Association of fasting glucagon-like peptide-1 with oxidative stress and subclinical atherosclerosis in type 2 diabetes.

AIM: Glucagon-like peptide-1(GLP-1) is a gut hormone that beside its main function in glucose homeostasis may play a role as an anti-oxidant and anti-atherosclerotic factor. The aim of this study was to estimate fasting total GLP-1 level in type 2 diabetes (T2DM) patients and to determine its relation with oxidative stress and atherosclerotic vascular changes. METHODS: The study included 60 T2DM male patients with age ≥40 and 30 healthy male subjects matched for age. All of them were subjected to measuring of fasting total GLP-1, 8-iso prostaglandin F2α (8-iso PGF2α) as a marker of oxidative stress and carotid intima media thickness (CIMT) as a marker of subclinical atherosclerosis. RESULTS: Fasting total GLP-1 was not significantly different in diabetics in comparison with healthy subjects (p = 0.52). Fasting total GLP-1 was found to have significant negative correlations with both 8-iso PGF2α (p < 0.05) and CIMT (p < 0.001). CONCLUSION: Endogenous fasting GLP-1 appears to have anti-oxidant and anti-atherosclerotic effects in T2DM.

Association of lipid peroxidation and interleukin-6 with carotid atherosclerosis in type 2 diabetes.

Enhanced lipid peroxidation and elevated interleukin-6 levels are common in type 2 diabetes mellitus patients. Atherosclerotic vascular complications greatly contribute to morbidity and mortality in diabetes. The aim of this study was to assess the relation of lipid peroxidation and interleukin-6 with carotid atherosclerosis in type 2 diabetes mellitus. METHODS: This cross-sectional study included 90 type 2 diabetes mellitus male patients with age ≥ 40 years and 30 healthy male subjects matched for age. All of them were subjected to measuring of 8-iso prostaglandin F2α as a marker of lipid peroxidation, interleukin-6 and carotid intima media thickness as a marker of carotid atherosclerosis. RESULTS: Both 8-iso prostaglandin F2α and interleukin-6 were found to have significant positive correlation with carotid intima media thickness (P < 0.001) and both were found to be significant predictors of the presence of subclinical carotid atherosclerosis in multiple regression analysis. CONCLUSION: Lipid peroxidation and interleukin-6 may play an important role in atherogenesis in type 2 diabetes mellitus and limiting their effects may reduce atherosclerotic vascular complications in type 2 diabetes mellitus.

Primary osteosarcoma of the talus.

Osteosarcoma OS of the talus is extremely rare, and few cases have been reported in the literature. We present a case of a 33-year-old male with painful swelling of his left ankle joint. He underwent several radiological diagnostic modalities that showed osteolytic lesion in the posterior aspect of the left talus associated with new bone formation projecting from the posterior-medial aspect of that bone. His chest x-ray showed multiple rounded lung metastases, some of them showed calcifications. Open biopsy was performed. The histopathology confirmed the diagnosis of osteoblastic OS of the talus.

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia.

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery May and Thurner syndrome is a well-known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy.

Gastric immature teratoma.

Gastric teratoma GT is a rare neoplasm which accounts for less than 1% of all teratomas in children. Little more than 100 cases of GT are reported in the literature out of which, about a dozen cases are of immature variety. We present a case of immature gastric teratoma in a 7-month-old male baby.

Pleuropulmonary blastoma. A rare childhood malignancy.

Pleuropulmonary blastoma PPB is an extremely rare, intrathoracic neoplasm of early childhood with unfavorable outcome. We present a case of a 4-year-old boy with progressive dyspnea due to tension pneumothorax. After chest tube insertion, the CT scan showed large multilocular cystic lesions containing air and solid areas involving the right lower lobe, and its related pleura. Thoracotomy was carried out, and the cyst was removed with the pleural solid areas. Histopathological examination confirmed the diagnosis of PPB type II. Postoperatively, the patient was scheduled to start chemotherapy in a specialized pediatric oncology center to complete the treatment.

Added value of graded compression ultrasound to the Alvarado score in cases of right iliac fossa pain.

