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   2018| October-December  | Volume 46 | Issue 4  
    Online since August 2, 2019

 
 
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ORIGINAL ARTICLES
Prospective randomized study comparing the efficacy of caudal bupivacaine versus bupivacaine–neostigmine in children undergoing congenital inguinal hernia repair
Omnia A.H El-Miseery, Lobna M. Abo El-Nasr, Ahmed S Bassouni, Hesham I El-Tatwey
October-December 2018, 46(4):239-244
DOI:10.4103/tmj.tmj_25_17  
Background Posthernioraphy pain in children is an unpleasant subjective sensation. The concept of postoperative pain relief and its utilization in the pediatric age group has improved dramatically over the recent years. Caudal block is one of the most common regional anesthetic techniques used in children that reduce the amount of inhaled and intravenous anesthetic administration, alter the stress response to surgery, and facilitate a rapid and smooth postoperative analgesia. Neostigmine is one of the additives known for significant analgesic prolongation, and it has been used safely in both adults and children. Aim The aim of the present study was to evaluate the effect of neostigmine as an additive for caudal analgesia in congenital inguinal hernia repair in pediatrics. Patients and methods This study was carried out on 70 children, with age range from 1 month to 6 years, having ASA status I–II, and scheduled for elective congenital inguinal hernia repair. Patients were randomized into two equal groups (35 patients in each group): group I, as bupivacaine group, where patients received 1 ml/kg bupivacaine 0.25%, and group II, as bupivacaine–neostigmine group, where patients received 1 ml/kg bupivacaine 0.25% and neostigmine 2 μg/kg. Heart rate and mean arterial blood pressure were recorded intraoperatively and postoperatively. Postoperative pain was assisted by face legs activity cry consolability pain scale, and the number of patients who needed postoperative rescue analgesia, total amount of rescue analgesia, and any undesirable adverse effects have been recorded. Results Heart rate and mean arterial blood pressure were statistically significantly lower in group II than in group I. Similarly, the face legs activity cry consolability behavioral pain score was significantly lower in group II than in group I. Moreover, the total number of patients who needed rescue analgesia and the total amount of rescue analgesia were significantly lower in group II than in group I. Patients who developed bradycardia were significantly higher in group II. There was no difference between both the groups in the incidence of pruritus or vomiting. None of our patients developed urine retention. Conclusion Addition of neostigmine to bupivacaine in a dose of 2 μg/kg results in superior analgesia than bupivacaine alone.
  388 67 -
Plasma galectin-3-binding protein level in patients with systemic lupus erythematosus
Samah Elsayed Abo-Elyazeed, Shereen F Gheida, Ghada AbdelMoamen Soliman, Mohamed M Gamea
October-December 2018, 46(4):249-254
DOI:10.4103/tmj.tmj_23_18  
Background Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects multiple organs. It is characterized by production of autoantibodies and immune complex deposition in various organs, leading to inflammation and tissue destruction. Although the definite etiopathogenesis of SLE remains unclear, many different mechanisms may contribute to the pathogenesis of SLE. Galectin-3 is a member of beta-galactoside-binding lectins. It has an essential role in negatively regulating T-cell receptor. Aim The aim of this work was to estimate the plasma level of galectin-3-binding protein (G3BP) in patients with SLE to assess its possible role in pathogenesis of the disease and its correlation to disease activity. Patients and methods The current study included 25 patients with SLE and 25 healthy individuals who served as a control group. Patients were divided according to systemic lupus erythematosus disease activity index score. Peripheral venous blood samples were taken from each participant, and plasma was examined by enzyme-linked immunosorbent assay for quantitative evaluation of G3BP. Results G3BP was significantly increased in SLE compared with control group. There was a significant positive relation between plasma G3BP level and family history. No significant correlation was found between plasma G3BP level and duration of the disease. A significant positive correlation was found between G3BP and activity of the disease according to systemic lupus erythematosus disease activity index. Conclusion G3BP may play a role in the pathogenesis of SLE and may be useful for therapeutic intervention in patients with SLE.
