The Interaction Between Angiotensin Converting The Egyptian Journal of Hospital Medicine Vol. ,1: 2-17
Dec.2000
Rec . Nov. 2000
I.S.S.N: 12084 The Interaction Between Angiotensin Converting Enzyme Inhibitor (Captopril) and Heat Stress in The Male Albino rats. 2-Tissue Analysis Eman G.E. Helal1, Samir A.M. Zaahkouk2, Talaat E.I. Abd-Rabo3 and Somaia Z.A. Rashed4. 1Al-Azhar University for girls, Faculty of Science, Zoology Department 2Al-Azhar University, Faculty of Science, Zoology Department 3Tanta University, Faculty of Science, Zoology Department ABSTRACT
Daily exposure to heat stress causes sustained elevation of blood pressure in rats.
It is known that the renin-angiotensin system is activated during episodes of behavioral stress, and the purpose of this work was to assess the action of captopril in the development of stress induced hypertension in rats.
Animals were divided into four groups. The first group served as a control,
while the other groups were subjected to heat stress of 40C and high hamidity of 80% for 10 successive days. The second group was served as heat stress, while the third and the fourth groups were received low and high doses of captopril (0.7 & 1.4 mg/kg. b.wt., respectively). After 10 days of treatment, half of animals from each group were decapitated and brain, liver, muscle, heart and kidney were separated and analysed. The other half of animals were left for another 10 days without any additional treatment for recovery.The results revealed a significant decrease in total protein of liver, heart, kidney, total lipids of heart, muscle and brain and total cholesterol of liver. On the other hand, insignificant change was noticed in muscle and brain total protein. Similarly, AST and ALT activities were also within the normal values for all the organs examined.Results exhibited that renin-angiotensin system may be important in the development of stress-induced hypertension in rats.
INTRODUCTION
and therfore the urgency of instituting
Hypertension has become a
the rapidincrease in proportion to the
relatively common problem in recent
years and it is often of long duration
magnitude of blood pressure elevation.
and refractory to standard antihype -
In fact, hyperten -sion is usually a
rtensive therapy. Epidemiologic studies
symptomatic until over end organ
indicate that the risks of damage to
damage is imminent or has already
kidney, heart, and brain are directly
occurred.
Angiotensin
converting
related to the extent of blood pressure
enzyme (ACE) inhibitors is popular in
elevation. Even mild hypertension in
the treatment of hypertension. Captopril
young or middle-aged adults increases
is one of them and it has been shown to
the risk of eventual and organ damage.
be effective in lowering blood pressure
The risk
in hypertensive patients. Laderle (1985) considered that captopril may have
2
AbstractThe Egyptian Journal of Hospital Medicine Vol. 18 32.
Dec.2000 Rec . Nov. 2000
I.S.S.N: 12084
Two-Dimensional and Three-Dimensional Ultrasonography In assessment of Fetal Malformations: Routine versus Selective Use
By Nahed H.Mohamed and Samia A. Sioudi
Obstetrics and Gynecology Department, Faculty of
Medicinal- Azhar University
Abstract Objective: This study was conducted trying to answer the question whether three- dimensional ultrasound imaging should be used routinely for prenatal screening of congenital malformations or only used selectively for specific high risk women for congenital malformations. Subjects & Methods: This study included 1000 pregnant women between 14 and 32 weeks gestation, Routine ultrasound examination was done during antenatal care of 500 pregnant women with no history of risk factors of congenital malformation, their ages were < 35 y (group 1). Selective ultrasound examination was indicated for screening of 500 pregnant women with history of one or more risk factors for getting malformed babies (group 2). Serial ultrasound examinations were done for assessment of fetal organs, first using transabdominal traditional 2-D ultrasound imaging, then 3-D ultrasound examinations using the same machine. Results: On routine antenatal examinations of group (1) there was no significant difference in detection of congenital malformations between 2-D and 3-D ultrasound examinations (0.2 % and 0.6 % respectively, P > 0.05). On the other hand, there was no significant difference between selective 2-D and 3-D ultrasound examinations of high- risk group (11) (0.8 % and 1.4 % respectively, P > 0.05). There was no significant difference between routine and selective ultrasound use for detection of congenital malformations (P> 0.05). Three-dimensional ultrasound provided the same informations as 2-D ultrasound imaging in 33.33% (1/3 diagnosed anomalies) of group (1) and 57.14% (4/7 anomalies) of group (11). Whereas it was more accurate in diagnosis of fetal anomalies than 2-D imaging in 66.66% (2/3 anomalies) of group (1) and 42.85%(3/7 anomalies) of group (2.).These results were not statistically significant (P>0.05). Conclusion: Many fetal malformations could be diagnosed by traditional 2-D ultrasonography, yet in some cases limitations do exist. Therefore, a high degree of expertise and training is needed. Traditional 2-D ultrasonography was used routinely early and late in pregnancy for other obstetric indications. We do not support the routine use of 3-D ultrasonography during antenatal assessment of the pregnant women . The adjunctive use of 3-D ultrasonographic imaging system with the 2-D imaging in selective cases can greatly increase diagnostic accuracy of congenital malformation. On the other hand, It is equally important to weigh the human costs against the benefit.
