Open femoral hernia repair: one skin incision for all

<p>Abstract</p> <p>Background</p> <p>Femoral hernias are relatively uncommon, however they are the most common incarcerated abdominal hernia, with strangulation of a viscus carrying significant mortality. Classically three approaches are described to open femoral hernia repair: Lockwood's infra-inguinal, Lotheissen's trans-inguinal and McEvedy's high approach. Each approach describes a separate skin incision and dissection to access the femoral sac. The decision as to which approach to adopt, predominantly dependent on the suspicion of finding strangulated bowel, is often a difficult one and in our opinion an unnecessary one.</p> <p>Methods</p> <p>We propose a technique for open femoral hernia repair that involves a single skin incision 1 cm above the medial half of the inguinal ligament that allows all of the above approaches to the hernia sac depending on the operative findings. Thus the repair of simple femoral hernias can be performed from below the inguinal ligament. If found, inguinal hernias can be repaired. More importantly, resection of compromised bowel can be achieved by accessing the peritoneal cavity with division of the linea semilunaris 4 cm above the inguinal ligament. This avoids compromise of the inguinal canal, and with medial retraction of the rectus abdominis muscle enables access to the peritoneal cavity and compromised bowel.</p> <p>Discussion</p> <p>This simple technique minimises the preoperative debate as to which incision will allow the best approach to the femoral hernia sac, allow for alteration to a simple inguinal hernia repair if necessary, and more importantly obviate the need for further skin incisions if compromised bowel is encountered that requires resection.</p

Different Tools for the Assessment of Bone Mass among Egyptian Adults

BACKGROUND: Several tools such as, dual X-ray absorptiometry (DXA), quantitative computed tomography (QCT) and self-assessment tool (OST), are being used for diagnosis of osteoporosis.OBJECTIVE: to compare the sensitivity and specify detection rate of bone mineral density (BMD) changes for DXA versus QCT and OST among a sample of Egyptian adults of both sexes.SUBJECTS AND METHODS: This study is a cross sectional one, which included 62 Egyptians, aged 20-65 years.  Each individual was assessed for BMD using DXA at femur and spine sites; QCT and OST which take into account body weight and age. Accordingly they were diagnosed as either osteoporotic/osteopenic or normal.RESULTS: The highest prevalence of osteopenia or osteoporosis was diagnosed among menopause women. DXA at femur has diagnosed more cases of osteoporosis (both osteopenic and osteoporotic) as compared to spine DXA or QCT, but OST is out of rang; as it failed to diagnose any case.CONCLUSION: DXA has been found to be more efficacious than QCT scan in the diagnosis of osteoporosis. DXA in femur is better than DXA-spine and QCT. Generally, DXA is the "gold standard" when assessing osteoporosis. Further studies are needed to modify the equation of OST and confirm its efficiency in Egyptians population

The Relation between Visceral and Subcutaneous Fat to Bone Mass among Egyptian Children and Adolescents

BACKGROUND: The relation between fat distribution and bone mass is still being debated in children and adolescents.AIM: To verify the influence of both visceral and subcutaneous fat on bone mass among Egyptian children and adolescents.SUBJECTS AND METHODS: The study involved 78 (38 boys and 40 girls) individuals from children (42) and adolescents (36), aged 8-17 years. They were divided into 2 age groups: children group (20 boys and 22 girls) aged 8-12 years and adolescent group (18 boys and 18 girls) aged 13-17 years. Anthropometric measurements, visceral and subcutaneous fat (measured by ultrasound), body composition, BMD and BMC (Measured by DXA), were attempted.RESULTS: Among children, significant positive correlations between visceral fat; in males; and subcutaneous fat; in females; with total BMC, BMD and its Z-score were revealed. After exclusion of age effect, the association between visceral fat in females with total BMD and its Z-score and lumbar BMD-Z-score became significant.  For adolescents, no correlation was observed between either visceral or subcutaneous fat with any parameter of bone mass.CONCLUSIONS: Visceral and subcutaneous fat had significant positive association with bone mass in children; males and females respectively. On the contrary such association disappeared during adolescence

Correlation Between Neutrophil-Lymphocyte Ratio, Platelets-Lymphocyte Ratio, and High-Resolution CT in Patients with COVID-19

