Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported.The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis. Conclusion: The modified technique permits one-stage repair of proximal hypospadias with low complication rates. Keywords: Hypospadias, Koyanagi, One stage urethroplasty

Recurrent Pneumonia in Children Admitted to Assiut University Children Hospital. Magnitude of the Problem and Possible Risk Factors

Background: Incidence data indicate that recurrent pneumonia occurs in 7.7–9% of all children withcommunity acquired pneumonia. We aim by this study to assess the prevalence of recurrent pneumoniaamong the admissions with diagnosis of pneumonia in Assiut university children hospital for one year andto try to define the possible related risk factors. Patients and methods: This is a prospective hospital basedstudy in Assiut University Children’s Hospital. Children younger than 16 years admitted with a hospitaldiagnosis of pneumonia to Assiut University Children’s Hospital for one year from 1 February 2017 to 31January 2018 were included.Results: Approximately 1 in 12 children with pneumonia in our locality have recurrent pneumonia with percentageof 12.61%. Cardiac diseases especially congenital heart diseases was the cause among 25.45%of the cases, immunodeficiency diseases represented 20.9% of the cases ,while bronchial asthma wasthe cause of recurrent pneumonia among 16.36% of the cases. As regard to risk factors in studied group,prematurity was detected among 7.27 % of the cases while more than 50% were formula fed and more than60% exposed to pollution. Father smoking was detected among 36.36% of cases. Patients aged > 6 yearsshowed significantly higher frequency in risk factors as obesity, indoor and outdoor pollution and use ofsteroids in comparison to other age groups. However, patients aged 0-3 years exhibited significantly higher% frequency of having heart disease, oro-motor in coordination /swallowing dysfunction, gastro esophagealreflux and under nutrition as risk factors for recurrent pneumonia in comparison to other age groups.Conclusions: The most frequent underlying cause for recurrent pneumonia in Assiut University Children’sHospital which presents the largest referral pediatric hospital in Upper Egypt for one year according to ourstudy was cardiac diseases; the second most frequent cause was immunodeficiency diseases, followedby bronchial asthma. Risk factors for recurrent pneumonia include socio-economic status of studiedcases, prematurity, exposure to passive smoking and in or outdoor pollution, obesity, under nutrition, lackof breast feeding, gastro esophageal reflux and steroids usage

Near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (nesidioblastosis): Mansoura experience

Background/purpose Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of persistent hypoglycemia in infancy with consequences such as seizures and brain damage. Treatment that prevents the occurrence of these sequele is essential. When medical therapy fails or complications are anticipated, early pancreatectomy is recommended to maintain euglycemia. The aim of this study was short-term evaluation of near-total pancreatectomy for PHHI after failure of medical treatment in patients in Mansoura, Egypt.Patients and methods During May 2002 to May 2010, 33 patients suffering from persistent hyperinsulinemic hypoglycemia were admitted to Mansoura university child hospital. Twenty patients responded to medical treatment and 13 patients (eight girls and five boys) were treated by near-total (90–95%) pancreatectomy after failure of medical treatment. Their ages at the time of surgery ranged from 20 days to 27 months. Only patients who were surgically managed were included in this study. All of them suffered from symptoms of PHHI: thermoregulatory problems in five cases, tremors in five cases, seizures in three, irritability in five, respiratory distress in eight, apnea in four, hypotonia in four, lethargy in five, and feeding difficulty in four cases. All cases were diagnosed following strict criteria that included bouts of hypoglycemia without acidosis coinciding with increased insulin level. Follow-up ranged from 3 months to 8 years.Results Primary success occurred in two cases (15%); four more cases (31%) developed temporary diabetes mellitus, and one case (8%) had a temporary pancreatic fistula. Eventually, total cure occurred in seven cases (54%); six cases (46%) developed a variety of complications; and persistent hypoglycemia was seen in two. Persistent diabetes mellitus was observed in three patients, developmental delay in one, and persistent neurological deficit in two patients; there was one case of mortality.Conclusion Near-total (90–95%) pancreatectomy is a suitable procedure for treatment of nesidioblastosis not responding to medical treatment and should be performed as early as possible. Keywords: Mansoura, near-total pancreatectomy, persistent hyperinsulinemic hypoglycemi

) and Other Risk Factors in Egyptian Subjects with Coronary Artery Disease

Abstract:Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Obesity has been suggested as a major risk factor for this disease. This study aims to assess the relation between obesity and CAD in a selected group of Egyptian population. Other risk factors, including blood pressure, blood glucose, and lipids have also been investigated. The study included 80 patients with CAD (mean age: 47.86 years, males / females: 43/37), and 40 healthy controls (mean age: 46.15 years, males / females: 13/27). CAD patients were divided according to their body mass index (BMI) into 2 main groups: normal weigh group (BMI: 18.5-24.9, n=40) and abnormal weight group (BMI≥25, n= 40), the latter group was further sub-divided into overweight group (BMI: 25.0-29.9, n= 20) and obese grou

Synthesis, Characterization, and In Vivo Anti-Cancer Activity of New Metal Complexes Derived from Isatin-N(4)antipyrinethiosemicarbazone Ligand Against Ehrlich Ascites Carcinoma Cells

