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  Citation statistics : Table of Contents
   2016| July-September  | Volume 44 | Issue 3  
    Online since January 19, 2017

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The role of multislice computed tomography in the diagnosis of gastric malignant tumors
Atef H Teama, Amr M El-Badry, Eslam S Yousef
July-September 2016, 44(3):119-126
Objective The aim of this study was to evaluate the efficacy of multislice computed tomography (MSCT) in the diagnosis and staging of gastric malignant tumors. Patients and methods This study included 40 patients who were highly suspected clinically and/or known cases of gastric tumors referred for MSCT examination and evaluation. The MSCT data were correlated and compared with histopathological results. Results Of those 40 patients, 39 were confirmed histopathologically to have malignant gastric tumor (39/40) (97.5%). Of those 39 patients, 36 were depicted using MSCT (36/39) with 92.3% sensitivity, and only three cases were underestimated as T0 (false negative) with MSCT. Those 39 patients were staged histopathologically as follows: T1, 10 patients; T2, nine patients; T3, six patients; and T4, 14 patients. Gastric tumor staging was also performed through MSCT, which had higher sensitivity in depiction and accurate staging of T4 (12/14) (85.7%) and T3 (5/6) (83.3%) in comparison with T2 (5/9) (55.6%) and T1 (5/10) (50%) staging. MSCT had 83.3% sensitivity in N0 staging, 60% in N1 staging, and 50% in N2 staging. Conclusion MSCT can provide valuable additional information and improve the detection and staging of both early and advanced gastric neoplasm. MSCT offers high diagnostic accuracy in tumor detection and staging of lymph node metastasis, and high reliable information as regards secondary tumors. MSCT is a valuable tool for monitoring response to treatment and post-treatment evaluation of gastric neoplasm.
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SYNTAX score II as a predictor of incomplete ST-segment resolution in patients with acute myocardial infarction treated with primary percutaneous intervention
Mohamed Naseem
July-September 2016, 44(3):127-133
Background Incomplete ST-segment resolution (STR) is a marker of impaired myocardial perfusion and adverse clinical outcome after primary percutaneous coronary intervention (PPCI). Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery score II (SS-II) has been developed combining anatomical and clinical variables. The aim of the present study was to evaluate the SS-II as a predictor of incomplete STR in patients with ST-segment elevation myocardial infarction (STEMI) treated with PPCI. Patients and methods The present study prospectively included 100 patients with STEMI treated with PPCI. SS-II was determined in all patients. The sum of ST-segment elevation was measured from standard 12-lead ECG obtained on admission and from a second ECG recorded 60 min after PPCI. STR resolution was defined as either complete (≥50%) or incomplete (<50%). Patients were divided into two groups according to STR: patients with complete STR (positive STR) were 76 in number (76%) and patients with incomplete STR (negative STR) were 24 in number (24%). Results Patients in the negative STR group were older, had higher prevalence of peripheral vascular disease, lower creatinine clearance (CrCl), higher peak troponin, lower ejection fraction and a higher SS-II (P value = <0.001, 0.018, <0.001, <0.001, <0.001 and <0.001 respectively). Patients in the negative STR group also had a longer time to reperfusion (P=0.016) and higher prevalence of myocardial blush grade 0/1 (P=0.016 and <0.001, respectively). On multivariable logistic regression analysis, SS-II was an independent predictor of incomplete STR (odds ratio=0.224, 95% confidence interval, 0.209–0.778, P=0.001). Receiver-operating characteristic curve analysis identified SS-II greater than 25 as the best cutoff value predictive for incomplete STR with a sensitivity of 79.2%, specificity of 73.9%, and area under receiver-operating characteristic curve of 79.2. Conclusion SS-II is an independent predictor of incomplete STR in patients with STEMI treated with PPCI.
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Comparative study between dye assisted microsurgical Subinguinal Varicocelectomy versus Subinguinal Conventional Technique for treatment of primary varicocele
Wafik I Aborahma, Mohamed M Elwageh, Ahmed H Elbarbary, Mohamed A Elhenedy
July-September 2016, 44(3):87-93
Background Division of lymphatic vessels during varicocelectomy could lead to secondary hydrocele formation and decrease of testicular function due to testicular edema. It was suggested that the use of methylene blue dye combined with optical magnification could reduce the incidence of postvaricocelectomy complications. Aim of the work To evaluate efficacy and safety of the dye assisted subingunial varicocelectomy with optical magnification in the treatment of primary varicocele. Patients and methods Sixty five patients having 80 primary varicoceles were randomly divided into two groups according to treatment procedure. The indications of surgery included patients with primary varicocele with infertility or varicocele with life style limiting pain. Thirty three patients (having 40 varicoceles) underwent subinguinal varicocelectomy with the aid of optical magnification after injection of dye (group I), and 32 patients (having 40 varicoceles) treated by subinguinal varicocelectomy with neither injection of dye nor magnification (group II). After surgery, the patients were assessed at 2 weeks, 3 months and 6 months for hydrocele formation, size of the testes using ultrasound, varicocele recurrence, pain or other complications. Results There were no reported complications with arterial injury in group I, while four procedures (10%) in group II were complicated by minor injury of the internal spermatic artery with P value = 0.045*. One procedure was complicated by hydrocele in group I (2.5%) in contrast to 7 procedures in group II (17.5%) with P value = 0.006*. Also, one procedure in group I and 7 procedures in group II were complicated by varicocele recurrence. This difference was statistically significant, P value = 0.006*. Conclusion Dye assisted lymphatic sparing subinguinal microsurgical varicocelectomy is simple, feasible, and could minimize varicocelectomy related complications.
