eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4389
4389
Original Article
A COMPARISON BETWEEN THREE DOSES OF BOLUS AND CONTINUOUS INFUSION OF EPIDURAL NEOSTIGMINE VERSUS FENTANYL AS ADJUVANT ANALGESICS IN ADULTS
Zeinab Sewan
1
Yasser El-Naggar
2
Islam Eleiwa
3
Al-Shaimaa Mohammed
4
Anesthesia and Intensive Care Department, Faculty of Medicine, Zagazig University
Anesthesia and Intensive Care Department, Faculty of Medicine, Zagazig University
Anesthesia and Intensive Care Department, Faculty of Medicine, Zagazig University
Anesthesia and Intensive Care Department, Faculty of Medicine, Zagazig University
Background: The cholinergic system has attracted new interest as a pharmacological target to accomplish effective analgesia without the limitations of opioid-induced side effects. Objective: the purpose of this prospective study was a comparison between three doses of bolus and continuous infusion of epidural neostigmine versus fentanyl as an adjuvant analgesic in adults. Patients and methods: In a prospective study of 160 adult patients undergoing lower half of the body surgeries using epidural anesthesia at Zagazig University Hospitals form May 2010 to May 2013 for comparing three doses of bolus and continuous infusion of epidural neostigmine versus fentanyl as an adjuvant analgesic. Result(s): The highest neostigmine dose used in this study 200 μg bolus or 125 μg/hour infusion showed significant better pain relief parameters than lower doses regarding duration of analgesia, postoperative VAS, number of diclophenac ampoules consumed in first postoperative 24 hours and patient satisfaction score with no significant different side effects. Neostigmine showed significant lower nausea/vomiting and no pruritis with no significant difference postoperative VAS,total number of diclophenac ampoules consumed in first postoperative 24 hours and patient satisfaction score in comparison to fentanyl but fentanyl showed significant longer duration of analgesia. Conclusion(s): The highest does of neostigmine either bolus or continuous infusion is better than lower doses and fentanyl showed longer duration of analgesia with more side effects than neostigmine doses with similar postoperative VAS, number of diclophenac ampoules consumption in first postoperative 24 hours and patient satisfaction score as highest dose neostigmine either infusion or bolus.
https://zumj.journals.ekb.eg/article_4389_7b72e90f9baf975016ea2cf265d05ef1.pdf
epidural anesthesia
Bupivacaine
Neostigmine
Fentanyl
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
8
10.21608/zumj.2014.4390
4390
Original Article
A COMPARATIVE STUDY BETWEEN I-GEL VERSUS CUFFED ENDOTRACHEAL TUBE IN LAPAROSCOPIC SURGERIES IN ADULT PATIENTS
Samia Massoud
1
Dalal Soud
2
Khaled Helmy
3
Mohamed Elsayed
4
Department of Anesthesia and Surgical Intensive Care,Faculty of Medicine, Zagazig University
Department of Anesthesia and Surgical Intensive Care,Faculty of Medicine, Zagazig University
Department of Anesthesia and Surgical Intensive Care,Faculty of Medicine, Zagazig University
Department of Anesthesia and Surgical Intensive Care ,Faculty of Medicine, Zagazig University
Background: Invention of the endotracheal tube made administration of anesthesia easy. However, laryngoscopic stimulation of oropharyngolaryngeal structures is associated with hemodynamic stress response. Recently, the I-gel has been invented. It is a new 2nd generation supraglottic airway device with a non-inflatable cuff which has several potential advantages including: easier insertion, minimal risk of tissue compression and stability after insertion. Objective: The aim of this study was to compare the I-gel to the cuffed endotracheal tube in laparoscopic surgeries in adult patients. Patients and Methods: A prospective randomized controlled clinical trial among 80 patients who underwent laparoscopic procedures. They were equally divided into two groups: I-gel and cuffed endotracheal tube (ETT) groups. Both the devices were compared as regards insertion characteristics, hemodynamic stability, gas exchange parameters, peak airway pressure changes and the incidence of postoperative complications. Results: No significant statistical difference between the two groups was found regarding heart rate, O2 saturation, end tidal CO2 and peak airway pressure changes. Regarding mean arterial blood pressure, it was more stable after insertion in the I-gel group (P=0.019). There was also significant difference in the insertion time (P=0.0029) and number of insertion attempts (P=0.04) between the two groups. Regarding ease of insertion of gastric tube, it was easier to be inserted in the ETT group (P=0.0001). The postoperative complications were higher in the ETT group; for dysphagia (P=0.0002), dysphonia (P=0.0007), nausea (P=0.0019), vomiting (P=0.00017). However, there was no difference in the presence of blood on the device (P=0.396). Conclusion: I-gel is a safe airway device during the laparoscopic procedures. It was better than the cuffed ETT regarding hemodynamic stability changes after insertion without affecting gas exchange parameters. Although the complications were higher in the ETT group but the gastric tube insertion was more difficult in the I-gel group.
