2 research outputs found

    A Comparison of the Human Umbilical Cord's Histomorphometric and Histological Structure in Pregnant Diabetic and Non-Diabetic Women

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    This study aimed to explore the histomorphometrical and histopathological alterations of umbilical cord (UC) vessels caused by gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM). A total of thirty UC samples were obtained from full term pregnant women without any complications. Ten out of thirty UCs were obtained from non-diabetic pregnant women (normal group), 10 from GDM and 10 from PGDM pregnant women. Segments from the placental attachment, center and fetal side of UCs were taken for each group. These segments were processed for paraffin blocks, sectioned, and stained with H&E, Masson trichrome (MT) and Periodic Acid Shift (PAS). The results of the histomorphometric study showed no significant differences in the UC mean weight among these three groups. In three different segments, GDM resulted in a significant decrease in artery and vein wall thickness compared to the control group. GDM and PGDM resulted in a non-significant difference in the diameter of artery and vein in fetal segment, the vein in placental segment, and artery in the central segment compared with normal. All the UCs in the three groups contained two arteries and one vein but only one cord recorded in the GDM group contained one artery and one vein. Histological study of diabetic UC segments showed extravasation of blood, artery discordance, degeneration of Warton’s jelly (WJ) fibers with formation of honeycomb like empty spaces, formation of multiple spaces between smooth muscle cells of tunica media and detachment of the umbilical arteries from surrounding WJ. In both diabetic groups, there was a marked decrease in collagen fibers in tunica intima and media with their irregular arrangement in both arteries and vein especially in placental segment. The results also showed there was a rich carbohydrate content in the intima and media in all three groups. In conclusion, the current results proved that GDM and PGDM have an adverse effect on the structure of UC and its vessels. Keywords: Umbilical cord; Diabetes mellitus; Histological study; Special stains; Blood vessels DOI: 10.7176/JBAH/13-6-04 Publication date: April 30th 2023

    Outcome of Multilevel Anterior Cervical Discectomy and Fusion without Plating

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    Background: Multilevel anterior cervical discectomy and fusion (ACDF) procedure had traditionally been associated with plating, however,  the increase in cost and complications associated with plating led us to investigate results of multilevel ACDF with polyether ether ketone (PEEK) cages without plating and study complication and fusion rates. Objective: To evaluate the clinical and radiological outcome of patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF) using polyether ether ketone (PEEK) cage with no plating. Patients and Methods: Sixty patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF), Surgical approach, using Polyether Ether Ketone (PEEK) cages with synthetic bone graft material with no plating. Their mean age was 48 year. All patients were evaluated clinically and radiologically for a mean time of one year. Assessment done comparing early and late post-operative cervical spinal x-rays for cage subsidence and migration. Improvement in axial neck and radicular pain were assessed using the Visual Analogue Score (VAS). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), A p value of ≤ 0.05 was considered statistically significant. Results: Sixty patients underwent Anterior Cervical Discectomy with Fusion (ACDF) through Cloward approach.  F:M ratio was 1:1. Two levels were operated in 75% of patients, while in 25% three levels were operated. The majority 85% underwent operation at C5-6 level, least operated levels were C3-C4 and C6-C7 36.7% and 66.7% underwent operation at C4-C5 level. None underwent operation at C2-C3 level. There was significant improvement in axial neck pain with VAS decreasing from 6 to 2, radicular pain improved from 7 to 2. Only one patient (1.7%) showed radiological subsidence of 3 mm after 6 months of operation with no further progression, cage slippage was observed in 2 patients (3.3%) by 1 mm in both cases but no radiological progression. All patients (100%) showed good fusion. Conclusion: Multilevel ACDF with PEEK cages without plating showed to be safe option and provided good fusion rates and clinical outcome in our patients
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