  387 55 -
The protective effect of folic acid and Vit B12 supplementation on albino rat lung injury due to cadmium inhalation
Rabab M Amer, Nahid M Tahoon
October-December 2018, 46(4):264-274
DOI:10.4103/tmj.tmj_82_17  
Background Folic acid and vitamin B12 are very important vitamins needed for normal cellular metabolic activities. Cadmium is a heavy metal that occurs naturally in the environment and Cadmium poisoning can occur through man-made pollution through agricultural and industrial activities. Aim Study of the effect of Cadmium of lung tissue of albino rats and the possible protective effect of administration of both Folic acid and vit B12 combination. Materials and Methods Thirty adult male albino rats were divided into 3 groups, a control group, Cadmium group, where rats received nebulized Cadmium chloride (CaCl2) and Cadmium + vit. group received Cadmium nebulization and both Folic acid and vit B12 supplementation. The lungs of rats of the 3 groups were collected and prepared for histopathological examination. Results Cadmium group sections showed disturbed lung architecture, shrunken alveoli and increased thickness of the alveolar wall. Vacuolation of the cytoplasm of some pneumocytes were noticed and some slides showed dilated congested blood sinusoids. Transmission electron microscopic sections revealed type II pneumocyte with hyperchromatic nucleus, perinuclear dilatation, dilated and mildly degenerated lamellar bodies. Cadmium + vit group showed that the lung tissue appears nearly normal with areas of mild thickening of the alveolar wall septa and mild edema inside alveoli. Conclusion It was concluded that both Folic acid and vit B12 supplementation proved to have a protective role against the harmful effects of Cadmium administration on the lung tissues of albino rats.
  327 52 -
Pediatric and adolescent new-onset gastroesophageal reflux after laparoscopic sleeve gastrectomy
Amir I AboMostafa, Ashraf A El Attar, Abdelghany E Mohamed, Mohamed M Shalaby, Mohamed A Atteyia
October-December 2018, 46(4):245-248
DOI:10.4103/tmj.tmj_78_17  
Background Sleeve gastrectomy has gained popularity since then as a definitive bariatric surgical procedure due to low-morbidity and mortality rates and short operation and hospitalization times. Aim The aim of this retrospective study is to evaluate the incidence of new-onset gastroesophageal reflux in pediatric and adolescent morbidly obese patients following a standardized laparoscopic sleeve gastrectomy (LSG) and to revise our option plans. Patients and methods Files of all operated morbidly obese pediatric and adolescent patients less than or equal to 20 years of age who underwent standardized LSG by a single surgeon in the Pediatric Surgery Unit, Surgery Department, Tanta University Hospital between January 2013 and December 2016 were retrospectively reviewed. Results The incidence of new-onset gastroesophageal reflux disease after LSG in our study (5.65–16.67%). Conclusion The incidence of new-onset gastroesophageal reflux disease after LSG in our study is small but deserves attention.
  299 53 -
Study of Wilms tumor 1 gene expression in patients with acute leukemia
Riham Moustafa Ahmed Abd-Elkodous, Amany Mohamed Abo-Elenein, Sara Mohamed Amr Hamam
October-December 2018, 46(4):255-263
DOI:10.4103/tmj.tmj_44_17  
Background Leukemias are a group of disorders characterized by the accumulation of malignant white blood cells in the bone marrow and blood. They are classified into two types: acute and chronic leukemia, which are further subdivided into lymphoid or myeloid categories according to the cell origin. The Wilms tumor 1 (WT1) gene product is a regulatory molecule of cell growth and differentiation. Wild-type WT1 gene is overexpressed in hematological cancers [acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic lymphocytic leukemia]. Aim The aim of this study was to study the WT1 gene expression in patients with acute leukemia. Patients and methods This study was carried out on 30 patients with acute leukemia. They were selected from patients admitted to the Tanta University Hospital. All individuals were subjected to laboratory investigations. Complete blood picture, bone marrow aspiration examination, cytochemical staining, and immunophenotyping and specific investigations by study of WT1 gene expression by real-time PCR were done. Results Positive WT 1 gene expression was detected in 70% of studied patients and negative WT 1 expression in 30% of studied patients. Moreover, positive WT 1 gene expression was detected in 84.6% of patients with AML. However, positive WT 1 gene expression was detected in 42.9% of patients with ALL. Conclusion The WT1 gene expression was increased in patients with acute leukemia. Moreover, the level of WT1 gene expression was increased in AML than ALL. The level of WT1 gene expression is decreased in patients with acute leukemia after chemotherapy and in patients during remission than its level before chemotherapy and in relapsed patients after chemotherapy. WT1 gene positive expression may be a good prognostic factor in patients with acute leukemia.