https://zumj.journals.ekb.eg/article_4390_c8a620fee3e681c61b3dd96edaa00071.pdf
Airway management
I-gel
Laparoscpic surgeries
Endotracheal tube
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
9
10.21608/zumj.2014.4391
4391
Original Article
A COMPARISON BETWEEN THE EFFECT OF ADDING DEXMEDETOMIDINE AND MIDAZOLAM TO INTRATHECAL BUPIVACAINE ON THE QUALITY OF SPINAL BLOCK FOR ORTHOPEDIC SURGERY.
Mahmoud Al-Arnous
1
Abd El-Mohsen Aly
2
Akmal Abdo
3
Mahamed El Said
4
Anesthesia and Intensive Care Department1, Zagazig University, Faculty of Me
Anesthesia and Intensive Care Department1, Zagazig University, Faculty of Medicin
Anesthesia and Intensive Care Department1, Zagazig University, Faculty of Medicine
Anesthesia and Intensive Care Department1, Zagazig University, Faculty of Medicine
Back ground: In spinal anesthesia various additive drugs have been tried with 0.5%hyper baric bupivacaine to look for the improvement in the quality and the duration of blockade like midazolam & 2-agonists. We designed a prospective, randomized, double blind study to compare the efficacy of midazolam and dexmedetomidine with 0.5% hyperbaric bupivacaine when given intrathecally in terms of effect and maximum level of sensory and motor blockade, overall duration and quality of analgesia, hemodynamic effects during intraoperative periods and any side effects.Aim of the study: A comparison between the effect of adding dexmedetomidine and midazolam as adjuvant to intrathecal Bupivicaine on the quality of spinal block for orthopedic surgeryPatients and Methods: Sixty six of American Society of Anesthesiologists physical status classes I and II patients scheduled for lower limb orthopedic surgery were enrolled in this study. According to the received intrathecal drug mixture, these patients were randomly divided into 3 equal groups (22 in each group). Group I (control group) received 2.5 ml heavy bupivacaine (0.5%) plus 0.5 ml normal saline intrathecally. Group II (dexamedetomedine group) received 2.5 ml heavy bupivacaine (0.5%) plus 5 μg dexamedetomedine in 0.5 ml normal saline intrathecally. Group III (midazolam group) received 2.5 ml heavy bupivacaine (0.5%) plus 2 mg midazolam in 0.5 ml normal saline intrathecally.Results: Patients in group II (Dexmedetomidine group) had a significantly longer sensory and motor block time than patients in group III (Midazolam group). The time of sensory block regression to S1 in group II (248.8±32.4 min) was significantly longer than the time in and in group III (208.3±21.7 min) (P=0.000). The time of motor block regression to reach Bromage score 0 in group II (235.6±32.4 min) was significantly longer than the time in group III (191.4±14.8 min) (P=0.000).Conclusions: Although both dexmedetomidine (5μg) and midazolam (2mg), when added to intrathecal heavy bupivacaine lead to prolongation of the motor and sensory block with hemodynamic stability and lack of sedation but dexmedetomidine was superior to midazolam in prolongation of the motor and sensory block.
