Decompressive craniectomy for spontaneous intracerebral hematoma, does it add benefit?

Background: Many studies discussed the validity of hematoma evacuation versus conservative treatment, and little research discussed the role of decompressive craniectomy in the management of SICH. The purpose of the study is to discuss the role of decompressive craniectomy alone in selected cases of supratentorial SICH and comparing it with the reported results of best medical treatment in the literatures. Patients and methods; Fourteen patients harboring SICH with mass effect were operated in Zagazig University Hospitals by decompressive craniectomy from March 2015 to September 2017. Inclusion criteria were hypertensive supratentorial SICH with massive edema and midline shift and GCS score below 10. Wide decompressive craniotomy was performed together with duroplasty. Patients were followed for 6 months postoperatively using modified Rankin scale (mRS). Results: There was 14 patients, 9 males and 5 females with mean age 69.7 (range 56 to 81), 8 right and 6 left sided hematoma with mean GCS of 7 (range 4 to 10), preoperative midline shift ranged from 9 mm to 15 mm (mean 12.7). Early postoperative follow up showed improvement of GCS mean 11 (range 6 to 15) and midline shift mean 3 mm (range 1 to 9) in the first 24 hours. At 6 months, mortality rate was 2/14. GOS showed good outcome (mRS 0-4) in 10 patients and poor outcome (mRS 5-6) in 4 patients. Conclusion: Decompressive craniectomy with duroplasty is an effective method for management of supratentorial SICH and is better than the best medical treatment in selected cases

Revision surgery in lumbar degenerative disease

Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery.Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain.Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients.Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery.Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected

Human papillomavirus (HPV) in Egyptian females: study by cytology, histopathology, colposcopy and molecular diagnosis of high risk types.

OBJECTIVES: In Northern Africa, the region Egypt belongs to, about 10.7% of women are estimated to harbour cervical human papillomavirus (HPV) infection and 78.4% of invasive cancers are attributed to HPVs 16 or 18. We aimed at comparing HPV detection by ISH-PCR tissue with other conventional available cheaper techniques, finding which of them can be relied upon in a developing country like Egypt for HPV detection. METHODS: Sixty patients were included. For them colposcopy, PAP smear, histopathology and detection of HPV using ISH PCR tissue and PCR swab were achieved. RESULTS: PCR-ISH tissue was positive in 53.33%, 46.6% were negative. Pap smear was negative in 26 cases (43.33%) and 43 cases (56.67%) were positive. LSIL with perinuclear halo represented nearly half of the positive cases (16/34; 47.05%), 10 cases were diagnosed as HSIL, 4 cases as ASCUS and 4 as AGC. Histopathology was negative in 12 (20%) cases and 48 (80%) cases were positive. CIN I and CIN I+ koliocytosis represented half of the cases (30/60) and more than half of positive cases (30/48; 62.5%). Comparing the results of pap smear, histopathology, colposcopy and PCR swab with ISH PCR tissue, highly significant results were seen with sensitivity of 87.5%, 100%, 62.5% and 56.2% respectively but the specificity were 78.6%, 42.9%, 28.6% and 100% respectively. CONCLUSION: Conventional cytology and histopathology were sensitive tests for detection of HPV. This may help for early detection of cancer cervix in a developing country like Egypt. PCR swab showed the highest specificity and the lowest sensitivity.

Semen quality and reproductive endocrinal function related to blood lead levels in infertile painters.

Lead causes male reproductive impairment among painters, but information is still limited. Therefore, the effect of lead on semen quality and reproductive endocrinal function in those patients was investigated. A case series of 27 infertile painters were subjected to semen analysis, measuring of blood lead level (PbB) and serum levels of endocrinal parameters including follicle-stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL). Significantly lower sperm count and motility were found in those with duration of exposure (≥ 15 years), but no significant difference was found for PbB and serum levels of FSH, LH, PRL and T. A significant negative correlation between PbB and spermatic count and motility was observed, while there was no significant correlation between PbB and all endocrinal parameters. Patients with PbB ≥ 20 µg dl(-1) showed a significant decrease in sperm motility and increase in testosterone alone among all measured hormones. But the observed decrease in sperm count did not reach a significant level. It is concluded that infertile painters are at risk of lead-related influence on semen quality, especially sperm motility and increased testosterone level without significant affection of other reproductive endocrinal parameters.

