Analysis of coupled shear wall tall buildings

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Superior Mesenteric Artery Syndrome Following Augmentation Cystoplasty

Superior mesenteric artery syndrome (SMAS) is a rare condition of external duodenal compression in the angle between the superior mesenteric artery and aorta. We report a case of SMAS following augmentation cystoplasty in a young patient. Superior mesenteric artery syndrome (SMAS) is a rare condition that usually presents with symptoms of upper gastrointestinal (GI) obstruction due to extrinsic compression of the third part of duodenum between the abdominal aorta posteriorly and superior mesenteric artery (SMA) anteriorly. Several predisposing factors have been described, however; severe weight loss is considered the most significant. Reduction in the angle and distance between the aorta and the SMA causes compression of the duodenum. Conservative treatment plays a major role in such cases; however, failure of such measures may warrant surgical intervention

Effect of oxytocin infusion versus tranexamic acid on reducing blood loss during hysteroscopic myomectomy: a randomized controlled trial

Background: Women undergoing hysteroscopic myomectomy are prone to significant blood loss and hematological disturbances. Oxytocin is a uterotonic drug, used mainly in obstetric practice. Tranexamic acid is a haemostatic drug that has been used to reduce blood loss after trauma and in many surgeries. The aim of our study was to compare the safety and efficacy of oxytocin versus tranexamic acid in reducing perioperative blood loss during hysteroscopic myomectomy.Methods: This study included 60 patients scheduled for hysteroscopic myomectomy allocated into 2 groups: group A: received 10 mg/kg of tranexamic acid slowly intravenous after induction of anesthesia, while group B: received infusion of 10 IU of oxytocin at a rate of 400 mIU/min throughout the procedure. Preoperative and postoperative hemoglobin and hematocrit levels, need for blood transfusion, duration of operation, complications and medications adverse effects were recorded.Results: The 2 groups were comparable in terms of the mean difference between preoperative and postoperative hemoglobin a hematocrit levels, operative time, operative complication and medications’ adverse effects. No patients needed blood component transfusion in either group.Conclusions: It can be concluded that tranexamic acid and oxytocin are equally effective in reducing blood loss and transfusion requirements during hysteroscopic myomectomy with comparable good safety profiles. Both of them can be used according to availability and surgeon preferences

Limited Invasive Techniques in Management of Sander's Type II, III Calcaneal Fractures

Background: A thorough understanding of the clinical and radiographic anatomy of the calcaneus and its articulations is crucial when attempting less invasive procedures for intraarticular calcaneus fractures.Objective: The aim of this work is to evaluate the functional outcome and to assess the anatomical restoration of the calcaneus with radiographic measurements after percutaneous fixation of Sanders type II and type III calcaneal fractures by K-wires and cannulated screws. Patients and methods: This was a prospective study that is conducted on 23 patients whom were classified as Sanders type II, III Calcaneal fractures. This study was done at Alexandria Police Hospital and Zagazig University Hospital. These patients were followed up for at least 6 months postoperatively. All patients in the study were evaluated including history taking and clinical examination. All patients had preoperative lab investigations and were evaluated radiologically with X-ray calcaneus and CT scan, and were followed up at outpatient clinic twice in the first week then once a week for the next two months.Results: The final results at the end of this study were satisfactory in 91.3% of patients and unsatisfactory in 8.7% of patients. About (81.3%) of the excellent results were obtained in Sanders type II fractures, while 18.7 % of the excellent results were obtained in Sanders type III fractures. Conclusion: Less invasive surgical techniques for treating displaced intraarticular calcaneus fractures have been undertaken in an attempt to reduce complications and improve recovery when surgery is indicated. These emerging techniques may be beneficial in patients with soft-tissue compromise, multiple comorbidities, and displaced intraarticular fractures with minimal comminution

Diagnostic value of F-18 FDG PET/CT for local and distant disease relapse surveillance in surgically treated RCC patients: Can it aid in establishing consensus follow up strategy?