https://zumj.journals.ekb.eg/article_4391_97c6fb145d201454061e91e789dc08cd.pdf
missed
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4392
4392
Original Article
LAPAROSCOPIC CHOLECYSTECTOMY UNDER THORACIC EPIDURAL ANESTHESIA IN COMPARISON WITH GENERAL ANESTHESIA
Lobna El Durgham
1
Osama Ahmad
2
Marwa Zakzouk
3
Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University
Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University
Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University
Background: Regional anesthesia for laparoscopic cholecystectomy (LC) is considered to have some advantages compared with general anesthesia. Patients can be awake and oriented at the end of the surgery and have less postoperative pain, nausea and vomiting. Problems related to general anesthesia such as oral and teeth injury during laryngoscopy, and a sore throat and stomach inflation as a result of mask ventilation might be avoided in a regional anesthetic setting.Objective: the aim of the study is to compare between thoracic epidural anesthesia (TEA) and general anesthesia (GA) for LC regarding intraoperative hemodynamics, postoperative analgesia and cost.Patients and methods: 116 patients undergoing elective laparoscopic cholecystectomy surgery in general surgery department in Zagazig University hospitals were randomly divided into two groups. Group A received GA with 1-2 μg/kg fentanyl, 2 mg/kg propofol, 0.5 mg/kg cis-tracrium and isoflurane 2 MAC. Group B received 15 ml bupivacaine 0.5% with 70-100 μg fentanyl in thoracic epidural catheter inserted at T 10-11 interspace. Both groups were given 30 ml bupivacaine 0.375% intraperitoneal infradiaphragmatic after insertion of the trocar and insufflations of the peritoneal cavity before starting surgery.Results: TEA proved to be having lower incidence of postoperative shoulder pain, postoperative nausea and vomiting (PONV) and lower cost than GA and a higher incidence of patient and surgeon satisfaction, hypotension and bradycardia.Conclusion: TEA may be a good alternative to GA for LC.
https://zumj.journals.ekb.eg/article_4392_6e850653b91b27cba8caa4116f50aae0.pdf
thoracic epidural anesthesia
Laparoscopic cholecystectomy
Bupivacaine
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
5
10.21608/zumj.2014.4393
4393
Original Article
INTRASTROMAL CORNEAL KERARING SEGMENTS FOR KERATOCONUS
Aly Bayoumy
1
Adel Farag
2
Medhat Shawky
3
Mohamed Abdel Hamid,
4
Ophthalmology department of Zagazig University Hospital.
Ophthalmology department of Zagazig University Hospital.
Ophthalmology department of Zagazig University Hospital.
Ophthalmology department of Zagazig University Hospital.
AIM: To assess the outcome of intrastromal corneal ring segments (Kera ring) for keratoconus.Study design: Retrospective noncomparative interventional case series.Patients and Methods: Sixty keratoconus eyes of 48 patients that had intrastromal corneal ring segments (Kera ring) implantation mechanically were reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), central corneal curvature, corneal astigmatism, and complications were analyzed.Results: At a mean follow-up period of 6 months, the UCVA improved in 90% of eyes, was unchanged in 10%, and none worsened. The BSCVA improved in 94% of eyes, was unchanged in 6%, and none worsened. The mean spherical equivalent (SE) was reduced from 7.42 ± 2.5 diopters (D) to 3.06 ± 2.33 D. and the mean refractive astigmatism, from 4.52 ± 1.61 D to 2.61 ± 1.69 D. The mean central corneal curvature was reduced from 51.45 ± 3.04 D to 47.37 ± 2.58 D. Intracorneal ring segment decentration occurred in 2 eyes (3.3%), segment extrusion in 10 eyes (16.7%), bacterial keratitis in 1 eye (1.7%) with segment extrusion, and a disciform keratitis in 1 eye (1.7%).Conclusion: Implantation of Kera ring segments in patients with keratoconus was a safe, effective and reversible procedure that led to stable results, on the short term of six months. Further clinical and experimental studies with more patients and longer follow-up are needed.
https://zumj.journals.ekb.eg/article_4393_4c462d5bbf9a33548fa330773eeaa961.pdf
( keratoconus – Keraring )
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4394
4394
Original Article
EVALUATION OF THE ROLE OF MUTANT IDH1, EGFR AND BCL2 PROTEIN EXPRESSION IN DISTINGUISHING DIFFUSE ASTROCYTOMA FROM ASTROCYTOSIS
Fouad EM
1
Saba I.
2
Rashed M.E. E.
3
Abdelwahab M.
