@article { author = {Aly, Mohammad and Arafat, Mohammad and Hussein, Ola and Hosny, Hanaa and Abdel-Hammed El Sayed, Ayman}, title = {EVALUATION OF ANGIOPOIETIN-2 AS AN EARLY MARKER FOR DIABETIC NEPHROPATHY INZAGAZIG UNIVERSITY HOSPITALS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {93-101}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13082}, abstract = {ABSTRACT Background: To assess the validity of measuring plasma Angiopoietin as a biomarker for early detection of diabeticnephropathy and todetermine the relation between plasma Ang-2 and inflammation in diabetic nephropathy patients inZagazig university Hospitals. Subjects and methods:This study included a total of 76 diabetic patients divided to microalbuminuria andmacroalbuminuria groups , each group contained 38 patients in addition to 40 healthy control subjects.Results: Plasma levels of Ang-2 was significantly higher in patients with microalbuminuria and macroalbuminuriacompared to healthy controls. Indeed, Ang-2 levels steadily increases with the progression of albuminuria . The studyshowed significant positive correlation between plasma Ang-2 , MAP and creatinine, uric acid, phosphorus, CRP, totalcholesterol and triglycrides . We observed also significant negative correlation between plasma Ang-2 and Hb, eGFR,serum calcium and albumin. Conclusion:Our results indicated that Plasma Angiopoietin-2 levels are elevated in patients with diabeticnephropathy . plasma Ang-2 steadily increase with the progression of albuminuria, suggesting their possible role as earlymarkers of microvascular angiopathy of glomeruli . Plasma Ang-2 is related to CRP, this implies that elevated levels ofthis biomarker occur as a result of inflammation and vascular dysfunction as a part of atherosclerotic process. Abbreviations: Ang-2 =Angiopoietin-2, CRP = C-reactive protein, Hb= hemoglobin, ACR = albumin-creatinineratio, ESRD = end stage renal disease, MAP= mean arterial pressure, FBS = fasting blood suger.  }, keywords = {Angiopoietin,Diabetes mellitus}, url = {https://zumj.journals.ekb.eg/article_13082.html}, eprint = {https://zumj.journals.ekb.eg/article_13082_4e9f8b8f704e92a2b0f3d4e277f0de59.pdf} } @article { author = {Elharrisi, Mona and Elsayed, Khalid and Mowafy, Shrief}, title = {FLUID CHALLENGES IN INTENSIVE CARE: MONITORING FLUID RESPONSIVENESS IN CRITICALLY ILL PATIENTS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {102-114}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13083}, abstract = {ABSTRACTIn patients with acute circulatory failure, the decision to give fluids or not should not be taken lightly. The risk of overzealous fluid administration has been clearly established. Moreover, volume expansion does not always increase cardiacoutput as one expects. Thus, after the very initial phase and/or if fluid losses are not obvious, predicting fluid responsiveness should be the first step of fluid strategy. For this purpose, the central venous pressure as well as other ―static‖markers of preload has been used for decades, but they are not reliable. Robust evidence suggests that this traditionaluse should be abandoned. Over the last 15 years, a number of dynamic tests have been developed. These tests are basedon the principle of inducing short term changes in cardiac preload, using heart–lung interactions, the passive leg raise orby the infusion of small volumes of fluid, and to observe the resulting effect on cardiac output. Pulse pressure andstroke volume variations were first developed, but they are reliable only under strict conditions. The variations in venacaval diameters share many limitations of pulse pressure variations. The passive legraising test is now supported bysolid evi dence and is more frequently used. More recently, the endexpiratory occlusion test has been described, whichis easily performed in ventilated patients. Unlike the traditional fluid challenge, these dynamic tests do not lead to fluidoverload. The dynamic tests are complementary, and clinicians should choose between them based on the status of thepatient