Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Andrea Castellucci, Pasquale Malara, Cristina Brandolini, Valeria Del Vecchio, Davide Giordano, Angelo Ghidini, Gian Gaetano Ferri, Antonio Pirodda
Abstract
Objectives
To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly.
Methods
Case report and literature review.
Results
A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers.
Conclusions
In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.
Individuals with MECP2 duplication syndrome (MDS) have varying degrees of severity in their mobility, hand use, developmental skills, and susceptibility to infections. In this study, we examine the relationship between duplication size, gene content, and overall phenotype in MDS using a clinical severity scale. Other genes typically duplicated within Xq28 (e.g. GDI1, RAB39B, FLNA) are associated with distinct clinical features independent of MECP2. We additionally compare the phenotype of this cohort (n=48) to other reported cohorts with MDS. Utilizing existing indices of clinical severity in Rett Syndrome, we found that larger duplication size correlates with higher severity in total clinical severity scores (r=.36; p=.02), and in total motor behavioral assessment inventory scores (r=.31; p=.05). Greater severity was associated with having the RAB39B gene duplicated, although most of these participants also had large duplications. Results suggest that developmental delays in the first 6 months of life, hypotonia, vasomotor disturbances, constipation, drooling, and bruxism are common in MDS. This is the first study to show that duplication size is related to clinical severity. Future studies should examine whether large duplications which do not encompass RAB39B also contribute to clinical severity. Results also suggest the need for creating an MDS specific severity scale.
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Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Hao Jin, Jinrui Fan, Jun Yang, Kun Liao, Zhuocheng He, Min Cui
Abstract
Background
It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid.
Case presentation
From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism.
Conclusions
This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Alexander L. Luryi, Elias M. Michaelides, Seilesh Babu, Dennis I. Bojrab, John F. Kveton, Robert S. Hong, John Zappia, Eric W. Sargent, Christopher A. Schutt
Abstract
Objectives
To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology.
Design
Retrospective chart review.
Participants
Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017.
Main outcome measures
Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses.
Results
Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05).
Conclusions
Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Sajjad Muhammad, Martin Lehecka, Saku T. Sinkkonen, Mika Niemelä
Abstract
The retrosigmoid approach for vestibular schwannoma surgery has remained the standard approach by most neurosurgeons. Drilling the posterior wall of the internal auditory meatus (IAM) is an essential step in removing the intrameatal tumor. During IAM drilling, three anatomical structures can be encountered, including the posterior semicircular canal, vestibular aqueduct, and jugular bulb. Any of these can be injured during drilling, especially if the jugular bulb lies above the inferior edge of the IAM. Although IAM drilling is performed in most vestibular schwannoma surgeries, information on how to manage complications such as jugular bulb injury is lacking. Here we use an intraoperative video to demonstrate how to manage the inadvertent injury to the jugular bulb in order to avoid massive blood loss. We present a case of a 39-year-old woman with hearing loss, diagnosed with a cerebellopontine angle mass extending into the IAM. Surgery was required due to tumor progression. We used the retrosigmoid approach to access the tumor. During IAM drilling, the jugular bulb was injured. A thin layer of bone wax was applied under continuous suction. The margins of the wax were then gently compressed with a dissector; great care was taken to avoid pushing the wax into the jugular bulb. Excess bone wax was removed (video 1). A small diamond drill (2 mm) was used for further drilling. Our instructional video shows the surgical approach, microsurgical anatomy, and technical aspects of managing massive bleeding from jugular bulb injury. It should therefore be helpful for young neurosurgeons.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Celeste Z. Nagy, Sarah Cantrell, Xin Wu, C. Arturo Solares
Abstract
We present a rare case of a vascular anomaly of the sphenoid and temporal bones causing an expandable mass of the temporal region with dependent patient positioning and characteristic osseous changes on imaging. Initial diagnosis considerations included multiple myeloma (MM), fibrous dysplasia (FD), Paget's disease, lymphoma, meningoencephalocele (MEC), and vascular malformation (VaM). VaMs of the head and neck are rare and typically arise in the mandible and maxilla. However, this case demonstrates a unique finding of a VaM of the sphenoid and temporal bones with important radiological features to distinguish the diagnosis of vascular anomaly from other etiologies.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Andrea L. Hanick, Joseph B. Meleca, Steven D. Billings, Paul C. Bryson
Abstract
Pyogenic granuloma (PG) may involve gingival mucosa (granuloma gravidarum) in pregnancy but rarely involves the airway. This case report is perhaps the only reported presentation of PG in the larynx causing hemoptysis at a late stage of pregnancy. On laryngoscopic exam, a vascular, right false vocal fold neoplasm was identified with pathological characteristics consistent with PG. Conclusions: Pyogenic granuloma is a relatively common tumor of pregnancy but rarely involves the larynx. In the case of airway involvement during pregnancy, it is best managed in coordination with the high-risk obstetrical team and can be removed safely via standard microsurgical techniques.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Hao Jin, Jinrui Fan, Jun Yang, Kun Liao, Zhuocheng He, Min Cui
Abstract
Background
It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid.
