Background As the hard palate is an essential region of the skull its gross anatomy and morphological variations have been of interest in many studies. Aim The aim of the present study was to describe the gross anatomy of the hard palate in Egyptian skulls, and determine sex from the morphometric study of the hard palate and location of the position of the greater palatine foramen (GPF) in relation to certain fixed intraoral anatomical reference points, all of which are visible or palpable in a living patient. Materials and methods In this study, 100 skulls (64 male and 36 female skulls) were subjected to the following measurements: palatal length, breadth, and height, the diameters of the GPF and its shape, the direction of opening of the GPF onto the palate, the relation of GPF to the maxillary molar teeth; the distance from the GPF to the midline maxillary suture, to the incisive foramen, to the posterior border of the hard palate, and to the tip of the hamular process of the pterygoid; the angle between the axis of the greater palatine canal (GPC) and the hard palate; the length of GPC plus the length of the pterygopalatine fossa; and the height of the maxilla. Twenty cadaveric heads were also dissected to measure the thickness of the palatal mucosa over the GPF. Results The mean palatal length was 51.65 ± 4.7 mm and palatal breadth was 38.68 ± 2.9 mm, with a highly significant difference between male and female skulls. Palatal height was 11.8 ± 2.7 mm with no significant difference between the two sexes. Of the total skulls 64% had narrow palates, 24% had intermediate ones, and 12% had wide palates with no significant difference between the two sexes; 36% had low palates, 56% had intermediate, and 8% of the sample had high-arched palates with a significant difference between the two sexes. The mean anteroposterior and transverse diameters of GPF were 4.86 ± 0.9 and 3.02 ± 0.7 mm, respectively. It was frequently an oval opening in 71%, a rounded opening in 22%, and lancet and slit in the remaining. Its direction in 69% was anteromedial, that in 28% was anterior, and that in 3% was anterolateral. The majority (84%) of the total foramina were opposite the maxillary third molar tooth. The mean distance from the GPF to the midline maxillary suture was 14.25 ± 1.7 mm, that from the GPF to the incisive foramen was 35.93 ± 3.5 mm, and that from the GPF to the posterior border of the hard palate was 3.89 ± 0.9 mm. The mean length of GPC and the pterygopalatine fossa was 29.39 ± 3.1 mm, the height of the maxilla was 30.44 ± 3.4 mm, and the difference between the two sexes was significant. The angle between the GPC and the horizontal plane of the hard palate was 40.48 ± 9.1°. The mean thickness of the palatal mucosa over the GPF was 4.92 ± 1.93 mm. Conclusion As the measurement studies of the hard palate show considerable variations among races, the data in this study will help clinicians to localize the GPF more precisely in Egyptian patients and to predict the depth of a needle to anesthetize the maxillary nerve with a low rate of complications.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction Menisci have a role in optimal knee function. Meniscal preservation in younger active individuals presenting with symptomatic meniscal disease is important. The success of meniscal repair depends on appropriate meniscal bed preparation and the surgical technique. Patients and methods A prospective study of 20 cases of post-traumatic meniscal tear was conducted during the period between March 2012 and December 2013. All cases were subjected to arthroscopic evaluation to confirm the diagnosis and ensure they fulfilled the criteria for repair on the basis of site, size, description, and associated injury of the tear. The inclusion criteria were vertical longitudinal tear from 1 to 3 cm in length in the red-red or red-white zone. The exclusion criteria were patient age older than 45 years, white-white zone tear, radial tear, and complex degenerative meniscal tear. The Lysholm score and International Knee Documentation Committee (IKDC) subjective and objective knee scores were used preoperatively and postoperatively for presentation of overall results. All cases were treated by means of the all-inside arthroscopic repair technique using a FasT-Fix meniscal repair device. Results Twenty patients were followed up for an average of 60 weeks. The mean age of the patients was 20.95 ± 1.60 years; the average suture used was 2.85; 70% had isolated meniscal injury, and 30% had associated anterior cruciate ligament (ACL) tear; the average tear length was 1.91 cm. The mean preoperative and postoperative Lysholm scores were 38.25 and 91.20, respectively. The mean preoperative and postoperative IKDC subjective evaluation results were 31.28 and 91.44, respectively. The preoperative IKDC objective evaluation results revealed 16 (80%) patients with severely abnormal knees (grade D) and four (20%) patients with abnormal knees (grade C). The postoperative IKDC objective evaluation results revealed two (10%) patients with abnormal knees (grade C), three (15%) patients with nearly normal knees (grade B), and 15 (75%) patients with normal knees (grade A). There is better improvement in scores if ACL reconstruction is performed simultaneously with meniscal repair, the procedure is performed for vertical longitudinal tears, the tear is in the 'red-red' zone, and the tear length is less than 21 mm. There were no differences in functional results on the basis of repair of medial meniscus or lateral meniscus, acute or chronic injuries, or age. Conclusion Better outcome of meniscal repair was seen in patients with vertical longitudinal tear in the red-red zone with a tear length of less than 21 mm and associated with ACL reconstruction.