Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701THE ROLE OF FETAL MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITY AND INTRAUTERINE TRANSFUSION IN MANAGEMENT OF FETAL ANEMIA IN RH- ALLOIMMUNIZED EGYPTIAN WOMEN19452910.21608/zumj.2015.4529ENFahmyA.Departments of obstetrics and gynecology, faculty of medicine, Zagazig UniversityEl HaiegDMDepartments of obstetrics and gynecology, faculty of medicine, Zagazig UniversityAbdel AzizRDepartments of obstetrics and gynecology, faculty of medicine, Zagazig UniversityMansour.RDepartments of obstetrics and gynecology, faculty of medicine, Zagazig UniversityJournal Article20171211Objective:To assess the predictive performance of the current reference values of peak systolic velocity of middle cerebral artery (MCA-PSV) in the detection of various degrees of fetal anemia in Rh-alloimmunized Egyptian women and to evaluate pregnancy outcome after prenatal treatment with ultrasound guided intrauterine fetal blood transfusion.<br />Materials and Methods: In a prospective study, 33 Rh-alloimmunized Egyptian women were evaluated by fetal MCA-PSV. MCA-PSV, intrahepatic umbilical venous maximum velocity (IHUV), liver length, and spleen perimeter were measured. Results before first fetal blood sampling or delivery were analyzed. Perinatal outcome was also recorded.<br />Results:Thresholds of ≥1.50 and ≥1.55 MOM's MCA-PSV were evaluated with all degrees of fetal anemia. For predicting moderate and severe anemia(Hb ≤0.65 MOM's), MCA-PSVof ≥1.50 MOM's has a 90.6% sensitivity, 55.0% specificity with positive likelihood ratio of 2.01 and negative likelihood ratio of 0.17 while IHUV maximum velocity sensitivity was 75%, specificity was 54%, +ve likelihood ratio was 1.4 and -ve likelihood ratio was 0.54.Sensitivity was obviously low for spleen perimeter and liver length (54%-32% respectively),also their specificity was (32%-33% respectively) in predicting moderate and severe anemia. By addition of IHUV velocity to MCA-PSV, has slightly increased test sensitivity to 94.44, almost same specificity 54.5% and predictive performance (+velikelihood ratio=2.08) and lowered false negative values. Total loss was 16/33 (48.5%) of which 25% (4/16) had miscarriage (fetal loss < 24 week) and 12 cases (36.3%) were early neonatal death in the first week of life. Ten fetuses were anemic by MCA-PSV follow up and required intrauterine transfusion. The total number of transfusions done during the study period was 23 times. Of the 10 pregnant women who required IUT, 4 fetuses (40 %) had died; 1 due to complicated IUT (fetal bradycardia) and 3 had miscarriage due to early severe fetal hydrops. Eighteen cases needed exchange transfusion within 7 days of birth.<br />Conclusion:It can be concluded that MCA-PSV has limited diagnostic accuracy for the prediction of moderate to severe fetal anemia in Rh-alloimmunized women. Although, it appears superior to other ultrasonographic parameters they need to be interpreted cautiously. Further work should be undertaken to develop test combinations and improve its diagnostic accuracy.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701PERCUTANEOUS NEPHROLITHOTOMY IN FLANK-FREE MODIFIED SUPINE VERSUS PRONE POSITION FOR TREATMENT OF STAGHORN STONES: A PROSPECTIVE RANDOMIZED STUDY110453910.21608/zumj.2015.4539ENAhmedEliwaUrology department faculty of medicine Zagazig UniversityLotfyBendaryUrology department faculty of medicine Zagazig UniversityAshrafShahinUrology department faculty of medicine Zagazig UniversityMahmoudEl AdlUrology department faculty of medicine Zagazig UniversityJournal Article20171211Background: The classic position for percutaneous nephrolithotomy is the prone position as it provide good access to the pelvicalyceal system especially in complex stones such as staghorn stones , however prone position has many limitations especially in morbid obesity and cardiopulmonary problems. Many concerns were made about performing PNL in supine position regarding availability of working space and the possibility of multiple puncture.