@article { author = {Y, El-Alfy and K, El-Kashishy and M, George and M, Abdel-Wahab}, title = {EXPRESSION OF GLYPICAN-3(GPC-3) AND 8-HYDROXYDEOXYGUANOSINE (8-OHDG) IN CHRONIC HEPATITIS C AND RELATIONSHIP WITH HEPATOCELLULAR CARCINOMA}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-12}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4441}, abstract = {Background: In Egypt, hepatocellular carcinoma (HCC) is the second most common cancer in men and the 6th most common cancer in women. Egypt has the highest prevalence of HCV in the world and the prevalence of HCC is increasing in the last years. Glypican-3 (GPC-3), a member of heparin sulfate proteoglycans, plays a role in cell growth, differentiation, and migration. 8-Hydroxydeoxyguanosine (8-OHdG) is an oxidatively modified promutagenic DNA that is produced by oxygen radicals and is recognized as a useful marker in estimating DNA damage induced by oxidative stress.The aim: This study was conducted to evaluate glypican-3 (GPC-3) and 8-hydroxydeoxyguanosine (8-OHdG) expression in chronic hepatitis C and hepatocellular carcinoma as predictive markers for hepatocellular carcinoma.Methods: 75 cases (50 cases of chronic hepatitis C and 25 of hepatocellular carcinoma) were examined immunohistochemically using antibodies against Glypican-3 (GPC-3) and 8-Hydroxydeoxyguanosine (8-OHdG).Results: Glypican-3 expression was observed in 18 % of cases of chronic hepatitis C, all positive cases were in the high grade, while none of low grade chronic hepatitis cases showed glypican-3 positivity. Glypican-3 expression was observed in 88% of cases of HCC. High 8-OHdG index was observed in 72.4% of cases of low grade chronic hepatitis and 95.2% of cases of high grade chronic hepatitis, while low index was observed in 27.6% of low grade chronic hepatitis and in 4.8% of cases of high grade chronic hepatitis. There was a statistically significant difference in 8-OHdG expression between low and high grade chronic hepatitis (P=0.05). There was no statistically significant difference in glypican-3 and 8-OHdG expression between different grades of HCC.Conclusion: Glypican-3 was expressed in 18% of cases of chronic hepatitis C, 35.1% of cirrhosis and 36.4% of cirrhosis adjacent to hepatocellular carcinoma. Our results suggest that GPC-3 may be considered as an early marker of liver carcinogenesis. 8-OHdG was observed in all cases of chronic hepatitis C, with high labeling index in 82% of cases and low index in 18% of cases. Our study showed high labeling index of 8-OHdG in 52% of cases of HCC. These results indicate that oxidative DNA damage is common in livers with chronic injury suggesting a possible link between chronic inflammation and hepatocarcinogenesis.}, keywords = {Glypican-3(GPC-3),8-Hydroxydeoxyguanosine (8-OHdG),Chronic hepatitis C,Hepatocellular carcinoma,Immunohistochemistry}, url = {https://zumj.journals.ekb.eg/article_4441.html}, eprint = {https://zumj.journals.ekb.eg/article_4441_98d5c751d0ede735c3a0fd08cc616bb0.pdf} } @article { author = {El Agrody, Ahmed and Khalil, Osama and Yousif, Monkez and Fawzi, Mohammed}, title = {INTERLEUKIN 28B GENE POLYMORPHISMS AS A PREDICTOR OF TREATMENT RESPONSE IN EGYPTIANS WITH CHRONIC HEPATITIS C.}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-8}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4442}, abstract = {Background: Egypt has the highest prevalence of HCV all over the world with 9% countrywide and up to 42% in certain rural areas. Combined PEG-IFN and ribavirin is still the only standard of care treatment in spite of its side effects, high costs and low sustained virological response rates. Hence, this provides a compelling reason for the identification of biomarker predictors of disease response to treatment.Aim of the work: This study is designed to identify IL28B gene polymorphisms in patients with chronic hepatitis C genotype 4 who received standard of care therapy to highlight its impact on response to treatment.Location of study: Viral Hepatitis Treatment Center at Al-Ahrar Hospital, Sharkia Governorate. and Biochemistry Departments of Faculty of Medicine, Zagazig University.Methods: Case control study on 124 patients with chronic hepatitis C who finished their treatment with standard of care therapy ( pegylated interferon and ribavirin). Sixty two patients were non responders to SOC therapy (case group) and 62 other