Acute Gastric Ischemia in a Case of Small Bowel Obstruction.

Gastric ischemia is a relatively rare condition that can lead to severe or life-threatening outcomes. It can be caused by various etiological factors, including vascular occlusion, atherosclerosis, vasculitis, hypovolemic shock, cardiac failure, mesenteric ischemia, splanchnic vasoconstriction, and abdominal compartment syndrome. Furthermore, gastric dilation can be caused by volvulus and acute necrotizing gastritis. This condition may go unnoticed in the setting of intestinal obstruction. In this case report, we describe a 43-year-old female who presented with signs, symptoms, and radiological findings indicative of small bowel obstruction accompanied by a severely dilated stomach. Our aim is to highlight the importance of considering gastric ischemia in patients with small bowel obstruction and to demonstrate the outcomes of a surgical approach in such presentations.

Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study.

PURPOSE: The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. METHODS: This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. RESULTS: Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. CONCLUSION: The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.

Performance of dialysis patients on the standard and basic Arabic versions of the Montreal Cognitive Assessments.

OBJECTIVES: To assess cognitive performance in Saudi patients on dialysis using Arabic versions of the Montreal Cognitive Assessment (MoCA) and assess the reliability of the scales. METHODS: We performed a cross-sectional study at the dialysis unit of King Saud University Medical City, Riyadh from April 2019 to March 2020. Patients ≥ 18 years of age with no history of dementia underwent cognitive assessment with the standard (MoCA-A) and basic (MoCA-B) Arabic versions, with repeat testing in a subset of participants. RESULTS: Recruitment included 83 participants, 56 on hemodialysis (HD) and 27 on peritoneal dialysis (PD). The mean±SD for age was 49.99 (15.48), and for years of education was 10.29 (5.5). The mean score for MoCA-A was 21.03±5.35, and for MoCA-B was 23.45±5.14. Younger age, longer years of education and peritoneal dialysis were significantly associated with higher MoCA scores on both versions (p<0.05). The ICC was 0.81 (95% CI 0.65, 0.91) and 0.77 (95% CI 0.58, 0.89) for MoCA-A and MoCA-B, respectively. The performance on the executive and calculation tasks were higher in the PD group on the MoCA-B. The recall mean score was higher in the PD group on the MoCA-A. CONCLUSION: The HD patients are at higher risk for cognitive impairment compared to PD patients. Age and education are important variables influencing performance. Both Arabic versions of the MoCA are reliable screening tools.

"Smart Optometry" phone-based application as a visual acuity testing tool among pediatric population.

OBJECTIVES: To evaluate the validity of a smartphone-based application for visual acuity (VA) testing in children and to compare parent and clinician-performed VA to standard VA assessment. METHODS: A cohort of 100 children aged <18 years old was recruited. Subjects were randomly assigned to either start with conventional distance VA chart screening or the smartphone VA assessment twice by both the clinician and the caregiver if applicable. Near VA scores were assessed using the near vision E chart. Accuracy and reliability values were analyzed. RESULTS: One hundred patients with an average age of 9.92 ± 3.0 years old were enrolled. The difference between conventional distance and application logMAR values was -0.023, and the difference between near vision and application logMAR values was -0.004. "Smart Optometry" had a sensitivity of 89.3% in detecting subnormal VA compared with conventional vision testing methods. Sensitivity in detecting subnormal VA was found to be higher in younger age groups up to 91.7% in comparison with the older age groups. The interclass correlation of application-measured VA scores by the caregivers and the clinician were 0.77 (95% CI; 0.67-0.83) using single measures and 0.87 (95%CI; 0.8-0.9) using average measures. CONCLUSION: "Smart Optometry" phone application was found to be an acceptable home-based VA testing tool with good inter-rater reliability for young children showing good sensitivity in detecting subnormal VA, but lower sensitivity in detecting amblyopia.

The Relationship between Cognitive Impairment and Coronary Artery Disease in Middle-aged Adults.