Introduction
Screening for fetal abnormalities has
Ultrasound is the chief method for
become one of the most profile health
detecting fetal malformations. In this
care issues of modern obstetrics.
context, Merz et al.(1995) reported that
18
IntroductionThe Egyptian Journal of Hospital Medicine Vol. 1, 33-47
Dec.2000
I.S.S.N: 12084 Rec . Nov. 2000
Human Parvovirus B19, Cytomegalovirus Infections and Thyroid Autoimmunity in Women with Recurrent First Trimester Abortion Azza H. El-Salakawy¹, Nahed H. Mohammed ², Olfat G. Shaker ³ and Ehab Ragaa Abdoul Raouf 4 ¹ Microbiology Department Faculty of Medicine ( Girls ), Al- Azhar University, 2Obstetrics and Gynecology Department, Faculty of Medicine (Girls), Al- Azhar University, ³Medical Biochemistry Department, Faculty of Medicine, Cairo University, 4 Human Genetic Department, National Research Center
Abstract OBJECTIVE: The goal of this study was to modify and optimize the screening and diagnostic procedures of unexplained recurrent abortion. Antithyroid antibodies, parvovirus B19 (B19V) and cytomegalovirus (CMV) infections, which were usually overlooked in clinical practice of handling cases of recurrent abortion, were studied to evaluate their role in the pathogenesis of recurrent first trimester abortion. Also , we tried to elucidate the importance of detection of these agents and whether it should be routine prenatal investigations of women with unexplained recurrent abortion. STUDY DESIGN: sixty women with unexplained recurrent first trimester abortion were the study group and thirty term healthy pregnant women, were selected as a control. Placental and fetal tissues were analyzed for B19V and CMV deoxyribonucleic acids using nested polymerase chain reaction (PCR) assay. Also sera were analyzed for T3, T4 and TSH levels, the presence of antithyroid antibodies (thyroglobulin and thyroid peroxidase), CMV specific IgM antibodies and parvovirus B19-DNA by dot blot hybridization assay. RESULTS: Parvovirus B19-DNA was demonstrated in nearly one third of the aborted products (19/60 - 31.67 %) and 6.67% of the placentas of the control group, that represent highly significant difference (P <0.001). Whereas, serum samples of the two groups were negative for parvovirus B19 viral DNA by dot blot hybridization. Cytomegalovirus DNA was demonstrated in 7/60 aborted tissues (11.67 %) and one placenta of the controls (3.33 %), that represent non significant changes (P > 0.05). In contrast, only 5 aborting women (8.33 %) and a woman of the control group (3.33%) were CMV-IgM seropositive, that also represent non significant changes (P > 0.05). Antithyroglobulin antibody levels were significantly higher in aborting women (7/60) than control (P < 0.05), whereas there was no significant changes in antithyroid peroxidase antibody levels between the two groups. Nine aborting women (15%) were seropositive for one or both of the thyroid autoantibodies compared with two (6.67%) of the control group, that represent non significant changes (P>0.05). We did not find any significant relation between thyroid autoimmunity and viral infections (B19V & CMV) in women with unexplained recurrent first trimester miscarriage. CONCLUSION: Parvovirus B19 infection was found to be an important pathogenic agent in recurrent first trimester abortion. It is essential to investigate for B19Vinfection among pregnant women with recurrent abortion. This significant finding demonstrates the usefulness of a sensitive molecular tool, PCR assay of viral DNA to aid in the diagnosis. However, testing for cytomegalovirus infection and antithyroid antibodies are not essential as routine prenatal investigations and should be restricted to certain patients with unexplained recurrent pregnancy loss.
