Cardiac and ocular manifestations in Egyptian patients with mucopolysaccharidoses

Cardiac and ocular manifestations were evaluated in 21 patients clinically suspected of mucopolysaccharidosis. After electrophoresis analysis of urinary glycoaminoglycans, 3 patients were excluded because their results did not correlate with any known type of mucopolysaccharidosis. Echocardiography revealed abnormal findings in 11 patients [61.1%]. The mitral valve was the most commonly affected valve; 7 patients [38.9%] had thickened mitral valve and 6 had mitral regurge. Corneal opacities were found in 3 patients [16.7%] and progressive increase in intraocular pressure in 1 patient [5.6%], while fundus examination showed early optic atrophy in 1 patient [5.6%] and bilateral papilloedema in 2 patients [11.1%]

Imaging follow-up diagnosis of post-extracorporeal shock-wave lithotripsy [ESWL] complications

Pre and post extracorporeal shock wave lithotripsy [ESWL] imaging follow-up was performed during the treatment of 100 kidneys and ureters with calculi through two years period, our study looking for kidey and urinary tract changes from ESWL effect. Before and after lighotripsy was performed, plain x-ray. Excretory urography, ultrasonography studies were done. C.T. maybe done when necessary to determine the effect of ESWL on the kidney and urinary tract. Multiple changes were noted in the form of renal subcapsular hematomas in nine patients [9%] [two large, six small and almost asymptomatic, intrarenal trematomas in two [2%] of patients. Perirenal subcapsular urinoma in two patients 92%] one of ten have had periureteric hematoma collection. Passage of the fragmented stone material was variable. 90% were stone free gradually after 3 months. Obstructive hydronephrosis in 20% due to inadequate stone fragmentation from the initial ESWL procedure especially with large stones 2 of these patients demonstrated pyonephrosis. Accumulation of an extensive amount of stone debris in the lower ureter were 30% of patients. So the imaging follow up of the patients is mandutory and good tool for diagnosis of post ESWL complications

Role of ultrasonogrphy [US] and computed tomography [US] in staging of cancer urinary bladder

Forty patients with cancer urinary bladder of different stages were studied to evaluate the role of U/S and C.T. in staging of cancer bladder. All patients were submitted to full clinical examination, Plain and intravenous urography cystoscopy, pre-operative histopathology, transabdominal ultrasound [U.S.] and peIvic computed tomography [C.T.] and post-operative histopathology. The accuracy of trans abdominal ultrasonography for staging of cancer urinary bladder was 82.5%, 5% were overstaged and 12.5% were under staged. The accuracy of computed tomography for staging of cancer urinary bladder was 90%, 7.5% were overstaged and 2.5% were understaged. So, we can conclude that ultrasonography should always be the primary imaging technique after I.V.U. in evaluating cancer urinary bladder and it is an important tool in the staging of bladder cancer as it has high sensitivity in addition of being readily, cheap and relatively easy to perform. However, C.T. scan in superior because C.T contrast enhancement can demostrate extravesical tumor spread and lymph enhancement can demonstrate extravesical tumor spread and lymph node enhancement with high sensitivity more than ultrasound which is limited by poor tumor visualization in obese patients, in those with small bladder capacity, gases and rigid abdominal wall

role of computerized axial tomography [CT], ultrasonography [US], transhepatic cholangiography [PTC] and endoscopic retrograde cholangiopancreatography [ERCP] in differentiating inflammatory from malignant pancreatic focal mass lesion

Fifteen patients with focal inflammatory masses of the pancreas were thoroughly studied over 3-year period from 25 patients who have had suspected pancreatic disease. Ultrasound [US] and computerized axial tomography [CT] were performed as a screening. Subjective pancreatic enlargement and/or distortion [nodular or irregular contour] were detected in 15 cases. Transhepatic cholangiography [THC] was performed allowed a diagnosis of inflammatory disease in three patients demonstrating long smooth stricture of the common bile duct [CBD] and the 4th patient had a short, smooth stricture producing incomplete obstruction suggesting malignancy and in three the distal CBD was completely obstructed with rat- tail tapering highly suggestive of malignancy. Endoscopic retrograde cholangiopancreatography [ERCP] was successful in eight patients since they permitted pancreatitis in three, two patients malignancy could not be determined and three patients had findings usually associated with malignancy, two of them had complete obstruction of the pancreatic duct, while one had "double duct sign". The mass identified by CT usually of the same pancreatic attenuation, although five contained small areas of low attenuation suggesting inflammation. Ten patients with pancreatic head mass demonstrated obstructive jaundice. On US the inflammatory masses appeared hypoechoic. The pancreatic duct was identified sonographically in four of five patients seen by CT

