The orthopaedic experience of Kasr Al Ainy Hospitals in the Egyptian revolution.

BACKGROUND: 25 January 2011 marks the onset of the Egyptian revolution. Causalities were estimated to be at least 846 moralities and 6000 injuries. The purpose of this study is to document the orthopaedic injuries coming to the tertiary center of Cairo University Hospitals (Kasr Al Ainy) during the climax of the Egyptian revolution and the lessons learnt. MATERIAL AND METHODS: We retrospectively reviewed all hospital admissions in the period of 28 January 2011 till 4th February 2011 due to injuries related to the revolution. Total number of patients examined by the orthopaedic residents and staff members in the emergency room during that period was 553 patients. A total of 110 patients were admitted to the orthopaedic department. RESULTS: Various injuries were encountered. The most common were gun shot injuries (45 cases), followed by falls (28 cases), road traffic accidents (26) and trauma by blunt objects (11 cases). Overall 121 operative procedures were conducted in the operative theater by our residents and staff members. Fractures of the femur were the most common fractures (27 cases) followed by forearm fractures (13 cases). Limitations were the availability of a limited variety of orthopaedic implants. CONCLUSION: We believe that tertiary centers should be prepared for mass causalities. A variety of orthopaedic implants should be within reach and that personnel should be trained to work under stressful environments with a well laid disaster management plan.

Prevalence and factors associated with genital prolapse: a hospital-based study in Alexandria (Part I).

Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital (The Maternity University Hospital in Alexandria) to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women (being non-pregnant, age 25 years and over), was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1) a structured interview using a questionnaire, 2) clinical examination, and 3) measurement of body mass index (BMI). Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type (65.5% of the whole sample), followed by utero-vaginal prolapse (3.5%). The most commonly reported complaints (89.9%) were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases (25.8%). Comparing women's report and diagnoses indicated a low sensitivity (33%) and very high specificity (100%). Stress incontinence and multiple sexual consequences were the most frequently reported complications (60.1% and 66.7% respectively). Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ (p = .0001, CI = 1.67-5.25), unskilled birth attendant (p = .0006, CI = 1.2-3.2), prolonged labor (p = .007, CI = 1.7-7.6), early resumption of routine activities during puerperium (p = 002, CI = 1.7-11.3) and history of obvious weight loss (p = .0026, CI = 1.19-17.2). The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized.

Perception of genital prolapse: a hospital-based study in Alexandria (Part II).

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery (beliefs were assessed through the Health Belief Model) were measured for women who knew that they were suffering of genital prolapse (n = 40). The results revealed that more than two thirds of cases (70.4%) had poor (36.4%) or fair knowledge (34%) and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of "susceptibility" to and "severity" of complications of genital prolapse (97.5% and 85% respectively). More than two thirds (67.5%) had high scores of "perceived benefits" of treatment and medical advice, while nearly one third (32.5%) scored moderate. The majority of women (82.5%) had either moderate scores (55%) or high scores (27.5%) of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases (65.6%) sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended.

Balloon dilation of the right ventricular outflow tract in tetralogy of Fallot: a palliative procedure.

Fifteen patients requiring palliation for tetralogy of Fallot were treated by balloon dilation because of hypercyanotic spells. The mean age at dilation was 1.9 +/- 0.7 years (range 0.5-3), and the mean weight 9.8 +/- 2.1 kg (range 6.0-13.5). Dilation of the outflow tract was combined with dilation of the left and/or right pulmonary arteries in 5 patients. Successful dilation was achieved in 12 patients (80%), but failed in 3 patients with hypoplastic pulmonary arteries. In one patient, the stenosis of the right pulmonary artery could not be dilated because of a very sharp angle at the site of the stenosis. Two of the 3 patients in whom the procedure failed died of severe cyanotic spells within 24 hours of the unsuccessful procedure. No major complications occurred during or after the procedure in the cases undergoing successful dilation. The arterial oxygen saturation increased significantly, from 71 +/- 5.7% to 89 +/- 3.9%, immediately after the procedure (p < 0.005). During a period of follow up of 6 +/- 3.7 months (range 1-13), the procedure was repeated on 3 occasions, and successfully accomplished in 2 of these. In conclusion, balloon dilation is a satisfactory palliative procedure for tetralogy of Fallot in those units in which total correction is not performed under 2 to 3 years of age.

Immunohistochemical and ultrastructural study of Langerhans's cells in squamous cell carcinoma of the cervix.

OBJECTIVE: To study Langerhans's cells (LCs) in cervical squamous cell carcinoma. STUDY DESIGN: The study was carried out in the Shatby University Hospital, Alexandria, Egypt. Thirty cases with squamous cell carcinoma, 10 cases with cervical intra-epithelial neoplasia (CIN) and 10 cases with normal exocervix were recruited. Sections from the exocervix were stained with gold chloride, immunostaining with S-100 protein antiserum, adenosine triphosphatase ATPase and electron microscopy. Statistical evaluation was done using the t-test. RESULTS: Gold chloride staining revealed significantly increased number of LCs in all cases of CIN compared to normal controls and with increasing grade of CIN (p < 0.001). No relationship between LCs number and the grade of carcinoma. Least branched LCs were predominant in the normal tissue while in neoplasia, these cells were of the most branched type, indicating a hyperactivity. S-100 protein positive LCs were almost absent in normal controls while their number were almost lower than the corresponding cases of CIN and invasive carcinoma after gold chloride or ATPase stainings. Signs of hyperactivity were evident in LCs of neoplastic cases after electron microscopy. CONCLUSIONS: Proliferation and increased number of LCs in CIN is an immune response, while such reaction is suppressed by invasive carcinoma.