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Role of interventional radiology in maintaining the vascular access for hemodialysis patients
Amany Elkharboutly, Mohamed Raslan
July-September 2016, 44(3):94-101
Background and aim Vascular access dysfunction is serious for hemodialysis patients. Interventional radiologist is able to salvage hemodialysis access fistulas with excellent clinical success. Patients and methods The procedures were carried out in the Interventional Radiology Unit of National Guard Hospital, Riyadh, Saudi Arabia, between January 2010 and March 2012. In total, 60 patients of vascular access dysfunction were included, who underwent diagnostic interventional angiographic procedures. Results A total of 60 patients included in study were divided into three groups: group I, which included six patients (10%) with synthetic grafts; group II, which included 15 patients (25%) with tunneled dialysis catheter; and group III, which included 39 patients (65%) with native fistulas. The angiographic success rate was lower for fistulas than for grafts (74.36 vs. 83.33%). Conclusion The catheter-based treatment of thrombosed and failing hemodialysis accesses achieves technical and clinical success in the majority of cases and allows patients to undergo immediate hemodialysis without the need for the placement of temporary dialysis catheters or surgical consumption of additional venous conduits.
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Relation of metabolic syndrome to the presence and severity of coronary artery ectasia
Mohamed Naseem, Sameh Samir
July-September 2016, 44(3):102-106
Background Coronary artery ectasia (CAE) refers to abnormal dilatation of the coronary vasculature. CAE has been suggested to be associated with inflammation. Previous studies have confirmed a positive association between metabolic syndrome (MS) and inflammatory markers. Therefore, the present study aimed to examine the association between CAE and MS and to evaluate the relationship between CAE severity and MS score. Patients and methods A total number of 100 patients with the diagnosis of coronary angiographic isolated CAE constituted the first group and 100 patients with obstructive coronary artery disease constituted the second group. Isolated CAE was defined as CAE without significant obstructive coronary artery stenosis. The severity of isolated CAE was determined according to the Markis classification. Obstructive coronary artery disease was defined as stenosis 50% or more of the lumen of one or major epicardial coronary artery. MS was defined according to the National Cholesterol Education Program criteria. The MS score was defined as the number of MS components present. Results Male sex predominance, a higher prevalence of MS, a higher level of triglycerides, and a lower of level of high-density lipoprotein were found in patients with isolated CAE (P=0.016, <0.001, <0.001, and <0.001, respectively). In multivariable logistic regression analysis, MS was independently associated with isolated CAE (odds ratio: 1.315; 95% confidence interval: 1.206–1.434; P<0.001). There was a significant correlation between CAE severity evaluated by means of the Markis classification and MS score. The severity of CAE was found to increase with increased MS score (r=−0.601 and P<0.001). Conclusion Isolated CAE is associated with MS and the severity of CAE increases with higher MS score.
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Role of heparin-binding protein and brachial artery reactivity as prognostic tests in critically ill patients with sepsis
H Ibrahim, M Ragab, F Rizk, I Abbas, Talal I.M Hagag
July-September 2016, 44(3):107-118
Context Early detection of severe sepsis is crucial for successful outcome. We hypothesized that the progression of sepsis to severe sepsis is preceded by vascular leakage, which may be caused by neutrophil-derived mediators such as heparin-binding protein (HBP). Also, vascular leakage can be assessed by flow-mediated dilatation (FMD) and reactive hyperemia. Thus, both HBP and brachial artery reactivity may predict the progression of sepsis to severe sepsis and septic shock. Aim The aim of the study was to identify the role of both HBP and brachial artery reactivity as predictors of morbidity and mortality in critically ill septic patients. Settings and design This is an observational prospective controlled study. Patients and methods Patients were classified into two groups. Group I included 40 patients with evident sepsis. Group II included 10 critically ill nonseptic patients who constituted the control group. HBP blood samples were collected at three time points over 6 days after admission. Brachial artery reactivity measurements were also taken. Statistical analysis Statistical analysis was carried out on a personal computer using IBM SPSS Statistics (version 22). Results Significant difference was detected between survivors and nonsurvivors in maximum sequential organ failure assessment (SOFA) score, white blood cells, HBP at baseline and that at 48 and 96 h. The receiver operating characteristic curve using baseline HBP for prediction of severe sepsis shows a sensitivity of 94.7% and a specificity of 100% at cutoff level more than 1.9 ng/ml, and that for prediction of mortality shows a sensitivity of 91.6% and specificity of 100% at levels more than 1.9 ng/ml. Highly significant difference exists between survivors and nonsurvivors in FMD, baseline velocity, hyperemic velocity, velocity difference, and postdeflation resistance index (RI). Receiver operating characteristic curve analysis for prediction of severe sepsis/septic shock using FMD showed a sensitivity of 94.7%, specificity of 100% and associated criterion 3.4% or less. Hyperemic velocity had a sensitivity of 100%, specificity of 100%, and associated criterion 39 cm/cardiac cycle or less. Conclusion Plasma HBP levels and brachial artery reactivity can predict severe sepsis and mortality in patients with sepsis.
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