33
Transvaginal Ultrasonographic Cervical Assessment as a PredictorThe Egyptian Journal of Hospital Medicine Vol. 1, 48 -59,
Dec.2000
I.S.S.N: 12084 Rec . Nov. 2000
Transvaginal Ultrasonographic Cervical Assessment as a Predictor Of Successful Labor Induction
By
Nahed H. Mohamed, Naglaa H. Mohamed and Mahmoud A. Mansour*
Obstetrics and Gynecology Department, Faculty of Medicine for Girls, and
*Biochemistry Department, Faculty of Pharmacy
Al- Azhar University
Abstract OBJECTIVE: To assess cervical maturation before labor induction with measurements obtained by transvaginal scans. Cervical length and detection rate of cervical gland area, were compared with Bishop score and serum Prostaglandin E2 levels at term for duration of labor, successful labor induction and mode of delivery. STUDY DESIGN: Transvaginal scans were performed for detection of cervical gland area and measurements of cervical length in 80 singleton pregnant women scheduled for induction of labor at >37 weeks of gestation. Cervical ripening was assessed simultaneously by Bishop score and preinduction serum prostaglandin E2 metabolite was detected by ELISA technique. Results were compared against parity, gestational age, and mode of delivery and induction-to-delivery interval. RESULTS: Seventy percent of the studied women were delivered vaginally (46.7% of nulliparous and 84 % of multiparous women). Women with cervical length <3.0 cm and also women with higher PGE2 levels had shorter labors (P< 0.01) and were more likely to be delivered vaginally (P< 0.05). Significant decrease in the detection rate of cervical gland area in women who had shorter labors and were delivery vaginally (P<0.05) and also in multiparous than nulliparous women (P < 0.01) . The mean serum PGE2 level was significantly higher in multiparous than nulliparous women (P < 0.01). Women with Bishop score > 4 also had shorter labors and were more likely to be delivered vaginally (P< 0.05). Whereas, there was no significant difference in the mode of delivery with Bishop score < 4 (P >0.05). Cervical length, detection rate of cervical gland area serum PGE2 levels, and Bishop score showed linear correlation with duration of labor (r =0.47 P< 0.05, r =0.58 P< 0.01, r = 0.67 P< 0.05 and r = 0.43, P <0.01 respectively). CONCLUSIONS: Ttransvaginal ultrasonographic cervical measurement is comparable to Bishop score in assessing cervical ripeness for labor induction. Cervical measurement parity and serum PGE2 were independent predictors of the mode of delivery. Whereas, the mode of delivery cold not be predicted in women with Bishop score < 4.
Introduction
Induction of labor in women with an
an important role in the control of
unripe cervix at term remains a
cervical ripening in human.