patients were responders (control group). In addition to the chemical, laboratory data and histological parameters that were taken from their files, blood samples were taken at the time of study for detection of SNPs for rs8099917 by PCR-RFLP technique.Results: The TT homozygous of rs8099917 genotype was detected in 54 (43.54%) of overall HCV patients, 42 of them (67.74%) achieved SVR. The GT heterozygous was detected in 48 (38.71%) of HCV patients, SVR was achieved in 9 (14.52%) of them. While, the GG genotype was found in 22 patients and 11 of them only (17.74%) were responders. Multiple regression analysis identified IL28 B SNP genotype as the single independent predictor of response to SOC therapy.Conclusion: These data suggest that host genetics may be useful for the prediction of treatment outcomes and that IL28B SNP genotype is an important predictive biomarker for SVR in patients with HCV genotypes 4.}, keywords = {missed}, url = {https://zumj.journals.ekb.eg/article_4442.html}, eprint = {https://zumj.journals.ekb.eg/article_4442_9d26a0f3a946c2365d4a1cf9c900b330.pdf} } @article { author = {Ghobashi, Maha and Fouda, Mohamed and Khafagy, Ghada and Said, Randa}, title = {EFFECT OF SOCIAL MARKETING CAMPAIGN ON UTILIZATION OF PRIMARY HEALTH CARE CURATIVE SERVICES IN URBAN SECTOR OF SHARKIA GOVERNORATE}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-10}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4443}, abstract = {Background: Primary Health Care (PHC) services underutilization was the main finding all over Egypt including Sharkia Governorate and social marketing campaign was a successful method to promote the use of such services. Aim & Objectives: The aim of this work is to maximize the utilization of PHC curative services with the following objectives: (1) to design and implement a tailored social marketing campaign in an urban area in Sharkia Governorate. (2) to assess the effect of this campaign on the rate of utilization of PHC curative services in the same urban area in Sharkia Governorate. Subjects & Methods: An intervention study in the form of six months social marketing campaign that was conducted in El-Ebrahemia City, Sharkia Governorate to promote the utilization of El-Ebrahemia Family Health Center (FHC) curative services. This campaign included internal and external marketing seminars, dissemination of promotional materials with participation of EL-Ebrahemia health district, the mosques leaders and the volunteers in its implementation. The evaluation was done through comparing the service output indicators and the households surveys results before and after campaign using Paired t test and McNamar test. Results: The campaign was able to increase the utilization of the studied households of all curative services especially 1st aid service from 0% to 17.6%. This was also accompanied with corresponding increase in the service output indicators during and after the campaign. Conclusion: Social marketing was an effective intervention to promote the utilization of El-Ebrahemia FHC curative services. Based on the results, it is recommended that the use of social marketing activities is an essential step to mobilize the served community to utilize PHC services.}, keywords = {social marketing,utilization,Primary health care curative services,Pareto analysis}, url = {https://zumj.journals.ekb.eg/article_4443.html}, eprint = {https://zumj.journals.ekb.eg/article_4443_6f763bea841da61814958791b0afcd9e.pdf} } @article { author = {Naguib, Tarek and Elsherbeiny, Eslam and Elzayyat, Ahmad and Tantawy, Ayman}, title = {PREDICTORS OF DEPRESSED LEFT VENTRICULAR FUNCTION IN PATIENTS PRESENTING WITH ST-ELEVATION MYOCARDIAL INFARCTION}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-13}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4444}, abstract = {Background: Left ventricular dysfunction after ST segment elevation myocardial infarction (STEMI) is the most important factor affecting morbidity and mortality. The primary objective of reperfusion therapy is to restore epicardial flow and to reperfuse the myocardial tissue. However, in some cases lack of microvascular reperfusion and, consequently, significant left ventricular (LV) dysfunction persist despite the rapid and sustained restoration of blood flow. Early in the course of STEMI, therapies that may harm patients who develop LV dysfunction, such