Dynamic CT evaluation of hepatic masses with intravenous and selective intra arterial contrast material

A new technique for the dynamic computed tomography CT of the liver with boluses of contrast media administered either via intravenous or selective intra- arterial approaches [with 50 gm non-ionic iodine load] was used. For most focal liver lesions, which are hypovascular in relation to the normal hepatic parenchyma, bolus contrast material enhancement and dynamic scanning improve delectability compared with that yielded by routine non-dynamic, contrast infusion technique. The bolus contrast enhanced dynamic scan technique is reproducible and of value in patients under going sequential CT for the assessment of tumor bulk response to chemotherapy. Patients who are potential candidates for the resection of focal hepatic lesions should preoperatively undergo intra-arterial contrast- enhanced CT. Moreover, this technique is useful in differentiating cavernous hemangioma from hepatocellular carcinoma or metastases. Dynamic CT is helpful in diagnosing minimac liver damage who have suffered blunt abdominal trauma. A total of thirty patients were studied and evaluated

Value of scrotal ultrasonography in scrotal swelling evaluation

The value of routine ultrasonography was evaluated in prospective study of 100 men with scrotal swelling. Ultrasonography [US] had a sensitivity of 100% and specificity of 99% for testicular tumor. Clinically, useful information was provided in 55% of patients and 10% might have avoided surgery if the ultrasound report was needed. Ultrasonography did not provide any additional information in patients with scrotal pain and an entirely normal scrotum clinically and in those with epididymal cysts in whom the testis was palpably normal. If these two groups were excluded from routine scrotal Ultrasonography, there would have been a 25% reduction in the number of examinations without any reduction in diagnostic yield

High resolution utrasonography and CT Evaluation with further postoperative pathology in diagnosing testicular neoplasm

High resolution [4.5 and 10 MH[z]] ultrasonography produces extremely detailed morphologic images of the tests. The sonographic features most helpful in detecting tumours are mass, bright acrogenic foci and diffuse parenchymal texture changes, of had one or more echogenic foci and 8 patients had a diffuse parenchymal texture change. Bright acrogenic foci were present in 4 patients of 8 testes that had a regressed germ-cell tumor. In an attempt to define the histopathologic features of bright echoogenic foci, we performed either needle localization under real-time guidance on four operative specimens. We observed immature bone and cartilage, calcification, tubular atrophy and fibrosis focal noncalcific scarring. Discovery of occult testicular neoplasm's was common [10/30]

Echinococcosis of the liver and biliary tree: ultrasound, CT and post-operative evaluation

The sonographic and CT appearances of echinococcal lesions of the liver were studied in 100 patients. A classification of these lesions, that reflects the pathology and natural history of the disease [type I, simple fluid-filled cysts, type IR, lesions containing undulated membranes that represent detached endocysts secondary to rupture, type II lesions that contain daughter cysts and/or formed echogenic material called matrix, and type III, dead, densely calcified lesions], was proposed. The natural progression of hepatic echinococcal cysts is from type I to type III. Daughter cyst formation is part of the natural aging process. When hydatid cysts are infected, they lose their characteristic sonographic appearance and become hyperechoic on CT. These lesions were hypodense [30-40 HU] and did not show enhancement after intravenous contrast enhancement. Precise evaluation of the lesions arising from correlative use of ultrasound and CT permits proper staging and treatment

Doppler ultrasound and cavernosography evaluation in infertile man with non-erection

Examination of the penile artery by duplex scanning in the assessment of impotence was evaluated in 140 impotent men. Scanning was done by Technicare, Diasonic DRF400, and penile artery measurements were taken before and after intracorporeal injection of papaverine hydrochloride 60 mg. The penile brachial index was measured in 80 patients and its predictive value compared with the results of duplex scanning and papaverine induced erection. On scanning evidence of good arterial inflow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterized the erectile response, with the dorsal artery being less helpful. All 30 patients with full erections following papaverine exhibited deep artery peak velocities of <25 cm/s, of the remaining 110 sub-optimal responsers, 20 also had this finding, all had undergone dynamic cavernosography, with 19 exhibited venous leakage. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosography. The penile/brachial index was shown to be suspected, and it was concluded that duplex scanning is a useful, noninvasive method in the assessment of impotence