BACKGROUND: Aim of the study was to evaluate the diagnostic performance of FDG PET-CT for the detection of local and distant disease relapse in surgically treated patients with renal cell carcinoma (RCC). MATERIAL AND METHODS: This retrospective study includes 96 patients underwent FDG PET-CT scanning in the post-surgical follow up within the first 6–12 months referred to nuclear medicine department, to perform PET/CT study. Each patient underwent FDG PET-CT with low dose CT, followed immediately by full dose Ce-CT. Sites of the relapse were categorized into local and distant recurrence. Distant recurrence sites were divided into lymph nodes, lung, bone, and other soft tissue sites. The final diagnosis of disease status was made on subsequent follow up by conventional imaging (CT/MRI), FDG PET-CT, or histopathology whenever possible. RESULTS: Local and/or distant disease relapse was confirmed in 69 (71.9%) patients and the rest 28.1% were free. Regarding local recurrence FDG PET-CT showed specificity of 100% compared to 98.6% with Ce-CT (p > 0.05) and higher sensitivity noted with Ce-CT (100%) compared to 96% with FDG PET-CT. For global distant sites of metastases Ce-CT revealed high sensitivity and NPV of 93.3% & 96.9% respectively yet lower specificity (93.96%) and PPV (87.5%) was seen with Ce-CT compared to 99.6% and 99.1% with FDG PET-CT respectively. The higher Ce-CT sensitivity was attributed to its ability to detected 100% of cases of lung metastases compared to 80.6% with FDG PET-CT (P-value < 0.05). CONCLUSION: FDG PET-CT appears to be a very efficient tool in post-surgical surveillance of patients with RCC with notable ability to probe even uncommon sites of distant recurrence

Cardiac sarcoidosis and ventricular arrhythmias. A rare association of a rare disease. A retrospective cohort study from the National Inpatient Sample and current evidence for management

Background: Sarcoidosis is an increasingly recognized multi-systemic condition. Cardiac sarcoidosis is associated with ventricular arrhythmias and higher mortality rates. Little epidemiological data is available regarding the disease and associated ventricular arrhythmias. Methods: Data from the National Inpatient Sample (NIS) database 2012–2014, were reviewed. Dis­charges associated with sarcoidosis were identified as the target population using relevant ICD-9-CM codes. Primary outcome was a diagnosis of ventricular tachycardia (VT) in the sarcoidosis population. Secondary outcomes include rate of ventricular fibrillation (VF) and cardiac arrest. Subgroup analyses were performed to examine the association of VT with multiple potential confounding clinical variables. Results: Of 18,013,878 health encounters, 46,289 (0.26%) subjects had a diagnosis of sarcoidosis. VT and VF were more prevalent among patients with sarcoidosis compared to those without a diagnosis of sarcoidosis (2.29% vs. 1.22%; p < 0.001 and 0.25% vs. 0.21%; p < 0.001, respectively). Sarcoidosis was also associated with a higher prevalence of cardiac arrest (0.72% vs. 0.6%; p < 0.001). In unadjusted analyses, all examined comorbidities were significantly more common in those with sar­coidosis, including diabetes mellitus (31.6% vs. 21.25%; p < 0.001), hypertension (65.2% vs. 51.74%; p < 0.001), chronic kidney disease (21.09% vs. 14.02%; p < 0.001), heart failure (24.87% vs. 15%; p < 0.001) and acute coronary syndrome (4.32% vs. 3.35%; p < 0.001). Conclusions: The present study showed that sarcoidosis was associated with increased rates of ven­tricular tachyarrhythmia, which can affect the overall disease morbidity and mortality