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, fractionated radiotherapy, and, recently, gamma knife surgery (GKS). The objective of this study was to evaluate the efficacy, safety, and role of GKS in the treatment of secretory pituitary adenomas as regards hormonal and adenoma size control. Between January 2010 and January 2014, a prospective analysis of 40 consecutive patients who underwent GKS for secretory pituitary adenomas at the International Medical Center, Cairo, Egypt, was carried out. Eight patients had adrenocorticotropic hormone-secreting adenoma, 16 patients had prolactin-secreting adenoma, and 16 had growth hormone-secreting adenoma. In 19 patients, GKS was the secondary treatment to a prior surgery with failure of hormonal control along with medical treatment. In the remaining 21 patients, the secretory pituitary adenomas were not controlled with medical treatment alone. The follow-up period ranged between 12 and 60 months. Hormonal control was achieved with either normalization or a marked decline in abnormal hormone level of more 50%. Radiological tumor size control was carried out with either tumor size stabilization or reduction. Among the 40 patients, 21 had microadenoma of 1 cm ³ volume or less. Overall, 24 patients (60%) had hormonal control and 38 patients (95%) had tumor size control after GKS. There was a direct correlation between tumor size, prescription radiation dose, and hormonal and size control after GKS. Twenty out of the treated 21 microadenoma cases showed both hormonal and size control. In conclusion, GKS is a safe and effective treatment method for secretory pituitary adenomas that have failed to respond to medical treatment alone or have postsurgical residual tumor, or recurrence, especially microadenomas.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objective The aim of this study was to evaluate the role of MRI and MR angiography in the assessment of vascular malformations as compared with the usefulness of duplex sonography and digital subtraction arteriography. Participants and methods A total of 40 patients (age range, 1-35 years; 21 male and 19 female) with diagnosed vascular malformations on the basis of color duplex imaging were examined on a 1.5 T whole-body MR scanner. Using parameters based on a fast localizer sequence, we acquired axial or coronal T1-, T2-, short-time inversion recovery (STIR) and contrast-enhanced T1-weighted images. Dynamic postcontrast three-dimensional (3D) gradient-echo MRIs were used for patients with high-flow arteriovenous malformation. MR data sets were evaluated for the detection of the lesion, determination of the malformation extent, involvement of surrounding structures, and vascular details with regard to the nidus, feeding arteries, and draining veins. Results were compared with findings from the digital subtraction angiography (DSA). Results All MRIs revealed 14 low-flow venous vascular malformations, 12 high-flow arteriovenous malformations, and 14 hemangiomas. The STIR sequence was helpful for determining the extent of vascular malformation, whereas dynamic postcontrast 3D MR angiography helped in the classification of the type of the vascular malformation. MR angiography was inferior to DSA in revealing the vascular details and for interventional procedure planning. Conclusion MRI and MR angiography appear to play a significant role in the assessment of vascular malformations. The protocol for imaging such vascular malformations should include dynamic postcontrast 3D gradient-echo MRI with STIR sequences. However, DSA is still required for more vascular detail delineation and definitive treatment decisions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objective Testosterone levels are frequently low in men with type 2 diabetes mellitus (DM), and the majority of these men have symptoms of hypogonadism. Obesity is associated with low testosterone levels in diabetic men. The aim of our work was to study the link between type 2 DM in men aged 40-50 years and the increased incidence of hypogonadism. Patients and methods Our study included two groups of patients: group A, which included 40 male diabetic patients (type 2) aged 40-50 years, and group B, which included 40 healthy age-matched control individuals. All patients and controls were subjected to a medical questionnaire and examination of BMI, waist-hip ratio (WHR), and laboratory investigations