INTRODUCTION: Acute appendicitis is one of the most common emergencies treated by the general surgeon. Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality, and surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. The aim of this study was to evaluate the sensitivity and specificity of the Alvarado score combined with ultrasounds of the abdomen and pelvis in cases of right iliac fossa pain with suspected acute appendicitis. METHODS: 100 patients admitted to the Department of Surgery at Alexandria Main University Hospital in 2013 complaining of right iliac fossa pain with suspected acute appendicitis were studied prospectively. The demographic information, histopathology, physical examination, laboratory data, Alvarado score, sonography report and histopathological reports of these patients were gathered. The treating surgeon made decisions for surgery or conservative management without any intervention from the research team. RESULTS: A combination of methods showed that Alvarado alone was 100% sensitive in excluding appendicitis at scores below five and was highly specific at scores above eight (91.9%) with no added value when combining it with ultrasound in those scores. On the other hand, ultrasound was beneficial only in patients with Alvarado scores between five and eight for detecting appendicitis and not excluding it (increasing specificity to 100% and not affecting sensitivity). CONCLUSION: Ultrasound is a good adjuvant examination in cases with Alvarado scores between five and eight in order to diagnose appendicitis. Negative ultrasound results do not exclude appendicitis and further assessment by other modalities should be performed.

INTRODUCTION: L'appendicite aigüe est l'une des urgences les plus courantes traitées par un chirurgien généraliste. L'appendicite simple peut évoluer en perforation, liée à une morbidité et une mortalité bien plus élevées, et les chirurgiens ont donc eu tendance à opérer lorsque le diagnostic était probable plutôt que d'attendre qu'il soit certain. Le but de cette étude était d'évaluer la sensibilité et la spécificité du score d'Alvarado associé à des échographies de l'abdomen et du bassin en cas de douleurs dans la fosse iliaque droite avec suspicion d'appendicite aigüe. MÉTHODES: 100 patients admis au Service de chirurgie de l'Hôpital universitaire principal d'Alexandrie en 2013 se plaignant de douleurs dans la fosse iliaque droite avec suspicion d'appendicite aigüe ont été étudiés de façon prospective. Les informations démographiques, l'histopathologie, les examens physiques, des données de laboratoire, les scores d'Alvarado, les rapports d'échographie et les rapports histopathologiques de ces patients ont été rassemblés. Le chirurgien traitant a pris la décision d'une intervention chirurgicale ou d'une prise en charge prudente sans aucune intervention de l'équipe de recherche. RÉSULTATS: Une combinaison des deux méthodes a montré qu'Alvarado seul était sensible à 100 % en termes d'exclusion de l'appendicite pour des scores inférieurs à cinq ans et était très spécifique pour des scores supérieurs à huit (91,89 %) sans valeur ajoutée constatée lors de sa combinaison avec une échographie pour ces scores. D'autre part, l'échographie n'a été bénéfique que chez les patients ayant des scores d'Alvarado situés entre cinq et huit pour détecter l'appendicite et non l'exclure (en augmentant la spécificité jusqu'à 100 % et sans incidence sur la sensibilité). CONCLUSION: L'échographie est un bon examen complémentaire pour diagnostiquer l'appendicite dans les cas où les scores d'Alvarado se situent entre cinq et huit. Le résultats de l'échographie négatifs n'excluent pas l'appendicite et une évaluation plus poussée par d'autres modalités doit être effectuée.

Assessment of gray matter heterotopia by magnetic resonance imaging.

AIM: To evaluate magnetic resonance imaging (MRI) features of different types of gray matter heterotopia. METHODS: Between June 2005 and December 2009, the medical records and MRI studies of patients with gray matter heterotopia were reviewed. The MRI morphologic findings of heterotopia were recorded along with the presence and type of associated cranial malformations. Available clinical and electrophysiological data were also recorded. RESULTS: 20 patients were included in the study. Their ages ranged from 9 mo to 39 years with a mean age of 15 years. All patients suffered from epileptic seizures. According to the location of heterotopia, patients were classified into three groups: subependymal (12), subcortical (5) and band (3) heterotopia. CONCLUSION: MRI was useful in diagnosing and differentiating between various types of gray matter heterotopia. The severity of clinical manifestations of heterotopia was related to the location and pattern of heterotopia. Determination of heterotopia type and its extent is useful for management planning and predicting prognosis.