The current study aimed to synthesize new metal coordination complexes with potential biomedical applications. Metal complexes were prepared via the reaction of isatin-N(4)anti- pyrinethiosemicarbazone ligand 1 with Cu(II), Ni(II), Co(II), Zn(II), and Fe(III) ions. The obtained metal complexes 2–12 were characterized using elemental, spectral (1H-NMR, EPR, Mass, IR, UV-Vis) and thermal (TGA) techniques, as well as magnetic moment and molar conductance measurements. In addition, their geometries were studied using EPR and UV–Vis spectroscopy. To evaluate the in vivo anti-cancer activities of these complexes, the ligand 1 and its metal complexes 2, 7 and 9 were tested against solid tumors. The solid tumors were induced by subcutaneous (SC) injection of Ehrlich ascites carcinoma (EAC) cells in mice. The impact of the selected complexes on the reduction of tumor volume was determined. Also, the expression levels of vascular endothelial growth factor (VEGF) and cysteine aspartyl-specific protease-7 (caspase-7) in tumor and liver tissues of mice bearing EAC tumor were determined. Moreover, their effects on alanine transaminase (ALT), aspartate transaminase (AST), albumin, and glucose levels were measured. The results revealed that the tested compounds, especially complex 9, reduced tumor volume, inhibited the expression of VEGF, and induced the expression of caspase-7. Additionally, they restored the levels of ALT, AST, albumin, and glucose close to their normal levels. Taken together, our newly synthesized metal complexes are promising anti-cancer agents against solid tumors induced by EAC cells as supported by the inhibition of VEGF and induction of caspase-7

Role of magnetic resonance imaging in loco-regional evaluation of cancer rectum, pre and post neoadjuvant therapy

The high rate of local recurrence is considered the major concern and challenge regarding the surgical treatment of cancer rectum. The target of use of pre-operative neoadjuvant therapy is reducing tumour size and improving its resectability in order to reduce local recurrence risk and improve survival rates.Plans for management and treatment of locally advanced rectal cancer showed clear changes after use of neoadjuvant therapy. This in turn necessitates accurate evaluation of the tumour parameters before and after use of combined chemotherapy and radiation therapy (CRT).Aim of study is to assess the initial stage of cancer rectum then its response to neoadjuvant therapy using MRI, prior to operative interference. This is followed by post-operative histo-pathological data correlation.Methods: This study was conducted on 50 patients. All patients were examined by high-resolution T2- weighted images. Turbo-spin-echo sequences taken in sagittal plane, axial plane perpendicular to tumor axis and coronal plane parallel to tumor axis or anal canal. All are according to tumor height. Diffusion weighted images (DWI) performed in all cases.Results: Following neoadjuvant therapy, down-staging was detected in this study in more than 90% of patients regarding the T2 signal and apparent diffusion coefficient (ADC) value of the tumour, also status of depth of involvement of meso-rectal fascia (MRF), circumferential resection margin (CRM), extramural vascular invasion (EMVI) and nodal involvement.Conclusion: Pre-operative MRI in cancer rectum is irreplaceable to assess initial staging and postneoadjuvant therapy response thus improving surgical results.Keywords:  MRI, CRT, DWI, ADC, MRF, CRM, EMV

Urine carcinoembryonic antigen levels are more useful than serum levels for early detection of Bilharzial and non-Bilharzial urinary bladder carcinoma: Observations of 43 Egyptian cases

BACKGROUND: Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen (CEA). PATIENTS AND METHODS: Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 nonbiharzial cases, in addition to 10 normal control cases. RESULTS: A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial, versus 62% in nonbilharzial bladder carcinoma. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial, was higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels. CONCLUSION: Urinary CEA is more useful than serum CEA in the early detection of urotherlial carcinoma particularly if provoked by bilharziasis. Its level is also correlated with the tumor stage

Anti-hepatotoxic effect of Casuarina stricta and Casuarina suberosa extracts on alcohol-induced liver toxicity in rats

In recent years, there has been a global trend toward the use of natural phytochemicals present in natural resources, such as fruits, vegetables, oilseeds, and herbs, as antioxidants and functional foods. The aim of the present study was to investigate the protective and antioxidant effects of methanolic extract of Casuarina stricta and Casuarina suberosa leaves on ethanol induced hepatotoxicity in rats. The ethanol intoxication (1 ml of 40 % ethanol for 100 gm body weight for 6 weeks) to rats resulted in a significant increase in serum ALT, AST, \u3b3 glutamyl transferase (\u3b3 GT), hydroxyproline, MDA level and a significant decrease in serum albumin, total protein, A/G ratio, total antioxidant capacity, SOD, catalase activities and GSH level, P < 0.05. The treatment with Casuarina stricta and Casuarina suberosa extract at a dose of 250 mg/Kg body weight together with ethanol for 6 weeks successfully prevented the alterations of studied parameters in the treated groups. Both extracts significantly increased the total antioxidant capacity. The experimental results indicate that, both Casuarina extracts have excellent hepatoprotective effect