@article { author = {}, title = {COMPARATIVE STUDY BETWEEN INFRAGENICULAR BALLOON ANGIOPLASTY AND CONSERVATIVE MANAGEMENT IN TREATMENT OF PATIENTS WITH CRITICAL LOWER LIMB ISCHEMIA}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {457-466}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18283}, abstract = {ABSTRACT Background: Critical limb ischemia (CLI) is a severe degree of peripheral arterial occlusive disease (PAD) that requires rapid intervention to avoid limb loss and its associated mortality and morbidity .The mainstay of treating of a patient with critical limb ischemia is to reperfuse his limb which can be achieved by direct revascularization by surgical interference or endovascular management or indirect revascularization through other conservative measures as medical therapy, spinal cord stimulation and hyperbaric oxygen. This study aims to compare between the outcomes of endovascular intervention and conservative management of patients with critical limb ischemia. Subjects & methods: The study included 76 patients with critical limb ischemia CLI, 38 patients were treated by endovascular intervention  and the other 38 patients were conservatively. Results: Results proved that revascularization of critical limb ischemia patients by endovascular intervention was better than conservative management in terms of limb salvagability and patient survival. Conclusion: Endovascular intervention was found to be a promising and more effective procedure than conservative management in patients with critical limb ischemia and the conservative procedure should be limited to patients not feasible to revascularization.}, keywords = {Keywords: Critical limb ischemia,Balloon angioplasty,Conservative}, url = {https://zumj.journals.ekb.eg/article_18283.html}, eprint = {https://zumj.journals.ekb.eg/article_18283_2086de587cc457271e9123d29cf6444e.pdf} } @article { author = {}, title = {CROSSED PINNING VERSUS TWO LATERAL WIRES IN THE MANAGEMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {467-472}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18284}, abstract = {Introduction: Closed reduction of supracondylar humerus fractures with K-wires has become the standard line of management with different opinions regarding the technique that is utilized. Aim: To compare the functional and radiological outcomes of lateral and cross pinning technique in supracondylar fractures of humerus in children. Materials and Methods: A prospective study with 57 cases of displaced fracture supracondylar humerus, treated by lateral (Group A n=28) and cross pinning (Group B n=29), was conducted between May 2013 and May 2015. Independent sample student’s t-test was done to assess the parameters like age, follow-up and duration of surgery. The results were expressed as mean with standard deviation and p<0.05 was considered as statistically significant. Results: As per the Gartland classification system, 46 (80.7%) patients had Type IIIA and 11 (19.2%) patients had Type IIIB fracture. The average surgical time was 28.3±1.6 minutes in Group A and 30±3.6 minutes in Group B (p=0.02). About, 3.5% patients in Group A had pin loosening. As per the Flynn criteria, 78.6% in Group A and 79.3% in Group B had excellent results. Conclusion: No significant difference in terms of functional and radiological outcome was observed between both the techniques. Thus, both the techniques have equal results. Key words; supracondylar humerus, percutaneous pinning }, keywords = {Key words,supracondylar humerus, percutaneous pinning}, url = {https://zumj.journals.ekb.eg/article_18284.html}, eprint = {https://zumj.journals.ekb.eg/article_18284_66dd8db4b54fded2051e9718a9dc79dd.pdf} } @article { author = {Soliman, Ahmed and Mokbel, Abd El monaem and Ammar, Mohamed and Mohamed, Mohamed}, title = {RADIOFREQUENCY ABLATION TECHNIQUE FOR DEEP SEATED BRAIN TUMORS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {473-477}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18285}, abstract = {ABSTRACT Fifteen pathologically diagnosed patients with grade II,III and IV primary or recurrent glioma (tumor diameter 2–5 cm) were randomly selected and underwent hyperthermia treatment in the form of radiofrequency treatment, and patients with recurrent tumors were treated with hyperthermia in combination with radiotherapy and chemotherapy. Hyperthermia treatment was administered at 90°C radio-frequency hyperthermia device. Electrodes were inserted into the tumor with the aid of a CT-guided stereotactic apparatus and heat was applied for 5 minutes . During follow up after hyperthermia treatment , patients were evaluated with head CT or MRI every month. Gliomas in the hyperthermia group exhibited growth retardation or growth termination. Decrease in tumour diameter was evident in 85% of the heated tumor tissue and there was a decrease in tumor diameter. Our findings indicate that radio frequency hyperthermia has a beneficial effect in the treatment of malignant glioma.