4
Pathology department, Faculty of Medicine, Zagazig University
Pathology department, Faculty of Medicine, Zagazig University
Pathology department, Faculty of Medicine, Zagazig University
Pathology department, Faculty of Medicine, Zagazig University
Background: Gliomas are the most relevant primary brain tumors. Diffuse astrocytomas are the most common type of gliomas .The distinction of diffuse infiltrating astrocytoma from reactive astrocytosis is one of the most difficult differential diagnosis especially with small biopsies (e.g. stereotactic biopsies). Several markers were used for this differentiation such as glial fibrillary acidic protein, ki67 and p53; but each of them has problems with sensitivity and specificity. The immunohistochemical markers such as mutant isocitrate dehydrogenase 1 (IDH1), EGFR and Bcl2 may be useful in this differentiation.Aim: This study was conducted to clarify the value of IDH1, EGFR and Bcl2 protein expression in making a clear distinction between diffuse infiltrating astrocytomas and morphologically similar reactive astrocytosis.Methods: Fifty representative cases; 30 cases WHO grade II diffuse astrocytomas and 20 cases of reactive conditions were examined immunohistochemically using antibodies against mutant IDH1, EGFR and Bcl2.Results: IDH1 was positive in 60% of astrocytomas cases but it was totally absent in reactive astrocytosis. EGFR was expressed in 50% of astrocytomas; but it was not expressed in reactive astrocytosis. Bcl2 expression was detected in 56.7% of astrocytomas cases. However; it was expressed also in 75% of reactive astrocytosis cases.Conclusion: IDH1, EGFR were the most useful IHC markers in the discrimination of low grade diffuse astrocytomas WHO II from reactive astrocytosis; particularly in small biopsies. Bcl2 play no role in this differentiation
https://zumj.journals.ekb.eg/article_4394_f714a5d4f139232f52fa0fde2e1bbcf6.pdf
astrocytoma
Astrocytosis
IDH1
eGFR
Bcl2
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
7
10.21608/zumj.2014.4395
4395
Original Article
DETECTION OF MALIGNANCY IN SOLITARY THYROID NODULE.
Ibrahim Mustafa
1
Mohamed Abood
2
Abd El Rahman Sadiq
3
Eman El Tokhy
4
General Surgery department,Faculty of Medicine, Zagazig University
General Surgery department,Faculty of Medicine, Zagazig University
General Surgery department,Faculty of Medicine, Zagazig University
Background: The presence of a solitary thyroid nodule is a risk factor for malignancy. The major challenge in management of the solitary thyroid nodule remains the assessment to which nodules require surgical excision and which can be followed conservatively. The fine needle aspiration cytology (FNAC) is one of the most important advances in the management of the thyroid nodules ,it has an accuracy rate greater than 90%. Objective: to assess the predictive value of conventional clinical examination, laboratory investigation and cytology (fine needle aspiration cytology (FNAC) and histopathology) in the diagnosis of malignancy in the solitary thyroid nodule and its impact on the development of a surgical policy for proper management.Patients and methods:a total of 100 patients with solitary thyroid nodules were thoroughly examined clinically after taking detail history and FNAC; all the patients were subjected to surgery after preoperative preparation and anesthesia checkup. Thyroidectomy specimen was evaluated by histopathologicalexamination .Exclusion criteria: multinoduler goiter, hypo and hyperthyroidism, patients refuse FNAC , other investigation and patients unfit for surgery .Statistical analysis: SPSS version 11. Results:In the present study both FNAC and histopathology was done in 100 patients of solitary thyroid nodule. Out of 100 cases, 86 cases were benign and 14 cases were malignant on histopathology. On cytology 84 cases were benign, 11 cases were malignant, and five cases were suspicious smear , two of them were (follicular adenoma) false positive case. Sensitivity was 100% , specificity was 97.6%, accuracy was 98%,positive predictive value was 87.5% and negative predictive value was 100%.Conclusion: Significant proportion of solitary thyroid nodule (14%) was malignant. So, careful assessment of thyroid nodule is important for early diagnosis. All cases with solitary thyroid nodules should have FNAC as pre-operative diagnostic method to reduce the number of patients referred for surgery.
https://zumj.journals.ekb.eg/article_4395_a6604d5bf0c1266c68cc59e56640ff74.pdf
Solitary thyroid nodule.FNAC
histopathology
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
3
10.21608/zumj.2014.4396
4396
Original Article
INCISIONAL HERNIA AFTER APPENDECTOMY: A CASE REPORT
Sakher Maayeh
1
Sadeq Da’meh
2
Diana RN
3
Asma Alhuniti
4
Abdelkhaleg Shboul
5
Sokinah Ammro
6
General surgery, (Queen Aliaa Hospital)
Anesthesia and intensive care, (Queen Aliaa Hospital)
Nursing department, (Queen Aliaa Hospital)
Nursing department, (Queen Aliaa Hospital)
Nursing department, (Queen Aliaa Hospital)
Nursing department, (Queen Aliaa Hospital)
Appendectomy is one of the most frequent of all surgical interventions. Thought it is technically considered as minor, its complication varies from infected wound, intra-abdominal abscess, paralytic ileus and incisional hernia.Our case presents the complication of post-appendectomy incisional hernia containing small bowel segment.
