Mohamed M. Abdel-Aziz

Excitatory amino acids and magnesium sulfate in neonatal asphyxia

OBJECTIVE The excitatory amino acids (EAA); glutamate and aspartate are released into the cerebrospinal fluids (CSF) of asphyxiated newborns. The objectives of this study were: (a) to examine the relation of the concentration of EAA in the CSF with the degree of brain injury, (b) To determine the time of the release of these EAA into the CSF, and (c) to detect the effect of magnesium sulfate (MgSO(4)) on their levels. DESIGNS AND METHODS. A randomized controlled trial was conducted on 47 full term asphyxiated newborns. Twenty three infants received an intravenous 10% solution of MgSO(4) at a dose of 250 mg/kg within the first 24h of life while the other 24 newborns received isotonic saline (0.9%) of an equal volume. Levels of glutamate and aspartate were measured before and 72 h after giving the trial solution. Results. In the study population (n=47) both glutamate and aspartate were significantly elevated in infants with higher grades of HIE compared to those with lower grades (P=0.013 and 0.031, respectively). Compared to baseline level, glutamate decreased significantly over time in placebo group (-8.28+/-14.26, P=0.025) and in MgSO(4) group (-14.39+/-18.72, P=0.005). Glutamate concentration did not differ between groups when measured at baseline (29.26+/-16.31 vs. 31.27+/-22.62, P=0.82) and at 72 h (19.28+/-15.63 vs. 19.6+/-16.54, P=0.87). The change in aspartate concentration over time was not significant in placebo group (-0.45+/-1.96, P=0.34) or in MgSO(4) group (-0.7+/-3.19, P=0.37). Aspartate did not differ between groups when measured at baseline (3.52+/-2.4 vs. 3.92+/-2.59, P=0.49) or at 72 h (2.79+/-1.24 vs. 3.05+/-2.48, P=0.92). Conclusions. The EAA; glutamate and aspartate are released in the CSF of asphyxiated newborns immediately after birth and declined by 72 h. Their initial concentrations correlated with the severity of HIE. Postnatal administration of MgSO(4) did not alter the levels of these 2 EAA.

Detection of serum p53 protein in patients with different gastrointestinal cancers.

Overexpression of p53 has been found in many types of human malignancy. The present study aimed to detect preoperative serum p53 among 158 patients with different gastrointestinal cancers using ELISA technique based on mouse anti-p53 DO-7 monoclonal antibody and anti-p53 rabbit polyclonal antibody. A single band of 53kDa was detected in nuclear protein tissue extracts of selected cancer patients and in 96% of the corresponding sera using Western blot assay. The ELISA technique revealed that the serum p53 was detected in 100% of patients with cholangiocarcinoma, 76% of pancreatic carcinoma, 75% of hepatocellular carcinoma, 70% of colon cancer, 60% of esophagus carcinoma, and 35% of gastric carcinoma. The serum p53 concentrations of the positive patients were highly elevated (P<0.001) compared with healthy individuals. These results suggest that immunodetection of serum p53 could be valuable for post-operative monitoring during follow up in preoperatively positive patients with gastrointestinal cancers.

Clinical evaluation of pepsin for laryngopharyngeal reflux in children with otitis media with effusion

OBJECTIVE We sought to evaluate the clinical role of pepsin for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME). METHODS Pepsin/pepsinogen and fibrinogen were analyzed in fifty effusion and blood samples of children with OME using enzyme linked immunosorbent assay (ELISA). Ambulatory 24-h dual-probe pH monitoring was additionally performed in 31 children divided into two groups according to response of medical treatment. RESULTS The effusion levels of pepsin/pepsinogen ranged from 8.5 to 1512 μg/dl and were up to 4-540 times higher than the concentrations found in plasma samples. The effusion levels of fibrinogen ranged from 0.05 to 4.1g/dl. Some effusion samples showed fibrinogen concentrations did not exceed 10 times higher than the concentrations found in plasma samples and others showed lower concentrations. The pH of effusion samples was 7.13 to 8.72. Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant acid reflux documented by either the esophageal probe or the pharyngeal probe and all of them had LPR. There is a significant positive correlation between the level of pepsin assayed in the effusions and the number of pharyngeal reflux episodes measured by pH monitoring. CONCLUSIONS Analysis of pepsin/pepsinogen in effusion samples of children with OME, using ELISA, can be considered as a reliable biochemical marker for assessment of laryngopharyngeal reflux.