}, keywords = {minimally invasive techniques,deep seated brain tumors,radio frequency hyperthermia,glioma,necrosis,CT,MRI}, url = {https://zumj.journals.ekb.eg/article_18285.html}, eprint = {https://zumj.journals.ekb.eg/article_18285_531f6839a8324f4a33db602c373baf70.pdf} } @article { author = {A Hefny, Ahmed and H Nasef, Mohammed and M Khira, Yousuf and Abd Abdelsalam, Mohammed}, title = {ARTHROSCOPIC ACROMIOPLASTY FOR TREATMENT OF SHOULDER IMPINGEMENT SYNDROME}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {478-485}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18286}, abstract = {Background: The technique of arthroscopic subacromial decompression (ASD) is an effective alternative to the open operation. The arthroscopic procedure is technically demanding. Patients and methods: Between January 2016 and February 2018, sixteen male patients, who fulfilled the criteria of the subacromial impingement syndrome, underwent arthroscopy, stability testing under anesthesia and arthroscopic acromioplasty. Pain was the chief complaint of every patient in this study. We used modified UCLA shoulder rating scale for clinical evaluation of the all patients. Pre-operative radiographs included an AP and axillary views added to 30° caudal tilt view or a supraspinatus outlet view were done routinely. MRI of the shoulder was done for all cases. Results: Satisfactory results were achieved in all patients and 6 of them were excellent according to UCLA score. Eight patients had good results and two fair, but no poor results were found in this study up to one year postoperative. Pain relief was the most dramatic benefit but function also improved. The subacromial space of the patients was filled with hypertrophic fibrous bands of bursal stroma, often with fibro-fatty tissue. Hyperemia was often observed. Surface ulcerations were identified on the rotator cuff in 8 cases. Rotator cuff partial tear in 4 cases. Conclusion:  In cases of primary impingement, calcific tendinitis, or partial thickness rotator cuff tears the arthroscopic acromioplasty and decompression, is the procedure of choice provided that no shoulder instability. The right indications and skilled hands, the results are better than the results of open acromioplasty, as the patients recover faster with less risk of deltoid muscle complications.}, keywords = {Arthroscopic,acromioplasty,impingement,shoulder}, url = {https://zumj.journals.ekb.eg/article_18286.html}, eprint = {https://zumj.journals.ekb.eg/article_18286_19899bd1adc63d288d025037671e9545.pdf} } @article { author = {H. Salama, Hosni}, title = {RESPONSE SHIFT IN PATIENTS WITH LUMBAR SPINE SURGERY ASSOCIATED WITH PAINFUL LOWER LIMB LESIONS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {486-491}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18287}, abstract = {ABSTRACT Background data: Response shift is a new concept in the evaluation of patient satisfaction, application of such concept in the field of spinal surgery is important because of variation of outcome measures. Spine problems constitute a major health burden all over the world. Purpose: Is to evaluate patient satisfaction after undergoing lumbar spine surgery and comparing patients with pure lumbar spine pathology with those having painful lower limb pathology associated with the original spine lesions. Study design: A prospective comparative study. Patients and methods: One hundred twenty six patients having lumbar spine pathology with radicular compression causing sciatica were evaluated pre and post operatively using patient self assessment questionnaire, visual analogue score (VAS). The study was conducted at Zagazig university hospitals from May 2014 to June 2015. There was 67 patients with associated lower limb painful pathology and 59 patients without lower limb painful lesions Results: Fifty seven out of 59 patients became better (VAS below 40). 34 changed to 32 patients with VAS from 41 to 60, 19 changed to 20 ( VAS from 61 to 80) and 6 to zero ( VAS from 81 to 100) in pure lumbar pathology group, while in the second group associated with painful lower limb pathology 37 (VAS 41 to 60), 19 (VAS 61 to 80), 11(VAS 81 to 100) changed to 23, 12, and 8 respectively, 0 patients changed to 24 with VAS from 21-40. Conclusion: patients who have lower limb painful lesions in addition to the original lumbar spine pathology tends to be less satisfied with the result of surgery than those patients having pure lumbar pathology.}, keywords = {Response shift. Lumbar spine surgery. Degenerative spine}, url = {https://zumj.journals.ekb.eg/article_18287.html}, eprint = {https://zumj.journals.ekb.eg/article_18287_ca4f5634ea602c0453b51ff3368404ae.pdf} } @article { author = {Balata, Ahmed and Abdel Latif, Howaida and Waly, Salwa and Mohamed, Ahmed}, title = {DEXMEDETOMIDINE VERSUS MAGNESIUM SULPHATE OR LIDOCAINE FOR BLUNTING STRESS RESPONSE TO DIRECT LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION IN ABDOMINAL SURGERIES.