as beta-blockers, are often administered.Aim of the work: construct a predictive score of the risk of developing left ventricular dysfunction in patients with STEMI.Patient and methods: This study was done in Cardiology department, Zagazig University on 100 patients; 78 males (78%) & 22 females (22%) with first acute STEMI underwent successful primary percutaneous intervention (pPCI). Within 72 hours of admission, all of the following parameters were reported: risk factors, blood pressure, heart rate, KILLIP class, need for mechanical ventilation (MV), cardiac enzymes, admission blood sugar, kidney function, lipid profile, electrocardiographic data (ST elevation in millimeters (mm), location of infarction, ST resolution, QRS width in milliseconds (ms), Selvester score), echocardiography (ejection fraction by Simpson's method, wall motion score index) and angiographic data (culprit artery, Total number of diseased vessels, severity of coronary artery disease, Gensini score and door to balloon time).Results: LV dysfunction was associated with decreased renal function (creatinine >1.1 mg/dl, p= 0.029), number of diseased vessels >2 (p=0.034), absence of complete ST segment resolution (p< 0.001), wall motion score index > 2.05 (p=0.008), sum of ST segment elevation >13.5 mm (p<0.001), QRS width >98.5 ms (p<0.001), Selvester score >3.5 (p<0.001) Gensini score >95 (p<0.001), anterior location of infarction (p =0.002) and KILLIP class >1 (p=0.003). A prediction score using these variables stratified patients into low, intermediate and high-risk groups for LV dysfunction; positive likelihood ratios for LV dysfunction in these groups were 2.9, 2.1, and 2.4, respectively.Conclusions: 10 key predictors of in-hospital LV dysfunction after STEMI were identified; a risk score based on these predictors helps to quickly identify patients presenting with STEMI who are at the highest risk for developing significant LV dysfunction and could guide optimal therapeutic choices.}, keywords = {ST-elevation myocardial infarction,left ventricular dysfunction,predictors,Score,primary angioplasty}, url = {https://zumj.journals.ekb.eg/article_4444.html}, eprint = {https://zumj.journals.ekb.eg/article_4444_7eb06b236e0005d0a19c0f40c44fc8b2.pdf} } @article { author = {Kenawy, Saeid and Sarhan, Taha and Nada, Waleed and Saad, Ahmed}, title = {COMPARISON BETWEEN ACRYSOF TORIC IOLS AND LIMBAL RELAXING INCISIONS FOR MANAGEMENT OF PREOPERATIVE ASTIGMATISM IN CATARACT PATIENTS}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-8}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4445}, abstract = {Purpose : The aim of this work is to compare toric intraocular lens (IOL) implantation, and limbal relaxing incisions to treat astigmatism during phacoemulsification.Design: Prospective randomised comparative study.Methods: 60 eyes of 60 patients were devided into 2 equal groups. 30 eyes were offered phacoemulsification with toric IOL implantation and 30 were implanted spherical IOLs with limbal relaxing incisions. Postoperative astigmatism and UCVA were measured and compared during week 1 and month 1 and after 3 months.Results: The mean preoperative BCVA was 0.1 ± 0.15 in toric subgroup, 0.15 ± 0.15 in LRI subgroup. The mean preoperative astigmatism was -2.4 +/-0.7 & -2.7+/- 0.7 respectively. At the first week: The mean postoperative UCVA at one week was 0.72 ± 0.12, 0.61 ± 0.09, in each group respectively. The mean postoperative astigmatism in the first week was -0.5 +/-0.3 & -1.27+/- 0.5 respectively. The mean postoperative UCVA at 1 month was 0.89 ± 0.14, 0.58 ± 0.1. The mean postoperative astigmatism was -0.55+/-0.35& -1.37+/- 0.5 respectively. In the 3 months follow up visit the mean for the postoperative UCVA was 0.9±0.13 and 0.59±0.16 for each subgroup respectively. The mean postoperative astigmatism was -1.25+/-0.25& -1.6+/- 0.5 respectively. There was a highly significant statistical difference between the result of UCVA preoperative and the results of UCVA at the early and last postoperative follow up. The average change of corneal astigmatism in the LRI group 1.1+/-0.6 Dioptres at three months.Conclusion: From our results, it is evident that LRIs are safe, predictable, and effective method for treating pre-existing astigmatism in cataract surgery. However, regression may occur after surgery. Toric IOL implantation has recently become available