Study of platelet activation,hypercoagulable state,and the association with pulmonary hypertension in children with β-thalassemia

Background

The increased survival rate of thalassemic patients has led to unmasking of management related complications which were infrequently encountered.

Functional activity of the rectum： A conduit organ or a storage organ or both？

AIM: To investigate whether the degree of rectal distension could define the rectum functions as a conduit or reservoir. METHODS: Response of the rectal and anal pressure to 2 types of rectal balloon distension, rapid voluminous and slow gradual distention, was recorded in 21 healthy volunteers (12 men, 9 women, age 41.7±10.6 years). The test was repeated with sphincteric squeeze on urgent sensation. RESULTS: Rapid voluminous rectal distension resulted in a significant rectal pressure increase (P < 0.001), an anal pressure decline (P < 0.05) and balloon expulsion. The subjects felt urgent sensation but did not feel the 1st rectal sensation. On urgent sensation, anal squeeze caused a significant rectal pressure decrease (P < 0.001) and urgency disappearance. Slow incremental rectal filling drew a rectometrogram with a "tone" limb representing a gradual rectal pressure increase during rectal filling, and an "evacuation limb" representing a sharp pressure increase during balloon expulsion. The curve recorded both the 1st rectal sensation and the urgent sensation. CONCLUSION: The rectum has apparently two functions: transportation (conduit) and storage, both depending on the degree of rectal filling. If the fecal material received by the rectum is small, it is stored in the rectum until a big volume is reached that can affect a degree of rectal distension sufficient to initiate the defecation reflex. Large volume rectal distension evokes directly the rectoanal inhibitory reflex with a resulting defecation.     

Electromyographic lag time and opening time: two novel noninvasive methods to investigate patients with anal outlet obstruction and their response to treatment.

Methods in use can diagnose anal outlet obstruction but not degree of obstruction. We introduced two novel noninvasive methods of diagnosing and evaluating the degree of anal outlet obstruction: pelvic floor electromyographic lag time and opening time. Pelvic floor electromyographic lag time measured time interval between start of pelvic floor muscle relaxation and start of anal outlet flow. Opening time calculated time lapse between start of rectal contraction and start of anal outlet flow. We investigated the hypothesis that pelvic floor electromyographic lag time and opening time can be used as investigative tools in diagnosing and evaluating degree of anal outlet obstruction. Thirty-one patients with anal outlet obstruction and 26 healthy volunteers were studied. Electromyography of external anal sphincter and anal and rectal pressures were recorded on rectal balloon distension until balloon was expelled. Pelvic floor electromyographic lag time and opening time were measured. Mean opening time and pelvic floor electromyographic lag time of the anal outlet obstruction patients showed significant increase compared to those of healthy volunteers. Pelvic floor electromyographic lag time was longer than opening time in both patients and controls, but the difference was not significant. Biofeedback effected improvement in 24 of the 31 patients. Thus, two novel investigative tools -- opening time and pelvic floor electromyographic lag time -- in diagnosis of anal outlet obstruction are presented. They exhibited significant increase in anal outlet obstruction patients over the healthy volunteers. There was no significant difference between pelvic floor electromyographic lag time and opening time readings.     

The operative trauma workload in a plastic surgery tertiary referral centre in Scotland

The trauma workload in plastic surgery is not well documented in the literature. The authors wished to investigate the operative trauma caseload in a tertiary referral plastic surgery centre to determine the demographics, mechanisms of injury, sites of injury and procedures performed. This study was conducted using a prospectively tabulated comprehensive database in which details of every trauma operation performed at the Canniesburn Plastic Surgery Unit (Glasgow, Scotland) are logged. The data from an 8-year study period (2003–2010) were collected for patient demographics, site of injury and operative procedures performed. The data from a shorter study period (April 2006–December 2010) were collected separately to investigate the mechanisms of injury. Data analysis was undertaken using Mintab 15 Statistical Software English. Analysis of 21,929 operative procedures on 8,880 patients was undertaken. There was a predominance of young male patients. More than 75% of trauma affected the limbs. The mechanism of injury was predominantly accidents (31%) including RTAs. The second most common mechanism was violent crime (17%), of which more than a quarter involved a knife. Notably, alcohol was a contributing factor in 3.4% of all trauma cases. Plastic surgery trauma involves injury to all sites of the body and the mechanisms are variable. However, certain mechanisms are arguably preventable through public health initiatives and legislative change in order to reduce the unnecessary economic burden on the health service. There is a significant operative caseload with a requirement for a varying complexity of reconstruction, ranging from debridements to microvascular free tissue transfer. Arguably, the plastic surgeon must be an integral part of any trauma centre.     

