Preterm Small Gestational Age Newborns: Impact on Renal Size and Function

OBJECTIVE: The objective of the study was to evaluate the size and function of the kidney in high-risk premature small gestational age (PT/SGA) newborns. Furthermore, estimation of the glomerular filtration rate (GFR) was done by comparing Cystatin C-based method with the creatinine –based method in those preterm newborns. PATIENTS AND METHODS: The study included 20 PT/SGA and controls (20 preterm appropriate for gestational age [PT/AGA] and 20 full-term [FT] newborns). Serum creatinine, blood urea nitrogen, and cystatin C were determined on days 3 and 7 of the study for all newborn infants. GFR was assessed by cystatin C-based method and creatinine-based method. Evaluation of the renal size by ultrasound was done on day 7 of neonatal life. RESULTS: A significant difference was found in the length and transverse diameter of both kidneys, comparing PT/SGA group with PT/AGA and FT group. Cystatin C on day 3 of PT/SGA group had a significant difference than PT/AGA and FT group. Estimation of GFR (eGFR) calculated by filler Zappitelli, Grubb, Larsson, and Dorum formulae of PT/SGA group had a significant difference comparing with PT/AGA and FT group on days 3 and 7. CONCLUSION: PT/SGA newborns have reduced renal size and immature renal function. Cystatin C is a marker for renal function superior to creatinine as it is not affected by body mass index, gestational age, and birth weight. Cystatin C-based eGFR is more accurate and more sensitive to minor changes in GFR than creatinine-based equation

Detection of the Timing of Human Skin Wounds by Immunohistochemical Analysis of CD14

Determination of time of injury is one of the most important topics in forensic autopsy. Several researches have been developed to estimate wound age, unfortunately with limited success. The aim of the present work was to evaluate the efficacy of Cluster of Differentiation 14 (CD14) as a reliable marker for estimating wound age. The study was conducted on forty bodies of victims with different types of wound and known infliction time. Skin samples were obtained during autopsy from the center of the wound. Sections from samples were histologically examined by H & E stain. Immunohistochemical staining was done using CD14 antibody and the staining density was evaluated semi-quantitatively. There was a statistically significant relation between wound age and percentage of CD14 expression. Expression of CD14 was 61.81±6.55 % in specimens from wounds aged less than 12 hours. It increased till reaching its maximum (96.40±3.78 %) for wounds aged between 1-3 days. Then it decreased dramatically to 14.80±3.49 % in wounds older than 3 days. CD14 is proved to be a reliable marker for estimating wound age. It gave best results in wounds aged between 1-3 days with an overall accuracy of 100%. Accordingly, it can be used to determine wound age in medicolegal practice

Evaluation of lymphatic regeneration in rat incisional wound healing and its use in wound age estimation

Objective: During the wound healing process, lymphatic regeneration in the injured skin has not been fully investigated. This work was designed to study the regeneration of lymphatic vessels in rat incisional wounds in relation to the duration after the wound infliction. Material and methods: We studied the regeneration of lymphatic vessels in the rat skin incisional wounds (sutured and unsutured) by immunohistochemistry using an antibody against D2-40, a marker of lymphatic endothelium. Results: Lymphatic vessels were detectable transiently at the wound edge and depth from day 3 till day 7, and none on day 10 in sutured wounds; and from day 5 till day 10, and none on day 14 in unsutured wounds. On the other hand, the center of the wound area did not show any evidence of lymphatic regeneration up to 60 days after the skin incision, regardless of presence/absence of sutures. Meanwhile, the regenerating blood vessels started to appear in the granulation tissue as early as day 2 in sutured wounds and day 3 in unsutured wounds. Conclusion: Lymphatic elements appear transiently in the wound edge, concurrent with the appearance of blood vessels but regress earlier. Identification of lymphatic vascular channels in the region of the wound may help to estimate the wound age in the early days after the injury. At later time points in the regeneration process, it may help to recognize the injured area, being the area where the dermis and subcutaneous tissue are devoid of lymphatics

Sex determination using anthropometric measurements from multi-slice computed tomography of the 12th thoracic and the first lumbar vertebrae among adult Egyptians

Introduction: Identification of the dismembered and skeletal remains has been a chal-lenge for forensic anthropologists. Aim: Therefore, the aim of the present study was to assess the sexual dimorphism from the 12th thoracic and the first lumbar vertebra measurements data obtained from reformatted images of multi-slice computed tomography (MSCT) and to derive equations for sex determination in the Egyptian population. Subjects and methods: The study was conducted on 120 adult Egyptian patients (54 males and 66 females) with a mean age of 37.1 ± 6.01. Twenty-four linear measurements were taken from the 12th thoracic and L1 vertebrae and then four ratios were calculated. The data was analyzed by the statistical package for social sciences (SPSS) version 20. Accuracies and regression equations for sex determination were then derived. Results: Fourteen measurements out of the 24 linear measurements showed significant sex differences when using the 12th thoracic vertebra. As regards to the first lumbar vertebra, only seven linear measurements and one ratio of the posterior height of the vertebral body/anterior height of the vertebral body (VBHp/VBHa) were sexually dimorphic. The percentage of accuracy of the 12th thoracic vertebra was found to be 93.1%, while that of the first lumbar was 68.0%. When combining the two vertebrae the accuracy increased to above 95% (96.3%). Conclusion: Finally, it was concluded that the 12th thoracic vertebra is more accurate for sex determination than the first lumbar vertebra in the Egyptian population, which means that bone dimensions are population specific

Endoscopi facial nerve surgery

Endoscopic facial nerve surger

Endoscopic Facial Nerve Surgery

Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route

Instrumentation and technologies in endoscopic ear surgery

This article covers state-of-the-art instruments and devices specially designated for endoscopic ear surgery. New technologies stimulate the creation of special endoscopic equipment and microinstruments specially designed to satisfy the exclusive requirements of endoscopic ear surgery, which contribute to the progress of the procedure. The article presents the advantages and disadvantages of working with ear endoscopes and details the advances in equipment used in ear endoscopies. New instruments specially modified for working with angled-vision endoscopes and considerations of the surgeon's use of them are discussed. © 2013 Elsevier Inc

COVID-19 and ear endoscopy in otologic practices

Purpose: Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. Methods: Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. Results: Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. Conclusion: The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy