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  Citation statistics : Table of Contents
   2014| January-March  | Volume 42 | Issue 1  
    Online since April 7, 2014

 
 
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CASE REPORT
Imaging of cherubism: case report and review of the literature
Rasha Elshafey
January-March 2014, 42(1):42-45
DOI:10.4103/1110-1415.130141  
Cherubism is a rare osseous disorder of children and adolescents. Although the radiologic characteristics of cherubism are not pathognomonic, the diagnosis is strongly suggested by bilateral relatively symmetric jaw involvement that is limited to the maxilla and mandible. Imaging typically shows expansile remodeling of the involved bones, thinning of the cortexes, and multilocular radiolucencies with a coarse trabecular pattern. Here, we report one child aged 5 years who underwent clinical, radiologic, genotyping, and histopathological evaluation. The patients' sex, age, and physical characteristics and clinical-radiological presentation were recorded.
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ORIGINAL ARTICLES
Early referral to nephrologist is required for improving outcome of chronic kidney disease patients
Mohamed F.T. Almaghraby
January-March 2014, 42(1):14-20
DOI:10.4103/1110-1415.130092  
Objective The aim of our study was to evaluate the impact of late referral (LR) on health parameters and mortality rate of chronic kidney disease (CKD) patients. Patients and methods This retrospective study includes patients referred to the Renal Replacement Therapy Unit. Patients were classified as early referrals (ERs) if their first encounter with a nephrologist occurred within 16 weeks before initiation of dialysis and all others patients were considered LRs. Collected data included constitutional data, data on underlying kidney diseases, clinical and laboratory data, and the modified Charlson comorbidity index (CCI). The outcomes of the study are presented as the follow-up mortality rates in both groups and their relationship with the timing of referral and collected data. Results The study included 370 CKD patients: 140 ERs and 230 LRs. Patients of the LR group had significantly higher blood pressure (BP) and CCI scores compared with those of the ER group. Laboratory data showed significantly lower hemoglobin concentration and estimated glomerular filtration rate (eGFR) with significantly higher serum phosphate, total cholesterol, and low-density lipoprotein levels in the LR group compared with the ER group. Thirty-one patients (8.4%) died: six from the ER group and 25 from the LR group, with a significantly higher mortality rate in the LR group compared with the ER group. Survival was negatively correlated with time till referral, age, CCI, BP, and multiplicity of associated comorbidities, whereas it was positively correlated with female sex and high eGFR. Statistical analyses showed that high CCI and low eGFR were significant specific predictors, whereas old age, LR, and high systolic BP were significant sensitive predictors for mortality. In the Cox regression analysis, the survival rate in ER patients was significantly better than that in LR patients after adjusting for several risk factors. Conclusion ER of CKD patients to a nephrologist significantly minimizes morbidities and improves the chances of survival, which is significantly affected by age, multiplicity of associated comorbidities, and GFR. Improving the knowledge of patients and general physicians on the hazards of LR to nephrologists will definitely improve the outcome of patients with CKD.
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Adapting quality assurance principles to open structure rhinoplasty Ahmed Elguindy
Ahmed Elguindy
January-March 2014, 42(1):35-41
DOI:10.4103/1110-1415.130132  
Background Rhinoplasty is a pursuit for perfection, and every esthetic surgeon strives for excellence. Aim The aim of the study was to evaluate the methodology and outcomes of open structure rhinoplasty after adapting quality assurance (QA) principles during planning, surgery, and follow-up. Participants and methods QA principles were adapted to a prospective cohort study conducted in a tertiary care center on 72 patients undergoing open structure rhinoplasty, starting with a surgeon recognizant of the nasal esthetic and functional standards (quality defining). Patient's esthetic and functional variants were analyzed and deformities were identified (quality measuring). Patient's objectives were checked against surgery limitations to realize expectations. Quality improvement required effective selection of techniques and efficient sequencing of steps. The results were checked against patient's expectations and satisfaction, and against conformance to the esthetic and functional standards. Results In all, 90.6% of the surgeries met patient's expectations, whereas 92.2% fulfilled patient's satisfaction. 85.9% of patients conformed to esthetic measures and 93.7% to functional parameters. Conclusion Adapting QA principles to open rhinoplasty allowed standardization of methodology and better assessment of operation outcomes in a precise and accurate manner. It enhances education through a progressive procedure, starting with defining norms, analyzing variants, identifying deformities, realizing demands, recognizing limitations, virtualizing possible result, reaching agreement, selecting technique, sequencing steps, performing a safe surgery, and ending with achieving preset goals effectively and efficiently with better patient's quality of life.
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Circulating obestatin level in diabetic and obese rats
Ghada M Abou Fard, Nermin M Madi, Abeer A Abo Zade
January-March 2014, 42(1):1-5
DOI:10.4103/1110-1415.130069  
Background Obestatin has been discovered as a product of the ghrelin gene. Its physiological actions are still a matter of debate. It is likely to be involved in the control of adipocyte function. It has been already shown that obestatin secretion is negatively modulated by food intake. Aim In this study, we investigated plasma obestatin level in diabetic and obese rats and studied the correlation of this hormone with glucose, homeostasis model assessment of insulin resistance, BMI, triglycerides, and total cholesterol in these two metabolic disorders. Materials and methods A total of 30 male albino rats were divided into three groups: the control group, the diabetic group, and the obese group. Plasma obestatin levels were measured and plasma glucose, insulin, triglyceride, total cholesterol, and BMI were also evaluated. Results Diabetic rats showed significant increase in all studied parameters except plasma obestatin, insulin, and BMI, which showed significant decrease as compared with the control group. However, the results of obese rats showed significant increase in all studied parameters except plasma obestatin, which showed significant decrease compared with either control or diabetic rats, but plasma glucose was significantly decreased as compared with diabetic rats only and homeostasis model assessment of insulin resistance was significantly increased as compared with control rats. The results revealed that plasma obestatin was negatively correlated with all studied parameters in both diabetic and obese rats and positively correlated with insulin in diabetic rats, whereas it had insignificant correlation with BMI in diabetic rats and with insulin in the obese group. Conclusion The decrease in obestatin levels was associated with metabolic disorders and this may contribute, in part, to the pathophysiology of diabetes and obesity.
