Study of psychological aspects in asthma an Egyptian experience

The problem of psychologic trouble in asthma is frequently overlooked, and needs to be assessed. For this purpose 40 asthmatic patients were investigated. A psychological trouble was found to be present in 55% of them; mostly in the form of anxiety/neurosis [84.6%]. Its proper conventional management, when added to the traditional phamacotherapy, stepped up the outcome of treatment in the particular case: The success, interpreted as relief and control parameters; combined together in the treatment which means controlled or partially controlled, reached 81.8% in these patients. The incidence of "difficult to treat" or uncontrolled cases dropped from 36.4% to 18.2%, when such cases received added psychotherapy. Even the comparison of the overall relief and control of patients revealed significant better outcome, when the proper treatment was applied to either patients with or without psychological trouble; figures being 81.8% and 77.7%, respectively. As a pilot study, this presentation calls for more elaborate study on the subject, with special attention to whether the relationship is a cause and effect one and/or a mere association

Surgical correction of congenital chest wall deformities: technique and early experience in Kasr El Aini hospital

Background: We herewith describe the technique we used in the one-setting surgical correction of different types of congenital chest wall [sternal or rib deformities]: deficient ribs or sternum; pectus excavatum, and the pectus carinatum defects

Patients and Methods: Our study was prospectively-undertaken from 2003 till 2006, in Kasr El Aini University Hospitals, Abul Reesh National Insurance Hospital for Students, and Tanta University. It enrolled 12 patients [7 males and 5 females] having 3 types of congenital sternal deformities: Cleft or Deficient Sternum [DS] [5 patients, 41.6%]; Pectus excavatum [PE] [6 patients, 50%]; and Pectus carinatum [PC] [1 patient, 8.3%]. Our youngest patient - at the time of surgical correction - was a 4 months-old male baby with deficient sternum; while the oldest was a 15-years old young man with pectus carina- tum. The mean age of our patients was 4 years +/- 5.5 months [range 4 months - 15 years]. Patients having PE [or their parents] mainly complained of cosmetic deformity followed by recurrence of chest infection; while CS patients [or their parents], expressed fear of possible trauma to the inadequately-protected heart. Follow-up period was done for all patients for a whole year postoperatively by means of clinical examination and questionnaire questions to the patient [or his or her relatives] asking them to share in the patients evaluation in comparison with the original complaint stating their opinion in grades as : excellent, good, fair [or accepted], and poor

Results: We had no mortality. No significant intraoperative morbidities were found. Blood loss was minimal and no transfusion was required. Postoperatively, transient mild unilateral seroma below the pectoralis muscle [needed a 5-days vacuum drainage] was noticed in 1 patient [8.3%]; mild Chest wall pain [ameliorated by oral and local analgesia] in 1 patient [8.3%]; and lag of cartilage regeneration leading to small anterolateral soft space [managed with increased oral calcium intake] in another patient [8.3%]. No other types of morbidity occurred eg: blood loss needing transfusion; Cardiac arrhythmias; or recurrence of sternal depression [pectus cases]. Postoperative hospital stay time was relatively short with a mean of 8 k 3.5 days [range 4 -13 days]. According to the patients [and or childis parents] words, the postoperative functional results were described as: excellent in 6 patients [50%]; good in 4 patients [33.3%]; and acceptable in 2 patients [16.6%]. Generally-speaking, patients and or their parents accepted the surgical results quite well and reported an obvious decline in the frequency of chest infections, and a favorable improvement in morals together with an increased tolerance for prolonged physical activity

Conclusion: our immediate and short-term results showed that marked congenital sternal de- formities should be surgically corrected once diagnosed after stabilization of the patients clinical condition. The technique[s] we used achieved adequate stabilization with a sound degree of patient safety. The postoperative results were satisfactory and acceptable for surgeons, patients, and their relatives. Longer follow-up results are still awaited