as a means of treating astigmatism. Toric IOL implantation was proven to be very effective, stable and safe}, keywords = {}, url = {https://zumj.journals.ekb.eg/article_4445.html}, eprint = {https://zumj.journals.ekb.eg/article_4445_e0af8aae3a3ff2210f0ec8beb0983e72.pdf} } @article { author = {Salwa, Ibrahim and A, El-Bialy and Mohamed, Mervat and El-Sheikh, Azza and A, Elhewala}, title = {COMPARATIVE STUDY OF ROTAVIRUS DETECTION}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-9}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4446}, abstract = {Background & objectives: Rotavirus is the major cause of acute gastroenteritis (AGE) in infant and young children all over the world. The objective of the study was to compare different methods for rotavirus detectionMethods: This study included 65 children with AGE and 35 healthy control. Stool samples were obtained and assayed for rotavirus by immunochromatography test (ICT), enzyme linked immunosorbent assay (ELISA) and quantitative real time RT-PCR (qr RT-PCR).Results: 50(76.9%) out of the 65 patients were positive by qrRT-PCR followed by 45(69.2%) by ICT and 44(67.7%) by ELISA. In addition there was statistically significant association between the severity of the disease as determined by the Vesikari score and rotavirus infection.Conclusion and recommendation: This study highlights the substantial health burden of rotavirus AGE among children less than 5 years of age. These data should help pediatricians and policy makers assess the potential benefits of introducing a rotavirus vaccine.}, keywords = {Rotavirus- Acute gastroenteritis (AGE)- Vesikari score- Quantitative real time RT-PCR (qr RT-PCR)}, url = {https://zumj.journals.ekb.eg/article_4446.html}, eprint = {https://zumj.journals.ekb.eg/article_4446_d132ea91c31020a13bf894896d347b3b.pdf} } @article { author = {Khalil, Amr and Resnick, Donald and Zeid, Ayman and Zaiton, Fatma}, title = {THE ROLE OF MAGNETIC RESONANCE MUSCULOSKELETAL IMAGING IN EVALUATION OF SPORTS INJURIES OF THE KNEE JOINT}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-10}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4447}, abstract = {Aim: to evaluate the role of magnetic resonance imaging in the assessment of sport injuries of the knee joint as an integral part of the musculoskeletal system.Methods: This study was done as a combined study between the Radiology Department of Zagazig University and the Radiology Department of University of California San Diego. It was conducted on 50 patients who were referred to the Radiology Department of the University of California San Diego. The patients were examined after sustaining different sports injuries of the knee joint. All the 50 patients were subjected to full history taking and Magnetic Resonance Imaging on the knee joint. The Magnetic Resonance Imaging results of 33 of these patients were compared with the results of knee arthroscopy.Results: The study included 50 patients complaining of sports related knee pain. The age of the patients ranged from 15 to 55 years with a mean age of 29.68 years. Most of the patients were males (38 patients), while 12 patients were females. The leading sports for knee injuries in this study were soccer, American football and running. The most common knee lesions were anterior cruciate ligament lesions (19 patients) and meniscal lesions (18 patients). In comparison with knee arthroscopy, magnetic resonance imaging revealed an overall 93.9 % sensitivity and 66.6 % specificity.Conclusion: Although arthroscopy has been considered the gold standard in knee sports injuries evaluation, MRI remains a reliable non-invasive modality that can reduce the use of diagnostic arthroscopy for evaluation of ligamentous, meniscal, bony and cartilaginous lesions.}, keywords = {Magnetic Resonance Imaging,knee,sports injuries,musculoskeletal,Anterior cruciate ligament,meniscus,ligaments,tendons}, url = {https://zumj.journals.ekb.eg/article_4447.html}, eprint = {https://zumj.journals.ekb.eg/article_4447_911b08a4307b051ce3a8642403274ebf.pdf} } @article { author = {Tharwat, Marwa and El Ashtokhy, Mamdouh and Mahfouz, Ragab and Ibrahim, Amal}, title = {ANGIOGRAPHIC STUDY OF ANATOMICAL VARIATIONS OF CORONARY ARTERIES BY USING DIAGNOSTIC CATHETER}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-9}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4448}, abstract = {Introduction:The coronary arteries may present several anomalies, in terms of both number and position. New image-based diagnostic techniques have led to greater reliability in the identification of these anomalies.Aim of the work:this work is done to study the angiographic pattern of normal coronary arteries variations by using the diagnostic catheter.Material and Methods: Any patient enlisted for angiography in catheterization lab in Zagazig University Hospital was enrolled in this study.Results: Data of 4246 patients who underwent coronary angiography were analysed. 