic dysfunction was
higher in patients with low flux dialyzer membrane [83.3%] than in patients with high flux dialyzer [16.7%] but
without significant statistical difference. There was no statistical difference between types of vascular access and
attacks of recurrent of hypotension during dialysis session among chronic hemodialysis patients in the study. The
percentage of Rt. Ventricular diastolic dysfunction was higher in patients with low flux dialyzer membrane [83.3%]
than in patients with high flux dialyzer [16.7%] but without significant statistical difference. Conclusion: this study
concluded a significant ventricular diastolic dysfunction in relation to type of vascular access in chronic
hemodialysis patients. Vascular access type has a significant relationship to the incidence of pulmonary
hypertension and Right ventricular systolic pressure (RVSP) in chronic hemodialysis patients.
Keywords: Rt.vent. dysfunction -AVF- hemodialysis-vascular access type- pulmonary Hypertension
INTRODUCTION
related care was found to be more than five-fold higher
The number of patients with end-stage chronic
for patients with arteriovenous graft (AVG) compared
kidney disease (CKD) requiring renal replacement
to patients with a functioning arteriovenous fstula
therapy has increased progressively worldwide (1).
(AVF) (2). It seems that the native AVF still remains the
Permanent vascular access (VA) is the life-line for the
first choice for VA, thereafter, VA still remains the
majority of these patients when hemodialysis (HD) is
base of the procedure and HD VA dysfunction is one
the treatment of choice. Thus, the successful creation
of the most important causes of morbidity in this
of permanent VA and the appropriate management to
population (3). Patients with end-stage renal disease
decrease the complications is mandatory, good
undergoing hemodialysis have high rates of morbidity
functional access is also vital in order to deliver
and mortality. Cardiovascular disease accounts for
adequate HD therapy in end-stage renal disease
almost half of this mortality, with the single most
(ESRD) patients, despite the advances that have taken
common cause being sudden cardiac death, early
place in the field of nephrology and particularly in
detection of abnormalities in cardiac structure and
dialysis, few things have changed in recent years with
function may be important to allow timely and
regards to VA, mainly the introduction of the
appropriate
cardiac
interventions
(4).
CVD
polytetrafluoroethylene graft and the cuffed double
complications are the major cause of mortality in CKD
lumen silicone catheter, However, the cost of VA
patients as compared with complications from chronic
5450
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5455-5560
Formal Abdominoplasty versus Mini-Abdominoplasty Post Laparoscopic Sleeve
Gastrectomy
Mohamed Ahmed Mohamed Aamer, Moheb Shoraby Eskandaros,
Bishoy Nagy Gerges*
Department of General Surgery, Faculty of Medicine Ain-Shams University
*Corresponding author: Bishoy Nagy Gerges, Mobile: 01009253841, Email: doctorbishoy@gmail.com
ABSTRACT
Background: obesity nowadays is associated with comorbidities that double folded the mortality as cancer,
cardiovascular disease, and diabetes. And weight loss by dietary changes and exercise usually does not achieve
the desired weight loss goals. As such, bariatric surgery has become the treatment of choice for obesity and co-
morbidities. Body contouring and specially abdominoplasty after bariatric surgery is a component in the
treatment of the obese patient and is well accepted by patients, despite the extensive scarring with all of the
surgical procedures. There is evidence that postbariatric surgery patients who have subsequent body
contouring surgery maintain their weight loss. Aim of the Work: to compare between formal and modern
mini-abdominoplasty after laparocopic sleeve gastrectomy. Patients and Methods: this comparative study
included two groups of thirty patients each, group I consisted of patients with redundancy at the ventral part of
the abdomen after weight loss stabilization at BMI 30 for more than 6 months post laparoscopic sleeve
gastrectomy, where formal, traditional, abdominoplasty was done to them. While group II consisted of patients
with redundancy at the ventral part of the abdomen after weight loss stabilization at BMI 30 for more than 6
months post laparoscopic sleeve gastrectomy, where modern mini-abdominoplasty was done to them. Results:
as regarding Flank fullness post Abdominoplasty Group I resolved the flank fullness except for 10 while
Group II 20 cases still with flank fullness, therefore there was statistical significant difference between the two
groups as (p value) = 0.009823. As regarding upper abdominal wall bulge condition resolved successfully in
27 cases from group I and only 10 from Group II, therefore there was statistical significant difference between
the two groups as (p value) = 0.000006. Conclusion: abdominoplasty gives the patient seeking weight loss the
encouragement and well to lose more weight and improve his psychological state, traditional abdominoplasty
provide a comprehensive treatment of abdominal wall redundancy, even in the most severe cases, the patients get
both functioning and cosmetic improvement. Mini-abdominoplasty is less effective, not appropriate method to treat
patients with lipodystrophy of the trunk and fullness of the flanks post laparoscopic sleeve gastrectomy and bariatric
surgeries.
Keywords: Study and compare formal, traditional, abdominoplasty and mini, abdominoplasty post
laparoscopic sleeve gastrectomy.
INTRODUCTION
gastric bypass, minigastric bypass. The doctor
Obesity nowadays is associated with
chooses the suitable operation to his patient
comorbidities that double folded the mortality as
according general condition and acceptability of
cancer, cardiovascular disease, and diabetes (1).
