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   Table of Contents - Current issue
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January-March 2017
Volume 45 | Issue 1
Page Nos. 1-55

Online since Wednesday, June 28, 2017

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ORIGINAL ARTICLES  

Role of multislice computed tomography in characterization of different retroperitoneal masses Highly accessed article p. 1
Ahmed Shalaan, Medhat Refaat, Hesham Farouk, Gamal Saleh Saleh
DOI:10.4103/tmj.tmj_1_17  
Background Multislice computed tomography imaging (MSCT) plays an integral role in the characterization of primary retroperitoneal masses and in the evaluation of their extent and involvement of adjacent structures, and therefore in treatment planning. Many authors have described useful imaging features to distinguish between the different entities. Aim The aim of this study was to evaluate the role of MSCT in differentiation of primary retroperitoneal masses in correlation with pathological findings. Patients and methods This prospective study was performed on 43 patients aiming to determine the role of cross-sectional computed tomography (CT) imaging in the differential diagnosis of primary retroperitoneal masses. Each case was submitted for pathological analysis either following open surgical biopsy, surgical excision, or image-guided biopsy by CT or ultrasound. Correlation of CT findings with pathological results was obtained. Results The calculated accuracy for the diagnosis and differential diagnosis of primary retroperitoneal masses by MSCT was 69.7% in the studied cases matched with pathological findings, which represented 30 cases of our study. This was helpful in narrowing the differential diagnosis and thus in treatment planning. Conclusion Multi-slice Computed Tomography (MSCT) is considered the basic standard in morphological evaluation, and the diagnosis of primary retroperitoneal masses according to their origin is carried out first and then characterization of the mass lesion is performed depending upon the specific imaging characteristics detected on CT examination such as consistency, component, vascularity and enhancement pattern, as well as specific pattern of spread.
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Study of therapeutic efficacy of percutaneous radiofrequency ablation versus percutaneous microwave ablation for hepatocellular carcinoma p. 8
Mohamed A Riad, Abdallah A Elsawy, Amr M Tawfik Elbadry, Laila M Sayed Ahmed
DOI:10.4103/tmj.tmj_45_16  
Background In the past two decades, thermal ablation therapy using energy sources has been increasingly accepted due to the advantages of greater capacity to devitalize hepatocellular carcinoma (HCC) with fewer treatment sessions. Among them, radiofrequency ablation (RFA) and microwave ablation (MWA) are the most commonly used modalities. Aim The aim of study was to compare RFA versus MWA in terms of therapeutic efficacy. Patients and methods This study included 130 patients proved to have HCC. They were divided into two groups. Group I included 70 patients who underwent RFA. Group II included 60 patients who underwent MWA. Results Comparison of complete ablation (CA), partial ablation (PA), local tumor progression (LTP), and distant recurrence was made between the two groups. The CA rate was 86.6% for the RF group and 91.6% for the MW group but without significance in lesions lower to 3 cm in diameter (P=0.7981). However, this difference was significant in lesions measuring 3.1–4 cm in diameter; the CA rate was 33.3% for the RF group and 85.7% for the MW group (P=0.0388). The PA rate was 13.3% for the RF group and 8.3% for the MW group but without significance in lesions lower to 3 cm in diameter (P=0.5843). However, this difference was statistically significant in lesions measuring 3.1–4 cm in diameter; the PA rate was 66.6% for the RF group and 14.2% for the MW group (P=0.0045). During the 18-month follow-up period for tumors lower to 3 cm in diameter of both groups, the LTP rate was 21% in the RF group and 13% in the MW group with a nonsignificant difference (P=0.1944), whereas for larger tumors (3.1–4 cm in diameter) the LTP rate was 33% in the RF group and 11% in the MW group with a significant difference (P=0.0387). Tumor distant recurrence was observed in 25 (41.6%) patients of the MW group and in 30 (42.8%) patients of the RF group with a nonsignificant difference (P=1.0000). Conclusion MW ablation is superior to RF ablation in HCC treatment, especially large one.