and the cardiac output monitoring technique. Several methods and tests are currently available to identifypreload responsiveness. All have some limitations, but they are frequently complementary. Along with elementsindicating the risk of fluid administration, they should help clinicians to take the decision to administer fluids or not in areasoned way.Key words: Pulse pressure variation, Stroke volume variation, Pulse contour analysis, Heart–lung interactions,Passive leg raising, Fluid responsiveness, Cardiac preload, Stroke volume, Volume expansion, Fluid therapy,Haemodynamic monitoring, Critical care, Echocardiography, ICU, Operating room  }, keywords = {}, url = {https://zumj.journals.ekb.eg/article_13083.html}, eprint = {https://zumj.journals.ekb.eg/article_13083_cc2aea360ced3faf5250e157efd03871.pdf} } @article { author = {Atwaa, Yehia and Mohamed, Mohamed and Salah, Emad and Abdel Maksoud, Rasha}, title = {VIDEO-ASSISTED THORACOSCOPIC BILATERAL SYMPATHECTOMY FOR PRIMARY HYPERHIDROSIS IN ZAGAZIG UNIVERSITY HOSPITALS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {115-122}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13084}, abstract = {ABSTRACTBackground:. Hyperhidrosis is the condition characterized by abnormally increased sweating/perspiration in excess ofthat required for regulation of body temperature. Hyperhydrosis can be primary or secondary. Primary hyperhidrosis isidiopathic in nature and the most affected regions are palms , axillae and feet. Palmar and axillo-palmar hyperhidrosis isa disabling disorder. It usually has negative impact on the patient’s social and professional life.The incidence of primaryhyperhydrosis is estimated to be around 0.6 to 1% . Management strategies to hyperhidrosis may be classified as nonsurgical or surgical Treatment. Thoracoscopic sympathectomy is considered the most effective and durable treatmentfor patients suffering from moderate to severe hyperhidrosis with good short-term results and minimal postoperativecomplications Aim of the work: The aim of the work is to evaluate and compare the immediate and long-termoutcomes of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis.Patients andMethods: From Jul. 2012 to Jun. 2017, a prospective study was conducted on fifty six patients, admitted to surgeryDepartments, zagazig university hospitals scheduled for bilateral thoracoscopic sympathectomy,for the treatment ofprimary hyperhydrosis involving the palms of both hands in all patients with or without involvement of the axillae.Allthe patients were considered in grades 3 or 4 of the HDSS in which their lifestyle and occupation were markedlyaffected.The sample included38 (67.9%) males and 18 (32.1%) female with mean age of 27.03±4.89.Statisticalanalysis: SPSS version 20. Results: In total number of 56 patients with primary hyperhidrosis who passed bilateralthoracoscopic sympathectomy, it was found that all patients had immediate stoppage of palmar hyperhidrosis. Themean hospital stay was1.08±0.28.Good Satisfaction had occurred in 51 cases(91.1%)The most common postoperativetroublesome was pleuritic chest pain in 18 cases(32.1%) .Compensatory sweating had occurred in 4 cases(7.1%). 4caseshad developed postoperative pneumothorax. Conclusion:Video-assisted thoracoscopic bilateral sympathectomy is arapid, reliable and safe technique. It presents important advantages over the staged procedures because it can be done ina single surgical procedure, requires placement of only two thoracic ports, avoiding the third port. The transaxillarybilateral approach provides as good if not better results and can certainly be done with similar or perhaps less morbidity.Furthermore, the bilateral approach reduces the time of patient recovery and reduces healthcare costs.