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Results in Journal The Medical Journal of Cairo University: 1,434

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The Medical Journal of Cairo University, Volume 87, pp 3597-3605; doi:10.21608/mjcu.2019.69901

Abstract:
Background: Diabetes mellitus has been reported to increase the risk of complications of liver cirrhosis and subsequent survival. Varices constitute the most common lethal cause of mortality in cirrhotic patients, consequently the association between DM and gastro-esophageal variceal bleeding becomes the focus of attention.Aim of Study: Is to elucidate whether DM is an independent risk factor for gastro-esophageal variceal bleeding in cirrhotic patients.Patients and Methods: This cross-sectional study was conducted in Internal Medicine Department, Faculty of Med-icine, Tanta University Emergency Hospital at Gastro-endoscopy Unit from September 2017 to July 2018 and included 120 patients. Group (A): Diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. Group (B): Non-diabetic cirrhotic patients with upper gastrointestinal variceal bleeding. The patients were subjected to history taking, laboratory investigations including: CBC, AST, ALT, bilirubin, albumin, blood urea, serum creatinine, Pa, INR, HBVs Ag, anti HCV Ab, RBG, HbA1c and gastrointestinal endoscope.Results: Of the 120 patients, there were 67 (55.8%) diabetics, 53 (44.2%) were non-diabetics, they were 47 (39.2%) child A, 73 (60.8%) child B & C. GEVB incidence was higher in child B & C than child A, also as regard sub grouping in child A, the diabetic patients were 32 (68.1%) while non-diabetics were 15 (31.9%) and in child B & C diabetics were 35 (47.9%) and non-diabetics were 38 (52.1%) with p-value (0.030), there was significant higher ratio of ascites, enceph-alopathy and recurrence of attacks of GEVB in child B & C than child A, there was significant higher ratio of ascites, previous attacks of encephalopathy and recurrence of attacks of GEVB in diabetics than non-diabetics and there was statis-tically significant higher incidence of recurrence of attacks of GEVB with HBA1c >7.Conclusion: The incidence of GEVB was significantly associated with DM in cirrhotic patients, especially in patients with Child-Pugh Class A.
The Medical Journal of Cairo University, Volume 87, pp 4387-4395; doi:10.21608/mjcu.2019.78256

Abstract:
Background: Claudin 4 is one of the tight junction proteins which considered one of the protective barriers that are mostly involved in the regulation of intercellular communication, paracellular transport and apical cell-to-cell adhesion. Over-expression of COX-2 and subsequent increase in prostaglandins (PGs) concentration have emerged in recent years as important players in cancer progression.Aim of Study: To explore immunohisto chemically the expression of both claudin-4 and COX2 in nasopharyngeal carcinoma and correlate their expression with each other and with different clinicopathological parameters.Material and Methods: This retrospective study was done upon formalin fixed, paraffin blocks of 32 nasopharngeal carcinoma cases and 6 non-neoplastic nasopharyngeal epithe-lium. The materials were obtained from archieves of Pathology Departement and Early Cancer Detection Unit (ECDU), Faculty of Medicine, Benha University during the years 2012- 2017. The immunohistochemical stain with Claudin 4 and COX2 was done and evaluated for each case.Results: High expression of claudin 4 was observed in 44% of studied nasopharyngeal cases with statistically signif-icant correlation with tumor stage and distant metastasis (p
The Medical Journal of Cairo University, Volume 87, pp 4255-4262; doi:10.21608/mjcu.2019.77428

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The Medical Journal of Cairo University, Volume 87, pp 4441-4447; doi:10.21608/mjcu.2019.78263

Abstract:
Background: This prospective study was conducted in a university hospital for comparing the results of two different techniques for surgical repair of inguinal hernia: Open mesh repair and laparoscopic mesh repair to detect the effectiveness of each operation and complications if any.Aim of Study: The aim of this work is to compare the results of mesh repair of inguinal hernia by open technique and by laparoscopic transabdominal preperitoneal technique (TAPP).Patients and Methods: The study included 92 cases of an inguinal hernia. They were selected by nonprobability sampling method. These cases were operated at Al Hussein University Hospital between January 2016 to September 2018. Inclusion criteria included patients with uncomplicated hernia. The age/sex, incidence, BMI, mode of presentation, co-morbidities, operative time, postoperative complications, pain and return to work were all evaluated and compared with many of standard published literature.Results: Postoperative wound infection developed in 6 cases of open hernioplasty and 1 case in laparoscopic surgery. Seroma at the operated site were found in 5 cases of open hernioplasty. The return to normal daily activity was 21 days after open technique compared to 13 days in TAPP. The mean duration of procedure was 59.5min in open surgery while it was 99min in laparoscopic group.Conclusion: Laparoscopic hernioplasty has a comparable result with an open procedure which should be considered in the surgical treatment of inguinal hernia.
The Medical Journal of Cairo University, Volume 87, pp 3985-3992; doi:10.21608/mjcu.2019.70352