patient body to the operation type (3). Following
And weight loss by dietary changes and exercise
massive weight loss thanks to Bariatric surgeries, a
usually does not achieve the desired weight loss
new deformity has emerged. The patient often
goals (1). As such, bariatric surgery has become the
experience soft tissue deflation with excess folds of
treatment of choice for obesity and co-morbidities
redundant skin and subcutaneous tissue that fails to
(2). Guidelines recommend bariatric operation for
retract and hangs from the torso, abdomen. This
morbidly obese patients, defined as those with a
excess skin redundancy can lead to both physical
body mass index (BMI) - 40 or patients with a BMI
and psychological problems. Hanging skin folds
- 35 who have associated comorbidities. And the
can impede movement and make it difficult to
current surgical options for Bariatric Surgery:
exercise. Skin may become macerated and prone to
restrictive procedures like vertical banded
recurrent infection in the intertriginous areas
gastroplasty (VBG), adjustable gastric banding
hooded by overhanging tissue. Patients are often
(AGB), sleeve gastroectomy (SG), malabsorptive
embarrassed by their new body shape and avoid
procedures
like:
jejunoileal
bypass,
undressing in front of people, which has an impact
biliopancreaticdiversion,
duodenal
switch
on relationships. Despite successful weight loss
procedure (DS) and combined procedures like
following bariatric surgery, a patient's body image,
5455
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5461-5465
A Comparative Study between Magnesium Sulphate and Nitroglycerin with
Propranolol in Controlled Hypotensive Anaesthesia during Middle Ear Surgeries
Hoda Omar Mahmoud, Manal Kamal Shams, Adel Alaa El-din Habib,
Amr Abdel Monem Al Sayed Ali*
Department of Anesthesia, Intensive care and Pain Management, Faculty of Medicine, Ain Shams University
*Corresponding author: Amr Abdel Monem Al Sayed Ali, Mobile: 01060577012, Email: amrmenem1990@gmail.com
ABSTRACT
Background: controlled hypotension is performed in order to reduce blood loss and the need for transfusion
during the surgery and to improve visibility of the surgical site by decreasing the arterial pressure until
hypotension is reached. Aim of the Work: to compare magnesium sulphate and nitroglycerin with propranolol
during middle ear surgery in terms of regarding their efficiency in inducing deliberate hypotension and
providing a better surgical field exposure during middle ear surgery. It also compared the influence of their use
of postoperative pain and recovery time. Patients and Methods: forty adult patients undergoing middle ear
surgery were included. Patients were randomly divided into two equal groups. Patients were assigned to
receive magnesium sulphate (M group) and nitroglycerin with propranolol (N group) from the period of Jan
2018 to August 2018. ASA physical status I, age group ranged from 18 to 60. Results: the current study shows
the ability of magnesium sulphate and nitroglycerin with propranolol to induce deliberate hypotension in
patients undergoing middle ear surgery. Mean arterial pressure was successfully reduced to the target values in
both groups. All drugs were equally successful to produce satisfactory surgical field. Conclusion: this study
included forty adult patients age ranged 18 to 60 undergoing middle ear surgery was included. Patients were
randomly divided into two equal groups. Patients were received magnesium sulphate (M group), or nitroglycerin
and propranolol (N group).
Keywords: Mean arterial pressure, post anesthetic care unit,
INTRODUCTION
propranolol during middle ear surgery in terms of
Several pharmacologic agentshave had been
regarding their efficiency in inducingdeliberate
used to produce deliberate hypotension. Direct
hypotension and providinga better surgical field
vasodilators as nitroprusside and nitroglycerine, alpha-
exposureduring middleear surgery. It also compared
2
adrenergic
agonistsasclonidine
and
the influence of their use of postoperative pain and
dexmedetomidine, beta adrenergic antagonists
recovery time.
aspropranolol and esmolol, alphaand betaadrenergic
PATIENTS AND METHODS
antagonistsaslabetalol, inhalational anesthetics as
isoflurane and sevoflurane, -receptors agonist as
Forty adult patients undergoing middle ear
remifentanil, and N-methyl d-aspartate antagonist
surgery were included. Patients were randomly
asmagnesium were all used to induce hypotension
divided into two equal groups. Patients were
during middleear surgery (1). Magnesium is the fourth
assigned to receive magnesium sulphate (M group)
most common salt in the human body after
and nitroglycerin with propranolol (N group) from
phosphorus, calcium and potassium. Magnesium
the period of Jan 2018 to August 2018. ASA
sulphate was previously used to induce deliberate
physical status I, age group ranged from 18to 60.
hypotension and it producesits hypotensive effect by
The study was approved by the Ethics Board of
limiting the outflow of calcium from the sarcoplasmic
Ain Shams University and an informed written
reticulum and producesa vasodilation effect by
consent was taken from each participant in the
increasing the synthesisof prostacyclin and inhibiting
study. Exclusion criteria: Hypertension, allergic
angiotensin converting enzyme activity. Hypotension
reactions to study drugs, renal, hepatic, or
induced by magnesium during surgery is also
cardiovascular diseases, neuromuscular disease,
explained by its powerful analgesic effect. The
atrio-ventricular conductance disturbance, opioid
analgesic action of magnesium is explained by its
or analgesic abuse, and chronic treatment with
antagonistic effect at N-methyl d-aspartate receptors (2).
opioids, or non- steroidal anti-inflammatory drugs.
Methods: In the operating room, the ECG
AIM OF THE WORK
electrodes were placed, an IV cannula was
The aim of our study is to compare
introduced and infusion of acetated Ringer's
magnesium sulphate and nitroglycerin with
solution was started approximately10 min before
5461
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5466-5469
Predictive and Prognostic Impact of Tumor-Infiltrating Lymphocytes (CD8+) In
Breast Cancer Treated With Neoadjuvant Chemotherapy
Zeinab Mohammed Abdel-Hafeez Elsayed 1, Mohammad Sabry Elkady 1, Waleed Abd Elmmonem
Biomy 1, Mai Mohamed Ali Ezz El Din 1, Manal Mohamed El Mahdy 2, Tag Ibrahim Omran 3, Radwa
Mohamed Sabra 3
Department of 1 Clinical Oncology and Nuclear Medicine and Department of 2 Clinical Pathology
Faculty of Medicine, Ain Shams University, 3 Maadi Armed Forces Medical Compound
Corresponding author: Radwa Mohamed Sabra, E-mail: Radwahamed7@gmail.com, Telephone: (+2) 01003935960
ABSTRACT
Background and Objectives: the use of neoadjuvant chemotherapy (NAC) in breast cancer induces a pCR in
only 3035% of patients. We can't depend only on clinical and pathological factors to distinguish the patients
who have no chance of a pCR or not. Moreover, the NAC scenario is the perfect setting to study possible
changes in TIL levels. Tumor-infiltrating lymphocytes (TIL) (CD) 8+ are essential components of tumor-
specific cellular adaptive immunity. However, only few studies have addressed the significance of (CD8+) TIL
in patients with breast cancer. Patients and Methods: we assessed the stromal and intratumral TIL, CD+8 in
pretreatment core biopsy by immuohistochemistry (IHC) in 45 patients with breast cancer received
neoadjuvant anthracyclin and docetaxel chemotherapy. CD8 classified into high or low according to the inter
quartile range. Tumors with 50% intratumoral or stromal lymphocytes were designated lymphocyte
predominant breast cancer (LPBC). Results: we found statistically significant correlation with high CD8 and
DFS and smaller tumor residual (95% CI, 18.6-22.9; P= 0.01) and (p=0.003) respectively. But there was no
significant difference regarding pCR or OS between high and low groups. Conclusion: this study confirmed
that the CD8 TIL is an important prognostic and predictive factor in breast cancer.