<br />Patients and Methods: This is a prospective randomized study that was carried out at urology department Zagazig University in the period from January 2012 till January 2014. The study included 60 patients with staghorn stones scheduled for PCNL and were randomized in two groups using the closed envelope method: Group [A] patients with staghorn stones undergoing PCNL in Flank free modified supine position and Group [B] patients with staghorn stones undergoing PCNL in the standard prone position. Staghorn stone was regarded as any renal stone that occupy the renal pelvis and at least one major calyx. Preplanned tracts were designed according to stone morphology.<br />Results: Operative time was calculated from the patients positioning for fixing ureteral catheter till the fixation of the nephrostomy. Regarding the operative time the mean operative time in both groups was 94.9 ±10.12 min .In group A the operative time [96.2±10.85minutes] was longer than group B [93.6±9.71] however this difference was statistically insignificant [P=0.3]. The overall transfusion rate was 5% [3 patients] two in group B one in group A. The mean pre-operative Hemoglobin in group A was 12.10 gm/ml ±0.74 which turned to 10.75gm/ml ±1.07 postoperatively. Only one patient in this group required blood transfusion [3.3%]. The mean preoperative Hemoglobin in group B was 12.01 gm/ml ±0.59 which turned to 10.83 gm/ml ±1.05 postoperatively. Post-operative KUB and U/S was done for all cases to evaluate stone clearance and residual fragments. It was done immediately post-operative day 1 and at the day of discharge. Over-All stone free rate [for both groups] at 24-h was 66.7% [40 patients].The stone free rate at 24-h imaging was higher in group B than in group A 70.0% [21patients] and 63.3% [19 patients] respectively however this was statistically insignificant [p=0.5].<br />Conclusion: Flank free modified supine position during percutaneous nephrolithotomy is safe and effective in treatment of staghorn stone that needs multiple punctures with comparable results to the standard prone positionZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701EXTENDED LYMPHADENECTOMY IN BLADDER CANCER DURING RADICAL CYSTECTOMY: BENEFIT AND MORBIDITY114454110.21608/zumj.2015.4541ENIslamMDepartment of Urology, Zagazig University, Zagazig, EgyptDiabMDepartment of Urology, Zagazig University, Zagazig, EgyptRedaSDepartment of Urology, Zagazig University, Zagazig, EgyptSaadAl QadyDepartment of Urology, Zagazig University, Zagazig, EgyptJournal Article20171211Background: Controversy still presents regarding the ideal proximal extension of lymphadenectomy at radical cystectomy.<br />Objective: To provide an accurate map of lymph node metastasis in patients with bladder cancer and to evaluate benefit and morbidity of extended lymphadenectomy.<br />Patient and method: A Prospective study of 65 patients with bladder transitional cell carcinoma with stage T2-T4a-Nx-M0 undergoing radical cystectomy with mapping extended lymphadenectomy was completed between September 2011 and March 2015 at the Department of Urology, Zagazig University Hospitals.<br />Intervention: Radical cystectomy with mapping extended lymphadenectomy.<br />Results: The mean ± SD total of retrieved lymph node number in the study population was 28.7±9.8. Twenty of 65 patients (30.7%) had positive LN. LN metastases above bifurcation of common iliac artery are common (40 % of patients with positive lymph node had metastasis in common iliac lymph nodes and presacral lymph nodes). No skip metastasis to above common iliac bifurcation LN. Negative LN patients had better survival than positive LN patients and survival did not affected by location, number and density of positive LN.<br />Conclusions: Extended lymphadenectomy till level of bifurcation of aorta provide better identification of positive lymph node correctly and good assign of pathological node metastasis stage in node positive cases without significant morbidity.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701NASAL AUGMENTATION WITH TEMPORALIS FASCIA WRAPPED DICED CARTILAGE GRAFT VERSUS CLASSIC CARTILAGE GRAFT114454210.21608/zumj.2015.4542ENMosaadEL-SesyOtorhinolaryngology Department, faculty of medicine, Benha University, EgyptAhmedEL-HamsharyOtorhinolaryngology Department, faculty of medicine, Benha University, EgyptAhmedShehataOtorhinolaryngology Department, faculty of medicine, Benha University, EgyptMohamedMDandOtorhinolaryngology Department, faculty of medicine, Benha University, EgyptTahaMohamedOtorhinolaryngology Department, faculty of medicine, Benha University, EgyptJournal Article20171211Objective: The aim of this work is to compare between the use of deep temporal fascia wrapped diced cartilage graft and classic cartilage graft in nasal augmentation as regards: Graft criteria , Post–operative residual deformity and the need for revision rhinoplasty.