challenge for the obstetrician. It is one
Ellwood et al (1981) reported that
of the most common aspects of obstetric practice, with 15% of all pregnant
the
cervical
production
of
women undergoing iinduction or
prostaglandins increases at term
augmentation of labor (Ventura et al,
followed by sharp increase at
1998). Prostaglandins undoubtly play
parturition and the amniotic fluid
48
Carbamate Toxicity and Protective effect ofThe Egyptian Journal of Hospital Medicine Vol., 1 : 60 - 77
Dec.2000
I.S.S.N: 12084
Rec . Nov. 2000
Carbamate Toxicity and Protective effect of vit. A and vit. E on some biochemical aspects of male albino rats Samir, A.M. Zaahkouk*; Eman, G.E. Helal , Talaat E.I. Abd-Rabo* amd Somaia Z.A. Rashed** Al-Azhar University for Girls, Faculty of Science, Zoology Department Al-Azhar University, Faculty of Science, Zoology Department, Tanta University, Faculty of Science, Zoology Department ABSTRACT
The effect of daily oral administration of carbamate (1/10 L.D50) on rats for 30
successive days were studied. The male rats were divided into five groups (control, control + oil, carbamate, carbamate + vit. A and carbamate + vit. E). Each group (except control and control + oil) was daily administrated carbamate (0.012 mg/kg B.wt.). Two groups of carbamate intoxicated animals provided with vit. A (700 mg/kg.B.wt) or vit. E (10 mg/kg.B.wt). Poisoning symptoms were recorded, e.g. unbalanse, diarrhea, have poor health and posterior limbs rigidity. Haematological parameters showed a significant decrease in red blood corpuscles (R.B.Cs), white blood corpuscles (W.B.Cs) count, Haemoglobin concentration and haematocrit value in groups treated with carbamate, and an improvement in these values was observed in groups treated with the anti-oxidants (vit. A and vit. E). Total lipids cholesterol, total proteins, albumin, glucose, LDH, AST, ALT, adrenaline and noradrenaline were measured in serum. Total proteins, total lipids, of tissues (liver, heart, muscle and kidney) were investigated.
The present study declare that, carbamate induced a significant elevetion in serum
LDH, glucose. total lipids,cholesterol, AST, ALT, adrenaline and noradrenaline. On the other hand, causes a significant reduction in total proteins and albumin.
The total lipids and total proteins of the tissue were recorded highly significant
decrease in the group treated with carbamate only. From another point of view, antioxidant ameliorated the effect of carbamate on tissues. So, it is clear that administration of vit. E or vit. A. reduced the effect of carbamate on biochemical alteration to various extent. The antioxidant property of vitamin A and vitamin E seem to be responsible for the observed protection against carbamate intoxication.
INTRODUCTION
The environmental pollution is
pesticides, that may build up in the food
one of the most serious problems that
chain
and
cause
widespread
faces mankind in this century. There are
contamination of the environment (El-
many types of pollutants that interfere
Sebae, 1993).
with our-life
both directly
and
More than 30,000 metric tons
indirectly. Furthermore, potential future
formulated pesticides (carbamate) were
hazards to human health and wildlife
important and used annually in the
can be created by residues from some
density population area along the green
long-lived
strip of land beside the river Nile and
The Egy ptian Journal of Hospital Medicine Vol., 1 : 78: 94
Dec.2000 Rec . Nov. 2000
I.S.S.N: 12084 Changes In Some Haematological And Biochemical Parameters of Albino Rats In Response to Low-energy Diet
By. Somaia Z. A. Rashed Tanta University, Faculty of Science, Zoology Department
ABSTRACT
The effect of low-energy diet (Low protein or low fat-diet) was studied using
male albino rats. The experiment was expended to 45 days (30 days treatment and 15 days recovery period). Body weight gain or loss as well as blood samples for blood picture (R.B.CS. W.B.CS count, Hb. concentration, Hct value and erythrocyte indices such as MCV, MCH and MCHC) well recorded Biochemical examination for glucose concentration, total protein, albumin, globulin and A/g ratio. Triglyceride level,
total cholesterol and LDL-cholesterol, and HDL-cholesterol level, in addition to
some hormones such as insulin, Testosterone and Leptin levels were examined at the end of the treatment period and the recovery period. A significant decrease in body weight gain percentage was observed in group fed low
protein or Low fat-diet and the body weight improved during and after the
recovery period. A significant decrease in R.B.CS, W.B.CS, count and Hb. concentration, and Hct value in treatment period and improved during and after recovery period. Total proteins, albumin and globulin were significantly affected by low protein or low-fat diet treatment in comparison with the control group. These effects were significantly counteracted by balanced diet. A significant decrease in triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol were observed in groups received diet containing low-protein or low fat as compared with the control group. The results of the present study showed a significant reduction in (Leptin, insulin and testosterone) level after treatment for 30 days and recovery period for 15 days.