Keywords: Breast cancer, CD8, Tumor infiltrating lymphocytes.
INTRODUCTION
tumor cells expressing tumor associated antigens
Breast cancer is the most common invasive
(TAAs) (7). This adaptive immune response is
malignancy and the second most common cause of
mediated via major histocompatibility complex
death from cancer in women (1). Over 1.5 million
(MHC), where CD8+ T cells induce tumor cell
women (25% of all women with cancer) are
death directly upon recognition of tumor protein
diagnosed with breast cancer every year throughout
presented in association with MHC class I
the world. In America, it is estimated that 30% of
molecules on tumor cells (8).
all new cancer cases among women are breast
PATIENTS AND METHODS
cancer in 2017 (2). In Egypt Like other countries the
age specific incidence rate shows progressive
This is a prospective, single arm, clinical
increase after the age of 30 years, to reach a sharp
trial which carried on 45 female patients with
peak of 177.4/100000 at the age group of 60-64
locally advanced breast cancer at both Clinical
years(3). Historically breast cancer was not thought
Oncology and Nuclear Medicine department Ain
to be immunologically active, particularly when
Shams university hospital and Maadi Armed
compared to other tumors like melanoma. But
Forces Medical Compound. All patients received
recent data has confirmed that tumor infiltrating
Preoperative chemotherapy including both taxanes
lymphocytes (TILs) present in breast cancer prior
and
anthracyclines.
Flurouracil
(500
to treatment can predict response to therapy and
mg/m2/21days), ebirubicin (100 mg /m2/21 days)
improved prognosis (4). During the early stages of
and cyclophosphamide (500 mg/m2/21days), for
this
process,
immune-surveillance-related
three or four cycles, followed by docetaxel (75-100
lymphocytes (CD8+ T cells, CD4+ type-1 T-helper
mg/m2/21 days) for three or four cycles followed
(Th-1) cells, and natural killer (NK) cells) are able
by radical surgery according to response,
to recognize and eliminate malignant cells(5).
radiotherapy and hormonal treatment is HR
Seventy-five percent of TILs are found to be T
positive cases. The study was approved by the
cells. Among these, CD8 cytotoxic T lymphocytes
Ethics Board of Ain Shams University and
(CTLs) cells represent the class of lymphocytes
an informed written consent was taken from
that correlate better with overall favorable clinical
each participant in the study. The paraffin blocks
outcome (6). It exhibits cytotoxic activity towards
from all 45 patients were retrieved from the
histopathology units at both centers. Then, 2µm
5466
Received:21/6/2018
Accepted:30/6/2018
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5470-5478
Validation of AFP Model as a Predictor of Response, Recurrence and Survival in
HCC Patients Underwent Locoregional Treatment
Mohamed Kamal Shaker, Heba Mohamed Abdella, Mohamed Mahmoud Mahmoud El Tabbakh &
Mohamed Atef Abu Hashima *
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University
*Corresponding Author: Mohamed Atef Abu Hashima, Phone No.: (+2) 01113501412, E-mail: midoatif.2014@gmail.com
ABSTRACT
Background: incidence of hepatocellular carcinoma (HCC) has rapidly increased worldwide. HCC is the sixth
most common malignancy and the third most common cause of cancer related death. Since HCC usually
develops in a damaged liver, the prognosis of HCC depends not only on tumor progression but also on the
degree of liver dysfunction. In Egypt, HCC constitutes 70.48% of all liver tumors among Egyptians. Aim of
the Work: to validate the use of AFP model as a predictor of response, recurrence and survival in
hepatocellular carcinoma patients after locoregional treatment. Patients and Methods: this study was
conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals. The study was
approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with
local research governance requirements. Results: according to this classification 130 patients are for RFA and
70 patients are for TACE but actually 132 patients underwent TACE and 68 patients underwent RFA this
could be explained by the facts that some lesions are large in size (>4cm) and others are located near main bile
duct, intestinal loop or blood vessel so RFA couldn't be done. Conclusion: AFP model may be a predictor of
response, recurrence and survival in HCC patients undergoing locoregional treatment (TACE or RFA) but more
studies with larger sample size are needed to validate its use.
Keywords: Hepatocellular Carcinoma - Locoregional Treatment - Alpha Fetoprotein
INTRODUCTION
fraction of all patients have access to transplantation,
Approximately 70%90% of patients with
and, even in the developed world, organ shortage
HCC have an established background of chronic
remains a major limiting factor. in these patients,
liver disease and cirrhosis, with major risk factors
local ablative therapies, including radiofrequency
for developing cirrhosis including chronic infection
ablation (RFA), chemoembolization, and potentially
with hepatitis B virus (HBV), hepatitis C virus
novel chemotherapeutic agents, may extend life and
(HCV), alcoholic liver disease, and nonalcoholic
provide palliation (4). Recently, the French study
steatohepatitis (NASH) (1). Additional risk factors
group for LT reported on a new predictive model for
for developing HCC include intake of aflatoxin-
HCC recurrence, namely the AFP model which was
contaminated food, diabetes, obesity, certain
based on tumor staging and AFP values at listing.
hereditary conditions such as hemochromatosis, and
Adding AFP to tumor size and number increased the
other metabolic disorders (2). HCC diagnosis was
accuracy for predicting recurrence post liver
based on histological criteria and/or imaging
transplantation. The AFP model was shown to be
techniques,
as
proposed
by
the
American
superior to Milan criteria in predicting recurrence in
Association for the Study of Liver Diseases. For the
a training set of HCC patients, and was subsequently
diagnosis of HCC, nodules found on ultrasound
validated in a cohort of French patients followed
surveillance that are smaller than 1 cm should be
prospectively under the control of the French
followed up with ultrasound at 3-month intervals.
organization for organ sharing. On these grounds,
Lesions larger than 1 cm in diameter should be
the AFP model was officially adopted in January
evaluated by dynamic magnetic resonance imaging
2013 in France for selecting HCC candidates (5).
or helical multidetector computed tomography (CT)
However, the alpha feto protein model has not been
scan using contrast. If the appearance is typical for
studied on HCC patients undergoing locoregional
HCC, no further investigation is required (3). There
treatment as regard response to treatment, HCC
are different treatment modalities for HCC.
recurrence and survival.
