A descriptive study of inflammatory bowel disease at an Egyptian tertiary care center.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients. MATERIALS AND METHODS: Two hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI). RESULTS: Median patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients. CONCLUSIONS: Although the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.

Neurofibromatosis type 2: Hearing preservation and rehabilitation.

The main manifestation of neurofibromatosis type 2 (NF2) is the development of bilateral vestibular schwannomas (VS). Consequently, one of the most severe functional sequelae is bilateral sensorineural hearing loss, caused by spontaneous tumor progression and/or treatment-related damage (surgery or radiosurgery). Preserving or restoring hearing is still challenging in NF2 no matter the strategy applied to each individual based on the natural history of VS. In this review, the different strategies for hearing preservation or rehabilitation are discussed and illustrated by several cases. A decisional algorithm for NF2 patients with VS is proposed that takes into consideration the tumor size and hearing level.

Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy.

OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.

Characteristics of stroke in Hofuf, Saudi Arabia.

BACKGROUND: Stroke is a common neurological disorder that is encountered in most hospitals in both developed and developing countries. This two-year study was designed to show the characteristics of the problem at the King Fahad Hospital, Hofuf, Saudi Arabia. PATIENTS AND METHOD: This was a prospective study of all Saudi stroke patients admitted to the medical wards in the study period. All patients were assessed individually by one of the two available neurologists. Data was collected on pre-designed protocol, and analysis was performed using tables and figures, and EpiInfo A(R) computer software. RESULTS: The 329 Saudi patients studied fulfilled the criteria for stroke. The male:female ratio of the patients was 1:1, and their ages ranged between 42 and 92 years (mean 62.8+/-11.1) for males, and between 20 and 100 years (mean 59.6+/-15.4) for females. The relative frequencies of stroke subtypes were ischemic infarcts (79%), of which 46% were lacunar infarcts, intracerebral hemorrhage (18.8%), and subarachnoid hemorrhage (2.2%). The most common risk factor was concomitant hypertension with diabetes mellitus (40.4%), hypertension alone (24.9%), diabetes alone (11.6%), atrial fibrillation (5.8%), other cardiac factors (5.5%), transient ischemic attack (TIA) and prior stroke (2.1% each), and smoking (1.8%). No risk factor was detected in 5.8% of the patients. The overall in-hospital mortality was 10.0%, with a significant male preponderance. CONCLUSION: This study demonstrated that stroke is a common neurological condition in the Al-Hassa region of the Kingdom. The male:female ratio was dissimilar from that observed in other parts of Saudi Arabia. The study also showed that hypertension with diabetes constituted a potent risk factor. Sickle cell anemia was not found to be a risk factor. The case fatality was low and both the incidence and mortality showed seasonal preference. We believe that there is a need to establish a Stroke Register at the King Fahad Hospital at Hofuf for the Al-Hassa region.

Comparative study of the effect of oral contraceptives containing 50 microgram of estrogen and those containing 20 microgram of estrogen on adrenal cortical function.

Because the adrenal cortex is an endocrine gland essential to life, its function was studied in women who were taking an oral contraceptive that contained either 50 microgram or 20 microgram of estrogen. Of 32 healthy women studied, 18 used an oral contraoceptive that contained 50 microgram of estrogen, and 14 used an oral contraceptive that contained 20 microgram of estrogen. With 50 microgram of estrogen, the total plasma cortisol level rose significantly, the level of urinary cortisol excretion did not change significantly, and the levels of 17-ketosteroids and 17-ketogenic steroids were significantly reduced. With 20 microgram of estrogen, there were no significant changes in the levels of total plasma cortisol, urinary cortisol excretion, and the excretion of 17-ketosteroids and 17-ketogenic steroids. Thus, adrenal cortical function was altered in women who used an oral contraceptive that contained 50 microgram of estrogen, but there was no significant effect with the use of an oral contraoceptive that contained only 20 microgram of estrogen. Our findings confirm previous ones in regard to the effects of 50 microgram of estrogen on adrenal cortical function, although no studies had been carried out previously on the effects of 20 microgram of estrogen.

PIP: The effect of oral contraceptives (OCs) containing 50 mcg vs those containing 20 mcg of ethinyl estradiol (EE) on adrenal cortex function was assessed. From a total of 32 women studied, 18 used the 50-mcg EE OC and 14 used the 20-mcg preparation. Blood and urine specimens were obtained at the start of the trial and in 3-month intervals for 9 months thereafter, and total plasma cortisol, urinary cortisol excretion, urinary 17-ketosteroids excretion, and urinary ketogenic steroids excretion were assayed. In women using the 50-mcg OC, the total plasma cortisol level rose significantly after 3, 6, and 9 months of OC use with no significant difference between the mean values of these periods. Urinary cortisol excretion level did not change significantly after 3, 6, and 9 months of use. Urinary levels of 17-ketosteroids and 17-ketogenic steroids were significantly reduced after 3, 6, and 9 months of OC use; however again means were not statistically significantly different. In the 20-mcg OC group, the measured substances did not change significantly after 3, 6, and 9 months, confirming the previously reported findings that adrenal cortical function was affected during use of high-dose EE OCs.