Tumor thrombosis of the inferior vena cava secondary to malignant abdominal neoplasms US, CT and MRI evaluation

18 patients with histologically proved tumor thrombi of the inferior vena cava [IVC] secondary to abdominal neoplasms were studied with the use of ultrasonography [US]. The primary neoplasms were renal cell carcinoma [10 cases], adrenal tumors [2 cases], retroperitoneal tumors [2 cases], and hepatic tumors [4 cases]. The positive diagnosis of tumor thrombus was better demonstrated by US studies, which showed echogenic endoluminal material within an enlarged IVC with a bulging anterior wall. On CT scans the tumor thrombus usually appeared as endoluminal filling defect surrounded by a rim of contrast material. Tumor thrombus could be evaluated by MRI appeared as endoluminal low signal intensity filling the IVC and expanding it. Invasion and extension outside the wall was better. US, CT and MRI are complementary in the preoperative assessment of tumor thrombus and their use obviates. The need for venacavography in many cases which is hazardous because of the possibility of dislodging thrombi and failed to demonstrate the cephalad extension of the tumor thrombus

Unreamed interlocking nailing of comminuted femoral shaft fractures

Reporting the experience gained in the use of closed unreamed comminuted fractures of the femur. 28 Winquist et al Types III and IV comminuted closed femoral shaft fractures in 28 patients. All were treated within 24 to 48 hours alter injury, in 1993 in Ainshams University Hospital and in Police Authority Hospital. A prospective study was carried out for closed interlocking antegrade nailing with a thin [10 - 11 mm diameter] Russell-Taylor Delta nail, using an unreamed static technique. Locking was both proximal and distal. Reaming was necessary in 2 cases. Hospitalisation 5 - 27 days, mean 15. Crutch walking was allowed on the second postoperative day in 23 patients [82.1%] who had no other injuries which did not allow it. In them full weight bearing was allowed when bony radiographic union was evident, ie after 13 -21 weeks, mean 17. Full radiographic union in all the material occurred after 13 - 38 weeks, mean 26. Delayed union after 38 weeks in 1 case; Knee stiffness 2; infection 1. Closed unreamed interlocking nail with Russell-Taylor Delta nail is successful in comminuted femoral shaft fracture with no need for dynamization

Assessment of self-care practices among patients with peripheral vascular Disease

Person's level of well being is directly proportional to the level of self-care activities that person engages in. Therefore, the purpose of this study is to assess self-care practices among peripheral vascular patients and factors hindering these practices. Also, to determine the impact of sex, education and occupation on them. The sample consisted of 50 patients suffering from various peripheral vascular diseases attending the Outpatient Clinic of the Vascular Unit, at the Main University Hospital, Alexandria. A structural interview was used. The results revealed that many patients knew the importance of self-care practices but not followed them due to lack of knowledge, motivation, skills and resources. Also, the results denoted that education has an effect on the following of these practices. Further researches about specific self-care actions used by adults in response to a variety of health deviations were recommended

Urinary incontinence and its impact upon elderly in some hospitals in Alexandria

The study was conducted at the urological, medical and neurological departments of the Main University Hospital and El-Hadara Traumatic Hospital in Alexandria. The sample comprised 150 elderly, aged 60 years and over and had urinary incontinence. Observation check list, designed questionnaire, pressure sore description scale and depression status scale were used for the purpose of the study. Demographic data were collected

Significance of intra-operative venography in comparison between high and low ligation on primary varicocele

Intra-operative pre- and post-high ligation spermatic venography was performed for 10 cases who had varicoceles and infertility, 8 of 10 were left varicoceles and one with bilateral varicocele. 6 showed suprapubic venous channels and 2 demonstrated scrotal collateral venous channels connecting the 2 testes. The final findings displayed that the most common etiology of recurrent varicoceles seems to be residual proximal central collateral veins, suprapubic and intrascrotal collateral venous channels were responsible for the varicocelectomy failure if the operation was performed unilaterally