}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {492-500}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18288}, abstract = {Back ground: Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response characterized by hypertension and tachycardia and also hormonal stress response characterized by increased secretion of pituitary hormones. The present study was undertaken to compare the efficacy of intravenous dexmedetomidine, lidocaine and magnesium sulphate in attenuating the stress response to direct laryngoscopy and endotracheal intubation. Subjects and Methods: The current prospective randomized clinical study was performed in Zagazig University hospitals. A total of 87 patients posted for elective abdominal surgeries under general anesthesia were enrolled in the study. Patientswere randomly divided into three groups, group-D (dexmedetomidine group), group-L (lidocaine group) and group-M (magnesium sulphate group) with 29 patients in each group.  Group-D was given 1mcg/kg dexmedetomidine , Group-M was given 30mg/kg of magnesium sulphate and Group-L was  given 1.5mg/kg  lidocaine all the study drugs were given by  IV infusions over a period of 10 minutes before induction of anesthesia which was standardized for all patients. The three groups were observed for changes in hemodynamic parameters at preinfusion of the study drug and preinduction of the anesthesia and 1, 3,5,10 minutes post intubation, blood glucose and cortisol level were measured at preinfusion and 10 min after intubation, Ramsay sedation score and postoperative pain were assessed at preinduction period and 1 hour postoperatively. Results:It was observed that both dexmedetomidine and magnesium sulphate attenuated the rise in the mean arterial blood pressure significantly, but lidocaine failed to attenuate it.Also dexmedetomidine only decreased the changes in the mean heart rate , serum cortisol, serum glucose level, Ramsay sedation score and postoperative pain significantly. Conclusion: This study seems to prove that dexmedetomidine and magnesium sulphate play an important role in blunting the stress response resulting from direct laryngoscopy and intubation.}, keywords = {Dexmedetomidine,Magnesium sulphate,Lidocaine,Stress response,laryngoscopy,hemodynamic parameters}, url = {https://zumj.journals.ekb.eg/article_18288.html}, eprint = {https://zumj.journals.ekb.eg/article_18288_a8e40ee237405c46f8535cd00ba8a942.pdf} } @article { author = {Dawoud, Bassant and Elarabawy, Reda and Abo Dewan, Khalid and Barakat, Ashraf}, title = {DYNAMIC CONTRAST-ENHANCED MR IMAGING IN DIAGNOSIS OF BREAST LESIONS}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {501-511}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18291}, abstract = {Objectives: To describe the diagnostic performance of dynamic contrast enhanced MRI in differentiating between benign and malignant breast lesions. Methods: the study was conducted on 40 patients with 40 lesions. MR examinations were performed using a closed MRI machine with magnets of intensity field 1.5 Tesla system,equipped with bilateral dedicated breast coils. All lesions were biopsied considering histopathologic findings as the standard of reference. Probability of malignancy was assessed according to BI-RADS for DCE-MRI. Diagnostic accuracy of DCE-MRI was statistically analyzed. Results: Regarding to the final outcome of the reviewed 40 MRI studies depending on the histopathological results accepted as standard reference, histopathology revealed malignancy in 67.5 % of lesions (27/40) and DCE-MRI showed sensitivity (96.3%) and specificity (76.9%) Conclusions: Dynamic contrast enhanced MRI facilitates differentiating benign and malignant breast lesions.}, keywords = {Breast lesions.Dynamic MRI}, url = {https://zumj.journals.ekb.eg/article_18291.html}, eprint = {https://zumj.journals.ekb.eg/article_18291_271ec09ab8cda7c232a1a26855f3a2eb.pdf} } @article { author = {Abd EL Reheem, Mohammed and Abdou, Mohsen and Abd El Azim, Adel and Mahmoud, Hossam}, title = {MINIMALLY INVASIVE TECHNIQUES IN MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {512-520}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18293}, abstract = {Background: Intra-articular calcaneus fractures are commonly occured after high-energy trauma. Avariety of techniques exists for anatomic reduction and surgical fixation .The optimal management of displaced intra-articular calcaneus fractures is controversial and represents a topic of sustained interest and research for the past two decades .  Open reduction and internal fixation (ORIF) via an extensile L-shaped approach has gained many soft tissue complications.  These complications include deep and superficial infections and wound sloughs, which reportedly occur in 1.8% to 27% of patients. This high frequency of infection is likely attributed to thin soft-tissue envelope around the calcaneus especially the lateral wall, which is exposed for surgery .  