Human leukocyte antigen in hydatidiform mole.

OBJECTIVE: To find any possible association between human leukocyte antigen (HLA) as a genetic marker and the development of hydatidiform mole (HM). METHOD: The lymphocyte microtoxicity technique was used to study the HLA antigens in 3 groups: 18 women with hydatidiform mole and their husbands (study group), 300 normal women (first control group), and 20 normal pregnant women and their husbands (second control group). RESULT: Hydatidiform mole is more frequent in women having HLA A1. The disease is more common in couples with partial compatibility of the B locus. CONCLUSION: HM occurs more frequently in women with certain HLA antigens and when the husband and wife have partial compatibility at the B locus.

Evaluation of calcium-antagonist (Nifedipine) in the treatment of pre-eclampsia.

The therapeutic effect of the calcium antagonist; Nifedipine was assessed in 30 patients with pre-eclampsia. Cases were randomly allocated into two groups; a study group (n = 20) who received Nifedipine capsules (20 mg every 8 h for 7 days) and a control group (n = 10) who received placebo capsules with the same regimen. After Nifedipine administration, there was a significant decrease in blood pressure, serum urea and creatinine and 24 h urinary proteins. No significant difference was found in FHR and S/D ratio of the umbilical artery between study and control groups or between initial values and after Nifedipine administration. Preliminary results indicated that Nifedipine decreased blood pressure and improved kidney functions without affecting the umbilical artery blood flow in cases of pre-eclampsia.

Serum nickel, copper and zinc in Norplant users.

Changes in serum nickel, copper and zinc were evaluated in 45 Norplant users. Two groups were selected for this study. Group I included 15 regularly menstruating females as controls and as short-term users (90 days after Norplant insertion). Group II included 30 Norplant users for one year or more as long-term users. These elements were determined by atomic absorption spectrophotometry. Serum nickel showed no significant change in short-term nor in long-term users when compared to the control group or to each other. Serum copper and zinc revealed a significant increase in short-term users for a short period of time, which returned to normal levels in long-term users. There was disappearance of the cyclic changes in serum copper and zinc concentrations on comparing their levels in ovulatory to non-ovulatory Norplant users. The use of Norplant has no deleterious effects on serum levels of nickel, copper and zinc.

PIP: Serum nickel, copper, and zinc levels were monitored by atomic absorption spectrophotometry in 15 women in the proliferative and luteal phases of their cycles before beginning Norplant contraception and 3 months later, and in 30 users of Norplant for 1 year or more. Serum nickel did not change significantly in short or longterm Norplant users in comparison with before Norplant self-controls or between groups, ranging from 0.221 to 0.28 mcg.dl. Serum copper rose from 100.07 mcg.dl in new users on Cycle Day 5 to 110.86 in ovulating women and 123.5 in nonovulating women in the control cycle. Copper was 118.7 before Norplant and not significantly different at 120.87 after 3 months. Copper levels were 104.26 in the 1st sample in longterm users, rising to 129.14 and 126.5 in ovulating and non-ovulating longterm users 3 months later. Zinc averaged 121.1 mcg/dl before Norplant on Day 5, falling to 94.86 and 97.38 in ovulating and nonovulating women in the luteal phase. Zinc rose slightly from 118.9 to 125.27 before and after 3 months on Norplant. Zinc fell from 107.9 to 91.86 and 94.61 in ovulating and nonovulating longterm users. The similarities and differences of these results with prior reports of trace element in oral and injectable contraceptive users are discussed.

Effect of prostaglandin E2 or prostaglandin synthesis inhibitors on human gonadotrophins and prolactin.

A role for prostaglandins (PGs) in the release of pituitary hormones in humans is controversial. The effect of PGE2 or PG synthesis inhibitors on gonadotrophin and prolactin (PRL) levels was evaluated in 50 volunteers (25 males and 25 females). Forty cases in four equal groups (Group I & II were males and group III & IV were females) received iv infusion of PGE2 in one cycle and non-steroidal anti-inflammatory drugs (NSAID) [Indomethacin or Naproxen] in the subsequent cycle. Control groups A & B (5 males and 5 females) received saline infusions in one cycle and placebo capsules in the next cycle. Neither PGE2 nor any of the two NSAID altered the basal levels of FSH or LH significantly. PGE2 infusions in males depressed PRL levels significantly two hours after the onset of infusions. Indomethacin raised PRL levels while Naproxen did not. In women, a similar response was also observed but prolactin levels decreased earlier (30 min from the PGE2 infusion). These data indicate a probable role for PGE2 or other prostanoids as well in the regulation of human PRL release but not in gonadotrophin secretion.

[Use of ketamine in cardiac surgery. A preliminary report]. / Die Anwendung von Ketamine in der Herzchirurgie. Ein vorläufiger Bericht

The phencyclidine derivative, ketamine hydrochloride, combines cardiovascular stimulating effects with antiarrhythmic properties and, therefore, the drug has been shown to be a highly suitable anesthetic for coronary artery surgery. This intravenously and intramuscularly administered "dissociative" anesthetic selectively depresses pathways and regions of the central nervous system associated with pain conduction and perception, thereby avoiding undesirable total nervous system depression. 129 patients suffering from marked coronary artery insufficiency underwent aortocoronary by-pass surgery, ketamine being the main anesthetic agent. Ketamine-induced anesthesia proved to be a simple and safe method of pain control during coronary artery reconstructive surgery and, compared with halothane anesthesia, showed a marked reduction of postoperative mortality (5%).