Acute spontaneous extraconal hematic cyst of the orbit.

A 49 year old man presented with one day history of mild right eye pain and proptosis. There was no definite history of trauma. On examination there was limitation of movement in all directions of gaze and 6 mm proptosis of his right eye. CT scan showed extraconal lesion compressing the optic nerve and inferior rectus muscle. Right inferior conjunctival fornix based approach was performed with lateral canthotomy and inferior cantholysis and exploration revealed a cyst containing blood which was removed.

Percutaneous imaging-guided interventions for acute biliary disorders in high surgical risk patients.

AIM: To evaluate the efficacy of percutaneous imaging-guided biliary interventions in the management of acute biliary disorders in high surgical risk patients. METHODS: One hundred and twenty two patients underwent 139 percutaneous imaging-guided biliary interventions during the period between January 2007 to December 2009. The patients included 73 women and 49 men with a mean age of 61 years (range 35-90 years).Fifty nine patients had acute biliary obstruction, 26 patients had acute biliary infection and 37 patients had abnormal collections. The procedures were performed under computed tomography (CT)- (73 patients), sonographic- (41 patients), and fluoroscopic-guidance (25 patients). Success rates and complications were determined. The χ(2) test with Yates' correction for continuity was applied to compare between these procedures. A P value < 0.05 was considered significant. RESULTS: The success rates for draining acute biliary obstruction under CT- , fluoroscopy- or ultrasound-guidance were 93.3%, 62.5% and 46.1%, respectively with significant P values (P = 0.026 and 0.002, respectively). In acute biliary infection, successful drainage was achieved in 22 patients (84.6%). The success rates in patients drained under ultrasound- and CT-guidance were 46.1% and 88.8%, respectively and drainage under CT-guidance was significantly higher (P = 0.0293). In 13 patients with bilomas, percutaneous drainage was successful in 11 patients (84.6%). Ten out of 12 cases with hepatic abscesses were drained with a success rate of 83.3%. In addition, the success rate of drainage in 12 cases with pancreatic pseudocysts was 83.3%. The reported complications were two deaths, four major and seven minor complications. CONCLUSION: Percutaneous imaging-guided biliary interventions help to promptly diagnose and effectively treat acute biliary disorders. They either cure the disorders or relieve sepsis and jaundice before operations.

Psuedomyxoma peritonei secondary to adenocarcinoma of the cecum.

Pseudomyxoma peritonei is a rare progressive disease. Patients commonly present with a picture of acute appendicitis or with increasing abdominal girth. We present a case of a 71 year old man who presented with right iliac fossa pain, fever and vomiting. His abdominal examination revealed right iliac fossa mass which was confirmed radiologically. Diagnostic laparoscopy showed jelly like material along with a right iliac fossa mass. The aspirate was negative for malignancy initially. Due to persistance and progression of his disease he underwent right hemicolectomy. Histopathological diagnosis showed moderately differentiated adenocarcinoma of the cecum Duke's C2.

Value of color Doppler sonography in the assessment of hemodialysis access dysfunction.

Arteriovenous fistula (AVF) is the most widely used means of vascular access for long-term hemodialysis (HD) and the complication rate related to AVF remains high. This study was conducted to determine the efficiency of Color Doppler sonography (CDS) in the assessment of AVF dysfunction. Over a period of 29 months, from January 2005 to May 2007, a total of 55 patients with AVF access dysfunction were included in the study. CDS were performed in the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. CDS allowed identification of 23 patients with stenotic segments and 16 others with venous thromboses. Six patients with venous aneurysm were encountered. Doppler flow rate assessment allowed differentiation of venous hypertension in two patients and steal syndrome in two other patients. Thus, the CDS findings carried a sensitivity rate of 96.4%. Two subclavian vein stenoses, causing reduced blood flow rate, were missed by CDS and later confirmed by angiography. Thirty-four patients underwent operative intervention. Our study suggests that CDS is an ideal noninvasive technique that allows the assessment of both anatomy and hemodynamics of an AVF.