INTRODUCTION
There is a widespread interest in
and arteriosclerosis, but the low fat diet
dietary protein or fat effect on various
causes reduction of serum total lipids
aspects of protein and lipid metabolism
Also there is a widespread agreement
and problems relating to hepatic and
that consumption of food low in protein
cardiovascular disease. Some problems
or low in fat resulted in substantial
can develop at the extremes either low
weight loss. The elegant model of Flatt
fat or low protein intakes. Excess fat
(1987) predicts that low protein or low
causes elevation of serum lipids and
fat diet should induce weight loss. Long
thus an increased risk of heart disease
term trials of low-fat or low protein
Detection of Hepatitis C Virus (HCV) RNA among YoungThe Egyptian Journal of Hospital Medicine Vol. 1, 95 - 102,
Dec.2000
I.S.S.N: 12084 Rec . Nov. 2000
Detection of Hepatitis C Virus (HCV) RNA among Young Adult Drug Users
Azza H. El. Salakawy Department of Microbiology, Faculty of Medicine for Girls, Al-Azhar University
A study to determine the frequency and potential risk factors of hepatitis C virus
(HCV) infection was carried out on 33 serum samples from drug users; admitted to hospital for treatment. Sera were screened for HCV antibodies (anti-HCV) using enzyme-linked immunosorbent assay (ELISA). Anti-HCV antibodies were detected in 11/33 (33.3%) of drug users versus 2/30 (6.7%) of volunteer blood donors (control group), which represent statistically significant changes (p < 0.001). HCV-RNA was detected by one step nested reverse transcription polymerase chain reaction (RT-PCR). HCV-RNA was detected in 7/11 (63.6%) of seropositive drug users, all of them were injection drug users.
There was significant association of HCV infection with age and injection drug
use (p < 0.05). However, there was no significant relation between the duration of drug abuse and HCV infection. From these findings, I conclude that HCV infections are common among injection drug users probably due to the intravenous use of drugs.
Introduction
An estimated 170 million people
In Egypt, there is high prevalence
worldwide have hepatitis C virus
of hepatitis C virus, where 10% - 20%
(HCV) infection (WHO, 1997). HCV is
of the general population is infected
a
major
cause
of
parenterally (Kamel et al 1992; Darwish et al,
transmitted acute hepatitis (Choo et al., 1993). As in other regions of the world, 1989). It is an enveloped positive
in Egypt some HCV infections are
stranded RNA virus in the family
caused by transfusions (Khalifa et al,
Flaviviridae, its genome consists of ~ 1993; AbdelWahab et al, 1994),
9.600 nucleotides which encodes of >
injection drug use (Bassily et al., 1995),
3.000 amino acids that is processed into
perinatal expossure (kumar et al,1997)
structural (S) and nonstructural (NS)
and percutaneous medical procedures
proteins (Kolykhalov et al., 1997). It is
(both traditional and non traditional).
an important cause of chronic hepatitis
HCV is widely spread among
and may eventually cause progressive
injecting drug users (IDUs) (van den
liver disease, cirrhosis, and liver cancer Hoek et al., 1990; Thomas et al, (Alter et al, 1992; Tong et al, 1995). 1997).The most common mode of HCV
95
The Interaction between ConvertingThe Egyptian Journal of Hospital Medicine Vol. ,1: 103 - 113
Dec.2000
Rec . Nov. 2000
I.S.S.N: 12084
Effect of Some Food Colorants (Synthetic and Natural products) of Young Albino Rats I- Liver and Kidney Functions
Eman G. E. Helal(1) Samir A.M.Zaahkouk(2) and Hamdy A. Mekkawy(3).
(1)
Zoology Department, Faculty of Science for Girls, Al - Azhar University
, Nasr City, Cairo.
(2)
Zoology Department, Faculty of Science, Al - Azhar University, Nasr City, Cairo.