High institute of nursing students perception of nursing as a career choice

The present study was done to assess the perception of the students of the first year, of the High Institutes of Nursing of the universities of Alexandria and Tanta of nursing as a career choice. The sample consisted of 200 students, 100 students randomly selected from each institute. A questionnaire was designed to collect the necessary data about the study subjects as well as their perception of nursing as a career choice, reasons for choosing it, their opinions regarding the advantages of nursing as a career, their opinions about reasons that induce "active nurses" to leave the profession, and their opinions regarding encouragement of a return to nursing profession. The findings revealed that the majority of the study sample in Alexandria and Tanta Universities [85%] perceived nursing as a career, while the minority of them did not perceive it as such. Nursing offers opportunities to manage a large group of people and to care for individuals, families and communities. Some students had misperception about nursing in the areas of considering nursing as a prestigious profession and designing and directing health programs. The findings also revealed that most of the study sample, both in Alexandria and Tanta choose nursing because they want to work with people. It is a job without a routine and a job with responsibility. The whole sample in Alexandria and Tanta stressed that they were put in the institute according to their total of marks attained in their GCE. They thought that the bad image of nursing, the nurses poor self-image, their low salary levels and other reasons induced "active nurses" to leave the nursing profession. Furthermore, the findings illustrated that it is very important to improve the nursing image both in hospitals and the community and to encourage a return to nursing profession

High resolution real-time ultrasonography in localization of the palpable and impalpable undescended testes

In prospective study ultrasound was compared to palpation in 50 cases their age ranged between 12 month, to 30 years in which a testis was not present in the scrotum. A testis was palpable in 20 of these instances [40%] and not palapted in 30 [60%]. Of 20 palpable undescended testis 13 [90%] were identified by ultrasound the other 2 diagnosed as lymph nodes. Of the 30 instances in .which a testis was not palpated 4 intra-abdominal and pelvic, 2 false positive sonogram in which a gubernaculum structure mimicked an undescended testis, 14 too small testes were identified most of them close to the internal inguinaI ring by ultrasound. Sonography is of high value, 1st step screening modality of choice. It is simple, reliable. Uncosty, non-invasive tool in localization of cryptorchid testis. It is ideal in inguinal localization and less than ideal in abdominal localization however MRI as a second step can display it

Renal allograft rejection ultrasound evaluation

Real time ultrasonography [US] was performed on the allografts of 35 patients, included 10 with successful renal trasplantation, five with acute tubular necrosis, three with cyclosporine toxicity, 16 with acute allograft rejection and one with renal artery stenosis. During the course of acute tubular necrosis 5/35 [14%] the renal anatomy remained sonographically unaltered and in acute cyclosporine toxicity 3/35 [8.5%] as well. During the course of acute rejection 16/35 [46%] there was a spectrum or sonographic findings including increase in renal volume [87.5%], Decreased amplitude of renal sinus echoes [87.5%], prominent medullary pyramids [75%], indistinct corticomedullary boundary [69%]. Decreased echogenicity or the renal parenchyma [56%], focal sonolucency in the renal parenchyma [25%], sparse cortical echoes [56%] and perirenal fluid collections [81%] as a result of hematoma or crescentic collections of fluid around the kidney. In renal artery stenosis 1/35 [3%] no sonographic abnormality detected except lack of renal hypertrophy. Our study encourages the use of sonography in acute post-Transplantation renal failure. If serial ultrasound studies are available and correlation with clinical data, laboratory data and radionuclide studies obtained the correct diagnosis may be reached without the use of invasive procedures

Comparative ultrasound and emergency excretory urography study in evaluating acute flank pain

To determine the role of ultrasound [US] in patients with acute flank pain and suspected acute urinary tract obstruction, a prospective study was performed on 30 patients comparing US with emergency excretory urography. US was not as sensitive as excretory urography for diagnosing hydronephrosis, for detecting ureteral or renal microlithiasis and calcification or for diagnosing forinceal rupture. Although US is an effective screening modality for hydronephrosis in patients with chronic renal obstruction, it is not useful for evaluating patients with acute flank pain in whom acute obstruction may be present. In this group of patients, excretory urography remains the examination of choice