Background Cognitive impairment is a phenomenon that appears late in many diseases. Many clinicians do not seriously consider cognitive impairment until there has been significant deterioration over time. Cognitive function can be assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methods Using an observational case-control study design, we examined the relationship between coronary artery disease (CAD) and cognitive impairment. Participants (57 patients with CAD and 60 healthy controls; age: 30-60 years) were recruited and sampled using a non-probability quota sampling technique. Self-administered questionnaires were used to collect data about participants' demographic information. Blood chemistry samples were obtained to evaluate patients for CAD. Mini-Mental State Examination (MMSE) and CANTAB using three subsets including intra-extra dimensional set shift, spatial span (SSP), and pattern recognition memory (PRM) were used to assess participants' cognitive function. Results The SSP and PRM were significantly lower in patients with CAD as compared with healthy controls. There were significant relationships of PRM with creatine kinase- muscle/brain, aspartate aminotransferase, and total cholesterol. On the other hand, SSP was found to have a significant relationship with triglycerides. Conclusion There is cognitive impairment in CAD patients that needs to be assessed for early interventions to maintain cognitive functions.

Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study.

OBJECTIVES: Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. MATERIALS AND METHODS: A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. RESULTS: The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. CONCLUSION: In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum.

Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required.

Treatment of hepatitis C virus infection in patients on maintenance hemodialysis: a single United Arab Emirates center experience.

BACKGROUND: Hepatitis C is prevalent among hemodialysis patients. In patients with normal kidney function, treatment with pegylated interferon and ribavirin can lead to eradication of HCV (hepatitis C virus). But the treatment is more problematic in patients with impaired kidney function, in part due to the altered pharmacokinetics of these medications. Despite recent guidelines, the optimal strategy in this group of patients is not well defined. METHOD: In a retrospective study, we reviewed all patients with chronic hepatitis C on hemodialysis treated at Sheikh Khalifa Medical City, in the United Arab Emirates between 2003 and 2009. The aim of our study was to determine the rate of sustained viral response (SVR) and to establish the safety and rate of dropouts in the different treatment regimens used (patients treated with peginterferon only and patients treated with peginterferon and low dose ribavirin). RESULTS: 22 patients were treated during this period. 5 patients received monotherapy with a reduced dose of peginterferon alfa 2b s.c. once weekly while 17 patients were treated with a combination of reduced dose of peginterferon alfa 2a or 2b s.c. once weekly and a low dose ribavirin (200mg/day). A SVR was achieved in 73% (16/22 patients) of the total patient population and in 76% (13/17 patients) in the sub-group of patients treated with a combination therapy. The tolerability was high. No patients had to discontinue their treatment. The use of ESA (erythropoietin stimulating agents) and G-CSF was common in the combination therapy (94% and 53% respectively). CONCLUSION: In our study of patients on hemodialysis with chronic hepatitis C, the use of peginterferon or a combination of peginterferon with a low daily dose of ribavirin achieved a high rate of SVR and the rate of dropout was low after pursuing an aggressive management of side effects.

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.

Fine needle aspiration vs. mTESE in non-obstructive azoospermia.

This study was carried out on 100 patients with non-obstructive azoospermia (NOA) to compare between results and complications of fine needle aspiration (FNA) vs. microdissection testicular sperm extraction (mTESE) sperm retrieval. They underwent history taking, clinical examination, semen analysis, serum follicle stimulating hormone estimation and scrotal Duplex. One testis was subjected to FNA screening whereas the other testis was subjected to mTESE and histopathology. Follow-up was by ultrasonography at 1, 3 and 6 months. The overall sperm retrieval rate was 54% by mTESE and 10% by FNA. Spermatozoa were retrieved by mTESE from all cases with hypospermatogenesis, severe hypospermatogenesis, 30% of Sertoli cell only (SCO), 16.7% of germ cell arrest and in 28.6% of tubular hyalinization. Sperms were retrieved by FNA in 33.3% of hypospermatogenesis, 9% in severe hypospermatogenesis, 5% in SCO, 16.7% in germ cell arrest, while no sperms were retrieved in the tubular hyalinization group. The total complication rate following mTESE was 10% in the early phase and none in the long-term follow-up compared to 24% of FNA side. It is concluded that mTESE is superior to FNA as regards sperm retrieval rate and lower incidence of complications in NOA patients.

Etiological factors of unconsummated marriage.