(3)
The National Center For Social and Criminological Research,
Zamalek P. O., P. C. 11561, Cairo, Egypt
ABSTRACT Food colorants are used all over the world in great amount. However, their use in food is still controversial. It causes and will cause severe tension to the consumers as the sensitivity of people increases to general health. This work was carried out to study and compare between the possible toxic effect of some natural (tumeric, carmine and chlorophyll) and synthetic (fast green, annatto and sunset-yellow), food colorants on liver and kidney function of young male albino rats. Such effect might explain hyperactivity of children that was claimed associated with consumption of food colorants. The study revealed that administration of both natural and synthetic food colorants (permitted dose) significantly increases serum AST and serum urea. All colorants with the exception of sun-set yellow significantly increase serum total bilirubin. While, chlorophyll, fast-green and sun-set yellow were significantly increase serum ALT. Some of the colorants used have a retard destructive effect on some vital organ functions, which extends even after the recovery period. Therefore, large quantities and /or long periods of colorants administration should not be used as additive in man's diet or as a drink. Hence, these colorants should restrictly be used in nutritional therapy. And more caring must be done prevent our children to eat or drink these colorants with much amounts or for long period.
Introduction
Material of natural origin have been
materials, mostly plant derived, could
used to provide colour in foods, drugs
be used to enhance the appearance of
and cosmetics for the thousands of
foods and thus tumeric, paprika and
years.
Ash
from
fires,
mineral
saffron were used for more than just
compounds and plants were probably
their flavouring properties. In the
among the first materials used for
nineteenth century, synthetic organic
cosmetic purposes ( Gount et al. , 1972)
dyes were developed to provide a more
Later, it was discovered that certain
economical and extensive array of
103
Immunological Assessment of addictsThe Egyptian Journal of Hospital Medicine Vol. 1, 114 -128
Dec.2000
I.S.S.N: 12084 Rec . Nov. 2000
Immunological Assessment of addicts Nadia Gamal El-Din Zaki(1) ,Kouka Saad Eldin Abdel-Wahab (2) Azza Hassan El-Salakawy,(2) Enas Ibrahim El-Gaafarawi(1) and Maha Hassan Shokair (3)
(1)The National Center for Social and Criminological Research.
(2) Microbiology Dept.,Faculty of Medicine for Girls, Al-Azhar University.
(3) Immunogenetics and Organ Transplantation Unit, Ain Shams Specialised Hospital.
Abstract
The aim of this study is to investigate some aspects of immunologic response
among Egyptian addicts. The study was conducted on 33 drug addicts who were admitted to hospital for treatment. They were males with age range (19-30; mean 24.73 years). They were followed up at 2-weeks intervals for one month. Blood samples from 18 addicts and 10 non-drug-user control blood donors were evaluated for some lymphocyte immunophenotypic markers by flow cytometric analysis. Addicts showed significantly (P < 0.001) decreased percentages of both T-helper (CD4+) and T- cytotoxic (CD8+) compared with controls. There was also significant (P < 0.05) reduction of CD4+/CD8+ lymphocyte ratio. Sera from all addicts, whether on hospital admission or follow-up samples were subjected to the following investigations. Some blood-borne viral infections were investigated; hepatitis B surface antigen (HBsAg) was present in 1/33 (3%) addicts. Hepatitis C virus antibodies (anti-HCV) were detected in 11/33 (33.3%) addicts versus 1/10 (10%) of controls. Human immunodeficiency virus antibodies (anti-HIV) were present in one serum out of 33 (3%) addicts. Reactivation of cytomegalovirus (CMV) latent infection was assessed by detection of anti-CMV IgM in 1/33 (3%) of addicts on hospital admission, which persisted during the first two weeks, then disappeared on the 4th week. Antibody activity as neutralizing antibodies to polioviruses 1,2 and 3 were tested in cell culture, the antibody titer was higher in follow-up samples than on the time of hospital admission. Antistreptolysin O (ASO) was detected in serum of one addict (3%) on hospital admission and in another addict 2- weeks later which indicated streptococcal infection. The acute inflammation phase C- reactive protein (CRP) was high in 7/33 (21.2%), 3/33 (9.1%) and 1/33 (3%) upon hospital admission, 2-weeks and 4-weeks, after cessation of drug use respectively. Introduction
There are considerable evidences which
Hilburger, 1998). The opiate drugs of
suggest that drug addiction has an effect
abuse are immunosuppressive, both in
on the humoral immunity and cell
humans and in experimental laboratory
mediated immunity which decreases
animals (Eisenstein et al., 1996). For
host resistance to infection. (Donahoe et
example, morphine treatment results in
al., 1987, Eisenstien et al., 1996).
