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   2015| October-December  | Volume 43 | Issue 4  
    Online since October 30, 2015

 
 
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ORIGINAL ARTICLES
Light and electron microscopic study of placenta in pre-eclampsia: a trial to define underlying changes and its clinical impact
Gamal E Abdel Salam, Omar A Alam, Usama F Ahmed, Mohamad F Al-Sherbeny
October-December 2015, 43(4):134-145
DOI:10.4103/1110-1415.168738  
Objectives The aim of this study was to evaluate histological changes of placental villi and blood vessels in pregnancy complicated by pre-eclampsia (PE) and their relation with clinical data. Patients and methods The study included 100 pregnant women developing PE at any time during pregnancy (PE group) and 100 pregnant women free of PE (control group). Collected data included age, gestational age, manifestations and severity of PE, neonatal birth weight (BW), and placental weight (PW). Placental tissue was obtained for light and electron microscopic examination. Results BW and PW showed a significant negative correlation with maternal BMI and the presence and severity of PE. Gestational age and development of PE were significant predictors for low PW, which is a significant predictor for low BW. Placentas of the PE group showed aggregation of syncytiotrophoblast cells, hyaline degeneration of connective tissue core, and endothelial lining of stem blood vessel; villous core was devoid of fetal blood vessel. Diffuse fibrous tissue formation, hypertrophic musculosa of stem blood vessel up to endarteritis obliterans and placental tissue bridges crossing intervillous spaces and villous arborization formed only of connective tissue with no cellular elements were observed. Electron microscopy confirmed these findings and showed attenuated blood vessels and excessive villous arborization covered with fibrin-like material. Conclusion Development of placental endarteritis obliterans with diminution of placental growth and proper invasion may underlie development of PE. Reduced PW is a reflection of this histological affection and is negatively correlated with severity of PE. Early PE is associated with more severe clinical manifestation and aggressive histological changes.
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Effect of proton pump inhibitor and voice therapy on reflux-related laryngeal disorders
Hatem Ezzeldin, Ahmed A Hasseba
October-December 2015, 43(4):127-133
DOI:10.4103/1110-1415.168728  
Objectives The aim of this study was to evaluate the effect of proton pump inhibitor (PPI) in combination with voice therapy (VT) in the treatment of patients with laryngopharyngeal reflux (LPR) and to evaluate the efficacy of 3-month treatment. Study design This was a prospective comparative study. Patients and methods A total of 50 patients having different symptoms of LPR were included. The reflux symptom index and reflux finding score were used to diagnose LPR. The patients were classified into two groups: group A patients were treated with omeprazole and VT, and group B patients were treated with omeprazole alone. The patients were followed up for 3 months. Acoustic analysis of voice and the voice handicap index were used to compare both groups. Results Laryngeal findings found in participants of this study were as follows: laryngeal erythema (28%) and posterior commissure hypertrophy and granulation tissue, which represented 16% each. Subglottic edema, ventricular obliteration, diffuse laryngeal edema, and thick endolaryngeal mucus were also observed. Results of acoustic correlates of dysphonia (Jitter, Shimmer, and harmonic-to-noise ratio) and voice handicap index showed significant improvement after 3 months of using PPI. However, marked improvement was observed in patients who received both PPI and VT together. Conclusion PPI in combinations with VT was more effective in alleviating laryngeal manifestations in patients with LPR compared with PPI alone. The duration of 3 months was sufficient to improve symptoms and manifestations in both groups.
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Can ultrasonography distinguish between complete and partial rupture of the Achilles tendon? A sonographic operative correlation
Hesham El Sheikh, Wael Azzam
October-December 2015, 43(4):120-126
DOI:10.4103/1110-1415.168727  
Purpose The aim of the study was to assess the capability of ultrasonography (US) to differentiate between complete and partial rupture of the Achilles tendon by comparing preoperative US with intraoperative findings. Patients and methods We compared US and operative findings in 47 patients with US diagnosis of Achilles tendon rupture. US assessed the continuity and thickness of the tendon and paratendon and the presence of hematoma or bone fragments within the tendon. Results Surgery confirmed complete rupture in all 29 tendons thought to be completely ruptured on US (accuracy = 100%) and confirmed partial rupture in 15 of the 18 tendons thought to be partially ruptured on US (accuracy = 83.3%); the remaining three cases showed retracted tendons with accompanying tendon tear consistent with complete rupture. The characteristic findings for complete tendon rupture were break of the tendon and paratendon, nonvisualization of the tendon, and the presence of gap (hematoma) or bone fragments within the tendon. The characteristic findings for partial tendon rupture were break of the tendon with intact paratendon, intact tendon with internal hypoechogenicity (tear), and tendon thickening. Conclusion US may help to distinguish partial from complete rupture of the Achilles tendon allowing for more appropriate patient management.
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Multislice CT coronary angiography is an additional tool for provisional diagnosis of acute chest pain with neither ECG nor echocardiography significant findings in emergency room
Hanan K Kassem, Naglaa L Dabees, Ayman A El-Sheikh, Mohamed S Hegab, Rasha M Dawoud, Hend M Mansour
October-December 2015, 43(4):113-119
DOI:10.4103/1110-1415.168724  
Background Multislice coronary computed tomography (CT) angiography is used to diagnose coronary artery disease (CAD) with good spatial and temporal resolution. Objective The aim of this study was to assess the uses of thin-slice multidetector row CT in the diagnosis of different vascular coronary causes of chest pain. Patients and methods A total of 20 patients were examined with full history taking, resting 12-lead ECG, cardiac biomarkers, and echocardiography. Thereafter, on the basis of their clinical manifestations or suspected progression of past condition they were enrolled for 160-multislice CT angiography using Ultravist 370 as a contrast medium. Results CT coronary angiography revealed the following: two cases were normal, two showed nonsignificant CAD, three showed significant CAD, 10 showed mild-to-moderate CAD, two showed anomalous coronary arteries, and one showed myocardial bridge. Conclusion CT angiography nowadays is considered the primary tool of diagnosis for different thoracic vascular disorders, being a safe, rapid method of diagnosis. Multislice coronary CT is a relatively new technique that gives physicians the advantage of screening emergency patients presenting with acute chest pain in a rapid and safe way for detection of their vascular diseases.
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