  303 41 -
A comparative study between epidural fentanyl, magnesium sulfate, or both for postoperative analgesia in hip surgeries
Hend A Ghoneem, Mohamed A El-Harty, Ahmed A El-Daba, Shaimaa F Mostafa
October-December 2018, 46(4):275-280
DOI:10.4103/tmj.tmj_32_17  
Background Postoperative analgesia after hip surgeries is important for adequate recovery and early mobilization. Epidural analgesia is one of the most accepted techniques. Aim The aim was to evaluate the analgesic efficacy of single bolus administration of epidural fentanyl, magnesium sulfate, and a combination of both in patients undergoing hip surgeries under spinal anesthesia. Patients and methods Ninety patients, 20–65 years, American Society of Anesthesiology I–III, undergoing elective hip surgery under spinal anesthesia were investigated. After wearing off of spinal anesthesia, the patients were allocated into three groups to receive single bolus epidural injection of fentanyl 1 µg/kg in the fentanyl (F) group, magnesium sulfate 75 mg in the magnesium sulfate (M) group, and a combination of both in the fentanyl magnesium sulfate (FM) group. All were diluted to a total volume of 10 ml. Visual analog scale, duration of analgesia, and total consumption of rescue analgesia were recorded. Results A combination of epidural fentanyl (1 µg/kg) and magnesium sulfate (75 mg) produced a significant reduction of postoperative visual analog scale at 3 and 6 h with a longer duration of analgesia and a lower rescue analgesic consumption without increased side effects. Conclusion Epidural fentanyl and magnesium sulfate provides adequate postoperative analgesia but with short duration. However, addition of magnesium sulfate as an adjuvant to epidural fentanyl improves the quality of postoperative analgesia, reduces the demand for rescue analgesia, and prolongs the duration of analgesia without additional side effects.
  292 38 -
Evaluation of the role of mast cell tryptase in the pathogenesis of skin tags
Ghada F.R Hassan, Hanan A Al-Shenawy
October-December 2018, 46(4):281-287
DOI:10.4103/tmj.tmj_16_18  
Background Skin tags (STs) are considered as common benign tumors of the skin. They are made of loose fibrous tissue and occur mainly on flexures and neck as protrusions that are soft and pedunculated. The etiopathogenesis of STs is not well understood yet. Mast cells (MCs) have been found to promote fibrosis and collagen deposition through tryptase, which is one of their mediators. So, there may be a link between MCs activation and STs formation. Aim The aim of this study was to evaluate tryptase from MCs and its possible role in the pathogenesis of STs. Patients and methods This study was carried out on 40 patients having STs. They were subjected to clinical examination, dermatological examination, and routine investigations. Moreover, skin biopsies were taken from STs from all 40 patients and from normal skin of 20 of these patients to act as a control group. All biopsies were stained by MC tryptase to study the count of MCs in controls as well as STs. Results STs had significantly higher MC counts compared with control skin. A significant positive correlation was found between MC count and serum triglycerides. A significant positive correlation between number of STs and age of the patients, BMI, and triglycerides was elicited. Obese and overweight patients showed higher MC count than normal weight patients. Thighs, axillae, and neck showed higher MC count compared with other sites, despite the relation between them being not significant. Conclusion MCs and their product tryptase are overexpressed in STs and may have an essential role in its pathogenesis.
  276 32 -
Evaluation of laparoscopic cholecystectomy in treatment of acute cholecystitis
Mohamed Mousa, Mohamed El-Shiekh, Hamdy Mohamed, Abd El-Monem Nagy
October-December 2018, 46(4):288-291
DOI:10.4103/tmj.tmj_52_17  
Background There is a controversy for laparoscopic cholecystectomy (LC) in acute cholecystitis with higher morbidity rates in an emergency procedure and the higher conversion rate to open procedure. The main reason is inflammation obscuring the view of Calot’s triangle view, whereas in late phase it is fibrotic adhesion, which will be associated with the bile duct injury. Aim This study was designed to evaluate the safety of LC for the treatment of acute cholecystitis. Patients and methods This prospective study included 30 patients who were treated by LC after 24 h. The timing of intervention was within 7 days from the beginning of the symptoms. Results All patients presented with elevated C reactive protein (CRP), which was higher in patients with high grade fever, who had palpable tender right hypochondrial mass and also in pyocele patients. Both CRP and total leukocyte count were noticed to be directly proportional to the amount of intraoperative hemorrhage. Males and pyocele patients had delayed time of intervention. Delayed timing of intervention was directly proportional to male and pyocele patients, intraoperative hemorrhage, and amount of drain postoperative. Total operative time was with mean 109.57 and blood loss was with mean 95. Longer operative time was associated with male sex, high-grade fever preoperatively, presence of palpable tender right hypochondrial mass, and higher total leukocyte count and CRP levels. Total hospital stay ranged from 4 to 6 days and increased with male sex and pyocele patients and delayed timing of intervention. Six patients had a postoperative superficial wound infection. Conclusion It was found that early LC allowed significantly shorter total hospital stay and early return to work and avoided repeated admissions for recurrent symptoms with no added morbidity or mortality.
  245 33 -