https://zumj.journals.ekb.eg/article_4396_8bf548c792e84011cd46412faad4df33.pdf
incisional hernia
Appendectomy
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
8
10.21608/zumj.2014.4397
4397
Original Article
LAPAROSCOPIC ASSISTED ANORECTOPLASTY: A NEW DEFINITIVE REPAIR OF HIGH IMPERFORATE ANUS
Tarek Gobran
1
Ameen Saleh
2
Omar ElEkiabi
3
Unit of Pediatric Surgery, Zagazig University
Unit of Pediatric Surgery, Zagazig University
Unit of Pediatric Surgery, Zagazig University
Background/ Purpose : The classic treatment of the the high anorectal anomalies over the last 3 decade is the posterior sagittal anorectoplasty. . Laparoscopic assisted anorectoplasty is a minimally invasive technique that aims at preserving the sphincters, placing sensate skin within the control of the sphincters, and shortening recovery. The objective of this work is to evaluate the effectiveness of the laproscopic assisted anorectoplasty for the infants suffering from high imperforate anus.Materials & Methods: Twenty eight patients with high anorectal anomalies were included in this study. All patients had laparoscopically assisted anorectal pull-through (LAARP) for high imperforate anus. Hospital charts and surgical notes were reviewed and clinical characteristics tabulated.Results: Postoperative complications included rectal mucosal prolapsed (n=3), intestinal obstruction (n=1),anal stricture(n=1) ,and development of blind ended posterior urethral fistula(n=1 ). There were no complications related to the urinary system, also there was no wound infection, no hernia throughthe port sites, or anal retraction. Six cases developed constipation. The overall clinical assessment for continence of the cases showed that 50% had good outcome, 36% had moderate, and 14% had poor functional outcomeConclusion: LAARP for treatment of high anorectal anomalies is a feasible technique with encouraging functional results . Before recommendation of its use as a treatment of choice ,we recommend more studies for further evaluation of this technique, as the studies done for this subject are still few.
https://zumj.journals.ekb.eg/article_4397_cc61bc952022382035cbbea67b788dcd.pdf
missed
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
8
10.21608/zumj.2014.4398
4398
Original Article
PATTERN OF PERIPHERAL ARTERIAL DISEASE IN DIABETIC AND NON DIABETIC PATIENTS: ASSOCIATION AND RISKS CORRELATION
Mohamed Aboleineen
1
Ragab mahfouz
2
Tamer Moustafa
3
Mohamed Abdeldayem
4
Cardiology Department, Faculty of Medicine-Zagazig University, Egypt
Cardiology Department, Faculty of Medicine-Zagazig University, Egypt
Cardiology Department, Faculty of Medicine-Zagazig University, Egypt
Background and Aim:Peripheral arterial disease (PAD) is a common cardiovascular complication in patients with diabetes. The presence of PAD is a potent marker of increased cardiovascular risk.Importantly, PAD is associated with a substantial increase in the risk of fatal and non-fatal cardiovascular and cerebrovascular events, including myocardial infarction (MI) and stroke. We aimed to examine the pattern and risk association of PAD in diabetics ersu nondiabetics in Egyptians scheduled for coronary angiography.Methods:The study included 200 patients with lower extremity arterial stenotic lesions, proved by peripheral angiography, in the cardiac catheterization laboratory of the Faculty of medicine, Zagazig University Hospital, during the period from November 2012 to January 2014. All patients were subjected to all of the following: Complete history taking, full general and local examination, ECG analysis, transthoracic echocardiography, peripheral angiography, calculation of Bollinger score for assessment of the PAD severity and the following laboratory work up: hs-CRP, HbA1C, Albumin in urine, GFR calculation, total cholesterol and total triglycerides.Results:There was no significant difference between both groups regarding age, sex, hypertension, smoking and positive family history (p-value >0.05), There was no significant difference between both groups regarding LVEDD, LVESD and EF (p-value >0.05), There was significant difference between both groups regarding hs-CRP, HbA1c, GFR, Albuminuria, Total cholesterol and Triglycerides (p-value ˂0.05), being higher in group (1), There was no significant difference between both groups regarding mean Bollinger score of the aorta, common iliac, external iliac, internal iliac, superficial femoral and profundafemoris arteries while there was highly significant difference between both groups regarding mean total Bollinger score, mean Bollinger score of popliteal, anterior tibial, peroneal artery and posterioirtibial arteries (below the knee arteries); being higher in group (1).There was significant positive correlation