Normal erectile function is subjected to the influence of psychological, hormonal, neurological, vascular and cavernosal factors. Unconsummated marriage is a common medical and social problem in andrology clinics in conservative communities. However, its etiological factors remain unclear. This work aimed to define the probable etiology of unconsummated marriage. A total of 191 patients were evaluated through history taking, constructed questionnaire, educational settings, clinical examination, lab investigation, imaging procedures and other measures. Psychogenic factors were the cause in 74.4% of the investigated patients. Performance anxiety was the cause in 52.9%, and in 21.5% other psychological distresses were responsible. Organic causes represent 7.3%, vaginismus 8.4%, premature ejaculation 3.1% and cases with undetermined etiology were 6.8%. In conclusion, performance anxiety was revealed to be the main contributor. However, other psychogenic, organic and social factors represent sizable etiological factors.

[Lips reanimation with temporalis myoplasty technique]. / Réanimation labiale par myoplastie du muscle temporal.

PURPOSE OF THE STUDY: The authors report their experience in lips reanimation with lengthening temporalis myoplasty for treatment of facial paralysis. MATERIALS AND METHODS: We studied 8 patients with permanent facial paralysis. The surgical technique allowed to transfer temporalis tendinous of coronoid process onto lips muscular strap, without aponevrotic relay. RESULTS: Functional and aesthetic results are exposed and so complications. Specialized facial physiotherapy rehabilitation is necessary in order to improve.

[Ethmoid adenocarcinoma: a series of 17 cases]. / Adénocarcinomes de l'ethmoïde. Notre expérience à propos d'une série de 17 cas.

INTRODUCTION: Ethmoid adenocarcinoma are and represent rare, 2.5 to 3% of head and neck cancers. The 5-year survival is around 50% for all stages. We present a series of 17 patients treated in our institution. OBJECTIVES: Expose the treatment of these patients and evaluate the results. METHODS: A retrospective study of 17 consecutive patients, treated between 1992 and 1999 for an ethmoid adenocarcinoma (15 T4 and 2 T2) and evaluated in 2002, with a mean follow-up of 5.8 years. RESULTS: In May 2002, 4 (23.53%) patients were alive and disease-free, 3 (17.65%) were alive with recurrence and 10 (58.82%) was died. The 5-year survival with Kaplan Meyer method is 41%. CONCLUSION: This series demonstrates the contribution of a combined approach for T3 and T4 tumors. The bifrontal approach induced an important morbidity in our series and should be replaced by the nasofrontal approach. Most teams agree that postoperative radiotherapy is necessary but the appropriateness of chemotherapy is still discussed. Some authors are of the opinion that it has no action on adenocarcinoma and others that it improves survival. It seems to have been efficient in our T4 patients.

[Acoustic comparison of esophageal versus tracheoesophageal speech]. / Comparaison acoustique entre voix oesophagienne et voix trachéo-oesophagienne.

The authors present results of an acoustic criterions analysis made next to 57 subjects, who had undergone total laryngectomy or total pharyngolaryngectomy, between 6 months and 3 years before. The study allows to assess, next to 29 tracheoesophageal voices and 30 oesophageal voices, the fundamental frequency, the vocal extensive, the maximum phonation time, and the study of pauses (number and time) in a reference sentence. The acoustic advantages of phonatory prothesis are confirmed, but the oesophageal voice knowledge must not be forgotten.

Hypercalcemia due to parathyroid adenoma.

Full text is available as a scanned copy of the original print version.

Comparison of six-month outcome of coronary artery stenting in patients <65, 65-75, and >75 years of age.