}, keywords = {Primary Hyperhydrosis,Thoracoscopic Sympathectomy and Compensatory Sweating}, url = {https://zumj.journals.ekb.eg/article_13084.html}, eprint = {https://zumj.journals.ekb.eg/article_13084_86a5c053abbc44bcbed8c6e23e20f760.pdf} } @article { author = {Sayed Ahmed, Ashraf and Abaza, Kamelia and El Sadek, Dina}, title = {FENTANYL VERSUS MAGNESIUM SULPHATE AS ADJUVANT TO HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR ELECTIVE CESAREAN SECTIONS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {123-128}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13085}, abstract = {ABSTRACTBackground: Subarachnoid block achieved a wide spread popularity as a simple and effective method ofanesthesia for elective cesarean sections.The use of intrathecal adjuvants has gained popularity, with theintention of reducing the dose of local anesthetics, maintaining hemodynamic stability and delaying the onset ofpain during the postoperative period The present study compared between fentanyl and magnesium sulphate asadjuvant to hyperbaric bupivcaine in subarachnoid block for patients undergoing elective cesarean sections.Subject and Methods: A total of 56 consented pregnant females undergoing elective cesarean sections, ASAgrade I and II, were randomized into two groups of 28 patientseach. Group F received 12.5 mg of intrathecal 0.5% hyperbaric bupivacaine ( 2.5 ml ) + 12.5 μg (0.25 mL)fentanyl + .75 ml normal saline, Group M 12.5 mg of intrathecal 0.5% hyperbaric bupivacaine ( 2.5 ml ) + 100mg (1 ml) magnesium sulfate. The two groups were assessed for character of the block, haemodynamic changes,duration of post operative analgesia, the side effects.Results: The onset of both sensory and motor block was slower in the magnesium group. The duration of spinalanesthesia and motor block were significantly longer in the magnesium group. Total analgesic doserequirement was less in Group M. Hemodynamic parameters were comparable in the two groups. Intrathecalmagnesium caused minimal side effects.Conclusion: The addition of magnesium sulfate 100 mg to bupivacaine for sub-arachnoid block in patientsundergoing elective cesarean section prolongs the duration of analgesia and reduces postoperative analgesicrequirements without additional side effects and adverse neonatal outcomes.}, keywords = {Subarachnoid block,magnesium sulfate,Fentanyl,post operative analgesia,elective cesarean sections}, url = {https://zumj.journals.ekb.eg/article_13085.html}, eprint = {https://zumj.journals.ekb.eg/article_13085_3939dc84034bebdeb5cac51d37cc400e.pdf} } @article { author = {Hassan, Ebtehag and Khalifa, Naglaa and Zaghlol, Sahar and Soliman, Ahmed}, title = {STUDY THE EXPRESSION OF TETRASPANIN (CD81) ON B CELLS IN RESPONSE TO INTERFERON THERAPY IN CHRONIC HCV PATIENTS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {129-134}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13086}, abstract = {ABSTRACTHepatitis C virus (HCV) infection causes life threatening disease due to its persistence in the liver, over time leading tocirrhosis and hepatocellular carcinoma. Therapeutic intervention with interferon (INF) - alpha combined with ribavirinis aimed at viral clearance, Interferon and ribavirin might discontinue the virus induced hepatocytes damage, thusslowing down the progress to end- stage liver disease. It has been demonstrated that HCV virion, via major structureenvelop (E) protein 2 or EIE2 complex could specifically bind to human CD81 molecule, thereby altering the cellularactivities in B cells, T cells and natural killer (NK) cells. CD81, a surface protein belonging to the tetraspanin family,facilitates B–T cell interaction in the process of antigen presentation Evidence has revealed that CD81 on B and T cellssubstantially enhanced T helper IL-4 secretion and NK-cell CD81 enabled E2-mediated reduction of the IFN-gammalevels Those data suggest that CD81 might activate the pathway leading to a predominant type-2 immune response, andas such be prone to cause a strong antibody production but weak or insufficient cytotoxic activities to clear the.The aimof this work was to investigate the clinical relevance and the possible mechanism of CD81 down-regulation under IFNalpha treatment to detect possible role of CD 81in response to INF therapy of chronic HCV patients.Subjects and Methods: The study included: Group I: 10 healthy subjects. And 60 HCV patients classified into 3groups: Group II: 20 chronic HCV patients have not received treatment Group IIIa: 20 chronic HCV patients havereceived treatment responsive to treatment Group IIIb: 20 chronic HCV patients have received treatment notresponsive to treatment .the patients were subjected to: (CBC) .liver and kidney function tests and special investigationCD 81, CD19, CD 22.Results: TLC and PLT higher in group I while ALT and AST were significantly higher in group II, while T. bilirubinwas significantly higher in group IIIb, Direct bilirubin was significantly higher in group II ,and Alb was significantlyhigher in group I ,ASMA and ANA more higher in group IIIb, AFP and TSH were significantly higher in group IIIb ,there was negative correlation between CD81 and TLC positive correlation between ALT, AST and CD81 werepositively correlated to T Bilirubin , D Bilirubin and CD81.There was also significant negative correlation betweenAlbumin and CD81. CD81, CD19, CD22 and Lymphocytes were significantly higher in group IIIb.Conclusion: In conclusion, CD81 down-regulation is a primary host response to interferon-alpha-based therapy and animmunophenotype associated with anti-HCV sustained virological response (SVR)  }, keywords = {HCV,CD81,interferone}, url = {https://zumj.journals.ekb.eg/article_13086.html}, eprint = {https://zumj.journals.ekb.eg/article_13086_4aba419c7c84452889c954a6742b3450.pdf} } @article { author = {Mohammed, Mohammed and Allam, Zaki and Hussein, Nawel and Hamrah, Nabil}, title = {RECTAL ADVANCEMENT FLAP TREATMENT COMPARED WITH SETON FOR HIGH TRANSSPHINCTERIC PERIANAL FISTULA}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {135-142}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13087}, abstract = {ABSTRACTBackground: Treatment of anal fistula is a balance between maximizing the chances of successful healing and avoidingcomplications particularly incontinence from division of the anal sphincters. Many surgical procedures have been usedin the treatment of anal fistula, with varying success. Endorectal advancement flap can be a useful tool for the surgeonfaced with an anal fistula. This study aims to compare outcomes for rectal flap advancement in comparison to setonplacement in treating high transsphincteric perianal fistula.Subjects & methods: The study included 54 patients with high transsphincteric perianal fistulas; 27 patients were treatedby rectal partial thickness advancement flap and the other 27 patients were treated by seton placement.Results: Results proved to be better with rectal advancement flap than seton regarding time to complete healing,postoperative wound infection, postoperative continence and recurrence.Conclusion: Rectal Advancement Flap was found to be a promising and a more effective procedure than seton withbetter healing rates and less liability for postoperative incontinence or recurrence.  }, keywords = {High perianal fistula,rectal advancement flap,Seton}, url = {https://zumj.journals.ekb.eg/article_13087.html}, eprint = {https://zumj.journals.ekb.eg/article_13087_1fd268170aecb81ebaf1ca76e3330a51.pdf} } @article { author = {Ebrahim, Ahmed and Fouad, Yasser and Ali, Magdy and El-Baz, Saeed}, title = {MYRINGOPLASTY OF CENTRAL TYMPANIC MEMBRANE PERFORATION WITH A FAT GRAFT FROM THE EAR LOBULE AND PLATELET RICH PLASMA.}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {143-149}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13088}, abstract = {ABSTRACTBackground: Fat myringoplasty had been described over 50 years to be a safe and simple option formyringoplasty. Platelet rich plasma [PRP] is a simple and minimally invasive method to obtain a highconcentrate of autologous growth factors that can facilitate wound healing.Objectives: To assess the effectiveness of using fat and PRP in myringoplasty.Patients and methods: Twenty patients with small to medium sized tympanic membrane perforations wereenrolled in this study. Under local anesthesia, the margin of the perforation was freshened, then a singlepiece of ear lobule fat graft, approximately double the size of the perforation, was placed through theperforation, then the PRP was applied over the fat graft.Results: Successful TM perforation repair was achieved in 36 ears [85.7%]. 