between total Bollinger score and hs-CRP, total Cholesterol and triglycerides in both groups, (p<0.05), while in group (1) there was significant positive correlation between total Bollinger score and each of HbA1C and Albuminuria (p<0.05), and significant negative correlation between total Bollinger score and GFR (p<0.05).Conclusions: The current study showed that peripheral arterial disease differs in diabetic patients compared to non-diabetics in severity (being more severe in diabetics), distribution (tends to more distal affection among diabetic patients), associated risk factors and predictors of severity (as in diabetics it depends more on HbA1C, GFR, dyslipidemia, hs-CRP and albuminuria while in non-diabetic patients it depends only on hs-CRP and dyslipidemia)
https://zumj.journals.ekb.eg/article_4398_f78633421f3bda534a73cddde40fc6ec.pdf
PAD (Peripheral artery disease)
Diabetes Mellites
Bollinger score
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
4
10.21608/zumj.2014.4399
4399
Original Article
LEFT VENTRICULAR EXTENSION INTO THE ABDOMEN
Abde Hakem SELEM
1
Mohammed Shafee
2
Associate Professor, Department of Cardiology, Zagazig University
Radiologist, Ibn Sina faculty of medicine
A rare developmental anomaly of the heart is described. It consisted of a tube like extension of the left ventricular apex toward the umbilicus superficially under the anterior abdominal wall abutting anterior surface of the liver and contracting synchronously with the myocardium. It is associated with a membranous subaortic ventricular septal defect and a centrally localized heart in the anterior mediastinum (figure 1). Three similar cases were reported in the fifties of the last century. Although there were different associated anomalies with the other three cases but all four cases were similar in the presence of the elongated ventricle in a tube like structure superficially into the abdomen suggesting a similarity in development.
https://zumj.journals.ekb.eg/article_4399_a7a0fa2e4519d81cd57c043828f62ac1.pdf
Congenital heart disease
Left ventricular extension
Ventricular Septal defect
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4400
4400
Original Article
DIAGNOSTIC ACCURACY OF ENDOSCOPIC BIOPSY VERSUS MUCOSAL RESECTION IN DETECTING HISTOPATHOLOGIC CHANGES OF BARRETT’S ESOPHAGUS AND ITS RELATED SUPERFICIAL LESIONS.
Hany Elsadek
1
Mamdouh Radwan
2
Department of Internal Medicine, Faculty of Medicine, Zagazig University
Pathology Department, Royal Commission Medical Center (RCMC), Yanbu, Saudi Arabia
Background: In most patients with Barrett's esophagus (BE), endoscopic surveillance for early detection of dysplastic or neoplastic changes depends on the results of forceps biopsy. Endoscopic mucosal resection (EMR) is rapidly growing as an excellent diagnostic and therapeutic method for BE with dysplastic and early neoplastic changes. It is not entirely clear what is the agreement between the histopathologic diagnosis based on biopsy specimen versus that based on mucosal resection specimen. Objective: The aim of this study was to check the accuracy of biopsy for precise histopathologic diagnosis of dysplasia and neoplasia, compared to EMR in patients with BE and its related superficial esophageal lesions. Methods: During the period from December 2011 to December 2013, 24 patients with previously diagnosed BE (18 men, 6 women, mean age 49.75 ± 13.3 years, range 32-83 years) underwent routine regular surveillance endoscopic examination. Targeted biopsies were taken from the visible lesions in 12 patients with macroscopically suspicious lesions of the esophagus (group 1), and 4 quadrant biopsies were taken from BE segments in 12 patients without visible lesions (group 2). Then EMR was performed within 3 weeks, in all patients. Results: Initial histopathologic diagnosis of biopsies were: non dysplastic BE (NDBE) in 11 cases, low-grade dysplasia (LGD) in 7 cases, high-grade dysplasia (HGD) in 4 cases, intramucosal carcinoma (IMC) in one case, and invasive adenocarcinoma (IAC) in one case. EMR based diagnosis was identical with biopsy based diagnosis in only 14 cases (58.33%). The diagnosis differed in 10 cases (41.67%); 9 of them (37.5%) had "Upgrading" (i.e. diagnosis towards a higher degree of dysplasia) of biopsy based diagnosis in comparison to EMR based diagnosis, while, only one case (4.17%) had "Downgrading" (i.e. diagnosis towards a lower degree of dysplasia) of biopsy based diagnosis in comparison to EMR based diagnosis. Conclusions: Endoscopic biopsy is not a satisfactory method for accurate diagnosis of esophageal dysplastic or neoplastic changes in BE patients with or without suspicious superficial lesions. EMR should therefore be the preferred diagnostic method in such patients.