We studied 1,238 patients receiving 1,880 coronary stents. In-hospital outcomes were divided by age into <65 years (n = 747, group 1), 65 to 75 years (n = 326, group 2), and >75 years (n = 165, group 3). Procedural success was 97.2%, 95.1%, and 98.8% in groups 1, 2, and 3, respectively (p = NS). There was 1 death (group 1). Myocardial infarction occurred in 1.2%, 2.8%, and 1.8%, bypass surgery occurred in 0.9%, 1.8%, and 1.2%, and repeat balloon angioplasty in 0.3%, 0.6%, and 0% of patients in groups 1, 2, and 3, respectively (p = NS for all comparisons). Vascular complications occurred in 2.8%, 4.9%, and 6.1% in groups 1, 2, and 3, respectively (p <0.05). Six-month follow-up of patients was divided by age: <65 years (n = 564, group 1); 65 to 75 years (n = 221, group 2); and >75 years (n = 122, group 3). Event-free survival was 94.5%, 90.5%, and 89.3% for groups 1, 2, and 3, respectively (p = NS). Death occurred in 0.4%, 0.5%, and 1.6%; myocardial infarction occurred in 1.2%, 2.3%, and 1.6%, and target vessel revascularization in 4.3%, 8.6%, and 7.4% for groups 1, 2, and 3, respectively (p = NS for all comparisons). Thus, coronary stenting produced favorable in-hospital and 6-month outcomes in all 3 age groups. Age itself should not preclude patients from undergoing coronary stenting.

Microparticle deposition in periarterial microvasculature and intramural dissections after porous balloon delivery into atherosclerotic vessels: quantitation and localization by confocal scanning laser microscopy.

Local delivery of pharmacologic or genetic agents with a porous balloon catheter offers a potential therapeutic approach to reducing restenosis and atherosclerosis and minimizing undesirable systemic toxicity. However, the delivery efficiency and intramural retention of liquid agents is low. The local intramural delivery and prolonged retention of 5 microns microparticles (MP) has been described previously. The current study was designed to evaluate the distribution of locally delivered MPs and to determine the effects of MP size and infusion pressure on intramural delivery efficiency. A 1% suspension of fluorescent, latex MPs (1 or 4.5 microns in diameter) was infused at either 3 or 6 atm into atherosclerotic rabbit femoral arteries (n = 32) immediately after angioplasty. Four groups of arteries were evaluated: 1) 1 micron MPs infused at 3 atm; 2) 1 micron MPs at 6 atm; 3) 4.5 microns MPs at 3 atm; and 4) 4.5 microns MP at 6 atm. The location of MPs was evaluated by fluorescent and light microscopy and confocal laser scanning microscopy. The tissue was dissolved and the delivered MPs quantified. All groups manifested numerous MPs within the vasa vasorum and periadventitial microvasculature, with a substantially lesser number within the neointimal and medial layers. The intramural deposition of the MPs was associated with dissection within the intima or media caused by the antecedent angioplasty or local delivery, indicating that an intact vessel wall is an anatomic barrier to MP delivery. The median values of fractional intramural delivery, defined as the percentage of infused MPs retained within the arterial wall, were 0.059%, 0.071%, 0.047%, and 0.062% for the groups 1 through 4, respectively (p not significant [NS]). The values of intramural particle concentration, expressed as the total number of MPs per weight of arterial tissue, were 55, 65, 1.5, and 1.2 x 10(4) MPs/mg for groups 1 through 4, respectively (p < 0.001 for 1 micron vs 4.5 microns MPs). Although more 1 microM MPs were delivered than 4.5 microns MPs, the fractional intramural delivery was unaffected by particle size or infusion pressure. The local delivery of MPs at atherosclerotic sites after angioplasty is characterized by fractional intramural delivery values similar to values of nonparticulate agents, with few MPs deposited into intima or media in the absence of a dissection caused by the antecedent angioplasty or the delivery procedure itself.

Differential effects of plasma from normal and ectopic gestation on lymphocyte proliferation.

This study investigated immunoregulatory differences as a result of anatomical changes in the fetomaternal interface. Thirty-one female subjects were recruited from a military tertiary-care facility. Ten subjects were non-pregnant while 21 were pregnant (nine normal and 12 ectopic gestations). Immune tests included one-way mixed lymphocyte cultures with and without maternal plasma, phytohemagglutinin stimulation and lymphocyte phenotypes. Basic statistics and a one-way ANOVA using Tuckey's HSD model were employed. Autologous plasma significantly enhanced the allogeneic responses of first-trimester pregnant females with normal gestations to spouses as well as to control male lymphocytes. This enhancement was not observed in either ectopically-pregnant or non-pregnant subjects. Mitogen stimulation and lymphocyte populations were similar in all three groups. The first trimester of normal pregnancy is characterized by the presence of soluble intrauterine pregnancy-specific lymphocyte-enhancing factors. Ectopic gestation lacks this phenomenon.