for evaluation of total testosterone, free testosterone, sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and glycosylated Hb (HbA1c). Results The patient group showed a significant decrease in serum total testosterone (3.83 ± 2.18 ng/ml), free testosterone (4.15 ± 2.08 pg/ml), and SHBG (27.48 ± 10.07 nmol/l) in comparison with the control group (6.14 ± 1.37 ng/ml, 13.82 ± 5.14 pg/ml, and 62.85 ± 9.17 nmol/l, respectively), a highly significant decrease in LH and FSH (2.35 ± 1.98 mIU/ml and 4.79 ± 2.72 IU/ml, respectively, vs. 4.56 ± 1.22 mIU/ml and 6.88 ± 1.69 IU/ml in the control group), and significant increase in prolactin and HbA1c (19.014 ± 8.65 ng/ml and 6.85 ± 2.12%, respectively, vs. 6.51 ± 2.2 and 4.3 ± 1.16 in the control group). In addition, there was a significant increase in BMI (35.2 ± 3.56 kg/m ² ) and WHR (1.02 ± 0.12) in comparison with the control group (22.22 ± 1.76 kg/m ² and 0.8 ± 0.04, respectively). Total testosterone concentration showed a positive nonsignificant correlation with SHBG (r = 0.076) but significant positive correlation with FSH and LH (r = 0.672 and 0.696, respectively) and significant negative correlation with serum HbA1c, BMI, and WHR (r = −0.324, −0.442, and −0.306, respectively) and highly significant negative correlation with prolactin (r = −0.783) in male patients with type 2 DM. Free testosterone showed a nonsignificant negative correlation with SHBG (r = −0.0229) and significant negative correlation with HbA1c, BMI, and WHR (r = −0.311, −0.373, and −0.374, respectively) but a highly significant negative correlation with prolactin (r = −0.740) and a highly significant positive correlation with FSH and LH (r = 0.798 and 0.762) in male patients with type 2 DM. Conclusion This study demonstrates that significant number of men with type 2 DM aged between 40 and 50 years have testosterone insufficiency and symptoms of hypogonadism.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objective The aim of this study was to declare the frequency of neurodevelopmental, behavioral, and psychiatric comorbidities associated with epilepsy and the relation of these disorders with several variables, including age at onset of epilepsy, duration of epilepsy, type of epilepsy, antiepileptic medications (monotherapy or polytherapy), and seizure frequency. Patients and methods This cross-sectional study included 50 epileptic children selected from those regularly attending the Neurology Outpatient Clinic in Mansoura University Children Hospital and already diagnosed with primary epilepsy and maintained on antiepileptic medications. They were subjected to full general and neurological assessment, Wechsler Intelligence Scale (IQ), Child Behavior Checklist, and Developmental Profile-3. Data were analyzed using SPSS program, version 16. Results Children with prolonged duration and earlier onset of epilepsy performed worse on Developmental Profile-3 assessment as they showed significantly delayed cognition, in addition to more attention problems and low IQ. Increased frequency associated with delayed cognitive, social, and communication development, low IQ, and attention problems were observed. Moreover, those with polytherapy were more significantly affected as regards cognition, communication, IQ, attention, social problems, thought problems, and anxiety depression. No significant differences were found between effects of sodium valproate and carbamazepine, but a high dose of valproate was associated with higher incidence of low IQ and cognitive and attention problems. Cognition, communication, and attention were more affected in patients with generalized epilepsy in comparison with those with partial epilepsy. Conclusion Childhood epilepsy is associated with cognitive deficits, intellectual decline, and behavioral problems, which are multifactorial, such as age of onset, frequency, type of seizure, prolonged seizures, antiepileptic drugs, and duration of epilepsy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background Obesity is an excessive accumulation of fat that adversely affects well-being and health. It is a major public health problem that affects nearly 18% of teenagers. Aim This study was conducted on primary school children in Menouf district to study the prevalence of obesity and overweight and some associated risk factors. Results Obesity was more prevalent in children between 6 and 9 years of age, and it is more prevalent in girls than in boys. The incidence of obesity was higher among urban than among rural children, and children attending private schools and of high socioeconomic levels were more obese. Conclusion and recommendation Childhood obesity has tripled in the past 30 years. The prevalence in 11 years has increased from 6.5% in 1980 to 19.6% in 2008. There is an urgent need to spread awareness about obesity, its consequences, and ways and means of prevention, especially among children and their families.