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Measurement of serum sex hormone-binding globulin as an early marker for gestational diabetes p. 14
Fatma S El Desh, Gamal F El Naggar, Manal A Eid, Engy A Ibrahim
DOI:10.4103/tmj.tmj_8_17  
Background It is estimated that 90% of all pregnancies associated with diabetes are due to gestational diabetes mellitus (GDM). If GDM is not properly treated, there is an increased risk for adverse maternal, fetal, and neonatal complications. Therefore, early diagnosis and accurate screening of GDM are necessary to reduce maternal and fetal morbidity and to help prevent or delay the onset of type 2 diabetes in the mother and offspring. The diagnosis of GDM appears to unmask women with inadequate β-cell reserves and gives a window of time for any prevention techniques, an idea that has been used in the Diabetes Prevention Program of the National Institutes of Health. Aim The aim of this study was to compare serum levels of serum sex hormone-binding globulin (SHBG) in pregnant women with GDM with levels in nondiabetic pregnant women as an early marker for GDM. Patients and methods This was a comparative study with a total of 45 participants in their second and third trimester of pregnancy. Group I (pregnant nondiabetic) included 25 women and group II included 20 women (pregnant with GDM). Maternal serum SHBG and high-sensitivity C-reactive protein (hs-CRP) were measured and compared between the two studied groups. Results SHBG concentrations were lower in the GDM group (SHBG=27.32±14.52) compared with the control group (SHBG=507.61±187.79) (P=0.0001). hs-CRP concentrations were higher in the GDM group (2964.65±315.06) than in the control group (2254.00±585.48), but with low sensitivity of 60.00% and accuracy of 77.78%. Conclusion SHBG is valuable for screening women for GDM risk, and hs-CRP as an inflammatory marker is not a dependable screening test for GDM.
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Effect of two exercise varieties on fetuin-A plasma level in experimental diabetic nephropathy p. 21
Mahmoud E Salama, Magdi A El-Damarawi
DOI:10.4103/tmj.tmj_44_16  
Background Diabetes mellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. Fetuin-A is a serum protein that represents an important factor in the pathophysiology of the metabolic syndrome, type 2 diabetes, and in patients with chronic kidney disease. Aim The aim of this work was to study the effect of different exercise varieties on fetuin-A (Fet-A) plasma level in experimental diabetic nephropathy. Material and methods Forty male Wistar rats weighing 150–200 g were used. Ten rats were considered as control (group I). Type 2 diabetes was induced in another 30 rats with the use of streptozotocin. The diabetic rats were divided into three groups as follows: group II, sedentary; group III, chronic regular moderate exercise; and group IV, irregular strenuous exercise. Results In group II, diabetes caused a significant increase in fasting glucose, total cholesterol, triglycerides, and creatinine plasma levels and microalbuminuria as compared with group I. In group III, moderate regular exercise produced a significant decrease in the same parameters as compared with group II. However, in group IV there were similar but less significant changes. Moreover, in group II there was a significant elevation in Fet-A, Interleukin-6, tumor necrosis factor-α, and C-reactive protein plasma levels. However, group III showed a significant reduction in these parameters, whereas in group IV there was a nonsignificant decrease as compared with group II. Moreover, diabetes produced a significant increase in TBARS level with a significant reduction in the antioxidant enzyme activities in kidney tissue as compared with group I. In group III, the exercise regimen produced a significant reduction in the same parameters as compared with group II. However, in group IV, there were similar but nonsignificant changes. Conclusion In type 2 diabetes with nephropathy, regular moderate exercise is more valuable program to reduce Fet-A plasma level and to improve associated renal damage compared with irregular strenuous one.
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Is there a relationship between Toxoplasma gondii immunoglobulin G seropositivity and idiopathic Parkinson’s disease and does it have a correlation with serum cortisol level? p. 29
Wesam M El Gendy, Nabila Abd El Azeem Yassen, Hazem Abd El Rahman Fayed, Marwa Adel Hasby Saad, Ahmed Abdel-Rahman Daoud
DOI:10.4103/1110-1415.209096  
Background Some research studies linked latent toxoplasmosis and psychiatric diseases. Now the main interest is the probable relation between toxoplasmosis and neurological diseases such as epilepsy and Parkinson’s disease. Aim The aim of this study was to detect the incidence of Toxoplasma gondii infection in patients with idiopathic Parkinson’s disease and correlate it to their blood level of cortisol. Patients and methods This study was conducted on 30 idiopathic Parkinson’s patients, 30 psychiatric patients, and 30 apparently healthy individuals. All participants were administered a questionnaire and subjected to detection of anti-Toxoplasma immunoglobulin M, anti-Toxoplasma immunoglobulin G (IgG), and cortisol blood level using enzyme-linked immunosorbent assay. Results Of the 90 cases, 41.11 and 1.11% were positive for anti-Toxoplasma IgG and IgM, respectively. The highest percentage of positive anti-Toxoplasma IgG cases was in the healthy group (46.67%) followed by the Parkinson’s disease group (43.3%). The mean cortisol level was higher in the Parkinson’s group than in other groups but still within normal levels. Contact with cats, drinking unfiltered water, and consuming unwashed raw vegetables were significantly higher in Toxoplasma IgG seropositive Parkinson’s patients. Highest percentage of anti-Toxoplasma IgG-positive cases in the Parkinson’s group was detected in stage 3 of the disease. Conclusion There is a high Toxoplasma seropositivity in association with Parkinson’s disease. T. gondii oocysts may be the most probable main cause of infection in idiopathic Parkinson’s patients, which may worsen the disease. Cortisol level was higher in Parkinson’s patients with no relationship with T. gondii seropositivity.