https://zumj.journals.ekb.eg/article_4400_99e2c1735e1e24b9ba44e49826e407af.pdf
Barrett's esophagus
dysplasia– adenocarcinoma
Biopsy
mucosal resection
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4401
4401
Original Article
PREVALENCE AND PATTERN OF DYSLIPIDEMIA IN ACUTE CORONARY SYNDROME PATIENTS ADMITTED TO MEDICAL INTENSIVE CARE UNIT IN ZAGAZIG UNIVERSITY HOSPITAL, EGYPT
Addulla Abdelaziz
1
Mohamed Fawzy
2
Internal Medicine and Biochemistry Departments, Faculty of Medicine, Zagazig University
Internal Medicine and Biochemistry Departments, Faculty of Medicine, Zagazig University
Background and aim of the work : Coronary artery disease (CAD) is the leading cause of mortality in men and women. Acute coronary syndrome (ACS), is a major reason for hospitalization in our country. The great majority of ACS patients have at least one major risk factor. Dyslipidemia has been identified as one of the most important modifiable risk factors for CAD. The aim of the study was to determine the prevalence and pattern of dyslipidemia , its relation to other modifiable risk factors in patients admitted with ACS to Medical ICU in Zagazig University Hospital, Egypt within a period of 11 months.Subjects and methods : The study included two groups; group one included 150 patients with ACS classified according to clinical presentation, the findings on the admission electrocardiogram (ECG) and the results of serial cardiac troponin levels, into myocardial infarction(MI), either ST-elevation or non ST- elevation MI, and unstable angina(UA) subgroups. The other group included 20 healthy subjects as controls. All subjects participated in this study were subjected to history, clinical examination routine investigations, lipid profile including total cholesterol (TC), high density lipoprotein (HDL), low desity lipoprotein (LDL) and triglycerides (TG) and lipoprotein (a) [Lp(a)] . Cardiac troponin and 12 leads ECGs were performed for diagnosis and follow up of the patients.Results: In patients with ACS, high levels of TC (> 200 mg/dl) were found in 60.67% ,high levels of LDL (> 130 mg/dl) were found in 58%, high levels of TG (> 150 mg/dl) were found in 63.33% and high levels of Lp(a) (> 30 mg/dl) were found in 62%, however, low levels of HDL (< 40 mg/dl) were found in 66% . There was a statistically significant elevation in TC, LDL, TG and Lp(a) serum levels in patients with ACS compared to control subjects (p<0.05) while the HDL was significantly low in ACS patient compared to control subjects (p <0.05). TC/HDL > 5 and TG/HDL > 4 were significantly higher in patients with ACS than controls. There was no significant difference between MI and UA patients regarding all lipid profile parameters. TC, LDL, TG and [Lp(a)] were significantly higher in males than in females while HDL was significantly higher in females compared to males. Also TC/HDL and TG/HDL ratios were sigificanly higher in males compared to females. All lipid components were significantly more prevalent in males than in females except TG where there was no significant difference between males and femalesThe Lp(a) values were significantly elevated in diabetic and in smoker patients with ACS (p<0.05) while the high values in hypertensive patients were insignificant (p=0.167). Stepwise regression analysis of lipid parameters revealed that TC/HDL and TG/HDL ratios were independant risk factors for ACS.Conclution: Dyslipidemia is one the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. High Lp (a) is widely prevalent amoung patients with ACS. specially those with diabetes mellitus and smokers. We recommend to pay more attention to serum lipids and other modifiable risk factors for prevention of ACS and more studies about Lp (a) as a risk factor of atherosclerosis and its impact on other systems is adviced.