<br />Patients and methods: The study was conducted on 30 patients with dorsal nasal deformity requiring augmentation rhinoplasty. Patients were classified into 2 groups: group I (15 patients) the augmentation was done by deep temporal fascia-wrapped diced cartilage (DC-F), group II (15 patients) the augmentation was done by one classic cartilage technique. Post-operative follow up of all patients was performed based on clinical, postoperative photography after one & six months and Magnetic Resonance Imaging (MRI) one &six months postoperatively to assess the rate of graft resorption .<br />Results: We found that dorsal augmentation with both grafts had a statistically significant effect on nasofrontal angle, nasofacial angle, dorsal projection at rhinion, mid dorsal projection and tip projection by changing their measurements toward the normal range. But the advantages of Temporalis fascia- wrapped diced cartilage graft technique ‘Turkish Delight’ are: more easy, adjustable graft volume, good handling , effective, better results and less morbidity of open rhinoplasty.<br />Conclusion: We conclude that the technique of using temporalis fascia –wrapped diced cartilage “Turkish Delight” offers good aesthetic results in augmentation of dorsal nasal deformities when compared with classic cartilage technique. Also decrease the need for revision rhinoplasty.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701SURGICAL RECONSTRUCTION OF THE POSTERIOR MEATAL WALL BY BIOGLASS VERSUS TITANIUM MESH114454310.21608/zumj.2015.4543ENSamirSorourOtorhinolaryngology department Faculty of Medicine, Zagazig University, Egypt.NasserMohammedOtorhinolaryngology department Faculty of Medicine, Zagazig University, Egypt.MagdyAbdel FattahOtorhinolaryngology department Faculty of Medicine, Zagazig University, Egypt.MohammedAbdel BaryOtorhinolaryngology department Faculty of Medicine, Zagazig University, Egypt.Journal Article20171211Background: Canal wall down mastoidectomy has many drawbacks including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, necissating periodic cleaning. Many of these proplems can be solved by reconstruction of the posterior meatal wall. Aim of work: To solve the cavity proplems after CWD mastoidectomy via reconstruction of posterior meatal wall, and to compare between the outcomes of the Bioglass versus titanium mesh in reconstruction of posterior meatal wall. Patients and methods: This study was applied on 40 patients that have chronic sappurative otitis media. All cases were subjected to canal wall down mastoid surgery with complete elimination of the disease and reconstruction of the posterior meatal wall. Patients were divided to 2 groups: group (A) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by Bioglass and the group (B) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by titanium micromesh; all patients were exposed to full preoperative evaluation, and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results: There is a significant difference between the two groups regarding postoperative complications mainly the postoperative granulations and discharge, the postoperative appearance of the external auditory canal contour, and the hearing gain in favor of group (A) but there is no significant difference between the 2 groups as regard the intraoperative difficulties, the other postoperative complications like wound infection, canal stenosis, extrusion or displacement of the materials and recurrence of cholesteatoma. Conclusion: Reconstruction of posterior canal wall can eliminate many of the cavity proplems after CWD mastoidectomy especially by using the Bioglass which shows better advantages than the titanium micromeshZagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701APOPTOSIS, MEMORY CELL, AND T-HELPER LYMPHOCYTES BALANCE BETWEEN SEVERE AND MILD BRONCHIAL ASTHMA113454510.21608/zumj.2015.4545ENMahaAbd El-wahedProfessor of clinical pathology, faculty of medicine, zagazig university,EbtesamAhmedProfessor of clinical pathology, faculty of medicine, zagazig university,MohamedMohamedNoraSaidAssistant lecturer of clinical pathology, faculty of medicine zagazig university.Journal Article20171211Background: Bronchial asthma is a characterized by chronic inflammation with reversible airway obstruction and airway hyper-reactivity. In order to choose the most appropriate line of therapy we need to understand the sequence of inflammatory reaction at every stage of asthma.