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background Diabetic cardiomyopathy is a common complication of diabetes mellitus. There are many pathophysiological mechanisms of diabetic cardiomyopathy, such as apoptosis and oxidative stress. Aim This study was designed to assess the issue of cardiomyocyte apoptosis as a possible cause of diabetic cardiomyopathy and the use of vitamin E as an antioxidant and losartan as an angiotensin II receptor blocker in suppressing this apoptosis. Materials and methods Rats were randomly divided into five groups of 10 animals each: group 1 included healthy control rats; group 2, the diabetic group, included rats that were made diabetic with a single injection of streptozotocin; group 3 included diabetic rats treated with losartan; group 4 included diabetic rats treated with vitamin E; and group 5 included diabetic rats treated with losartan and vitamin E. At the end of the experimental period, plasma glucose and serum lipid profile were evaluated. The heart rate and mean systemic arterial blood pressure were measured in all groups. Oxidative stress as assessed with malondialdehyde and reduced glutathione (GSH-PX) concentrations, as well as caspase-3 activity as an index of apoptosis, was determined in cardiac tissue. In addition, cardiac apoptosis was measured with the BCL-X immunohistochemistry technique. Results Administration of vitamin E and losartan caused significant decrease in apoptosis. In addition, there was significant decrease in malondialdehyde and caspase-3 and significant increase in GSH in cardiac tissue homogenate, with significant decrease in the serum lipid level. The mean systemic arterial blood pressure was significantly decreased, whereas heart rate increased to normal level. Conclusion Vitamin E and losartan have a protective effect on diabetes-induced cardiomyopathy in rats.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background Nigella Sativa (NS) is one of the traditionally used herb well known for its healing properties. The most of the therapeutic properties of this plant is due to the presence of Thymoquinone (TQ), the major bioactive component of the essential oil. TQ is also a promising dietary chemopreventive agent for the treatment of number of diseases. Very low level of toxicity has been reported through acute and chronic toxicity studies. Aim The present study aimed to investigate the anti-ischemic effect of NS using carotid artery occlusion model in rats.This study also aimed to investigate the effect of NS on SVP induced hepatotoxicity. Method 0Animals given NS and TMZ for 21 days then subjected to 45 min for brain ischemia then reperfusion.Animals administered NS, SVP for 21 days then subjected to serum measurement of serum ALT & AST and liver histopathological examination. Results NS significantly reduced the percent of necrosis and reduced the size of cerebral infarction compared to control and enhanced the effect of TMZ on cerebral ischemia.NS produced significant decrease in serum ALT and AST and improvement of histopathlogical picture compared to SVP group. Conclusion These results indicate that the NS could have a therapeutic effect against cerebral ischemia.NS has protective effect against SVP induced hepatotoxicity.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction Children with congenital heart disease (CHD) have been reported to show significant growth retardation both prenatally and postnatally. Different types of cardiac malformation can affect nutrition and growth to varying degrees. Objectives The aim of this study was to assess the relationship between insulin-like growth factor 1 (IGF-1) and age, height, weight, head circumference, and BMI of infants. Materials and methods This was a case-control study conducted on 45 infants and children. The study included 30 children with CHD attending the Pediatric Cardiology Unit in Benha University Hospital from December 2012 to May 2013 who constituted the diseased group (groups 1 and 2). Their ages exceeded the neonatal period. Fifteen healthy sex-matched and age-matched children served as the control group (group 3). The infants were subjected to history taking, complete clinical examination, and assessment of serum IGF-1, serum insulin, and random blood sugar. All data were recorded and analyzed in detail. Growth retardation in children with CHD was assessed. Results There was significant difference between cases of CHD and the healthy control group as regards weight and BMI. There was significant difference between infants with cyanotic and those with acyanotic CHD as regards the weight. The cyanotic group was underweight. A significant difference was found in the length between the cyanotic and the acyanotic group. Infants in the cyanotic group were of short stature. There was significant difference between the cyanotic group and the acyanotic group as regards IGF-1 concentration, with the cyanotic group having lower concentration compared with the acyanotic group. Conclusion In light of this study we found that infants with CHD had lower IGF-1 levels compared with controls. Cyanotic CHD in children caused more pronounced growth retardation in comparison with acyanotic CHD.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]