Resection may benefit certain patients, albeit mostly
AIM OF THE WORK
transiently. Many patients are not candidates given
To validate the use of AFP model as a
the advanced stage of their cancer at diagnosis or
predictor of response, recurrence and survival in
their degree of liver disease and, ideally, could be
hepatocellular carcinoma patients after locoregional
cured by liver transplantation. Globally, only a
treatment.
5470
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5479-5484
Dexamethasone versus Ondansetron in Prevention of Postoperative Nausea and
Vomiting After Laparoscopic Surgery
Raafat A. Hammad, Abeer M. Eldeek, Rania M. Hussien, Ahmed A. Shendy
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Ahmed A. Shendy; Mobile: 01273214325; Email: drahmedanwer0@gmail.com
ABSTRACT
Background: postoperative nausea and vomiting (PONV) are a common distressing symptoms in patients
undergoing laparoscopic surgery and can contribute to anxiety, dehydration, metabolic abnormality, wound
disruption, delayed recovery and other issues. The incidence of PONV varies from 20 to 80 % of all surgeries,
and it is an economic and social burden. Aim of the Work: was to assess whether dexamethasone is a cost-
effective alternative to ondansetron in the prevention of PONV in patients undergoing laparoscopic surgery.
Patients and Methods: A study was conducted at Ain Shams University Hospitals between November 2017
and April 2018, after obtaining approval of research ethical committee and patients' informed consents. 80
Patients were included in the study and underwent elective laparoscopic surgery and received general
anesthesia. Results: The study showed a statistically significant difference between groups regarding PO
nausea and other postoperative complications. Conclusion: Dexamethasone 8 mg was as effective as ondansetron
4 mg. Dexamethasone provided a simple, safe, cheap, and effective postoperative nausea and emesis prevention
method with the advantage of being cheaper decreasing the economic burden.
Keywords: Dexamethasone, Ondansetron, Postoperative Nausea, Vomiting, Laparoscopic Surgery
INTRODUCTION
as an effective anti-emetic agent in patients
Postoperative nausea and vomiting (PONV)
undergoing cancer chemotherapy in 1981, Wang et
are a common distressing symptoms in patients
al. (5) confirmed that dexamethasone is most effective
undergoing laparoscopic surgery and can contribute
when it is administered at the induction rather than at
to anxiety, dehydration, metabolic abnormality,
the termination of anesthesia. However, the
wound disruption, delayed recovery and other issues.
mechanism underlying the anti-emetic effects of
The incidence of PONV varies from 20 to 80 % of all
dexamethasone is still unknown. It may be involved
surgeries, and it is an economic and social burden (1).
in central inhibition of prostaglandin synthesis, or it
The treatment of nausea and vomiting should be
may cause a decrease in serotonin turnover in the
aimed at specific receptors/mediators that appear to
central nervous system. Today, cost-benefit analyses
be largely contributing to an individual patient's
have become an important factor when considering
experience. A greater appreciation of which particular
what drugs to use as prophylactic antiemetics.
mechanisms are playing a major role for an individual
However, it has not been established whether
patient may lead to targeted therapies in attempts to
dexamethasone is a cost-effective alternative to
eliminate nausea and vomiting, minimize treatment
ondansetron in the prevention of PONV in patients
induced adverse effects, and optimize patient
undergoing laparoscopic surgery (6).
outcomes (2). Metoclopramide is a medication used
AIM OF THE WORK
mostly for stomach and esophageal problems. It is
The aim of this study was to assess whether
Antiemetic (prokinetic agent) potent dopamine-
dexamethasone is a cost-effective alternative to
receptor antagonist. Common side effects include:
ondansetron in the prevention of PONV in patients
feeling tired, diarrhea, and feeling restless. More
undergoing laparoscopic surgery.
serious side effects include: movement disorder like
tardive dyskinesia, a condition called neuroleptic
PATIENTS AND METHODS
malignant syndrome and depression (3). Ondansetron
This study included a total of 80 patients
is a selective seretonin (5 hydroxytryptamine, 5-HT3)
who underwent elective laparoscopic surgery and
receptor antagonist that exhibits an anti-emetic action
received general anesthesia, attending at Ain Shams
by antagonizing vomiting signals in the afferent
University Hospitals. The study was approved by
pathway from the stomach, small intestine and
the Ethics Board of Ain Shams University and
solitary tract nucleus, and is effective at preventing
an informed written consent was taken from each
PONV, however the high cost of this drug has
participant in the study. This study was conducted
prevented it from being widely used (4).
between November 2017 and April 2018. Patients
Dexamethasone, a corticosteroid, was first reported
were randomly divided into two equal groups, each
5479
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5485-5489
A Comparison between Post-Operative Analgesia after Intrathecal Injection of
Nalbuphine versus Fentanyl as an Adjuvent to Bupivacaine after Cesarean Section
Azza Youssef Ibrahim, Kareem Youssef Kamal, Hany Magdy Fahim, Ahmed Nasser Ahmed
Department of Anesthesiology, I.C.U and Pain Management, Faculty of Medicine, Ain Shams University
*Corresponding author: Ahmed Nasser Ahmed, E-Mail: ahmednasser_91@hotmail.com, Mobile: 01282220006
ABSTRACT
Background: one of the primary aims of anesthesia is to alleviate the patient's pain and agony, by permitting
the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real
importance in recent years considering the central, peripheral and immunological stress response to tissue
injury. Any expertise acquired in this field should be extended into the postoperative period, which is the
period of severe, intolerable pain requiring attention. So there is a need for extended analgesia without any side
effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become popular to
optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression,
nausea, vomiting, urinary retention and pruritus, limit their use. Aim of the Work: the purpose of this study
was to assess the postoperative analgesic requirements and the spinally mediated analgesic effects of
intrathecal nalbuphine as an adjunct to intrathecal bupivacaine after cesarean section in comparison to
intrathecal bupivacaine plus fentanyl. Patients and Methods: eighty female patients came to Demerdash
Hospital for cesarean delivery, they were randomly allocated into two equal groups (40 patients) group F and
group N. Group F: Bupivacaine-Fentanyl: Patients received an intrathecal injection of 2 ml of 0.5% heavy
(hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphine: Patients received
an intrathecal injection of 2 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.8 mg) Nalbuphine.