<br />Aim of the work: we aimed to study apoptosis tendency, CD4+/CD8+ ratio, memory /naïve , and T- helper 1 and 2 cytokines in vitro synthesis from peripheral blood lymphocytes (PBL) in mild persistent asthma and severe persistent asthma during acute exacerbation attacks. Patients and methods: This study comprised 50 participants divided into three groups: Group I: 10 healthy volunteers, Group II: 20 patients of mild persistent asthma, Group III: 20 patients of severe persistent asthma. All members of this study were subjected to: Immunophenotyping by flow-cytometry. Lymphocyte populations were analyzed by using CD3+CD4+ (T helper cells), CD3+ CD8+ (T cytotoxic cells), CD4+/CD8+ ratio, BCL2, CD45RO+ (memory T cells), and CD45RA+ (naïve T cells) markers with calculation of CD45RO+ / CD45RA+ ratio and Th2/Th1 cytokines profile, in the form of IL-4/IFN-γ ratio by Enzyme linked immunossorbant assay (ELISA). Results: We found an elevation in CD45RO and CD45RO+ / CD45RA+ ratio of T lymphocytes in severe than in mild asthmatics. Bcl-2 was elevated in severe asthma in relation to mild asthma and healthy group. While, no significant difference could be detected in CD4+/CD8+ ratio among the three groups. IL-4 and IL-4/ IFN-γ ratio were increased in the mild and severe groups compared to the control group. Conclusion: The immune reactions differs greatly according to the severity of asthma, with more memory T cells, longer life span of PBL and a greater role of Th1 cytokines.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701HISTOPATHOLOGICAL EFFECT OF SPIRULINA IN RENAL ISCHEMIA REPERFUSION IN RATS17454710.21608/zumj.2015.4547ENDinaAbd- AllahDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, EgyptAzzaAbdel-AzizDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, EgyptAmiraEl-HawaryDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.FatmaEl- HusseiniDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.SoheirSiragJournal Article20171211Background/Aim: Ischemia/reperfusion (I/R) injury occurs in renal transplantation, and it could be a risk factor for late renal allograft failure. Several exogenous antioxidants used in prevention of renal I/R injury. Multiple experimental studies demonstrated the antioxidant effect of Spirulina. This study focused on the effects of Spirulina on histopathology of kidney subjected to I/R injury.<br />Methods: Renal I/R was induced in male Sprague-Dwaley rats by occluding the left renal artery then right nephrectomty. Group I was sham operated rats; group II, control (non treated rats); and group III, Spirulina-treated rats (1000 mg/kg BW, orally. 7 days before I/R). Rats were sacrificed 1 & 3 days post reperfusion. The effects of Spirulina on both necrosis and regeneration of kidney tubules caused by renal I/R injury were assayed and scored.<br />Results: Spirulina pretreatment decrease the necrotic injury and improve tubular regeneration after 1 and 3days of renal I/R injury.<br />Conclusion: Spirulina decreased the necrotic activity index in rat kidney after I/R injury and help in tubular regeneration.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701THE VALUE OF TOX AS A DIAGNOSTIC MARKER FOR MYCOSIS FUNGOIDES (MF)18454810.21608/zumj.2015.4548ENSherineRefatDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.IbrahimEL-ShawafDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.AzmyAbd EL- HameedDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, EgyptEmanEL-TanaihyDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, EgyptAmroElkarefDepartment of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Journal Article20171211Background/Aim: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Differentiation of MF from its benign mimickers is important to ensure proper management. TOX is a critical regulator of early T-cell development that is considered as a useful marker for MF diagnosis and prognosis. The current study aimed to test the role of TOX immunohistochemistry (IHC) as a diagnostic marker of MF differentiating it from its benign mimickers.