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   Table of Contents - Current issue
January-April 2019
Volume 25 | Issue 1
Page Nos. 1-43

Online since Tuesday, August 27, 2019

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Evaluation of aesthetic and functional outcome of different techniques of secondary cleft lip rhinoplasty p. 1
Tarek F.A Keshk, Yasser M El-Shikh, Sherif I Elkashty, Mohammed A.G Ismail
Objectives The objective of this article is to evaluate the esthetic and functional outcome of secondary rhinoplasty in patients who have unilateral cleft lip nasal deformity with the help of using costal cartilage as a source of different graft materials. Background Although there have been improvements in primary rhinoplasty techniques in patients with unilateral cleft lip nasal deformity, this does not exclude the possibility of later revision surgery. In secondary rhinoplasty for cleft lip patients, the underlying skeletal support of the nose should be addressed to improve projection of the nose. In addition, correction of the hypoplastic lower lateral cartilage requires insertion of cartilage or bone grafts to add better support and symmetry. Costal cartilage is considered a better source of graft material to be used in secondary rhinoplasty. Patients and methods This clinical trial included 20 patients who were managed in Plastic Surgery Department, Menoufia University Hospital, from January 2016 to January 2018. All patients had unilateral cleft lip in infancy with residual nasal deformity in adulthood. Costal cartilage rib graft was harvested, carved, and used for maxillary augmentation, columellar strut graft, and lateral crural strut graft. Results Three anthropometric measurements (nostril height, width, and gap area) were used for evaluation of esthetic results, and subjective evaluation of nasal obstructive symptoms was used for functional improvement. A significant improvement of both esthetic and functional results was reported in the study and satisfactory outcome for both surgeons and the patients. Conclusion Maxillary augmentation beneath the base of the nose is important in cleft lip secondary rhinoplasty for better support of the columella and lower lateral cartilage. Costal cartilage is a good source of nasal grafting materials owing to its strength, availability in large amount, and ability of being carved for different options.
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Cirrhosis-associated liver nodules in Egyptian patients: correlation of histopathologic and MRI with diffusion findings p. 7
Lamiaa I.A Metwally, Sanaa A.M El Tatawy, Naglaa A.H Zayed
Aim This study aimed to examine the role of enhanced MRI combined with diffusion in the characterization of cirrhotic nodules, to differentiate benign cirrhotic nodules from premalignant and malignant ones, and to determine treatment planning and management. Patients and methods Precontrast T1, T2, T2-Spectral Attenuated Inversion Recovery, in-phase and out-phase gradient echo sequence, dynamic contrast-enhanced, and diffusion-weighted MRI, b values (0, 500, 1000 s/mm) were obtained in 40 patients with cirrhotic liver (total of 58 focal nodules). The morphological features of each lesion were recorded: size, shape, margin, signal, pattern of contrast enhancement, number, and site of focal lesions in the diffusion images with apparent diffusion coefficient values. Results Lesions were divided according to MR diagnosis and divided histopathologically into four groups: group A: malignant, group B: premalignant (dysplastic), group C: regeneration, and group D: siderotic nodules. Histopathologically, they were divided into 26 hepatocellular carcinoma, nine low-grade dysplastic, nine high-grade dysplastic, 12 regeneration, and two siderotic nodules. The accuracy of MRI was 93%, the sensitivity was 100%, and the specificity was 70% in this study. Conclusion Contrast-enhanced MRI with diffusion-weighted imaging is sensitive for early detection of malignant neoplastic hepatic lesions, and for differentiation between premalignant and malignant lesions.