115 patients who had anomalous of coronary arteries were entered into final data analysis.The following data could be concluded: The overall incidence of primary congenital coronary anomalies was 2.7% (115 out of 4,246 patients) in our angiographic population, of whom 86 were males (74.7%) and 29 were females (25.3%). The mean age was (45.95 ± 11.65) years. Anomalous LCX was the most common coronary anomaly being present in 35 patients (0.82%) . The second most common anomaly was myocardial bridge and it was present in 31 patients (0.73%). Anomalous RCA was present in eighteen patients (15.65%). Left main coronary artery was absent in two cases (1.7%) and it has anomalous origin from right coronary sinus (RCS) in another two cases (1.7%). On the other hand, anomalous LAD was present in 8 patients (6.95 %). Coronary aneurysms were observed in 10 cases (7.82%). On the other hand, coronary fistulas were diagnosed in nine cases (8.7%). The incidence of coronary anomalies among cases with coronary artery detected disease was 72.2% (83 cases) while this incidence among those without angiographically detected coronary artery disease was 27.8% (32 cases). Hence, the frequency of coronary artery anomaly was significantly higher among patients with CAD than those without CAD ( P < 0.0001). Conclusion:Coronary artery anomaly is a common anomaly between the populations. It could be the only cause of chest pain without significant coronary lesion.}, keywords = {missed}, url = {https://zumj.journals.ekb.eg/article_4448.html}, eprint = {https://zumj.journals.ekb.eg/article_4448_d7997feff2f7ec77779fbcd6e794cfc0.pdf} } @article { author = {}, title = {MULTISLICE COMPUTED TOMOGRAPHY EVALUATION OF PULMONARY HYPERTENSION SECONDARY TO LUNG DISEASES}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-9}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4449}, abstract = {Aim: to evaluate the role of multislice computed tomography in diagnosis of pulmonary hypertension secondary to lung diseases.Patients and Methods: This study was done during the period from March 2014 to August 2014. Patients were subjected to radiological examinations including plain X-ray, echocardiography and multislice computed tomography (MSCT)Results: 30 patients 18 male and 12 female with age ranged from 30 to 72 years. The size of the main pulmonary artery (PA) was the first radiological sign to be assessed. The main PA diameter to be measured at point of bifurcation at right angle to its long axis and just lateral to the ascending aorta. Among our 30 cases, 27 patients have a ratio between the main pulmonary artery size and the ascending aorta size (PA / AO ratio) more than (1: 1).Conclusion: MSCT has a main role in evaluation of pulmonary hypertension secondary to lung diseases.}, keywords = {MSCT,pulmonary, hypertension}, url = {https://zumj.journals.ekb.eg/article_4449.html}, eprint = {https://zumj.journals.ekb.eg/article_4449_06c2dc22074bfe58ae1ac72dee1f72dc.pdf} } @article { author = {}, title = {UTILITY OF THREE DIMENSIONAL MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN EVALUATION OF BILIARY OBSTRUCTION IN ADULTS}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-8}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4450}, abstract = {Aim: To assess the diagnostic value of 3D MRCP in evaluation of cases with biliary obstruction.Patients and Methods: 20 patients with clinical suspicion of biliary obstruction were encountered in the study and subjected to imaging assessment including MRI of the abdomen and 3D MRCP.Results: Our results showed that the commonly affected age group was the group between 28: 38 years old, males were affected more than females, The most common age group in males was 38 : 47 years, while the most common age group in females was 29 : 40 years. The most common clinical findings in our patients was jaundice and biliary colic. Increased total and direct bilirubin was the main laboratory findings in our study. According to the cause of biliary obstruction, 4 patients had benign biliary obstruction (20%), 5 patients had malignant biliary obstruction (25%), 5 patients had calcular obstruction (25 %), and 6 patients had post-cholecystectomy biliary complications (30%).Conclusion: 3D MRCP has a main role in evaluation of biliary obstruction and should follow US diagnosed biliary obstruction, replacing the diagnostic role of ERCP and staging role of CT in malignant biliary obstruction.