<br />Materials and Methods: This work was carried out on 103 skin biopsies, 51 MF cases and 52 inflammatory mimickers. The diagnoses were established after clinicopathologic correlation. IHC was done in MF cases for TOX, CD4, CD8 and CD7 (in TOX negative cases), while the other mimickers stained only by TOX.<br />Results: TOX expression showed a significant positive expression in MF cases compared to inflammatory dermatoses, with 62% sensitivity and 100% specificity. There was positive correlation between TOX staining and CD4/CD8 ratio in MF cases. In addition, TOX positivity in plaque MF was stronger than in patch MF. Also, TOX negative MF cases were negative for CD7.<br />Conclusions: Positive TOX expression favors MF, but its negativity doesn't exclude the diagnosis of MF. Combining TOX with CD4/CD8 ratio and CD7 may be useful in diagnosis of MF beside the clinical and histopathological diagnosis. The stronger TOX positivity in plaque more than patch MF may correlate with the progression of the disease.Zagazig University, Faculty of MedicineZagazig University Medical Journal1110-143121420150701COMPARATIVE GLUCOSE-LOWERING AND RENOPROTECTIVE EFFECTS OF SITAGLIPTIN AND INSULIN AND THEIR COMBINED THERAPY ON TYPE-2 DIABETES MELLITUS WITH NEPHROPATHY IN RATS114455010.21608/zumj.2015.4550ENMohamedKelanyClinical Pharmacology Departments, Faculties of Medicine, Universities of ZagazigMahmoudElotamiClinical Pharmacology Departments, Faculties of Medicine, Universities of MenoufeyaTahirHakamiClinical Pharmacology Departments, Faculties of Medicine, Universities of Jazan, Saudi ArabiaJournal Article20171211Aims: The study compared the glucose-lowering and renoprotective effects of sitagliptin, insulin and their combination on high-fat, high-sugar diet, streptozotocin (STZ)-induced type-2 diabetes mellitus (T2DM) with nephropathy in rats. Methods: In addition to the normal control group (n= 8), diabetes was induced in adult male Spurge-Dawley rats by 6-week high-fat, high-sugar diet followed by a single intraperitoneal injection of streptozotocin 30 mg/kg BW. For four weeks thereafter, diabetic rats (n= 32) were divided into 4 equal groups (n<br />= 8) and received daily: vehicle (untreated diabetic group), insulin 10 IU/kg SC, sitagliptin 30 mg/kg PO, or combined sitagliptin-insulin, and continued on the same diet. We assessed a group of blood/serum measures of glucose metabolism and kidney functions and histopathology. Results: Compared to control group, the untreated diabetic rats developed significant decreases in body weight (BW) and serum insulin, increases in kidney weight (KW), KW/BW ratio, blood glucose and AGEs levels, increases in blood urea, creatinine, urine output, albuminuria and renal tissue TGF-β1 levels, and decrease in the creatinine clearance and showed variable glomerular, tubule-interstitial and vascular kidney lesions. Sitagliptin monotherapy stabilized the BW, KW and KW/BW ratio, reduced the blood glucose, AGEs, urea, creatinine, urine output, albuminuria and renal tissue TGF-β1 levels and increased the serum insulin and creatinine clearance, with greater improving the biochemical parameters (and not blood glucose), and ameliorating kidney histopathological lesions more than insulin alone. In contrast, insulin produced better effects on BW and KW/BW ratio. Importantly, sitagliptin-insulin co-treatment highly and greatly improved measures of glucose metabolism and kidney functions, and highly ameliorated kidney lesions when compared to treatment with insulin or sitagliptin alone. Conclusion: Combined sitagliptin-insulin therapy, in rats with T2DM and nephropathy, produced greater glycemic control and renoprotective effects more than treatment with sitagliptin or insulin alone. This combined therapy could have clinical unique application in the management of T2DM with nephropathy.