100% success rate wasobtained in small peroration and 79.3%in medium sized perforation. There was significant postoperativeimprovement in the mean air bone gap [p = 0.0016].Conclusion: Adding PRP to fat myringoplasty is a safe, effective, cost saving and minimally invasiveprocedure. It is suitable to repair small as well as moderate sized TM perforations.  }, keywords = {Myringoplasty,platelet rich plasma,tympanic membrane. Ear lobule fat}, url = {https://zumj.journals.ekb.eg/article_13088.html}, eprint = {https://zumj.journals.ekb.eg/article_13088_b6855c0c96f10aded70ad682bccacec7.pdf} } @article { author = {Abd Elhameid, Azza and Amin, Abd Elaziz and Alnemr, Amr and Selim Mohamed, Maha}, title = {EFFECT OF LAPAROSCOPIC OVARIAN CYSTECTOMY FOR ENDOMETRIOMA ON OVARIAN RESERVE}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {150-156}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13089}, abstract = {ABSTRACTBackground: To assess the effect of laparoscopic ovarian cystectomy for endometrioma on ovarian reserve bymarkers as Anti-Mullerian Hormone and Follicle Stimulating Hormone.Subjects: 48 Women of reproductive age who had ultrasonographic diagnosis of endometrioma measuring>3cmwhether unilateral or bilateral and subjected to laparoscopic excision.Methods: From January 2017 to December 2017, Women with endometrioma underwent to laparoscopicexcision. Serum AMH and FSH were determined preoperatively and 3months postoperative.Results: There was a statistically significant reduction in postoperative mean value of AMH ( 2.04+ 1.69 ) whencompared to the preoperative mean value of AMH (2.59+ 1.85 ) and a statistically significant rise inpostoperative mean value of serum FSH (7.23+ 1.48 ), when compared to preoperative mean value of FSH(5.50+ 1.85 ). Post-operative AMH decreases were greater in patients with endometriomas > 5cm in diametercompared with smaller ones and in patients with bilateral endometriomas compared with unilateral ones.Conclusion: Laparoscopic cystectomy for endometrioma has an adverse impact on ovarian reserve. Bilateralityand size of endometrioma increase the adverse effect of Laparocopic ovarian cystectomy on the ovarian reserve.  }, keywords = {endometrioma,Laparoscopic cystectomy,Anti-Mullerian hormone,Follicle Stimulating Hormone}, url = {https://zumj.journals.ekb.eg/article_13089.html}, eprint = {https://zumj.journals.ekb.eg/article_13089_583897a86df5b8401b101c4e469a19dd.pdf} } @article { author = {Mohammed, Osama and Abd-Elsamee, Magdy and Roshdy, Hisham and Soliman, Mohammed}, title = {EPICARDIAL FAT VOLUME AS A PREDICTOR OF THE SEVERITY OF CAD BY MSCT}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {157-165}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13090}, abstract = {ABSTRACTBackground: Distribution of body fat is known to be more independent and potent predictor of morbidity andmortality than total body adipocity. Each visceral fat storage is anatomically and functionally different and accordingto its closeness to an organ, it exerts a specific local function for each one. Epicardial adipose tissue (EAT) as a fatdepot is further implicated on coronary artery disease (CAD) because of proximity to the adventitia of major epicardialcoronary arteries. Epicardial fat volume (EFV) can be evaluated by MSCT even without contrast injection which helpsin prediction of the presence and the severity of CAD.Objectives: To evaluate the relationship between epicardial fat volume and the severity of coronary artery diseaseamong patients presented by chest pain with low to intermediate pretest probability for CAD using Multi-Slice CTcoronary angiography.Subjects and methods: The study included 100 patients, 94 males and 6 females with mean age 56.03 ± 10.24 yearswho were referred to the MSCT coronary angiography unit in Zagazig University