Results: the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately
prolonged the time of postoperative analgesia, while the duration of analgesia was more prolonged and the
adverse effects were minimal with the group of nalbuphine, our result shows no significant difference, but
shows significant difference in the More rapid onset of sensory block with Fentanyl than with Naluphine, more
rapid Regression time to S1 dermatome with Fentanyl than with Naluphine, the duration of motor block is
shorter with Fentanyl than with Naluphine, patients receive rescue analgesia 6 h postoperatively is fewer with
Nalpuphine than Fentanyl. Conclusion: more rapid onset of motor block in fentanyl group than in nalbuphine
group, more rapid onset of sensory block with Fentanyl than with Naluphine, more rapid regression time to S1
dermatome with Fentanyl than with Naluphine.
Keywords: Bupivacaine, Fentany, intrathecal, ACTH, PDPH, Intra-thecal
INTRODUCTION
higher blocks is reduced(2). Opiods have been a
Spinal anesthesia is the preferred mean for
choice in regional (intrathecal and epidural routes)
cesarean section, being simple to perform,
anesthesia to improve the antinociceptive effect of
economical and produces rapid onset of anesthesia
local anesthetics. nalbuphine and fentanyl are being
and complete muscle relaxation. It carries high
used intrathecally together with local anesthetics in
efficiency, involves less drug doses, minimal
cesarean section. Potentiating the effect of
neonatal depression, awake mother and lesser
intrathecal local anesthetics by addition of
incidences of aspiration pneumonitis. However, it
intrathecal opiods for intra-abdominal surgeries is
also produces a fixed duration of anesthesia,
known. In this study by addition of nalbuphine and
postdural puncture headache, hypotension and
fentanyl we tried to minimize the dose of
lesser control of block height (1). Bupivacaine an
bupivacaine, thereby reducing the side effects
amide type of local anesthetic; has high potency,
caused by higher doses of intrathecal bupivacaine
slow onset (5-8 minutes) and long duration of
in cesarean section(3).
action (1.5-2 hours). For cesarean section
AIM OF THE WORK
intrathecal dose of hyperbaric bupivacaine is 12 to
The purpose of this study is to compare the
10.8 mg. Cesarean delivery requires traction of
post-operative analgesic effect of intrathecal
peritoneum and handling of intraperitoneal organs,
nalbuphine as an adjuvant to bupivacaine during
resulting in intraoperative visceral pain. With
cesarean delivery and intrathecal fentanyl as an
higher doses of hyperbaric bupivacaine, incidence
adjuvant to bupivacaine during cesarean delivery.
of intraoperative visceral pain associated with
5485
Received:21/6/2018
Accepted:30/6/2018
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5490-5494
The Role of Ultrasound in Evaluation of Meniscal Injury
Nada Sayed Mahdy*, Hossam Mousa Sakr, Allam Elsayed Allam
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Nada Sayed Mahdy Sorial, Mobile: +201159149249, E-Mail: Nada.sayedmahdy@yahoo.com
ABSTRACT
Background: meniscal tear is one of the most common injuries of knee joint , MRI is considered to be 1st
choice to diagnose meniscal tear. The Question of the study is if we can use U/S as screening tool for Meniscal
injuries before MRI. Aim of the Work: to determine the clinical usefulness of ultrasonography for diagnosis
of meniscal pathology in patients with acute knee pain and compare its diagnostic accuracy to MRI in a
clinical setting. Patients and Methods: this study was carried out in Radiology department, Ain Shams
University hospitals. 15 patients with MRI proven Meniscal tear underwent knee ultrasound examination.
Results: the overall sensitivity of ultrasound examination for meniscal tears was 77%. Conclusion: ultrasound
appears to be useful for the screening of meniscal tears but detection of the morphology of meniscal tears seems
insufficient.
Keywords: Meniscal Tear, Magnetic Resonance Imaging, Musculoskeletal Ultrasound
INTRODUCTION
using MRI, such as the presence of indwelling
The menisci are 2 semilunar wedges in the
cardiac pacemakers, metal implants, patient
knee joint positioned between the tibia and the
intolerance due to claustrophobia and delay in
femur. The medial meniscus is semicircular or C-
treatmentdue to long wait periods (3). As a result,
shaped and approximately 3.5 cm in length from
recent studies have demonstrated point-of-care
anterior to posterior (1). It is asymmetric with a
ultrasound (POCUS) as an alternative, non-invasive
considerably wider posterior horn than anterior horn.
and real-time imaging modality to evaluate the soft
The lateral meniscus is more nearly circular or O-
tissue pathology of the knee, including injuries to
shaped and covers a larger portion of the tibial
the medial meniscus and medial collateral ligament
plateau surface than the medial meniscus (2). The
(MCL) (7). Ultrasound has become the primary
middle portion of the medial meniscus being more
diagnostic tool in traumatic, inflammatory and
firmly attached via connection with fibers of the
degenerative soft tissue conditions. It is also used to
deep medial collateral ligament, but no attachment
monitor the condition of joints, ligaments, cartilage
of the lateral meniscus to the lateral collateral
and muscles (4). Ultrasound has some advantages
ligament (3, 4, 5). Meniscal injuries may be the most
over MRI (4): 1. First, it costs less, 2. Second, with
common knee injury (6). The prevalence of acute
ultrasound it is possible to obtain dynamic imaging
meniscal tears is 61 cases per 100,000 persons. In
and observe meniscal motion and dislocation by
patients older than 65 years, the rate of degenerative
moving the knee, 3. Third, all patients, including
meniscal tears is 60% (7). The classification of
those who are claustrophobic, can undergo
meniscal
tears
provides
a
description
of
ultrasound, 4. Fourth, ultrasound facilitates bilateral
pathoanatomy. The types of meniscus tears include
comparison and repetitions at will, 5. Fifth, many
the following (1): 1. Longitudinal tears that may take
ultrasound machines can be brought to the patient,
the shape of a bucket handle if displaced, 2. Radial
and explanation of the results can be rapid. There are
tears, 3. Parrot-beak or oblique flap tears, 4.
also limitations to using ultrasound. There is a
Horizontal tears, 5. Root tears, 6. Complex tears that
relatively steep learning curve and dependence on
combine variants of the above. One of the most
the training, skill, and experience of the operator (7).
common mechanisms for knee injury is direct
A wide variety of MRI pulse sequences can be
trauma, which is commonly seen in athletic injuries
performed to produce diagnostic quality images (8).