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Effects of N-acetylcysteine on acetic-acid-induced ulcerative colitis in experimental rat model p. 36
Asmaa Mahmoud Ghalwash, Nema Ali Soliman, Hala Elsaid Hamouda, Salwa Akhnoukh Absakhron
DOI:10.4103/tmj.tmj_42_16  
Background Ulcerative colitis (UC) is a disorder involving the large intestine characterized by contiguous inflammation of colonic lamina propria with subsequent injury and disruption of the mucosal barrier. Antioxidant protects against the injurious effects of oxidative stress. The aim of this study is to investigate the beneficial effects of N-acetylcysteine (NAC) in a rat model of acetic-acid-induced colitis. Materials and methods UC was induced by acetic acid at a dose of 4% acetic acid in 0.9% NaCl solution intrarectally through a fine rubber catheter under light ether anesthesia. A total of 50 male albino rats were involved in this study, divided into four groups: group І (control group); group II (colitis group); group IIІ (treated group), which was equally subdivided into group IIІa (co-treated group) − which was given intraperitoneal NAC (dose: 500 mg/kg body weight) on the day of induction − and group IIІb (post-treated group) − which received intraperitoneal NAC 24 h after acetic acid administration; and group IV (positive control group), which received intraperitoneal NAC (dose: 500 mg/kg body weight) at the same dosage of treated colitis group. Nitric oxide level, myeloperoxidase activity, thioredoxin reductase 1 activity, and caspase 3 level were evaluated, and histopathological evaluation was done. Results NAC significantly decreased myeloperoxidase and thioredoxin reductase 1 activities, as well as nitric oxide and caspase 3 levels. Conclusion On basis of these results, it could be concluded that NAC exhibits anti-inflammatory, antioxidant, and antiapoptotic effects in experimentally induced UC in rats, reflecting its importance as a candidate for UC treatment and management.
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Evaluation of transient evoked otoacoustic emissions using low-level laser stimulation in individuals with normal hearing with tinnitus p. 45
Hanaa H Elsanadiky, Yasser Nafie
DOI:10.4103/tmj.tmj_20_17  
Background Tinnitus is a very disturbing phantom perception of a sound that does not exist. Low-level laser therapy (LLLT) has been recently discussed as a treatment modality for inner ear cochlear dysfunction. Aim In this study, we evaluated the effectiveness of using LLLT in individuals with long-term complaints of tinnitus of unknown etiology. In addition, the present study compared cochlear outer hair cell function in individuals with normal hearing with and without tinnitus using transient evoked otoacoustic emissions (TEOAEs). Participants and methods A total of 31 participants were included in this study, and all of them had normal hearing. Twenty-one of them who complained of nonpulsatile tinnitus of unknown etiology comprised the study group, and 10 individuals without tinnitus were included as controls. All participants were subjected to complete audiological evaluation and TEOAEs. The responses were documented for all participants before and after using LLLT. Results There were no significant differences between individuals with normal hearing with and without tinnitus with regard to audiological evaluation and TEOAEs. In addition, there was no change in TEOAEs in tinnitus patients after using low-level laser stimulation in our test protocol. Conclusion Participants with normal hearing complaining of tinnitus have normal TEOAEs. The use of LLLT was not effective objectively as recorded by TEOAEs, but there was mild improvement subjectively.
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Role of biliary stenting in management of large or multiple common bile duct stones p. 51
Ola M.M. Darwish, Samah A El-Shweikh, Mohamed M El-Bedewy, Mohamed E Enaba
DOI:10.4103/tmj.tmj_39_16  
Background Common bile duct (CBD) stones are seen in ∼7–12%. They vary in size ranging from rather small (∼1–2 mm) to very large (>3 cm). Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and basket or balloon extraction are well-established therapeutic procedures for the management of CBD stones. Aim The aim of the present study was to assess the role of biliary stenting in management of large or multiple CBD stones by comparison between stone size, number, and index between both sessions of ERCP, with average duration of 2 months. Patients and methods A total of 25 patients referred to our center with radiological evidence of large CBD stones (≥2 cm) and/or multiple stones (≥3) were included. Initial ERCP with biliary stenting was performed. After 2 months or more, second-look ERCP was performed with stone extraction, with comparison of stone number, size, and index between both sessions. Results Our study showed statistical significant reduction in stone size, index, and number, with availability of stones removal in the second session. Moreover, reduction in bilirubin level was observed. Conclusion In conclusion, temporary biliary stenting within an average of 2 months has a role in the management of large and multiple CBD stones and will facilitate stone extraction.
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