}, keywords = {3D MRCP,Biliary obstruction}, url = {https://zumj.journals.ekb.eg/article_4450.html}, eprint = {https://zumj.journals.ekb.eg/article_4450_ab5042c2895c9104d93ee8526f0c47b1.pdf} } @article { author = {El Saady, Mostafa and Metwally, Khaled and Hefny, Mohamed and El Hady, Waleed}, title = {EVALUATION OF POST OPERATIVE PERITONEAL LAVAGE TO PREVENT RECURRENT ADHESIVE INTESTINAL OBSTRUCTION}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-7}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4451}, abstract = {Objective: to evaluate the effectiveness of postoperative peritoneal lavage (PPL) in prevention of recurrent Adhesive Small Bowel Obstruction (ASBO).Patients and methods: a total of 36 patients were included in this study. All of these patients suffered from ASBO. They were randomized into two groups. Group I (18 patients) were treated with adhesiolysis followed by PPL and group II (18 patients) were treated with adhesiolysis alone . Patients were followed up for an average period of 15 months to detect the incidence of recurrent ASBO. Results: :In group1 only one (5.6%) patient had an attack of ASBO which responded to conservative management and did not need redo operation while in group II seven (38.9%) patients developed a recurrent episode of ASBO four of them(22.2%)needed surgical re exploration. So the rate of surgical reoperation in group 1 was zero in comparison to group 2 which was( 16.6%). Conclusion: PPL is a new hope for prevention of recurrent ASBO that achieved statistically significant reduction in the recurrence rate and surgical redo.}, keywords = {missed}, url = {https://zumj.journals.ekb.eg/article_4451.html}, eprint = {https://zumj.journals.ekb.eg/article_4451_94b59c5ecf723d5f755555cf7920a6c8.pdf} } @article { author = {Elmaghawry, Mohammed and Mobasher, Mohammed and Abd-Elfattah, Magdy and Tantawy, Ahmed and Ali, Atef and Anany, Ahmed}, title = {RECONSTRUCTION OF POSTERIOR MEATAL AND/OR LATERAL ATTIC WALLS IN CHOLESTEATOMA SURGERY}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-8}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4452}, abstract = {Purpose: To evaluate reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterior canal wall and bone pâté during the first stage operation.Patients and methods: Twenty ears of twenty patients with chronic suppurative otitis media with cholesteatoma. Cases with extensive destruction of posterior canal wall and mastoid cortex, low tegmen, significant anterior or lateral sigmoid sinus, only functioning ear, labyrinthine fistula and previous canal wall down mastoidectomy were excluded. The surgical technique includes cortical mastoidectomy and bone pâté collection,temporary removal of the bony posterosuperior meatal wall(PMW) by cutting the entire PMW as one piece with a microsagittal saw to offer optimal exposure of tympanic cavity,attic and retrotympanum for complete eradication of cholesteatoma and then repositioning of this wall in its anatomical site supported with bone pâté in attic and mastoid.The condition of reconstructed PMW and the status of middle ear were evaluated by computed tomography scan, otoendoscopic examination and staged second–look surgery.Results:Cholesteatoma in the mastoid, antrum , attic and retrotympanum could be removed with safety in all cases; no serous intraoperative complications occurred, intraoperative difficulties included: damage of posterosuperior canal wall during saw cutting in one case(5%) and mild dural injury during superior cutting in one case(5%) , through follow–up , the new reconstructed canal appeared to be of near normal size, shape and contour, and no dislocation or necrosis of the reconstructed posterior canal wall was noted. The postoperative complications included: wound infection in one case (5%) , tinnitus in two cases (10%) and recurrent cholestearoma in one case(5%).Conclusion: Our surgical technique which includes reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterosuperior meatal wall after its temporary removal provides optimal surgical exposure during the procedure, restores near normal anatomy of the external auditory canal , has low recurrence rate(5%) and avoids the troubles of open mastoid cavity, making this surgical procedure an attractive alternative to the standard CWU and CWD procedures.