Case presentation
From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism.
Conclusions
This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Andrea Castellucci, Pasquale Malara, Cristina Brandolini, Valeria Del Vecchio, Davide Giordano, Angelo Ghidini, Gian Gaetano Ferri, Antonio Pirodda
Abstract
Objectives
To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly.
Methods
Case report and literature review.
Results
A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers.
Conclusions
In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.
Source: American Journal of Otolaryngology, Volume 40, Issue 2
Author(s): Kayvon F. Sharif, Fred M. Baik, Lauren E. Yue, Muhammad Qazi, Margaret Brandwein-Weber, Azita S. Khorsandi, Mark L. Urken
Abstract
Background
Osteoradionecrosis (ORN) is a well-known complication following irradiation of head and neck malignancies. ORN commonly occurs in the mandible but is rarely reported in the hyoid bone.
Case presentation
A 76-year-old female with a history of oropharyngeal squamous cell carcinoma presented with pharyngocutaneous fistula 14 years after primary chemoradiation. Imaging showed necrosis of the hyoid bone. She underwent excision of the hyoid to rule out malignancy. Pathology was negative for carcinoma, but did show extensive fragmentation and bony necrosis consistent with ORN. The patient's clinical course, surgical treatment, and management considerations are discussed here.
Conclusions
Hyoid ORN should remain in the differential during diagnostic workup of previously irradiated head and neck cancer patients. The presentation of a pharyngocutaneous fistula should prompt workup to rule out malignancy before assigning a diagnosis of ORN.
Improper storage and disposal of medications potentially pose a significant risk to both humans and animals. It also increases the economic burden to the society. The objective of this study was to investigate the storage and disposal habits of medications among the public of Saudi Arabia. The common place for storage for most of the medications was the fridge, followed by bedroom, kitchen, living room, and bathroom. An average of one to five unused medications were stored inside the house in Saudi. Antipyretic, pain medications and cough medications were the most common stored medications. Furthermore, we attempt to endorse the guidelines by the Food and Drug Administration for the best disposal practices.
The major constraints in the design of wireless body area network (WBAN) can be attributed to the battery autonomy, need for high data rate services, and low interference from the devices operating within the industrial, scientific, and medical (ISM) bands. To meet the demand for high data rate services and low power spectral density to avoid ISM band interference, an ultra-wideband (UWB) system-based technology has been proposed. This study focuses on the design and demonstration of an UWB modem to be used in the WBAN applications and the evaluation of its performance in near-real-world scenarios affected by additive white Gaussian noise interference. The modem is tested with different values of signal-to-noise ratio (SNR). Results show that the performance of the modem degrades as the value of SNR decreases.
Study Background: Trypanosoma cruzi and Toxoplasma gondii parasitic infections in human immunodeficiency virus (HIV)-positive patients could accelerate the progression of HIV infection, which may result into immunosuppression due to immune responses involving cytokines and CD4 + cells. Aim and Objective: This work was designed to determine the immunochemical evidence of T. cruzi and T. gondii parasitic infections in HIV/acquired immunodeficiency syndrome subjects in relationship with the CD4+ count. Materials and Methods: Fifty HIV-positive subjects (25 females and 25 males) aged 14–57 years were recruited as test subjects while 100 HIV-seronegative age-matched individuals were recruited as control. T. cruzi and T. gondii parasitic infections were determined in the subjects by ELISA, while CD4+ cells enumeration was carried out in the subjects by cyflowmetry, and HIV test was carried out by immunochromatography and western blotting. Results: The results obtained showed a significantly lower CD4+ cells in T. cruzi- and T. gondii-infected HIV-positive patients than the HIV-positive and HIV-negative subjects who were not infected with any of the parasites (<0.05). There was also a significantly lower CD4+ cells in T. gondii-infected HIV-positive patients than T. cruzi-infected HIV-positive patients (<0.05). The frequency of T. cruzi in HIV-positive patients was 18% (9) which was more prevalent in male patients (12%[6] vs. 6% [3]) while that of T. gondii-infected HIV-positive patients was 14% (7), was more prevalent in females than males (10%[5] vs. 4% [2]). T. cruzi parasitic infection was found to be more prevalent compared to T. gondii infection among HIV-positive patients (18%[9] vs. 14% [7]). Conclusion: There parasitic infection caused a significant decrease in CD4+ cells in HIV subjects. There was also a gender difference in the parasitic infection of T. cruzi and T. gondii while the frequency of T. cruzi was 18% (9) and T. gondii was 14% (7).