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Ultrastructural characteristics of synovial fluid cells in rheumatoid arthritis and osteoarthritis
Amal A Abd-El-Hafez, Ali El-Deeb, Mervat Esmail, Rehab Al Sernagawy
January-March 2014, 42(1):21-30
DOI:10.4103/1110-1415.130114  
Aim The aim of the study was to evaluate the range of activation changes of polymorphonuclear leukocytes and the ratio of apoptosis and necrosis in synovial cells of patients with rheumatoid arthritis (RA) and osteoarthritis (OA), to study and compare the ultrastructural features of synovial fluid (SF) cells from RA and OA patients, to correlate it to activities of the diseases, and to produce microscopic translation to the events that occurred in the joint. Patients and methods Synovial effusions were aspirated from the knee joints of patients with RA (seven samples) and with primary OA (14 samples). Cytospin preparations were processed for transmission electron microscopy and assessed for the incidence of the neutrophil granulocytes, the dominating cell population in the arthritic SF, apoptosis, and cytophagocytic cells (CPCs) in the SF. Results In all samples under investigation, most of the synovial effusion cells had intact ultrastructure with a certain amount of apoptotic cells dominating over the cells with signs of necrosis and with few CPC. The highest rate of apoptosis was discovered in the synovial effusions of patients with RA and the lowest in those with OA; in addition, the incidence of CPC was lower in patients with OA. In RA, the current disease activity correlated with the incidence of the neutrophil granulocytes and of the apoptotic cells. Conclusion These data suggest that, in RA, despite exposure to the antiapoptotic signals, apoptosis of the synovial effusion polymorphonuclear leukocytes is maintained at a significantly higher level than in OA, providing elimination of the neutrophils accumulating in the joint cavity, and thus stimulating resolution of joint inflammation.
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Endoscopic endonasal trans-sphenoidal management of cystic sellar lesions
M Amer, M Barakat
January-March 2014, 42(1):31-34
DOI:10.4103/1110-1415.130125  
Introduction The trans-sphenoidal route is now considered the standard approach for pituitary adenomas. This approach is increasingly safe with the use of endoscope. Aim of the study The aim of this study was to assess 11 patients with cystic sellar lesion operated by an endoscopic endonasal trans-sphenoidal approach. Patients and methods Between January 2007 and January 2011, 11 patients underwent standard endoscopic endonasal trans-sphenoidal surgery in the neurosurgical department, Tanta University, Egypt. All patients underwent complete clinical, endocrinological, and visual field evaluation before operation. The imaging study was performed by MRI of the sellar region with and without intravenous gadolinium contrast. Results The study included 11 patients: six female patients and five male patients, with a mean age of 34 years. The aim of the procedure for cystic lesion was to open the cyst cavity and remove a part of its wall through the sphenoid sinus and to remove the solid component if present. Conclusion The use of endoscopy in the treatment of cystic lesion is considered a very useful tool with its panoramic view that permits better exploration of the cystic cavity to assess the completeness of tumor removal.
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Chronic subdural hematoma: complication avoidance
Ahmed Abdel Salam Shakal, Ehab Ezzat El Gamal, Ashraf Mohamed Farid
January-March 2014, 42(1):6-13
DOI:10.4103/1110-1415.130078  
Background and objective Chronic subdural hematoma (CSDH) is defined as the presence of a typical neomembrane, typical liquefied blood within the hematoma cavity, and 3 weeks of more of acute subdural hematoma. It has been classified into separate, laminar, homogenous, and trabecular types. This study analyzed the complications after burr hole evacuation in CSDHs and the best methods to avoid or at least minimize them. Materials and Methods A total of 28 patients who were suffering from complications after evacuation of CSDH were analyzed. Data on patients and treatment protocol were collected. Medical problems were also managed. Complications were studied as regards their causes and avoidance. Results The highest incidence of complications is observed in the seventh decade of life. Recurrence was the most common complication especially in the separate type. The recurrence rate was higher among patients operated through a single burr hole. Extradural hematomas, although rare, were observed in three patients. Acute subdural hematoma and cerebral infarction had the worst prognosis. Conclusion Subgaleal dissection and insertion of a subgaleal drain are important for absorption and suction of the residual air and blood. In addition, intraoperative copious saline irrigation and postoperative meticulous follow-up are important for patients with a high risk of recurrence, especially those with hematomas of the separate type. During evacuation of the hematoma, we must avoid sudden decompression of the brain as it leads to cerebral infarction or intracranial hemorrhage. It is important to inform the anesthetist before performing the drainage that the blood pressure should be closely monitored and maintained at normal levels while infusing normal saline during surgery to avoid hypotension, which may lead to infarction. Any source of blood from the extradural space must be adequately dealt with.
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