(2). When injury occurs, the superficial MCL is the
These include T1, proton density, T2, STIR, spin
most commonly damaged ligament of the knee,
echo, fast (turbo) spin-echo, and gradient-echo
usually induced by valgus stress, and can
sequences, which all have been proven suitable for
occasionally be accompanied by a tear in the medial
knee imaging (9). The Menisci: Sagittal image: The
meniscus (5). Magnetic resonance imaging (MRI) has
anterior and the posterior horns of menisci appear as
historically been considered to be the golden
isosceles triangles. The posterior horn of either
standard imaging modality to diagnose medial knee
menisci should never appear smaller than the
injuries. However, there are significant limitations of
anterior horn. On both sides, the menisci appear as
flat bands. On lateral side, the more central the slices
5490
Received:21/6/2018
Accepted:30/6/2018
ABSTRACT
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5495-5498
Change in Left Ventricular End Diastolic Pressure (LVEDP) as apredictor of
Adverse Effect in Patients undergoing Primary PCI
Osama Amin Abd- Elhamid, Akram Abdelbary, Ahmed Battah, Tarek Elgohary
Critical Care Department, Faculty of Medicine, Cairo University.
*Corresponding Author: Osama Amin Abd- Elhamid , E-mail: osamaamin130@yahoo.com
ABSTRACT
Background: in acute myocardial infarction (MI), decreasing compliance of the left ventricle is directly
associated with prognosis. Patients and Methods: 30 patients presented with acute ST segment elevation MI
Who underwent primary PCI within 12 hours of presentation. All patients were subjected to full history taking,
physical examination, serial ECG, cardiac enzymes and measurement of LVEDP just before and after Primary
PCI using end hole catheter. Results: post revascularization left ventricular end diastolic pressure (LVEDP)
decreased. There is significant correlation between LVEDP change and left ventricular dysfunction (p
value:0.014). Significant correlation between LVEDP and mortality are present. Conclusion: change in LVEDP
measured just pre and post primary PCI are significantly correlated with adverse clinical outcome in patients with
acute STEMI.
Keywords: LVEDP, STEMI, Primary PCI.
INTRODUCTION
(ECG), by regression of ST elevation, but there is a
The aim of reperfusion therapy for many
need for methods to demonstrate left ventricle and
years has focused on achieving epicardial artery
microvascular function improvement (10). Primary
patency at the site of the occlusive thrombus(1). It is
percutaneous coronary intervention (PCI) is
now possible, through advances in interventional
regarded as the best reperfusion model in STEMI.
techniques
and
adjunctive
pharmacological
PCI may be used to show hemodynamic changes in
treatment, to achieve TIMI (Thrombosis In
the left ventricle or to measure left ventricle end-
Myocardial Infarction) grade 3 epicardial flow
diastolic pressure (LVEDP) for evaluation of
(normal) in 95% of patients(2). The myocardial blush
reperfusion efficacy and success.
grade (MBG) has been devised for the visual
PATIENTS AND METHODS
assessment of myocardial reperfusion after primary
percutaneous coronary intervention (PCI), and this
30 patients were prospectively enrolled in
score is an independent predictor for adverse
our study presented with their first STEMI event and
outcome(3). Despite this achievement, mortality,
were undergone primary PCI within the first 24
although declining, still remains high. This is
hours of presentation. The study was approved by
possibly because despite restoration of TIMI grade 3
the Ethics Board of Cairo University. We
flow, 40% of patients do not achieve microvascular
excluded patients with previous ischemic events,
flow, which should be the goal of reperfusion
cardiogenic shock, severe valvular heart disease and
therapy (4, 5). Successful rescue PCI within 324
patients with refractory ventricular arrhythmias. All
hours of the onset of chest pain has been associated
patients were subjected to full history taking
with improved LV systolic function at a mean
regarding risk factors for ischemic heart disease as
follow-up period of 22 months (6). In this study,
diabetes mellitus, hypertension, hyperlipidemia, any
baseline and repeated Echocardiography were used
history of other diseases or regular medications.
to assess LV systolic function. Other studies of
Serial ECG was recorded, cardiac enzymes were
primary PCI have also reported improved LV
measured, other biochemical parameters were also
systolic function compared to thrombolysis (7). In
measured as serum creatinine, electrolytes, CBC and
acute myocardial infarction (MI), decreasing
coagulation profile. Primary PCI procedure: the
compliance of the left ventricle is directly associated
procedure was performed according to standard
with prognosis. In patients with ST segment
practice, un-fractionated heparin 70U/kg was used
elevation MI (STEMI), left ventricular filling
for procedural anticoagulation, both direct stenting
pressure increase(8). Early improvement of perfusion
protocol and pre-dilatation were included, invasive
after MI will improve left ventricle function and
LVEDP measurement in the catheterization lab, on
decrease the infarction area, thus decreasing
table, after performing the coronary angiography
mortality(9).The efficacy of reperfusion treatment
just before and after the primary PCI using an end-
may be shown indirectly with electrocardiography
hole catheter in the shown technique.
5495
Received:21/6/2018
Accepted:30/6/2018
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5499-5504
Relation of Cord Cortisol Level and Respiratory Distress Syndrome in Preterm
Salah Abd-Rabbou Elsayed, Mohamed Abdel Salam Zannoun, Tarek Mostafa Emran,
Amany Mostafa Elzalabany
Pediatrics Department, New Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
*Corresponding author: Mohamed Abdel Salam Zannoun, E-Mail: M_Zannoun@yahoo.com, Mobile: 01061201206
ABSTRACT
Background: numerous studies have shown that severity of respiratory distress syndrome may affect the
endogenous cortisol secretion in preterm infants. Aim of the Work: assess the relationship between Cortisol
level in umbilical cord in first and third day after delivery & Respiratory distress syndrome in preterm.