Context: The dental clinic is presumed to be a suitable and practical place for smoking cessation counseling. Clinical dental students have an opportunity to play a crucial role in educating their patients about the impact of smoking and promote their oral and general health. Aims: This study aims to determine the perceptions of clinical dental students toward smoking cessation counseling and the barriers to promote it. Settings and Design: This cross-sectional study was conducted in Riyadh, Saudi Arabia in July 2017 among clinical dental students and interns of five dental schools. Subjects and Methods: We used a questionnaire derived from a similar study. The online questionnaires were distributed through social media. Statistical Analysis Used: Data analysis was achieved using SPSS 24.0 Mac version (Release 24.0, IBM, USA) through Chi-square test. Statistical significance was considered at P < 0.05. Results: A total of 291 individuals participated in the study. Most of the respondents were nonsmokers (79.4%). In comparison between junior and senior dental students with regard to their perceptions of smoking cessation counseling, it was found that there was no significant difference between the two groups. Most of the respondents were interested in becoming trained on how to assist patients to quit (72.9%). Furthermore, the majority of participants inquired about their patients' smoking status (87.6%). The most frequently cited barrier was lack of training to help patients quit smoking (67%). Conclusions: This study identified the lack of appropriate training and insufficient knowledge toward tobacco use cessation counseling.
REVIEW ARTICLE
Storage and disposal practice of unused medication among the Saudi families: An endorsement for best practice
p. 1
Jisha M Lucca, Dhfer Alshayban, Duaa Alsulaiman DOI:10.4103/ijas.ijas_21_18
Improper storage and disposal of medications potentially pose a significant risk to both humans and animals. It also increases the economic burden to the society. The objective of this study was to investigate the storage and disposal habits of medications among the public of Saudi Arabia. The common place for storage for most of the medications was the fridge, followed by bedroom, kitchen, living room, and bathroom. An average of one to five unused medications were stored inside the house in Saudi. Antipyretic, pain medications and cough medications were the most common stored medications. Furthermore, we attempt to endorse the guidelines by the Food and Drug Administration for the best disposal practices.
Ultra-wideband transceiver model for wireless body area network applications
p. 7
Mohanad Abdulhamid, Onyango Ben Sewe DOI:10.4103/ijas.ijas_16_18
The major constraints in the design of wireless body area network (WBAN) can be attributed to the battery autonomy, need for high data rate services, and low interference from the devices operating within the industrial, scientific, and medical (ISM) bands. To meet the demand for high data rate services and low power spectral density to avoid ISM band interference, an ultra-wideband (UWB) system-based technology has been proposed. This study focuses on the design and demonstration of an UWB modem to be used in the WBAN applications and the evaluation of its performance in near-real-world scenarios affected by additive white Gaussian noise interference. The modem is tested with different values of signal-to-noise ratio (SNR). Results show that the performance of the modem degrades as the value of SNR decreases.