https://zumj.journals.ekb.eg/article_4401_4d83dc15cb2487003166c531e1124d32.pdf
missed
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
7
10.21608/zumj.2014.4402
4402
Original Article
ASSOCIATION OF ANGIOTENSIN CONVERTING ENZYME GENE POLYMORPHISM AND DIABETIC NEPHROPATHY IN TYPE 2 DIABETES MELLITUS IN SHARKIA GOVERNORATE
Hala Yousef
1
Youssry El-Siad Abo-Elmagd
2
Monkez Yousif
3
Waffa WaffEmam
4
Biochemistry Departments, Faculty of Medicine, Zagazig University
Biochemistry Departments, Faculty of Medicine, Zagazig University
Internal Medicine Departments, Faculty of Medicine, Zagazig University
Biochemistry Departments, Faculty of Medicine, Zagazig University
Diabetic nephropathy (DN) is the leading cause of end – stage renal disease (ESRD) worldwide. The pathogenesis of this condition is not well understood clearly at present. The relationship between angiotensin- converting enzyme (ACE) insertion/ deletion (I/D) gene polymorphism and risk of DN is still conflicting. Therefore, we designed this study to investigate the association of ACE I/D gene polymorphism and development of diabetic nephropathy in a cohort of Egyptian population from Sharkia Governorate. Ninety patients with type 2 diabetes mellitus were included in the study. The first group included 45 without nephropathy while the second group included 45 with nephropathy. Both groups were subjected to full history taking, physical examination, routine laboratory investigations including fasting and 2 hours post prandial blood glucose, glycosylated hemoglobin, urine albumin excretion and urinary creatinine estimation. ACE I /D genotyping was carried out by polymerase chain reaction (PCR) amplification using allele specific primers. The frequencies of ACE DD, ID and II genotypes in group I were 11.1%, 55.6%, 33.3%. But in group II were 33.3%, 46.7%, 20% respectively. DD genotype was significantly more frequent in group II than group I (33.3% VI 11.1%), odd ratio1.5; 95%, Confidence interval (1.049-2.145), p<0.01). The ACE DD genotype is associated with diabetic nephropathy in Sharkia governorate.
https://zumj.journals.ekb.eg/article_4402_8e1044ff6fa6ec29a5c2bbe0684f3d79.pdf
diabetic nephropathy
Angiotensin converting enzyme
insertion/deletion polymorphisnm
eng
Zagazig University, Faculty of Medicine
Zagazig University Medical Journal
1110-1431
2357-0717
2014-05-01
20
3
1
10
10.21608/zumj.2014.4403
4403
Original Article
COMPARATIVE STUDY BETWEEN FAT AND PERICHONDRIUM GRAFT MYRINGOPLASTY
Magdy A. Fattah
1
Adly Tantawy
2
Waleed Ibrahim
3
Mohamed El- Nemr
4
ENT department, Zagazig University
ENT department, Zagazig University
Audiology Unit ENT department Zagazig University
ENT department, Zagazig University
Introduction: Longstanding tympanic membrane perforation may cause hearing loss and middle ear infection even if they are small in size. The purpose of myringoplasty is to repair such perforations and thus to improve hearing and eliminate the susceptibility to middle ear infection.Methodology: This study was included 40 patients with dry central tympanic membrane perforation, not associated with ossicular pathology, retraction pocket or cholesteatoma showing conductive hearing loss with an air bone gab not exceeding 30 dBHL in the studied ear. Patients were divided into 2 groups (group I and group II) 20 patients who have undergone fat myringoplasty and 20 patients who have undergone perichondrium tympanoplasty. Each group was subdivided into 2 subgroups (A and B) according to size of perforation. Audiological evaluation was done pre and postoperative.Results: In fat myringoplasty, the success rate was 50% with success rate of 80% in group I A (<4 mm) and a success rate of 20% in group IB (>4 mm). In perichondrium tympanoplasty, the overall success rate was about 80% with only 4 failed cases from 20 cases.It was found that there was improvement of hearing in group IA ranging from 7.5-10dB with a mean of 9±1 while in group IIA; there was improvement of hearing ranging from 5-20 dB with a mean of 10±6.5. There was no significant difference as regards improvement of hearing (P=0.67). While in group IB, the 2 successful cases showed improvement of hearing ranging of about 10 dB while in group IIB; there was improvement of hearing ranging from 7.5-20 dB with a mean of 12± 5dB. So, in large perforation, there was no significant difference between the studies groups (P=0.6).Conclusion: Fat graft myringoplasty is a reliable technique with shorter duration less operative care. Success rate is higher for perichondrium graft. Hearing improvement is not significantly different between both groups.
https://zumj.journals.ekb.eg/article_4403_d851ff00d5919436897d7af299513074.pdf
fat graft- Perichondrium tympanoplast