}, keywords = {cholesteatoma,Canal wall down mastoidectomy,Canal wall up mastoidectomy,Posterior canal wall reconstruction,open cavity}, url = {https://zumj.journals.ekb.eg/article_4452.html}, eprint = {https://zumj.journals.ekb.eg/article_4452_8949e0e0ab6801b558316c4b17a89880.pdf} } @article { author = {mahfouz, Ragab and Abdelsemei, Magdy and Moustafa, Tamer and Mohammed, Elsayed}, title = {UTILITY OF NON-INVASIVE CORONARY FLOW PATTERN VERSUS FRACTIONAL FLOW PRESSURE DROP FOR LEFT ANTERIOR CORONARY ARTERY STENTING}, journal = {Zagazig University Medical Journal}, volume = {20}, number = {6}, pages = {1-9}, year = {2017}, publisher = {Zagazig University, Faculty of Medicine}, issn = {1110-1431}, eissn = {2357-0717}, doi = {10.21608/zumj.2017.4453}, abstract = {Background and Aim: To assess the usefulness of coronary flow reserve as a guide in patient with left anterior descending coronary artery lesion during percutaneous coronary intervention in comparison with fractional flow reserve.Methods: The study included 80 patients with left anterior descending artery stenotic lesions, proved by coronary angiography, in the cardiac catheterization laboratory of the Faculty of Military Hospital, during the period from November 2012 to June 2014. All patients were subjected to all of the following: Complete history taking, full general and local examination, ECG analysis. All our patient were assessed by Doppler wire to measure pressure drop at LAD lesion and also by non-invasive coronary flow pattern utilizing transthoracic echo-Doppler study. Then we compare the results of both values on the basis of the improvement in left ventricular ejection fraction( by biplane Simpson rule) to find the cut point at which we can document that this LAD lesion deserve stenting .Results: FFR was negatively correlated with significant correlation with EF improvement with R value of -0.575 and P-value of 0.008,figure. Also there is strong inversed relation with lesion percent with R-value of-0.468 and P-value of 0.01. The correlation between FFR and improvement in wall motion score was significantly inversed with R-value of -0.519 and P-value of 0.03. Also there was strong correlation between FFR and CFR ,P-value was 0.00 and R-value was+0.436.CFR has strong reciprocal correlation with FFR (P-value was 0.00 and R-value was. inve+0.436. There is significant correlation of CFR with EF improvement with R value of -0.583and P-value of 0.002. Also there is significant correlation of CFR with lesion percent with R-value of -0.585and P-value of 0.001, figure. The correlation between CFR and wall motion score was significant with R-value of-0.393 and P-value of 0.03.The optimal cutoff values for coronary flow reserve of <1.75 was the best value for indication of stenting of an intermediate coronary lesion. A sensitivity of 92% and a specificity of 87%. On the other hand the best cut-of value of fractional flow reserve was <0.75 for indication of stenting for an intermediate coronary artery lesion with a sensitivity of 94% and specificity of 86%.Conclusions: The current study showed Coronary flow reserve measurements by TTE in the distal to mid LAD were feasible in most patients with an optimal cut-off value < 1.75 showed high accuracy to detect angiographically significant stenoses in the LAD. This is comparable to <0.75 as an optimal cut-off value of FFR to detect angiographically significant stenoses. CFR measurement utilizing TTE might be considered as a simple non-invasive tool for functional status of an intermediate coronary artery lesion for stenting.}, keywords = {LAD (left anterior descending artery ),coronary flow reserve,fractional flow reserve}, url = {https://zumj.journals.ekb.eg/article_4453.html}, eprint = {https://zumj.journals.ekb.eg/article_4453_2d93135d7002000e8cedd1d3d568e28a.pdf} }