Immunochemical evidence of Trypanosoma cruzi and Toxoplasma gondii parasitic infections in human immunodeficiency virus/acquired immunodeficiency syndrome subjects in relationship with the CD4+ count
p. 16
Mathew Folaranmi Olaniyan, Oladayo Abayomi Kilo DOI:10.4103/ijas.ijas_19_18
Study Background: Trypanosoma cruzi and Toxoplasma gondii parasitic infections in human immunodeficiency virus (HIV)-positive patients could accelerate the progression of HIV infection, which may result into immunosuppression due to immune responses involving cytokines and CD4 + cells. Aim and Objective: This work was designed to determine the immunochemical evidence of T. cruzi and T. gondiiparasitic infections in HIV/acquired immunodeficiency syndrome subjects in relationship with the CD4+ count.Materials and Methods: Fifty HIV-positive subjects (25 females and 25 males) aged 14–57 years were recruited as test subjects while 100 HIV-seronegative age-matched individuals were recruited as control. T. cruzi and T. gondii parasitic infections were determined in the subjects by ELISA, while CD4+ cells enumeration was carried out in the subjects by cyflowmetry, and HIV test was carried out by immunochromatography and western blotting. Results: The results obtained showed a significantly lower CD4+ cells in T. cruzi- and T. gondii-infected HIV-positive patients than the HIV-positive and HIV-negative subjects who were not infected with any of the parasites (<0.05). There was also a significantly lower CD4+ cells in T. gondii-infected HIV-positive patients than T. cruzi-infected HIV-positive patients (<0.05). The frequency of T. cruzi in HIV-positive patients was 18% (9) which was more prevalent in male patients (12%[6]vs. 6% [3]) while that of T. gondii-infected HIV-positive patients was 14% (7), was more prevalent in females than males (10%[5] vs. 4% [2]). T. cruzi parasitic infection was found to be more prevalent compared to T. gondii infection among HIV-positive patients (18%[9] vs. 14% [7]). Conclusion: There parasitic infection caused a significant decrease in CD4+ cells in HIV subjects. There was also a gender difference in the parasitic infection of T. cruzi and T. gondii while the frequency of T. cruzi was 18% (9) and T. gondii was 14% (7).
Perceptions of smoking cessation counseling among dental students in Riyadh, Saudi Arabia: A cross-sectional study
p. 21
Abdulmalik A Alhussain, Rand F Alsaif, Jawaher M Alahmari, Ali A Aleheideb DOI:10.4103/ijas.ijas_20_18
Context: The dental clinic is presumed to be a suitable and practical place for smoking cessation counseling. Clinical dental students have an opportunity to play a crucial role in educating their patients about the impact of smoking and promote their oral and general health. Aims: This study aims to determine the perceptions of clinical dental students toward smoking cessation counseling and the barriers to promote it. Settings and Design: This cross-sectional study was conducted in Riyadh, Saudi Arabia in July 2017 among clinical dental students and interns of five dental schools. Subjects and Methods: We used a questionnaire derived from a similar study. The online questionnaires were distributed through social media. Statistical Analysis Used:Data analysis was achieved using SPSS 24.0 Mac version (Release 24.0, IBM, USA) through Chi-square test. Statistical significance was considered at P < 0.05. Results: A total of 291 individuals participated in the study. Most of the respondents were nonsmokers (79.4%). In comparison between junior and senior dental students with regard to their perceptions of smoking cessation counseling, it was found that there was no significant difference between the two groups. Most of the respondents were interested in becoming trained on how to assist patients to quit (72.9%). Furthermore, the majority of participants inquired about their patients' smoking status (87.6%). The most frequently cited barrier was lack of training to help patients quit smoking (67%). Conclusions: This study identified the lack of appropriate training and insufficient knowledge toward tobacco use cessation counseling.
Mustafa T Ahmed, Mohamed B M. Kotb, Mohamed S Shahine, Hassan M Harby, Mahmoud T A. Mohamed
DOI:10.4103/JCMRP.JCMRP_95_18
Aim The aim of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in managing predominantly cystic benign thyroid nodules in euthyroid individuals and avoid complication of surgery, provide symptomatic, cosmetic improvement, decrease the hospital stay and rapid recovery. Patients and methods The study is an experimental clinical trial. Twenty patients (34.20 ± 7.52 years; 60% women) with symptomatic benign thyroid cysts were included. In all cases, cytology before treatment, thyroid function before and after PEI, maximum cyst diameter, and volume were determined. PEI was conducted using 99% sterile ethanol, and pain perceived by the patients was assessed. After follow-up, final cyst diameter and volume were determined. Results The patients mean age was 34.20 ± 7.52 years, and 60% were females. A single session of PEI was required to complete the procedure. Mean initial maximum cyst diameter was 4.3 cm. Mean reduction in the cyst volume was 94.38%±4.04. During PEI, 40% of patients experienced pain. No complications of PEI were observed. After 6 months of follow-up, cysts were reduced more than 95% in 75% of patients, and reduced less than 95% in 25% of patients. Conclusion PEI can be the first-line treatment of benign thyroid cysts. It is a highly efficacious and safe technique with improvement in clinical conditions, with very low recurrence rate, and with no complications except pain associated with injection, which can be managed by analgesic.