the suppression of phagocytosis by
Opiates have been shown to produce
macrophages (Rojavin et al., 1993) and
profound effects on the immune system
polymorphnuclear cells (Pacifici et al.,
(Arora et al., 1990; Eisenstein and
1994), as well as inhibition of
114
Has primary overlap replaced end-to-end repair for anal sphincter rupture during vaginal deliveryThe Egyptian Journal of Hospital Medicine Vol. 1, 129 -137 Dec.2000
I.S.S.N: 12084 Rec . Nov. 2000
Has primary overlap replaced end-to-end repair for anal sphincter
rupture during vaginal delivery?
Nagwa Abd El-Ghaffar Mohamed, *Maha Abd El-Mongi Abd El-Rahman
Department of Obstetrics and Gynaecology, *Department of General Surgery
Faculty of Medicine for Girls Al-Azhar University, Cairo, Egypt.
Abstract:
Twenty primigravidae women were included in this study. Their age ranged from (20-32) years. They were requiring primary repair for third degree tear occurring during vaginal delivery. All repairs were performed immediately after obstetric disruption. A ruptured internal sphincter was repaired separately and the torn ends of the external sphincter were overlaped in 10 women and approximated as end-to-end in the other 10 women, and sutured with 3/0 polydioxanone sulphate sutures. Sixteen women were followed up, and for all bowel function, clinical assessement, and anal endosonography were performed at a mean of 120 days after delivary. Eleven percent had persistent sonographic external sphincter defects with overlap, and 57% with end to end repair. Also, we found similar percent of internal sphincter defects with overlap, and end-to- end repair. There was no significant difference between the two techniques with regard to the clinical outcome. Based on the preceding results it would appear that sonographic image for external sphincter is better with overlap than end-to-end repair, but we can not conclusively prove that overlap is superior to the end-to-end repair for better clinical outcome obtained from both techniques.
Introduction:
Vaginal delivery is the major
in obstetric practice, including reduced
cause of anal incontinence in women(14).
ocular surveillance of perineum, lack of
Anal endosonography revealed occult
manual perineal protection, complicated
sphincter injury after vaginal delivery
birth positions, deficient support and
even in the absence of sphincter tears
assistance at delivery, are associated
diagnosed at birth(11). Sphincter rupture
with an increased risk of sphincter
is classified as a third degree tear when
lacerations. Nulliparity, instrumental
the fibers of the anal sphincter are torn,
delivery, high birth weight, shoulder
and fourth degree if in addition the anal
dystocia, fetal presentation, episiotomy
mucosa is breached(2). The incidence of
and epidural anaesthesia are also
anal sphincter rupture varies between
considered risk factors(9). Primary anal
0.5% and 2.5% in centres where
sphincter repair is generally performed
mediolateral episiotomy is practised,
by an obstetrician immediately after
compared with 7% in units performing
delivery using the technique of end-to-
a midline episiotomy(16). Modification
end approximation of the torn sphincter
129
Progress and Future challenges The Egyptian Journal of Hospital Medicine Vol. 1, 138 - 147
Dec.2000
Rec . Nov. 2000
I.S.S.N: 12084
Experience of 20 years in Management of Medullohlastoma ( A long term Retro spective study) By Dr. Alaa Abdel Hay (MD), Manal Moawad(MD)** Hussein Boushnak (MD)*** and Hohamed Kabil*
*Neurosurgical, **Radiation Oncology and General Surgery. Departments, Faculty of
Medicine - Ain Shams University Abstract :
Treatment for patients with newly diagnosed medulloblastoma includes surgical
resection followed by craniospinal radiotherapy. Adjuvant chemotherapy has been shown to increase the cure rate with high risk or average risk disease and is now a standard part of contemporary management (Gajjor et al., 99).