Intramedullary nailing for diaphyseal forearm fractures in children after failed conservative treatment

Purpose. To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures. Methods. 11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed. Results. After a mean follow-up of 24 (range, 12–30) months, results were excellent in 14 patients, good in 5, and fair in one. None was poor. The mean operating time was 36 minutes. The mean time to bone union was 10 (range, 7–12) weeks. The mean time in the cast was 6 (range, 4–11) weeks. The mean time to implant removal was 8 (range, 6–10) months. All patients regained a full range of elbow movement, except in one who had limited supination and pronation (<20°) due to a degree of malrotation. Two patients had pain owing to nail protrusion. One patient had a superficial infection. One patient had transient neurapraxia. Conclusion. Intramedullary nailing using Ender nails plus cast immobilisation is effective for diaphyseal forearm fractures in children after conservative treatment has failed.

Is primary closure a feasible and acceptable option in the era of t-tube-free common bile duct exploration for choledocholithiasis?

Introduction Common bile duct exploration (CBDE) has the advantage of managing cholecystocholedocholithiasis with single-stage procedure. There is still a debate about the benefits and drawbacks after T-tube usage. The aim of this study was to evaluate the value of primary common bile duct (CBD) closure and routine T-tube usage after CBDE. Patients and methods A total of 220 patients underwent CBDE by means of choledochotomy for common bile duct stones. Patients were divided into two groups. Group A included 63 patients who were managed with primary closure of the CBD, and group B included 157 patients who were managed using T-tube after assumed CBD clearance. Demographics, preoperative radiology, intraoperative findings, and postoperative complications were collected and analyzed between the two groups. Results Among the study patients, 138 patients (63%) underwent laparoscopic common bile duct exploration: 36 patients (57%) in group A and 102 patients (65%) in group B. Wound infection and abdominal collections were significantly more obvious in group B patients ( P P P =0.065). Residual stones were encountered in 11 patients (5%). Hospital stay was significantly longer in group B patients; the mean hospital stay was 4 days (range=3–35 days) in group B versus 3 days (range=1–13 days) in group A ( P Conclusion We encourage primary CBD closure over the use of T-tube, as it provides a more comfortable postoperative course, shorter hospital stay, and is more accepted by patients.

Diaphragmatic mobilization technique for anterolateral thoracolumbar exposure

Background Traditional diaphragmatic incision to expose the thoracolumbar junction is associated with significant morbidity. In an effort to eliminate the drawbacks during and after thoracolumbar exposure, the technique of diaphragmatic mobilization has been developed to expose T12, L1 and upper L2 vertebral bodies. Objective The objective of this study was to demonstrate the feasibility and clinical experience of diaphragmatic mobilization technique to the thoracolumbar junction. Materials and methods Seventeen patients with spinal pathology at the thoracolumbar junction (T12, L1 and L2) underwent surgery using left-sided thoracotomy with diaphragmatic mobilization. In each case, the lateral aspect of the involved vertebra with the disc space proximal and distal was exposed with the mid-vertebra proximal and distal. Preoperative and intraoperative fluoroscopy was used to assure correct level together with daily postoperative chest radiography until chest drain removal. Operative results, complications and early outcomes were assessed. Conclusion Diaphragmatic mobilization allowed adequate thoracolumbar exposure to perform corpectomy, decompression and strut grafting plus or minus fixation without the need for circumferential release, thus avoiding its possible complications. In addition, it can be considered as an alternative for surgeons lacking experience, or facilities with video-assisted thoracoscopic surgery.

