Effect of date palm (Phoenix dactylifera L.) leaves on productive performance of growing lambs.

Eighteen 4-month-old lambs, with a mean live weight (LW) of 19.47 ± 0.20 kg, were used to evaluate the nutritive value of date palm leaves (DPL) ensiled with different additives in a completely randomized design. Lambs were stratified into three groups of 6 lambs each and fed a control diet comprising 60% concentrate feed mixture (CFM) and 40% DPL silage (T1). In other treatments, the DPL silage (DPLS) of the control treatment was replaced with EM1 additive-treated DPLS (T2) or El-Mofeed additive-treated DPLS (T3). Apparent digestibility, total digestible nutrient, digestible crude protein, dry matter intake, daily weight gain (DWG), price of DWG, daily profit, and economics of feed efficiency were higher (P < 0.05) for the additives-treated DPLS relative to the control, with T2 enhancing these parameters compared with T3. With exception of ruminal pH, which was reduced, concentrations of ruminal NH3-N and total volatile fatty acids (VFA) increased 4 h post feeding. However, ruminal NH3-N and total VFA were greater (P < 0.05) for the additives-treated DPLS, with T2 producing higher values than T3. Ruminal pH and feed cost/kg LW gain were lower for T2 relative to other treatments. Blood constituents were within the normal ranges for lambs, though slightly altered by treatments. Whereas serum total protein, albumin, and globulin were affected (P < 0.05) in this rank order, T1 < T3 < T2, other serum parameters were not affected. Relative feed cost and relative daily profit were lower and higher respectively for T2 than for T3. It is concluded that additives-treated DPLS is nutritionally superior to untreated DPLS as a roughage source in total mixed rations fed to growing lambs. However, for improved performance of the lambs and economic benefits, EM1-treated DPLS is recommended.

Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis.

In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

The role of endonasal surgery in the management of frontoethmoidal osteomas.

Recently endonasal surgery has been considered to be a valuable contribution in the management of paranasal sinus osteoma. A retrospective evaluation study of 34 frontoethmoidal osteomas (23 frontal and 11 ethmoidal osteomas) treated at a tertiary care facility from 1990 to 1999 is presented. Twenty three osteomas (68%) were resected endonasally. Eleven osteomas (32%) were removed using an osteoplastic frontal sinus approach with coronal incision. In 5 cases of huge osteomas originating at the anterior frontal sinus wall, reconstruction of the resected anterior-frontal sinus wall was achieved by autologous outer table grafts harvested from the parietal region. Endoscopic and radiological follow-up ranging from 1 to 32 months showed three incomplete endonasal osteoma resections. Complete osteoma removal was achieved via endonasal revision surgery in two of these cases, while the third small residual osteoma remains under observation. There was no case of osteoplastic osteoma removal where incomplete osteoma resection became obvious during follow-up. Ethmoidal osteomas without extrasinusal extension can be resected endonasally. The endonasal approach should be considered also for frontal sinus osteomas if (1) sufficient frontal sinus access can be achieved endonasally, (2) the osteoma is placed medially to a virtual sagittal plane through the lamina papyracea, and (3) the tumour base is at the inferior part of the posterior frontal sinus wall. We favour the osteoplastic frontal sinus approach with coronal incision if an external approach is required to achieve tumour resection with the best aesthetic results.

Experiences with endonasal surgery in angiofibroma.

Surgery is the most common treatment for angiofibromas, but the approach is still a major point of discussion. Five cases of angiofibroma with typical localisation were treated surgically by an endonasal approach at the Fulda Academic Teaching Hospital from 1994 to 1997. This article presents an analysis of the clinical findings, computer tomography and magnetic resonance imaging, preoperative embolization, operative technique and complications. Endoscopic and radiologic follow-up ranging from 5 to 39 months excluded any residual tumour or recurrence. The endonasal microendoscopic approach with adequate preoperative embolization should be considered as an useful technique for removing tumours with considerable size without using an external incision.

[Reconstruction of the forehead region with tabula externa of the skull]. / Rekstruktion der Stirnregion mit Tabula externa des Schädels.

BACKGROUND: Calvarial bone graft is often used in reconstructive cranio-facial surgery. As most common three different forms can be distinguished: outer-table bone, full thickness grafts and composite flaps (bone with a periostal or muscular pedicle). PATIENT AND METHOD: An extensive fibrous dysplasia of the frontal region was removed in a 26 years old patient. Reconstruction was carried out with alloplastic material achieving a good esthetic result. Recurrent seroma and occurrence of a fistula demanded removal of the alloplastic material and en-bloc reconstruction of the forehead region was accomplished with a parietal outer-table graft. Within a follow-up time of one year a good esthetic and stable reconstruction has been achieved. CONCLUSION: Split-thickness calvarial bone is still a versatile graft in reconstruction of the forehead region. Although a low rate of side effects in harvesting calvarial bone grafts are in general expected, one has to be aware of dural lesions occuring in the donor site during craniotomy.