Diffuse idiopathic hyperplasia of the sternocleidomastoid muscle in a child.

Unilateral diffuse or localized enlargement of the sternocleidomastoid muscle (SCM) is an event commonly seen in infancy, and is popularly known as 'sternocleidomastoid tumor'. The condition, which usually spontaneously resolves with or without physiotherapy, is due to a hematoma following a difficult labor. The muscle regains its elasticity and complete function. In some infants it resolves with fibromatous changes in the muscle leading to shortening, fibrosis and finally culminating in torticollis. We describe a case of idiopathic diffuse enlargement of unilateral SCM in a 12-year-old child without any functional compromise or torticollis. The histopathological and clinical characteristics differentiating it from more commonly described sternocleidomastoid tumor or fibromatosis coli are described. We believe this is the first case report of idiopathic hyperplasia of SCM.

Atherosclerosis in sickle cell disease - a review.

Acute, vaso-occlusive crises are the most common and earliest clinical manifestations of sickle cell disease. Recent thoughts about development of atherosclerosis as a result of this disease are presented. Current insights into the pathogenesis of atherosclerosis in sickle cell disease are reviewed, in particular the role of endothelial dysfunction, homocysteine and platelets. Common and uncommon sites of atherosclerosis are described. Radiological assessment and potential therapeutic agents to slow the progression of atherosclerosis are discussed. Finally, treatment of atherosclerosis in certain sites is evaluated and reviewed.

Handlebar hernia: a rare type of abdominal wall hernia.

Handlebar hernias are abdominal wall hernias resulting from direct trauma to the anterior abdominal wall. They usually result at weak anatomic locations of the abdominal wall. Such traumatic hernias are rare, requiring a high index of suspicion for a clinical diagnosis. We report the case of a handlebar hernia resulting from an injury sustained during a vehicular injury, and discuss the management of such injuries.

Surgical and endovascular management of arteriovenous malformation: case series from a single center.

Management of arteriovenous malformation (AVM) remains a major challenge to vascular surgeons. A multidisciplinary approach was introduced in our hospital to manage these cases from October 2003 to date. This is a report of our experience in their management. A prospective study was done on all patients with symptomatic AVM admitted to our unit between October 2003 and May 2006. All patients had preoperative duplex scanning and magnetic resonance imaging with or without conventional angiography. A multidisciplinary team assessed and treated these cases according to the type of malformation. Thirty-two cases were included in this study, with a mean follow-up of 18.3 months. Of these, 20 cases were predominantly venous and treated with surgical excision (n = 14) or ethanol sclerotherapy (n = 6). Twelve cases were predominantly arterial or arteriovenous shunting; 10 were treated with preoperative embolization followed by surgical excision and the remaining 2 with superselective embolization alone. The overall complication rate was high (31%). However, all were minor and settled down conservatively. No recurrence was observed in the early follow-up period. Management of AVM by a surgical and endovascular approach can deliver excellent results, with acceptable morbidity and no recurrence in the early follow-up period.

A Case of Intussuscepted Meckle's Diverticulum Diagnosed Through Computed Tomography Scan of the Abdomen.

Meckle's diverticulum, the commonest congenital anomaly of the gastrointestinal tract, can become the leading point of intestinal intussusception. However, the precise pre-operative diagnosis can be difficult. We report here a case of a 15-year old boy with acute abdomen in whom intussuscepted Meckle's diverticulum was diagnosed pre-operatively by CT scan. We conclude that CT scan is a safe, non-invasive tool to diagnose this condition before surgery and can improve outcome, especially in the acute abdomen with doubtful diagnosis.

Müllerian duct cyst as a cause of acute infantile-onset epididymitis.

Müllerian duct cyst is a congenital anomaly that originates from remnants of the müllerian duct that usually regresses in utero. It is most commonly detected in adult males during the third and fourth decades of life. Müllerian duct cyst is rarely reported in infants less than 1 year of age, in whom diagnosis is difficult because of immaturity of the genital tract. In this case report, we describe the sonographic and CT appearance of a large intrapelvic müllerian duct cyst presenting with acute epididymitis in a 9-month-old infant. The embryological basis, imaging findings and relation to epididymitis are discussed.