Stress among Mansoura (Egypt) baccalaureate nursing students

Background: Over the last years, details regarding levels of stress and sources of stress have emerged in studies of nursing students in Western population To date, there only few similar reports on clinical stress, anxiety, depression among the Arab population .This study was conducted to examine the level of perceived stress among baccalaureate Mansoura nursing students and to highlight the possible predicting factors. Methods: In this cross- sectional study, Data were obtained from 373 students using a self-administered questionnaire, including questions on sociodemographics, list of possible stressors, perceived stress, physical wellbeing factors, anxiety and depressive symptoms. Results: Prevalence of high stress level, anxiety and depression were 40.2%, 46.6% and 27.9%, respectively. On average each student reported a mean of 4.6 stressors and academic pressures were the most frequent stressors .In regression analysis the number of stressors and global sickness index score were predictors of high stress level. Conclusion: These findings call for introduction of stress management programs and psychiatric care into nursing health services of the University.Key words: Nursing students, stress, Depression, Anxiety, Arab culture, Egyp

Chest wall reconstruction still has place in Today’s modern practice:" a tertiary center experience"

Background: The key factor following chest wall resection is the preservation of the stability and integrity of the chest wall to support the respiration and protect the underlying organs. The present study aims to evaluate the use of the available grafts and prosthetic materials at our center in chest wall reconstruction with adherence to the proper surgical techniques, good perioperative and postoperative care to obtain good results. Methods: This is a retrospective single center study that concludes all patients underwent chest wall reconstruction for a variety of defects resulting from resection of tumors, trauma due to primarily firearms or motor car accidents, resection of radio necrotic tissues, infection and dehiscence of median sternotomy wounds after cardiac surgery.  Results: Study population consisted of 30 patients between January 2015and may 2018, among them were 20 male (70%) and 10 female patients (30%), with a median age of 43 ± 16.3 years, resection and reconstruction was performed in 23 cases (15 neoplastic,5 infective and  3 firearm cases) while reconstruction alone was performed in 7 (traumatic flail chest)  cases. Eighteen patients, underwent rib resection with an average 4.18 ± 2.2 ribs (range 2-6). Associated lung resection was performed in 5 patients (27.8 %): diaphragmatic resection was done in 2 cases in addition total sternal resection was performed in 5 cases. Most of the patients (96.7%) had primary healing of their wounds. there was one death (3.3%) in the early postoperative period. The average length of hospital stay for all patients was 8.7 days (range: 5–15). Respiratory complications occurred in three cases in the form of atelectasis and pneumonia at the ipsilateral side of reconstruction. Three cases suffered wound seroma which successfully managed by daily dressing and antibiotic coverage. Conclusions: according to our study and the analysis of similar studies, adequate perioperative preparation of patient undergoing chest wall resection and reconstruction with adherence to effective surgical techniques allowed us to use the available materials at our center for chest wall reconstruction with good and effective results without adding burden in terms of cost on the patient

Advanced Protocol of Shock Wave Therapy for Diabetic Foot Ulcer

Abstract: Foot ulceration is one of the most common and severe complications of diabetes mellitus causing hospitalization and amputation of lower limb. Delivery of shock wave therapy stimulates the early expression of angiogenesis-related growth factors so it results in new vessel in-growth that improves blood supply, increases cell proliferation and accelerates tissue regeneration and healing. Purpose of this study was to evaluate the effectiveness of shock wave therapy in enhancing diabetic wound healing. Material & methods Forty diabetic patients with stage (II or III) lower limb ulcers were randomly divided into two groups (shock wave group and control group). Shock wave group received 3 sessions of unfocused shock wave (500 pulses/cm 2 at 0.1 mJ/mm 2 ) one session every week beside traditional wound care, the control group received traditional wound care. The methods of assessment were wound surface area and epithelialization rate. Results showed significant decrease in wound surface area and increase in the rate of epithelialization in shock wave group compared to the control group. Conclusions From the finding of the current study we concluded that shock wave with these parameters (500 pulses/cm 2 at 0.1 mJ/mm 2 ) is an effective, safe, relatively inexpensive, simple and available modality in enhancing and accelerating diabetic wound healing