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Additive value of dexmedetomidine in endoscopic ultrasound-guided celiac plexus neurolysis for the treatment of liver cancer pain p. 22
Ahmed A Ghafar, Salah Rozaik, Ahmed M Saed, Elsayed Ghoneem, Soliman Faried
Background Hepatocellular carcinoma is the most common primary liver cancer that usually develops in a background of cirrhosis. It is usually diagnosed at advanced stages and abdominal pain may be the first presentation where it represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in the relief of pain as a result of upper abdominal malignancy. Dexmedetomidine is an α2 adrenoreceptor highly selective agonist approved for procedural sedation use. Patients and methods Fifty patients who were divided into two groups with hepatocellular carcinoma-associated abdominal pain in need of opioid analgesics underwent endoscopic ultrasound-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second one. Patients give their abdominal pain a score according to the numeric rating scale-11 before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure. Results The study have included 50 patients who were divided in two groups: 32 men and 18 women with a mean age of 60.12±5.07 years for group 1 and 58.32±5.03 years for group 2. There were no significant difference between the two groups as regards medical, laboratory, or tumor characteristics. The median pain score decreases from 8.32±0.75 before the procedure to 3.75±3.72 24 week after the procedure in group 1 and from 8.08±0.86 before to 1.67±2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks of follow-up. There was no statistically significant difference between the two groups as regards the median survival time. Conclusion The addition of dexmedetomidine to bupivacaine 0.5% in endoscopic ultrasound-CPN demonstrated beneficial effects as regards the degree and duration of pain relief with negligible effect on patient survival.
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Role of flaxseed oil and silymarin in amelioration of lead-induced kidney injury p. 29
Dalia A Gaber, Waleed A Badawy
Aim This study was undertaken to test the effect of flaxseed oil and silymarin on the oxidative stress induced in the renal tissue of male albino rats on exposure to a sublethal dose of lead acetate. Methods Adult male albino rats were exposed to oral doses of lead acetate solution (1/20 LD50) for 6 weeks. Flax seed oil was added to second group and a third group received silymarin in addition. Results Lead-induced oxidative stress was indicated by elevated malondialdehyde level in kidney homogenates. This level dropped markedly in kidney tissue of rats receiving flaxseed oil, and better results were observed in the group receiving both flaxseed oil and silymarin. Histopathological examination of hematoxylin and eosin-stained kidney sections showed degenerative changes in the kidney tissue, in addition to disorganization of the collecting duct. Renal function was not significantly affected. Less degenerative changes were noted in the group receiving flaxseed oil, and they were nearly abolished in the group receiving both flaxseed oil and silymarin. The normal kidney histology was almost restored in such group. Endogenous antioxidants like reduced glutathione and glutathione peroxidase enzyme levels were reduced with lead acetate intake and raised significantly (P<0.05) with flaxseed oil intake. The addition of silymarin resulted in further increase in glutathione peroxidase level (P<0.05). Conclusion This study revealed the potential protective role of flaxseed oil as a compound rich in phenolic antioxidant components. Silymarin, a potent antioxidant known for its hepatoprotective effect, has a synergistic effect when added to flaxseed oil, ameliorating lead-induced renal damage.
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Nephroprotective effect of peroxisome proliferator-activated receptor-α and peroxisome proliferator-activated receptor-γ agonists on thioacetamide-induced nephrotoxicity in rats p. 38
Remon R Rofaeil, Ahlam M Abdellah, Nagwa M Zenhom
Aim This study, for the first time, evaluates the effect of PPARα/γ agonists on thioacetamide (TA)-induced nephrotoxicity in rats. Methods Male wistar rats were treated with TA (50 mg/kg, twice weekly for 6 weeks) to induce nephrotoxicity. Results Our results showed that bezafibrate and telmisartan caused significant decrease in urea, creatinine and renal malondialdehyde (MDA) which were elevated with TA administration. At the same time, both drugs caused significant increase in renal nitric oxide (NO) and renal superoxide dismutase (SOD) which were reduced with TA. Meanwhile, TA caused significant reduction in PPARα and PPARγ expression, telmisartan increased only PPARγ expression and bezafibrate increased only PPARα expression. Conclusion Our findings suggests that bezafibrate and telmisartan are protective against TA-induced nephrotoxicity possibly through their antioxidant activity.
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