Recently, less invasive surgical techniques for treating displaced intra-articular calcaneus fractures have been undertaken in an attempt to reduce complication rates and promising clinical and radiographic outcomes.These recent techniques include limited-incision sinus tarsi ORIF,percutaneous stabilization with pins and /or screws, and minimally invasive plate osteosynthesis (MIPO( Subjects:This study was conducted on 12 patients (10 males 83.3% & 2 females 16.7 %) with displaced intra-articular calcaneal fractures treated with less invasive techniques in the Orthopedics and Traumatology Department of  Zagazig University Hospitals from April 2017 to October 2017 with a follow up period of six months. . This study was done in Zagazig University Hospitals,Egypt on 12 patiens with displaced intraarticular calcaneal fractures including displaced Essex-Lopresti fractures, Sanders type II fractures, Sanders type III fractures in patients with multiple co morbidities. Results & Discussion Results Collected data will be presented in tables and suitable graphs and analyzed by computer software (SPSS version 19) using appropriate statistical methods. Discussion done on results compared to related relevant literatures and specific researches to explain the reasons for getting such results. Conclusion less invasive surgical techniques for treating displaced calcaneus fractures are very effective and smart procedurs to reduce complications and improve recovery when surgery is indicated.}, keywords = {Less invasive,Calcaneus,Fractures,fixation}, url = {https://zumj.journals.ekb.eg/article_18293.html}, eprint = {https://zumj.journals.ekb.eg/article_18293_96f46742c7aef9553f1672f90e5e12c5.pdf} } @article { author = {Mohamed Abdeen, Mohamed and Abdel Wahab Kelany, Omar and El Adawy, Amr and El Hewala, Tarek}, title = {LONG SEGMENT VERSUS SHORT SEGMENT FIXATION WITH INDEX LEVEL IN THORACOLUMBAR BURST FRACTURE}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {521-525}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18294}, abstract = {Background   The goal of this study is to compare the results of long segment fixation versus short segment fixation with index level. Methods   Fifty patients were enrolled in two groups twenty five patients each. First group was treated by long segment fixation. Second group was treated by short segment fixation with index level screw. Results This was found to be statistically significant comparing between long segment fixation group with short segment with index level group regarding mean intraoperative blood loss, mean operative time and mean incision length. At the final follow it was found that the mean LKA preoperatively, after 3months and 6 months postoperatively was statistically insignificant.  Conclusion The results of short segment fixation with index level are encouraging and comparable to those of long segment fixation regard correction of local kyphotic angle with less motion segments fixation in short segment group.}, keywords = {Thoracolumbar . Spine . Long segment fixation. Short segment fixation with index level}, url = {https://zumj.journals.ekb.eg/article_18294.html}, eprint = {https://zumj.journals.ekb.eg/article_18294_754cbddd9c8ecacf76e6ad3128178f46.pdf} } @article { author = {Almolla, Rania and Hassan, Hanan and Fawzi, Amr}, title = {MSCT IN NON-OPERATIVE MANAGEMENT OF HIGH GRADE BLUNT RENAL TRAUMA, A PROSPECTIVE STUDY}, journal = {Zagazig University Medical Journal}, volume = {24}, number = {6}, pages = {526-543}, year = {2018}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2018.18295}, abstract = {Aim: To highlight the validity of MSCT in predicting the efficacy of non-operative management in patients with high grade blunt renal trauma using American Association for the Surgery of Trauma (AAST) renal injury scale Patients and methods: Through a prospective study included 39 patients with high grades blunt renal traumas (grade III, IV and V), MSCT was done for all included cases and correlated to AAST grading system then we followed up non-operated cases by clinical, laboratory and US for all cases and CT in 12 cases along two weeks period. Statistical analysis was done for planed management immediately after CT and proper management done through two weeks of follow up. Results: MSCT graded the injury into grade III, IV and V according to AAST grading system presented in 48.7%, 33.3% and 17.9 % respectively. 74.4% of cases underwent conservative management, 5.1% underwent immediate surgical nephrectomy, 7.7 % underwent intervention embolization and double J fixation was done in 7.7%. Within 2 weeks of follow up conservative management was sufficient  in only 64.1% as some patients developed other predisposing factors demanded further interventions and a total percentage of 17.9% of our cases underwent surgical laparotomy (6 cases nephrectomy and one case renorrhaphy), surgical percutaneous drainage of urinoma in  one case and renal artery embolization raised to 10.3% of our cases. Conclusion: MSCT can determine the exact criteria for selecting patients for conservative management in hemodynamic stable patients. Non-operative management strategy in line with repeated imaging and close clinical follow up salvaged the affected kidney in most of the cases. }, keywords = {Renal trauma,MSCT,nephrectomy,AAST}, url = {https://zumj.journals.ekb.eg/article_18295.html}, eprint = {https://zumj.journals.ekb.eg/article_18295_9f4874e35f9167c55bc8dc781b3e9153.pdf} }