Abstract:
Background: Reconstruction of soft tissue defects of the distal third leg are common challenging therapeutic problems with significant long-term morbidity. Treatment options include cross leg flaps, local flaps (as muscle flaps and fasciocutaneous flaps) and the free vascularized flaps.Aim of Study: The aim of this study is to evaluate the clinical outcome of reversed hemisoleus muscle flap in cov-erage of traumatic soft tissue defects in the distal third of the leg.Patients and Methods: In this prospective study, we present 21 patients with traumatic soft tissue defects in the distal third leg with exposure of bone, tendons and neurovas-cular structures, managed by reversed medial hemisoleus muscle flap. Clinical and radiological data were analyzed.Results: The outcome of the flap surgery was evaluated after at least 6 months follow-up on the basis of flap survival, graft intake, functional gain and donor site morbidity [1]. Clinical results were graded as excellent, good, fair as follows: 13 showed excellent results (61.9%), 7 showed good survival (33.3%) and 1 flap was graded as fair (4.8%) with no poor results. The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Accordingly, satisfactory results were found in 20 patients (95.2%), and the unsatisfactory results were found in 1 patient (4.8%) with reliable soft-tissue cov-erage and complete wound healing in all patients.Conclusion: This study shows that reversed medial hem-isoleus muscle flap is a reliable reconstructive option for traumatic soft tissue defects on the medial side of the distal tibia in selected cases.
The Medical Journal of Cairo University, Volume 87, pp 3289-3296; doi:10.21608/mjcu.2019.65623

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The Medical Journal of Cairo University, Volume 87, pp 3859-3864; doi:10.21608/mjcu.2019.70137

Abstract:
Background: Chronic shoulder pain affects the quality of life and limits daily activities. Suprascapular nerve block is an effective technique in management of chronic shoulder pain. Suprascapular injection technique had several drawbacks particularly repeated injections that may affect the patients' outcomes. RFA is considered a safe technique especially with ultrasound guidance, having a long duration of action with absence of any complications or organ damage.Aim of Study: This study aimed to examine the effective-ness of radiofrequency ablation (RFA) of the suprascapular nerve in comparison to the injection of lidocaine and hydro-cortisone mixture under ultrasound guidance.Patients and Methods: 20 patients with chronic shoulder pain were divided in to two equal groups one group was submitted to RFA of the suprascapular nerve using the Cool-Tip RF system and an internally cooled electrode (group A) and the other group had lidocaine and hydrocortisone mixture injection (group B) of the same nerve, both groups were followed-up over a period of 6 months with pre and post interventional assessment of the pain though visual analogue score for pain (VAS).Results: All patients had chronic shoulder pain not re-sponding to medical treatment and physiotherapy, after RFA, 6 patients were pain free, 4 cases had mild pain that responded to conservative treatment, regarding those of the injection group all cases had relief for 3 months, at 6 months, only 3 had no complain while 4 patients had recurrence and 3 had stationary course of pain relief.Conclusion: RFA proved to be a superior technique com-pared to the injection method in management of chronic shoulder pain.
The Medical Journal of Cairo University, Volume 87, pp 3427-3434; doi:10.21608/mjcu.2019.65639

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The Medical Journal of Cairo University, Volume 87, pp 3649-3656; doi:10.21608/mjcu.2019.69911

Abstract:
Background: Abdomino-perineal resection is still a pro-cedure of choice in the management of rectal cancer. A left iliac permanent colostomy has a great impact on the quality of life of the patients. Many procedures and techniques have been introduced for the creation of a perineal colostomy aiming at improving the QOL of these patients.Aim of Study: This work is a scientific practical contribu-tion to improve the quality of life of patients after APR for carcinoma of the rectum. To achieve this, a subjective evalu-ation of an innovative unprecedented technique for a continent perineal colostomy instead of the left iliac colostomy was done.Material and Methods: A prospective observational study included 20 patients with low rectal cancer treated surgically with APR followed by a perineal colostomy using an innovative technique of a circular smooth muscle cuff. An immediate (Synchronous) reconstruction after APR was done in 14. In 6 patients the operation as a delayed (Metachronous) step 2- 4 years after APR. Patients were subjectively evaluated using Kirwan's scoring system.Results: Thirteen patients (72%) were continent; 2 normal continence for gas and stool and 11 patients were continent only for stool. Four patients had minor soiling. Seventeen patients (94.5%) were satisfied. Only one patient suffered incontinence.Conclusion: This new technique proved to be valuable in improving the QOL of patients with rectal cancer after APR. The procedure achieved 94% patient satisfaction.
The Medical Journal of Cairo University, Volume 87, pp 3639-3647; doi:10.21608/mjcu.2019.69910

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