Patients and Methods: a case control study that includes 90 preterm infant. Each included infant was
submitted to history taking, complete clinical examination and laboratory investigations including complete
blood count, arterial blood gases, level of cortisol in day one and day three. Results: in the present work, there
was no significant difference between cases and controls as regard age, gender, weight, gestational age, as
regards the serum cortisol levels in the studied groups,this study revealed that mean level of serum cortisol in
1stday of life among the three groups showed elevation and showed no significant statistical difference
between the three groups (P-value = 0.107) Regarding mean level of serum cortisol in 3rd day of life showed
high significant difference between the three groups (P-value = 0.001). group I (without RDS) marked lower
than both groups II&III (with RDS), and comparison between group II and III regarding the same value,
showed that group III had significant higher level than group II (P-value = 0.001). Conclusion: preterm infants
respond to the stress at delivery and cortisol production continues in infants with RDS than those without RDS.
Keywords: Cord Cortisol, Preterm, Respiratory Distress, Stress Response.
INTRODUCTION
Damitte (Al-AzharUniversity) during period from
A preterm birth is defined as live birth at <
October 2016 to January 2018. Subject: 90
36 weeks' gestation and a lower cutoff defined in
preterm newborns were included into the study,
some countries as 20 or 22 weeks' gestation. This
divided in 2 groups: Patient groups: consist of 60
group is further trichotomized as late preterm (>32
Preterm infant diagnosed with Respiratory distress
weeks), very preterm (28<32 weeks) and extremely
syndrome which divided in 2 subgroups. Mild to
preterm (<28weeks) (1). Approximately 11% of births
Moderate Respiratory distress syndrome. Severe
in the United States occur before 37 completed weeks
Respiratory distress syndrome. Control group:
of gestation, which is considered premature, or
consist of 30 of healthy Preterm infant, healthy
preterm, birth (2). Respiratory distress syndrome
status was determined through examination and
(RDS) is a breathing disorder that affects preterm
investigation. Inclusion criteria: born preterm
babies due to surfactant deficiency. Surfactant is a
babies (gestational age 30-37 weeks), any mode of
liquid that coats the inside of the lungs. It helps keep
delivery, both genders, birth weight. (>1000gm).
them open, so that infants can breathe in air once they
Exclusion criteria: Neonatal sepsis, birth asphyxia
are born (3). A low secretory capacity of the adrenal
or any complication during birth, congenital
cortex may cause a diminished stress response during
anomalies, meconium stained amniotic fluid, any
the acute illness in preterm infants and could lead to
complication arising during the hospital stay,
increased morbidity in these infants(4). Researchers
antenatal steroid intake, maternal disease or any
have long measured cortisol as a marker of both acute
type of stress during pregnancy, all the newborns in
and chronic stress, whether collected from serum,
this study were subjected to the following: 1-
blood, saliva, or urine(5).
Comprehensive
history
taking
including:
antenatal history: maternal age, maternal disease
AIM OF THE WORK
(diabetes or immune disease) and drug intake, natal
The aim of this study is to assess the
history: Gestational age, sex, mode of delivery,
relationship between Cortisol level in umbilical cord
birth trauma, family history: consanguinity,
in first and third day after delivery & Respiratory
congenital anomalies, respiratory distress in
distress syndrome (RDS) in preterm.
previous sibling and endocrinal disease. 2- Clinical
examination for neonates: Recording apgar score
PATIENTS AND METHODS
at 1 and 5 minutes, gestational age by new ballard
This is a prospective cohort study done in
score,
Anthropometric
measures,
general
Damnhour Teaching hospital and Hospital at new
examination, cardiac, chest, abdominal and
5499
Received:21/6/2018
Accepted:30/6/2018
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5505-5512
Role of MRI in Diagnosis of Endometrial Cancer
Lobna Abdelmonem Habib, Mona Mohamed Salaheldin Alhawary, Emad Hamed Abd Eldayem,
Ahmed Fathy Abd Alghany.
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Mona Mohamed Salaheldin Alhawary, Mobile: +201228366488, E-mail:m16mona@yahoo.com
ABSTRACT
Background: the role of MRI in female pelvic imaging has been magnified nowadays by the aid of diffusion
weighted magnetic resonance imaging (DW-MRI) and contrast enhanced imaging for better assessment of
endometrial cancer. Aim of the Work: this study aimed to show MRI role in diagnosis of female patients with
endometrial cancer for better evaluation, prognosis and treatment strategies according to preoperative MRI
staging. Patients and Methods: this study carried out in Radiology Department of Ain Shams University
Hospitals. This study included 25 patients. All patients were subjected to careful history taking, histologic
diagnosis of endometrial carcinoma and pelvic MRI was done. Results: the diagnosis capability of the MRI in
comparison to histopathology in patients with endometrial carcinoma was significant. Conclusion: MR imaging
with the aid of contrast enhanced images, diffusion weighted images and ADC mapping, had a great role in
diagnosis of endometrial cancer as part of pre-operative assessment for lesion characterization and staging of the
disease, that improve overall survival rate of patients by choosing better treatment plan.
Keywords: Endometrial Carcinoma, MRI.