Comparison between early and late cholecystectomy after gallstone pancreatitis
p. 67
Ahmed M Mohammed, Hesham A Reyad, Mohamed K Ewis DOI:10.4103/JCMRP.JCMRP_108_18
Acute biliary pancreatitis is one of the most common gastrointestinal illnesses necessitating inpatient hospital admission. With an increasing incidence of gallstone disease, in the setting of a changing healthcare landscape, surgical indications must be carefully examined. The principles of management, including common duct clearance, bowel rest, and interval cholecystectomy to avoid recurrent disease have not changed, however with the refi nement of minimally invasive techniques, timing of intervention deserves re-examination. We seek to make evidence based recommendations on the timing of cholecystectomy following acute biliary pancreatitis.
Early postoperative outcomes of coronary artery bypass grafting patients on-pump versus off-pump
p. 69
El Shafiee M Mohamed, Ghoniem F Ahmed, Taha M Ahmed, Roushdi Z Mohamed DOI:10.4103/JCMRP.JCMRP_81_18
Coronary artery bypass grafting (CABG) is defined as "open-heart surgery in which a section of a blood vessel is grafted from the aorta to the coronary artery to bypass the blocked section of the coronary artery. Cardiac surgery became more feasible in the late 1930s with the development of the heart-lung machine by Dr. John Gibbon which enabled cardiopulmonary bypass (CPB). This study aimed at comparing early postoperative outcomes between patients undergone CABG on-pump versus off-pump. The study was done on 40 patients, 20 of them was done by on-pump technique and the other 20 was done by off-pump technique. All the patients were transferred to intensive care unit and were observed for the following criteria: Early postoperative bleeding, Cardiac support (Medical or Mechanical), Different types of Arrythmias, Renal function and Hospital stay. Early postoperative bleeding: appears to be more with On-pump technique in the first 3 post operative days. Cardiac support (Medical or Mechanical): No significant difference with both techniques. Different types of Arrythmias: No significant difference with both techniques. Renal function: No significant difference with both techniques except of only one patient needed renal dialysis was done by on-pump technique. Hospital stay: No significant difference with both techniques with mean days of hospital stay for all patients of 8 days. In conclusion, our trial did not show any overall advantage to the use of the off-pump as compared with the on-pump cardiac surgical approach for coronary bypass grafting.
Effect of topical and systemic tranexamic acid on bleeding and quality of surgical field during ear exploration surgery: a double-blind, randomised clinical trial
p. 75
Ahmed M Mohareb, Sherif S. A. Elrahim, Saeid M Elsawy, Seham M Moeen, Ragaa A Herdan, Sally A Kamel DOI:10.4103/JCMRP.JCMRP_56_18
Background The surgical field during microscopic ear surgery is small and needs specific anesthetic considerations to improve the surgical field quality and control the bleeding during ear surgery, as little amount of bleeding can impair the quality of the surgical field and the surgical outcome. This can be achieved by different methods, which carry specific risks, such as hypotensive anesthesia, and use of local vasoconstrictors, which are associated with cardiac and hemodynamic risks. The objective of this study was to assess the effect of tranexamic acid (TXA) topically and systemically on bleeding and quality of surgical field during ear exploration surgery. Materials and methods A total of 90 patients undergoing ear exploration surgery were randomly divided into three group. Group A included 30 patients who received systemic TXA in a dose of 10–15 mg intravenous over 30 min, followed by infusion in a dose of 1 mg/kg/h throughout surgery. Group B included 30 patients who received topical TXA in dilution of 1 g diluted in 200 ml saline for surgical wash and soaking the used gauze for compression on the bleeding site. Group C included 30 patients who received diluted adrenaline 1 mg diluted in 200 ml saline used for surgical wash and soaking gauze used for compression of the bleeding site, and this was considered as a control group. Assessment parameters included intraoperative blood loss, quality of surgical field using Boezaart grading with 0–5 scores, hemodynamics and perioperative adverse effects. Results There were no significant differences between groups in the demographic and clinical characteristics regarding age, sex, weight, and height and in anesthesia time, surgical time or time of recovery. The quality of the surgical field was better in group B than groups A and C. The intraoperative bleeding was significantly reduced in group B more than groups A and C, and postoperative nausea, vomiting and blurring of vision were more in group A than the other groups. Conclusion Topical application of TXA has a more significant effect on reducing bleeding and improving the quality of the surgical field during ear exploration surgery with nonsignificant adverse effects.