Heme oxygenase enzyme activity in seminal plasma of oligoasthenoteratozoospermic males with varicocele.

This work aimed to assess seminal plasma heme oxygenase (HO) enzyme activity in oligoasthenoteratozoospermia (OAT) males with varicocele. Ninety-three men were divided according to their sperm count and clinical examination into: healthy fertile controls (n = 34), OAT without varicocele (n = 37) and OAT associated with varicocele (n = 22). They were subjected to semen analysis and estimation of seminal plasma HO enzyme activity in the form of bilirubin concentration. Seminal plasma HO enzyme activity decreased significantly in OAT cases compared with controls. Seminal plasma HO in OAT cases associated with varicocele decreased significantly compared with OAT cases without varicocele and healthy controls (mean +/- SD; 109.2 +/- 29.5, 283.6 +/- 88.4, 669.5 +/- 236.1 nMol bilirubin/mg ptn/min, P < 0.001). There was positive correlation between seminal plasma HO enzyme activity and sperm concentration, per cent of motile spermatozoa, number of motile spermatozoas ml(-1) and significant negative correlation with sperm abnormal forms per cent. It is concluded that varicocele has a negative impact on seminal HO enzyme activity. Therefore, improved seminal picture after correcting varicocele repair might be related, in part, to improved HO action(s).

Heme oxygenase enzyme activity in human seminal plasma of fertile and infertile males.

This work aimed to assess heme oxygenase (HO) enzyme activity relationship with different human semen parameters. One hundred and twenty men were divided according to their sperm count and clinical examination into: obstructive azoospermia (n = 20), nonobstructive azoospermia (NOA) (n = 25), oligozoospermia (n = 35) and normozoospermia (n = 40). Semen analysis, western blot for HO-1 and HO-2, and estimation of seminal plasma HO enzyme activity chemically in the form of bilirubin concentration were carried out. Seminal plasma HO enzyme activity was very low in OA specimens, low in NOA, moderate in oligozoospermia while higher in normozoospermia (mean +/- SD; 6.26 +/- 2.2, 81.4 +/- 35.5, 283.8 +/- 90.1, 657.4 +/- 227.6 pmol ml(-1) min(-1)) with significant differences. Western blot analysis demonstrated HO-2 expression in all studied groups whereas HO-1 was highly expressed in fertile normozoospermic group compared with other groups. There was positive correlation between seminal plasma HO enzyme activity and sperm concentration, sperm motility percentage, motile spermatozoa ml(-1) and sperm normal morphology per cent. It is concluded that HO enzyme activity in the human seminal plasma is related to spermatogenesis and sperm-motility processes.

Synthesis of novel 3-pyridinecarbonitriles with amino acid function and their fluorescence properties.

A variety of N-[(4,6-diaryl-3-pyridinecarbonitrile)-2-yl] amino acid esters 2-4 were synthesized through the reaction of 2-bromo-3-pyridinecarbonitriles 1 with the appropriate alpha-amino acid ester hydrochloride in refluxing dioxane in the presence of triethylamine as dehydrohalogenating agent. Similarly, N'-glycylglycine analogues 5 were obtained through the reaction of 1 with the dipeptide ester. On the other hand, attempts were made towards the construction of amino acid derivatives 7 through the reaction of 1 with aqueous solution alpha-amino acids 6 in refluxing pyridine, but were unsuccessful, and instead the unexpected 2-amino-3-pyridinecarbonitriles 8 were isolated. The fluorescence properties of the newly synthesized pyridines 2-5 were evaluated. Some of the prepared compounds show considerable antibacterial activity.