INTRODUCTION
metastases were diagnosed when the short-axis
Endometrial carcinoma is the most common
diameter of the LN was 10 mm or above and
malignancy of the female genital tract (1). The
describing the characteristics of malignancy (5). The
disease occurs most frequently in women during the
histological grade of the tumor is well known as one
sixth and seventh decades of life (2). It typically
of the most important prognostic factors regarding
presents with abnormal uterine bleeding in 75% to
the lymph nodes metastasis and overall survival of
90% of patients (3). MRI has been shown to be the
the patient (8). Diffusion-weighted imaging (DWI)
best imaging modality in disease staging and
with the aid of quantitative apparent diffusion
treatment planning compared to endo-vaginal
coefficient (ADC) measurement is a unique, non-
ultrasound and computed tomography, because of its
invasive modality that was shown to improve the
contrast resolution and multi-planar capability (4).
radiological diagnosis of malignant tumors (9). Areas
The role of MRI in endometrial cancer includes the
characterized by high signal intensity (restricted
evaluation of depth of myometrial invasion, cervical
diffusion) at DWI or by low values of the ADC
invasion, and nodal metastasis. This greatly
generally correspond with foci of hypercellularity
optimize the surgical procedure and therapeutic
represents a malignant tissue (10). Overall MRI helps
strategy(1). Prognosis depends on patient's age,
in decreasing endometrial carcinoma mortality rate
histological grade, depth of myometrial invasion,
due to early diagnosis and pre-operative staging.
cervical invasion, and the presence of lymph node
Post-operative MRI of the pelvis helps in assessing
metastases (4). Magnetic resonance imaging has
tumor reduction and decrease recurrence rate by
proven to be an accurate tool for assessing the depth
choosing proper postoperative management(11).
of myometrial invasion. It differentiates the presence
AIM OF THE WORK
of deep myometrial invasion from more superficial
The aim of this study was to show the MRI
involvement. The depth of myometrial invasion
role in diagnosis of female patients with endometrial
could be identified on a T2-weighted image
cancer.
according to junctional zone invasion (5). In
postmenopausal women, the junctional zone may be
PATIENTS AND METHODS
poorly visible and the myometrium may be thinned
The current study is a cross sectional
due to uterine involution, making the presence and
prospective studypatients were referred from the
depth of myometrial infiltration more difficult to
Gynecology Department to the Women's imaging
assess(6). Endometrial cancer is usually demonstrated
Unit at Radio-Diagnosis Department ofAin Shams
as thickened endometrium or mass displaying hypo-
University Hospitals in the period from November
to-isointense on T1WI with an intermediate signal
2017 to April 2018.The study was approved by
intensity on T2WI(7). On MRI, lymph node
the Ethics Board of Ain Shams University and
5505
Received:21/6/2018
Accepted:30/6/2018
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5513-5516
Comparison between Hypertonic Saline (3%) and Normal Saline (0.9%) as a
Preload before Spinal Anaesthesia in Caesarean Section
Fahmy Saad Latif, Dalia Ahmed Ibraheem, Amin Mohammed Alansary,
Mariam Gamal Motawashleh Salama
Department of Anaesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University
Corresponding author: Mariam Gamal Motawashleh Salama, Mobile: 01273393347, Email: gmariam488@gmail.com
ABSTRACT
Background: spinal anesthesia is frequently used for cesarean delivery because of its rapid onset, a dense
neural block, little risk of local anesthetic toxicity and minimal transfer of drug to the fetus. General anesthesia
is preferred in emergency obstetric situations, such as cord prolapse, in which there is a need for reliable
induction, and also bleeding placenta previa. Unfortunately it is frequently accompanied by hypotension,
which may be defined in absolute terms as a systolic blood pressure (SBP) of 90 or 100 mmHg or in relative
terms as a percentage (20% fall from baseline). Aim of the Work: the aim of this study is to compare
hypertonic saline (3%)and normal saline (0.9%) in preventing spinal induced hypotension. Patients and
Methods: in our study, 40 patients were randomly divided into 2 equal groups: Group A: received hypertonic
saline (3%) (4ml/kg) . Group B: received normal saline (0.9%)(13ml/kg). Results: our study showed that
hypertonic saline (3%) was more effective than normal saline to prevent spinal induced hypotension and it did
not affect the neonatal outcome. Conclusion: neonatal outcome was excellent with the use of either hypertonic
saline (3%) or normal saline (0.9%) as a preload for the parturient who received spinal anesthesia before cesarean
section.
Keywords: Blood Pressure, Diastolic Blood Pressure, Gestational Age, Systolic Blood Pressure
INTRODUCTION
cardiovascular restrictions because there is reduction
Hypotension
is
the
most
common
of free water administration (3).
complication following spinal anaesthesia for
AIM OF THE WORK
cesarean delivery. In severe cases, it can have
This study compares between hypertonic
detrimental effects on both mother (unconsciousness
saline (3%) and normal saline (0.9%) in prevention
and pulmonary aspiration) and neonate (hypoxia,
of
spinal
induced
hypotension
in
females
acidosis, and neurological injury) (1). The prevention
undergoing elective caesarean section.
of hypotension appears more likely to decrease
maternal symptoms than the treatment of established
PATIENTS AND METHODS
hypotension (2). Initial fluid administration with
Type of Study: prospective randomized
isotonic fluids is often used for the prevention of
controlled Trial. Study Setting: the operating theatres
hypotension. It is well tolerated by healthy young
of Ain shams University Hospitals at the
patients but not in patients with cardiovascular
gynecological and obstetric department, Cairo, Egypt.
restrictions. Because in patients with diminished
Study Period: 5 months. Study Population:
cardiac reserve, if preloading is performed with a
pregnant females undergoing cesarean section under
large volume of fluid, a substantial amount of excess
spinal anesthesia. Inclusion Criteria: ASA I,ASA II,
free water will remain in the body after spinal
18 to 35 years old, ideal body weight 60-90 kg.
anaesthesia, the excess free water may be harmful
Exclusion Criteria: Patient refusal, ASA III,ASA
during postoperative recovery. Colloid preload
IV, age less than 18 or more than 35 years old, body
seems to be more effective than crystalloid in the
weight less than 60 or more than 90 kg, if there is
prevention of spinal anesthesia induced hypotension
contraindication of spinal anesthesia like diseases of
but they are linked to a number of complications like
the central nervous system, marked degree of anemia,
anaphylactoid reactions and changes in coagulation
cardiac decompensation, patients with coronary artery
function (3). Hypertonic saline increases plasma
disease, history of coagulation abnormality or
osmolarity and causes fluid shift from the
bleeding tendency. Group Allocation Method:
intracellular to the extracellular space. This
random. Sample Size: 40 Patients. Ethical
improves the hemodynamic changes occurring with
Considerations:
will be followed. Study
spinal anaesthesia. There is no risk of allergic
Procedures: All Patients were assigned randomly by
reactions like colloid infusion and is desired for
computer to two equal groups (20 patients per group).
Group A (20): Pregnant females received hypertonic
5513
Received:21/6/2018
Accepted:30/6/2018