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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 25 | Issue 2
Page Nos. 45-75

Online since Wednesday, March 4, 2020

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ORIGINAL ARTICLES  

Mesenteric ischemia: can multidetector computed tomography angiography be a one-stop diagnostic solution? p. 45
Lamiaa I.A Metwally, Ahmed Adelsamie, Ahmed Mostafa, Rabab Salama
DOI:10.4103/kamj.kamj_16_19  
Background Mesenteric ischemia is a medical condition in which inflammation and injury of the small intestine result from inadequate blood supply. Mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic depending on the time course of symptoms. Multi Detector Computed Tomography MDCT has high sensitivity and specificity for diagnosing acute primary mesenteric ischemia. Aim and objectives Our objective was to evaluate the role of MDCT angiography in evaluation of patients with suspected mesenteric ischemia as regards vascular and intestinal abnormalities. Patients and methods This prospective study was performed on 60 patients clinically suspected of having mesenteric ischemia, referred to the radiology department of Cairo University hospitals from the emergency hospital and the out-patient clinics and in-patient departments of general surgery and of Endemic Infectious diseases and Hepatogastroenterology. Patients suspected clinically to have mesenteric ischemia were initially examined by Doppler and if showed mesenteric vascular suspicious findings by Doppler, they were referred to CT angiography examination. Results In our study we found that 40 patients (66.7%) out of 60 patients showed abnormal MDCT findings which explained the cause of mesenteric ischemia in these patients. The most prevalent CT findings in 40 patients with positive CT angiographic findings in acute mesenteric ischemia (AMI) were bowel wall thickening in 12 patients (30%), bowel distension in 8 patients (20%) and lack of mural enhancement in 10 patients (25%). Computed tomography angiography (CTA) detected accurately the cause of AMI where arterial thrombo-embolism was common cause of AMI (62.5%) and the SMA was the most frequent site in patients with AMI than mesenteric venous thrombosis with AMI (37.5%). 50% of patients with AMI showed pneumatosis intestinalis and surgical exploration revealed bowel infarction and resection anastomosis was done. Conclusion MDCT is fast, safe, accurate and non-invasive imaging modality of choice in patients with suspected mesenteric ischemia which is able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention, also confirmation or exclusion of various other differential diagnoses of acute abdominal conditions.
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Anatomical and radiological study of the variations of profound femoris artery and its branches p. 53
Mohamed A Moaty, Esraa A.M Mahmoud
DOI:10.4103/kamj.kamj_11_19  
Introduction The femoral artery begins at the level of the midinguinal point as a continuation of the external iliac artery, and profound femoris artery (PFA) is the main branch of femoral artery that arises variably. Aim The aim of this study was to show the anatomical variations of PFA and its branches. Patients and methods (i) In the cadaveric study, femoral triangles of 20 lower limbs of 10 cadavers were dissected to study origin, course, and branches of PFA. The origin, course, and branches were noted. The distance of origin of PFA from midinguinal point was measured with the help of a scale. The width of femoral and PFA was measured with the help of a divider and a scale. (ii) In the radiological study, we retrospectively reviewed 49 patients (92 sides) undergoing femoral computed tomography angiography. Results Overall, 49.2% of them showed posterolateral origin of PFA on the right side and 62.7% on the left side followed by lateral origin in 33.9% on the right side and 23.7% on the left side, but the least percentage was to be posteromedial origin with no significant variations of other parameters (P≥0.05) except for medial circumflex femoral artery origin to lateral circumflex femoral artery origin site of origin between right and left sides (P≤0.05). Conclusion It could be concluded that variations of PFA and its branches are common, and it is most important to know variant origin of PFA and its branches, as they have an important role during preoperative clinical evaluation.
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Risk factors for familial and nonfamilial young ischemic stroke p. 66
Ho Sin, Sin O Hwang, Sun Hwa Jo, Gum Song Song, Se Ryong Han
DOI:10.4103/kamj.kamj_12_19  
Aim In this study, the authors presented the 10-year survey on risk factors among young patients with ischemic stroke according to their family history. Patients and methods The population includes 92 young patients with ischemic stroke who had been admitted at Neurology Department of Pyongyang Medical College Hospital, Kim Il Sung University, between January 2007 and August 2016. Among them, young patients with familial history of ischemic stroke were 34 (11 females and 23 males), with a mean age of 38.9±3.54 years, and nonfamilial ones were 58 (13 females and 45 males), with mean age of 37.5±4.21 years (18–44 years old). Results Young patients with familial history of ischemic stroke with 5–10 risk factors were more than nonfamilial group, but young patients with nonfamilial ischemic stroke with 10–15 risk factors were more than familial group. Moreover, the effect of each risk factor is different in the two groups. Conclusion Incidence of young ischemic stroke is different between familial and nonfamilial groups, and nonfamilial patients have more risk factors than familial ones.
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Posterior sagittal rectopexy in the management of persistent and recurrent complete rectal prolapse in children p. 70
Hisham A Almetaher, Mohamed A Shehata
DOI:10.4103/kamj.kamj_19_19  
Aim The aim of this study was to evaluate the clinical and functional results of posterior sagittal rectopexy (PSR) in children with persistent and recurrent rectal prolapse. Patients and methods All patients with recurrent rectal prolapse after injection sclerotherapy or previous anal cerclage and patients with prolonged persistent prolapse needing surgery were subjected to PSR. Follow-up extended in the outpatient clinic for 6 months, and the patients were observed for any change in bowel habits, continence, and postoperative complication (incontinence and bleeding). Results This study included 12 patients with persistent rectal prolapse not responding to conservative treatment for 1 year and eight patients with recurrent rectal prolapse. Their ages at the operation ranged from 3 to 10 years. The mean operative time was 60 min (range, 40–80 min). Early postoperative complications include wound infection in four cases, which responded to antibiotics and daily dressings, and four patients with temporary constipation responding to laxatives and regulation of diet habits. Recurrence occurred in one patient in the form of partial mucosal prolapse. Conclusion PSR is a safe and effective procedure for persistent and recurrent rectal prolapse in children with excellent clinical and functional results.
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Effect of using rigid versus nonrigid attachments on stresses induced in peri-implant bone in implant-supported prostheses (finite element analysis): a nonrandomized in-vitro study p. 74
Hitham M Shalaby
DOI:10.4103/kamj.kamj_27_19  
Background Peri-implant bone stresses can sometimes be detrimental. Efforts are made in order to keep these stresses at the normal level. Methods A finite element analysis was carried out in which two models were compared, the rigid attachment used in a fixed prosthesis versus the nonrigid one used in a removable prosthesis. Both of them were completely implant-supported. Results Have shown that the rigid type produced higher stresses than the nonrigid one. Conclusion Nonrigid attachments are more biocompatible than the rigid attachments.
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