Background: COVID-19 is a highly infectious disease that necessitates simple and rapid methods for recognising severe patients. Aims: To correlate between chest lesions in CT, neutrophil-lymphocyte ratio (NLR), and platelets-lymphocytes ratio in patients with COVID-19, and to detect their cut-off values as an early warning of severe COVID-19 in Egyptian patients. Subjects and Methods: A cross-sectional study included 100 adult patients with COVID-19 attending Ahmed Maher Teaching Hospital, Cairo, Egypt. Clinical, laboratory, and radiological assessments were done. They were classified according to their CT grades into three groups: seven patients with a normal chest CT, 45 non-severe cases, and 48 severe cases. Results: Dyspnoea was the most common symptom among the severe cases (79.2%) and fever among non-severe cases (71.1%), while cough (85.7%) was the most common among cases with a normal CT. The age, NLR, C-reactive protein (CRP), and D-dimer of severe cases were significantly the highest, while the absolute lymphocytes were significantly the lowest. Highly significant positive correlations were found between CT grades with D-dimer, NLR, and CRP; significant positive correlation was found with age; and significant negative correlation with CT. Using receiver operating characteristic analysis, areas under the curve of D-dimer, NLR, age, CRP, ferritin, and platelet-lymphocyte ratio were 0.760, 0.698, 0.640, 0.627, 0.614, and 0.595, respectively. The optimal cut-off value of NLR was 2.50 with 0.74 specificity, 0.61 sensitivity, and 67.5 accuracy. Conclusion: NLR is a reliable and easy-to-use predictor of COVID-19 severity. NLR (>2.5) should prompt prescription of a chest CT as it could reveal essential lesions that influence further management

1,2-Bis[(1,3-benzodioxol-5-yl)methyl­idene]hydrazine

The complete mol­ecule of the title compound, C16H12N2O4, is generated by the application of a centre of inversion. The (1,3-benzodioxol-5-yl)methyl­idene fused-ring system is approximately planar (r.m.s. deviation = 0.020 Å) and is essentially coplanar with the central hydrazine group [dihedral angle = 5.08 (9)°]. Weak π–π inter­molecular inter­actions are observed [centroid–centroid distance = 3.8553 (8) Å], providing some packing stability

Utjecaj progesterona na toksičnost benzena u štakora

Benzene is a frequently used industrial solvent. Its toxic manifestations could be modified by sex hormones, but mechanisms of their action are poorly understood. We have examined the influence of progesterone on lipid peroxidation (malondialdehyde), reduced glutathione (GSH), and cytochrome P450 2E1 (CYP2E1) in the liver and kidneys of female rats. Progesterone applied to benzene-treated rats inhibited the formation of reactive oxygen species (ROS), but in ovariectomised benzene-treated rats it significantly increased GSH in the liver. No improvement in CYP2E1 activity was observed in progesterone treated rats. Our results evidence that progesterone changes benzene toxicity (generation of ROS, oxidative stress). However, the probable antioxidative effect of progesterone needs to be confirmed by further studies.Benzen se u industriji često rabi kao otapalo. Zna se da na njegovu toksičnost mogu utjecati spolni hormoni, ali su mehanizmi njihova djelovanja još uvijek slabo poznati. Ispitali smo utjecaj progesterona na peroksidaciju lipida (malondialdehida), pad razina glutationa te aktivnost citokroma P450 2E1 (CYP2E1) u jetri i bubrezima štakorica. Primjena progesterona u štakorica koje su prethodno primile benzen inhibirala je stvaranje reaktivnih molekula kisika (engl. reactive oxygen species, krat. ROS), ali je u štakorica s ovariektomijom koje su također primile benzen doveo do značajnoga rasta glutationa u jetri. U štakorica koje su primile progesteron nije zamijećena poboljšana aktivnost izoeznima CYP2E1. Naši rezultati potvrđuju da progesteron utječe na toksičnost benzena (stvaranje ROS-a i oksidativni stres). Međutim, tek u budućim istraživanjima valja potvrditi djeluje li progesteron antioksidativno

1,2-Bis(3-phen­oxy­benzyl­idene)hydrazine

Mol­ecules of the title compound, C26H20N2O2, reside on crystallographic centres of inversion located at the mid-point of the N—N bond. The benzyl­idene ring is essentially coplanar with the central hydrazine group, with an inter­planar angle of 4.5 (2)°, whereas the phenyl ring is oriented at 34.0 (3)° with respect to the mean plane of the central 1,2-dibenzyl­idenehydrazine group. In the crystal, C—H⋯π(arene)-ring inter­actions link mol­ecules about inversion centres