Objective Hemothorax is the most frequent complication from chest trauma. In most of the cases, chest tube will be sufficient for treatment, but in a minority of patients, more intervention will be needed to evacuate a retained hemothorax. We aimed in this study to compare between video-assisted thoracoscopy (VATS) evacuation of retained clotted blood and reinsertion of thoracostomy tube to explore the safety and complications of such techniques. Patients and methods A prospective randomized case–control study was conducted on patients who presented with retained hemothorax admitted to trauma unit from July 2017 to July 2018. Results During the time frame from July 2017 to July 2018, our trauma unit got 44 879 patients. Approximately 14 722 of them needed admission, with only 288 patients requiring primary chest tube for hemothorax, of which 35 patients met the inclusion criteria of this study. They were then divided into two groups: group A (16 patients) underwent evacuation by VATS. The operative time for VATS ranged from 24 to 130 min, with mean time 79.8 min (after VATS), and needed drainage days range from 2 to 7 days, with mean of 3.31 days. One (6.25%) patient need thoracotomy. No wound infection or empyema was present in group A. Control group (group B) included 19 patients in whom the chest tube was reinserted. The needed days of drainage range from 4 to 10 days, with mean 6.47 days, with significant value (P = 0.001). Three (15.78%) patients had wound infection at the site of thoracostomy tube. On follow-up, we noticed four (20.05%) patients with empyema. Conclusion Early VATS for evacuation of retained hemothorax is feasible and safe in trauma patients. Moreover, VATS evacuation leads to shorter hospital stay and less need for open thoracotomy in comparison with reinsertion of a chest tube.
Comparison of epithelium-off and transepithelial corneal collagen cross-linking for the treatment of keratoconus
p. 87
Mahmoud N Gamal, Saleh Y Samir, Sayed A Mohamed, Ali A Asmaa DOI:10.4103/JCMRP.JCMRP_89_18
Objective The aim of the study was to assess the safety and efficacy of epithelium-off corneal cross-linking versus epithelium-on cross-linking in the treatment of keratoconus. Patients and methods This study was performed on 42 eyes of 22 patients who were divided into two groups. The first group was the epithelium-off cross-linking (CXL) group that included 23 eyes of 12 patients, whereas the second group was the epithelium-on cross-linking group (the TECXL group) that included 19 eyes of 10 patients. Results On comparing the effect of epi-off and epi-on we found that epithelium-on CXL is superior to epithelium-off CXL regarding pain, complications, early patient convalescence as we found significant difference between epi-on and epi-off groups in postoperative complications. In epithelium-on CXL regarding eight (42%) eyes had pain, 0 eye had delayed reepithelization, one (5.26%) eye had stromal haze, and six (31.57%) eyes had treatment failure. However, epithelium-off CXL is superior to epithelium-on CXL regarding the efficacy in visual stabilization and improvement as we found a significant improvement in anterior elevation and Kmax with P = 0.04 and 0.02, respectively. Epithelium-off CXL had significant reduction in Kmax with P = 0.03, anterior elevation had significant reduction with P = 0.04 epithelium-on CXL having nonsignificant change in Kmax and anterior elevation. ConclusionActually, in this study, it was found that TECXL was the procedure of choice for patient comfortability, safety, and convalescence. However, the results of the study confirmed that epithelium-off CXL was the procedure of choice for the patient benefit and guaranteed visual stabilization and additional visual improvement convalescence.
The role of histone H3K27 dimethylation in early-stage urinary bladder carcinoma: the relevance of risk factor
p. 93
Ragaa H Salama, Marwa A Gaber, Khalid M Rezk, Samia F Hamed DOI:10.4103/JCMRP.JCMRP_102_18
Background Epigenetic alterations, including post-translational modification of histone tails by methylation may play an important role in carcinogenesis. Objective The aim was to evaluate the global histone H3K27 dimethylation (H3K27me2) levels in bladder cancer (BC) and to compare these levels in different types and stages of BC. Materials and Methods Venous blood from 45 BC patients and 45 apparently healthy controls was used. The two risk factors such as Schistosoma haematobium infection and smoking were investigated. Histone extraction was done and used to determine the global levels of H3K27 dimethylation. Results Global level of H3K27 dimethylation was significantly lower in BC patients than in healthy controls. We observed a negative correlation between histone dimethylation levels and the smoking state (both in patients and controls). Receiver operating characteristic curve showed that histone H3K27me2 at a cut-off point less than 49.68 ng/μl has 69% sensitivity and 64.5% specificity for the prediction of BC with an area under the curve of 0.67 (P = 0.001). However, there was no statistically significant difference in H3K27me2 levels as regards history of S. haematobium infection (P = 0.6), histopathological types (P = 0.3), and the stages of cancer (P = 0.8).Conclusion The global histone H3K27 dimethylation may substantiate the potential to improve the detection of early-stage urinary bladder carcinoma. Also, the decreased level of histone H3K27me2 in smokers (either patients or controls) could be one entity that explain smoking as a risk factor for BC.
The added value of ST-elevation in lead aVR to clinical thrombolysis in myocardial infarction risk score in predicting the angiographic severity and extent of coronary artery disease in patients with non-ST-elevation acute coronary syndrome
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Mohammad F Badry, Khaled M Elmaghraby, Hatem A Helmy, Salwa R Demitry DOI:10.4103/JCMRP.JCMRP_10_18
Introduction The use of ST-segment elevation (STE) in lead aVR in addition to thrombolysis in myocardial infarction (TIMI) risk score may improve the early risk stratification and the management of patients at high-risk coronary artery disease, with subsequent effect on morbidity and mortality. Patients and methods A total of 65 patients who underwent coronary angiograms in Sohag Heart Specialized Center in the period between September 2013 and March 2014 were the participants of the study. All patients were subjected to full history taking, clinical evaluation, laboratory investigations, ECGs, TIMI scoring, and coronary angiography by femoral approach. Results Of the 65 patients, 59 patients were found to have significant coronary artery disease with 39 of them had STE in aVR lead, and none of the normal coronary angiography (CA) cases had STE in this lead. Of the 39 with STE-aVR, 13 patients had left main disease and 30 of them had multivessel disease. ST-aVR was elevated in 17 cases with low or intermediate risk according to TIMI score (9.1 and 55% of both groups, respectively), and was normal in three (12%) of the patients with high-risk TIMI score. Thus, STE-aVR could predict another 28.8% of high-risk cases that would not be detected by TIMI. Conclusion STE in lead aVR has a diagnostic and prognostic value in patients with non-STE acute coronary syndrome and may provide an additional prognostic value to the conventional cardiovascular risk factors, particularly in patients from the TIMI low-risk and intermediate-risk groups.
99mTc-DMSA renal cortical quantitative SPECT/CT imaging in diabetic patients: Feasibility and initial results
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Hebat-Allah A.A.R Askar, Hemat Abdel-Samea, Yasser G Ali, Mohamed A Mekkawy, Wlaa A Mohamd DOI:10.4103/JCMRP.JCMRP_136_18
Introduction Diabetes mellitus is a common cause of chronic kidney disease. Radionuclide imaging of the kidneys using technetium-99m-labeled dimercaptosuccinic acid (99mTc-DMSA) is a well-established method for the evaluation of kidney parenchyma. We hypothesize that early preclinical detection of renal affection in diabetic patients can be done by quantitative single-photon emission computed tomography (SPECT) imaging using 99mTc-DMSA. Patients and methods In this study we included 29 patients: 13 diabetic and 16 volunteers as control. All must have within normal renal function. We excluded patients with known history of renal disease or abnormal renal function, patients with systemic diseases directly affect kidney function rather than diabetes. All patients included in our study were subjected to detailed clinical history, renal function, and quantitative 99mTc-DMSA renal imaging using SPECT/computed tomography techniques. About 5 mCi of 99mTc-DMSA were injected intravenously. Then imaging was acquired after 2–4 h in the supine position using a dual-head gamma camera with a low-energy all-purpose collimator. SPECT/computed tomography images are then taken. Data were reconstructed; then a 3D ball region of interest is drawn over each kidney to assess the counts of the kidney. Results There was a significant difference in the mean of the BMI-corrected counts divided by the injected dose (P = 0.024). The same results were obtained when the counts were summed and corrected according to the injected dose between the two groups (P = 0.034). Conclusion Quantitative SPECT 99mTc-DMSA imaging may have a role in the evaluation of renal functions in diabetics with no clinical evidence of renal affection.