Hospital and Kobri Elkobba MilitaryHospital during the period from January 2017 to August 2017. All patients were subjected to through history takingincluding age, sex, family history of CAD, DM, HTN, smoking, complete clinical examination including BMI andoverweight was defined as ≥ 25 kg/m2, standard ECG, analysis of lipid profile, measurement of serum creatinine andrandom blood glucose level as well as Multi-slice CT angiography.Results: There was significant relationship between EFV and Proximal LAD and D1 lesions (p = 0.020) as regardingsegment involvement score (SIS) and segment stenosis score (SSS) by MSCT. Epicardial fat volume (EFV) was125.34 ± 35.37 cm3 (range from 47.4 to 221.3 cm3 and the median value of EFV in our patients was 123.35 cm3) andCoronary artery calcium score (CACS) was 157.69 ± 352.95 (range from 0 to 2212 and the median value was 29.55)with significant relationship between EFV and Ca score (p = 0.009), highly significant relationship between EFV andSIS score and SSS score (p < 0.001). There was significant relationship between EFV and sex (p = 0.002), highlysignificant relationship between EFV and hypertension and diabetes mellitus (p < 0.001), no significant relationshipbetween EFV and smoking (p = 0.754) and family history of ischemic heart disease (p = 0.082), significantrelationship between EFV and age (p = 0.011), highly significant relationship between EFV and serum cholesterol,LDL, serum triglycerides, LDL/HDL ratio, BMI and inversely proportional to HDL (p < 0.001).Conclusion: we concluded in our study that EFV was associated with coronary atherosclerosis and EFV increasedsteeply in patients with significant coronary artery stenosis and in those with severe coronary artery calcification asrevealed by MSCT angiography. Quantitation of EFV may be useful in addition to coronary artery calcium score as apredictor to identify patients at risk for CAD.  }, keywords = {Epicardial fat volume,coronary artery disease and Multi-slice CT angiography}, url = {https://zumj.journals.ekb.eg/article_13090.html}, eprint = {https://zumj.journals.ekb.eg/article_13090_5d4c6a8fee79f35ae6c30623bf9b568e.pdf} } @article { author = {El Gerby, Khaled and Amin, Mohamed and Amin Mousa, Mohamed}, title = {ASSESSMENT OF THE ROLE OF 128 ROW MULTI DETECTOR COMPUTED TOMOGRAPHY IN THE EVALUATION OF CORONARY ARTERY BYPASS GRAFTS PATENCY}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {2}, pages = {166-177}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.13091}, abstract = {ABSTRACTBackground: The recently developed 128 row multidetector CT had made a revolution in coronary artery bypass grafts(CABG) patency evaluation due to high temporal and spatial resolution beside it is being non invasive.Subjects and Methods: 50 patients were enrolled for ECG gated CT of coronary arteries bypass grafts between January 2015and May 2017.Patients underwent conventional coronary angiography within 2 weeks of MDCT exam. Administration of beta blocker andnitroglycerin was done prior to CT exam. Breath hold training was mandatory.Results: 46 grafts were arterial and 74 were venous. 36 of the arterial grafts (78.2 %) were patent, 6 (13 %) were significantlynarrowed and 4 (8.8 %) were completely occluded. Regarding venous grafts, 52 (70.2 %) of them were patent, 14 (19 %) weresignificantly narrowed and 8 (10.8 %) were completely occluded. CT angiography compared to the conventional angiographyas a gold standard technique gave us a sensitivity of 100%, a specificity of about 98% and an accuracy of about 93.6% in theassessment of any type of coronary artery grafts.Conclusion: MDCT is considered the imaging modality of choice at the current days to evaluate the patency and stenosis ofcoronary artery bypass grafts than the conventional coronary angiography due to its multiple drawbacks.}, keywords = {MDCT,global left ventricular function,Coronary Artery Disease}, url = {https://zumj.journals.ekb.eg/article_13091.html}, eprint = {https://zumj.journals.ekb.eg/article_13091_be1f97fc47de8d67b63c177254b53096.pdf} }