Advance in surgery and radiotherapy techniques have improved results in the
last few decades (Paker 1999). These procedures have important early and long term morbidity that must be weighted in order to offer the patient an acceptable risk-beniefit likelihood. The purpose of this study was to analyze the various clinical and prognostic features which might affect the survival of medulloblastoma and to asses the response of patients to treatment.
This study includes 288 patients with medulloblastoma who were treated in both
Neurosurgical and Radiation Oncology Departments during the period 1981 and 2000.
Statistical analysis has proven that the median survival was not affected
significantly by the sex or site of tumor but the most significant variables that affected the median survival were the extent of surgery and stage of the tumor, age and histopathology. Shunt operation reduces the incidence of post operative mortality markedly. Introduction:
Medulloblastoma constitutes from
The prognosis for medullob -lastoma
10% to 20% of primary CNS tumors in
has improved remarkably in the past 40
children and about 40% of all posterior
years as a consequence of advances in
fossa tumors (Heideman et al., 1997).
radiotherapy (Brandes et al., 1999).
Surgical removal of the tumor is
In 1994, Carr et al., reported a trend
considered the first step of treatment to
of better survival in adult patients
establish definite diagnosis, releive the
treated with chemotherapy meanwhile
acute symptoms and reduces the bulk of
adjuvant chemotherapy was of value if
tumor (Brandes et al., 1999). Total or
given for patients with high risk of
near total resection exerts an important
recurrence (Brandes et al., 1999).
infleunce on recurrence of medullob -
Recently Millot et al., 1999,
lastoma (Bailey et al., 1995).
reported encouraging results with the
138
MULTIVARIATE ANALYSIS OF Bcl-2, APOPTOSIS, P53, AND HER-2/neu IN BREAST CANCER: A SHORT TERM FOLLOW UP The Egyptian Journal of Hospital Medicine Vol. 1, 148 - 163
Dec.2000
I.S.S.N: 12084
Multivariate Analysis of Bcl-2, Apoptosis, P53, And Her-2/Neu In Breast Cancer: A Short Term Follow Up 1o. El-Ahmady, 2e. El-Salahy3 M. Mahmoud, 4m. Abdel Wahab, 2s. Eissa And A. Khalifa
1Biochemistry Dep., Ain Shams Faculty of Pharmacy,
2Biochemistry Dep., Ain Shams Faculty of Medicine, 3Biochemistry Dep., National Research, Dokki, Giza,
4Radiation Oncology Dep., Ain Shams Faculty of Medicine. Abstract: Background. Several molecular genetic alterations in breast cancer, including aneuploidy, altered apoptosis, aberrant expression of p53, HER-2/neu and Bcl-2, have been associated with poor prognosis in breast cancer patients. To determine the importance of molecular-genetic factors relative to more traditional surgical- pathologic prognostic factors, multivariate analysis was performed. Materials and Methods. Ninety-four fresh tissue samples of primary breast carcinoma were studied with flow cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and PR) were measured in the cytosol fraction using Abbott ELISA assays, HER-2/neu was determined in the membrane fraction and mutant p53 protein in the nuclear fraction, both, by Oncogene Science ELIZA procedures. Bcl-2 and apoptosis (Cell death) were measured in cell lysates by Oncogene Science & Boehringer Mannheim ELISA assays. In addition, information regarding surgical-pathological features of the tumor was obtained. Multivariate analysis using unconditional logistic regression model was done to identify variables predictive of poor prognosis. Results. Using univariate analysis, histological grade, tumor stage, lymph node status, HER-2/neu, and mutant p53, were predictive of poor short-term prognosis. By multivariate analysis, tumor stage, lymph node status, HER-2/neu were independent factors. Grade subgroup analysis versus time of relapse, illustrated a predictive value of Bcl-2 in only low-grade tumors while apoptosis was significant in high-grade type. Conclusion. Among a panel of molecular- genetic factors investigated, HER-2/neu was the most strongly predictive of poor short- term prognosis in breast cancer. Patients with HER-2/neu positive tumors can benefit from Herceptin therapy.
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