Percutaneous ethanol injection for benign cystic thyroid nodules
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Mustafa T Ahmed, Mohamed B M. Kotb, Mohamed S Shahine, Hassan M Harby, Mahmoud T A. Mohamed DOI:10.4103/JCMRP.JCMRP_95_18
Aim The aim of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in managing predominantly cystic benign thyroid nodules in euthyroid individuals and avoid complication of surgery, provide symptomatic, cosmetic improvement, decrease the hospital stay and rapid recovery. Patients and methods The study is an experimental clinical trial. Twenty patients (34.20 ± 7.52 years; 60% women) with symptomatic benign thyroid cysts were included. In all cases, cytology before treatment, thyroid function before and after PEI, maximum cyst diameter, and volume were determined. PEI was conducted using 99% sterile ethanol, and pain perceived by the patients was assessed. After follow-up, final cyst diameter and volume were determined. Results The patients mean age was 34.20 ± 7.52 years, and 60% were females. A single session of PEI was required to complete the procedure. Mean initial maximum cyst diameter was 4.3 cm. Mean reduction in the cyst volume was 94.38%±4.04. During PEI, 40% of patients experienced pain. No complications of PEI were observed. After 6 months of follow-up, cysts were reduced more than 95% in 75% of patients, and reduced less than 95% in 25% of patients. Conclusion PEI can be the first-line treatment of benign thyroid cysts. It is a highly efficacious and safe technique with improvement in clinical conditions, with very low recurrence rate, and with no complications except pain associated with injection, which can be managed by analgesic.
Presternal local analgesia for postoperative pain relief after open heart surgery: A randomized, controlled study
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Safya A Hamed Mostafa, Emad Z Kamel, Mohammed I Seddik, Ahmed S Shahin, Mohamed M Ahmed DOI:10.4103/JCMRP.JCMRP_88_17
Infiltration of local anesthetics near the surgical wound has shown to improve early postoperative pain in various surgical procedures, especially after open heart surgery. Inadequate pain control reduces the capacity to cough, mobility, increases the frequency of atelectasis, and prolongs recovery. Patients and methods This study is designed to examine the efficacy of postoperative 1 g paracetamol/6 h, ketorolac tromethamine 30 mg/8–12 h as conventional analgesia versus bupivacaine plus magnesium sulfate through a single presternal catheter for postoperative pain relief after cardiac surgery. Forty patients were scheduled for valve replacement cardiac surgeries and were randomly assigned into two groups (20 patients in each group). Group M: each patient has received bupivacaine 0.125% with 5% magnesium sulfate through the presternal soft catheter at a fixed rate of 5 ml/h. Group B: each patient only has received postoperative 1 g paracetamol/6 h, ketorolac tromethamine 30 mg/8 h. For postoperative breakthrough pain, rescue analgesia in the form of 25 μg fentanyl was used, with recording of total required doses in both groups. Results The mean numeric pain scale was significantly lower in group M than in group B at most time points. The overall fentanyl requirements over the first 48 h were significantly lower in group M than in group B (33 ± 11.7 vs. 150 ± 1.6 μg, respectively). There was no statistically significant difference between the two groups regarding ICU stay and blood glucose level. Conclusion Local presternal bupivacaine with magnesium sulfate provided adequate postoperative analgesia and less opioid requirements.
Outcomes of ureteroscopy in Assiut University Hospital: A prospective study
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Amr E Darwish, Mohamed M Gadelmoula, Islam F Abdelkawi, Atef M Abdel-Latif, Ahmed M Abdel-Moneim DOI:10.4103/JCMRP.JCMRP_100_18
Context Recent technological advances have led to the expansion of indications and success of ureteroscopy (URS) for stone disease, while decreasing complication rates. Aims The aim was to evaluate the outcomes of URS for treatment of ureteral stones in our hospital. Settings and design This was a descriptive case series.Materials and methods Patients included were adults with ureteral stone(s) managed by URS. Perioperative together with long-term postoperative data were analyzed. Follow-up extended for 12 months. Statistical analysis Data analysis was done using SPSS version 19. χ2 and Fisher exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when less than 0.05. Results During the period from May 2015 to August 2016, 251 adult patients underwent 263 ureteroscopies for treatment of 304 ureteral stones. The mean total stone burden was 12.8 ± 5.9 mm. Treatment of bilateral and ipsilateral multiple stones was performed in 12 and 34 cases, respectively. Impacted stone(s) were treated in 49 (18.6%) procedures. The mean operative time was 54.8 ± 22.68 min. Initial and final stone-free rates were 83.3 and 100%, respectively. The overall complications rate was 28.1%, including mucosal injury (n = 20, 7.6%), false passage (n = 25, 9.1%), perforation (n = 7, 3.8%), and stricture (n = 4, 1.5%). Multivariable analysis revealed that impacted stones had a significant association with intraoperative complications. Conclusion URS is a safe and effective procedure for treatment of ureteral stones. However, impacted stones are associated with significantly higher complications rate.