Interleukin-1β, interleukin-6, and tumor necrosis factor-α in the cerebrospinal fluid of term infants with hypoxic-ischemic encephalopathy after postnatal treatment with magnesium sulfate

Proinflammatory cytokines play a role in the pathogenesis of hypoxic-ischemic encephalopathy (HIE). We aimed: 1) to characterize the expression of interleukin-1 β (IL-1 β ), IL-6 and tumor necrosis factor- α (TNF- α ) in the cerebrospinal fluid (CSF) of term infants with HIE, and 2) to determine the impact of a single dose of magnesium sulfate (MgSO 4 ) on their concentrations. We analyzed the samples of CSF that were collected during a randomized controlled trial on the use of MgSO 4 in neonatal asphyxia. Two samples were obtained from each subject; one was obtained on admission and the second sample was collected at 72 hr of life. The grades of HIE in the 47 included newborns were mild ( n = 15), moderate ( n = 17), and severe ( n = 15). After the collection of the first CSF sample, 23 newborns received a single dose of MgSO 4 , whereas the other 24 newborns received an equal volume of normal saline placebo. Concentrations of IL-1 β , IL-6 and TNF- α in the CSF were quantified by enzyme-linked immunosorbent assay in all CSF samples. The initial concentration of IL-1 β and IL-6 correlated with the severity grades of HIE ( P = 004 and P = 0001, respectively) while TNF- α did not. At 72 hr, a significant decline in the concentration of TNF- α (pg/mL) was observed in samples of MgSO 4 -treated infants when compared to the control group (–28 ± 90 vs. 102 ± 404, P = 0.01), whereas the two treatment groups did not differ in IL-1 β or IL-6. Short-term clinical outcomes correlated best with IL-1 β at baseline, IL-6 at baseline and IL-6 at 72 hr. We conclude that cytokine activation, as manifested by increased IL-1 β and IL-6 in the CSF, is positively correlated with the severity of HIE. Treatment with a single dose of MgSO 4 was efficacious in aborting the activation of TNF- α but did not alter the expression of IL-1 β or IL-6.

08:50 AM: Pepsin Assay: A Marker for Reflux in Pediatric Glue Ear

PROBLEM: The objectives of this national survey were to evaluate patients’ perceptions of the burden of allergic rhinitis (AR) and important attributes of allergy medications. METHODS: A cross-sectional, random-digit-dialing telephone survey of 31,470 US households was conducted to identify adult AR patients. In structured, 35-minute telephone interviews, respondents with AR (ie, patients diagnosed by a physician as having AR and either taking AR medication or had AR symptoms during the past year) were questioned about allergies, severity and frequency of symptoms, and satisfaction with treatment. Additionally, the survey evaluated frequency of symptoms of sinusitis (ie, ear pain/pressure and facial pain/ pressure) in AR patients. RESULTS: Some 2,500 AR sufferers completed the survey. Congestion was the most frequent symptom reported by 60% of patients, and 40% of patients reported it as extremely bothersome; 25% of patients reported headache as extremely bothersome, whereas 16% and 11% of patients, respectively, reported facial pain and ear pain as extremely bothersome; 60% of patients reported sinus problems, and 16% and 15% of patients, respectively, experienced earaches and migraines in the previous week. Patients estimated productivity at 72% on days when allergy symptoms were at their worst versus 95% on days without symptoms; 40% of patient reported that allergies had at least a moderate effect on daily life; 77% of patients said that they adhered to health practitioner advice at least most of the time. CONCLUSION: This survey provided details on patients’ perceptions of AR severity and the cost in terms of lost productivity. Headache is frequently reported by AR patients; however, it may be misdiagnosed as migraine and considered unrelated to AR. Symptoms of sinusitis are also reported by AR patients and need to be monitored. SIGNIFICANCE: Patients with AR experience a range of unpleasant side effects that decrease productivity and quality of life. SUPPORT: ALTANA Pharma US.