Computed tomography of the orbit – A review and an update

Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit have been competing for the hearts and minds of health care providers for well over 2 decades. While several drawbacks pertaining to CT have been outlined since the introduction of MRI, CT remains the standard diagnostic test for evaluating cross-sectional, 2 or 3-dimensional images of the body.     

Experimental model of varicocele

The purpose of this investigation was to create a varicocele model in animals and to study the subsequent alterations in testicular physiology. The study comprised 22 dogs divided into 2 groups: test and control. In the test group (17 dogs), excision of a longitudinal strip of the fasciomuscular tube of the spermatic cord was done on one side only. In the control group (5 dogs), the spermatic cord was exposed without interference with the tube. Testicular temperature was measured, and biopsies from the 2 testicles and semen specimens were examined. Re-examination for variceal changes was performed in 3 dogs at the 4th postoperative week; in 3 dogs at the 6th, and in 16 dogs (11 test and 5 control) at the 8th postoperative week. Sections from spermatic cord and testicle were examined microscopically. Serum levels of testosterone follicle-stimulating hormone, luteinizing hormone and prolactin were assayed preoperatively and at the time of re-examination. Manifest varicocele was detected in 16 of 17 detubated dogs. It was huge in all dogs re-examined after 8 weeks. Semen showed decreased sperm count in all test animals except 1. The animals with induced varicocele had higher testicular temperature than the controls. Microscopically, the detubated spermatic cords have shown variceal changes and the testicle degenerative changes in all the test animals. Similar changes were encountered in the contralateral testicle in the animals re-examined at 8th week. Radioimmunoassay showed a significant decrease of serum testosterone and increase of prolactin postoperatively. Follicle-stimulating hormone and luteinizing hormone showed no significant change from the preoperative level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Life cycle Analysis of Aluminum Foil Packaging Material

A fundamental tent of life cycle analysis (LCA) is that every material product must become a waste. To choose the greener products, it is necessary to take into account their environmental impacts from cradle to grave. LCA is the tool used to measure environmental improvements. Aluminum (Al) is the third most common element found in the earth's crust, after oxygen and silicon. Al packaging foil was chosen as the material for the study with its life cycle perspective at Alexandria. The Al packaging produced from virgin and recycled Al was investigated through life cycle stages in these two production processes; primary and secondary. The aim of this study is to evaluate the environmental impact of aluminum packaging process by using life cycle analysis of its product from two different starting raw materials (virgin and recycled aluminum). The input and output materials, energy, water, natural gas consumptions, and solid waste uses in the foil industry had been analyzed in order to identify those with significant contribution to the total environmental impacts. From the survey done on the two life cycles, it was found that in environmental terms, the most important emissions from the primary process are the emission of CO(2) and perfluorocarbon (PFC) gases, which produce the greenhouse effect, and SO(2) as well as the emission of fluorides and polyaromatic hydrocarbons (PAH compounds), which are toxic to humans and the environment. On over all material balance, it was found that the ingot shares by 45% of the feed to the casthouse furnaces at Egyptian Copper Work (ECW), net production of the casthouse is 43.76% and the yield of rotary dross furnace (RDF) is 28.8%. The net production of the foil unit represents 35% of the total input to the unit. By comparing the two life cycles, it is obvious that, for water consumption, 93.5% is used in the primary cycle, while 6.5% is used in the secondary cycle. For electricity consumption, 99.3% is used in the primary cycle; while 0.63% is used in the secondary cycle. For the natural gas consumption, 46.66% is used in the primary cycle excluding Nag' Hammady as it uses fuel oil, while 53.34% is used in the secondary cycle. Using a matrix approach, the primary cycle scored 6 heavy loaded factors out of 9, while the secondary cycle scored 3 heavy loaded factors out of 9. It can be concluded that Al recycling (secondary cycle) in Al industry decreases the use of virgin material, energy use, and environmental loadings, while increasing the economic life of products, and reducing overall material demands. So, the secondary cycle is to be recommended and is the most favorable option in most of the factors influencing the two cycles. Monitoring of the furnaces, automatic control of the metal, proper dross cooling, better refining of molten Al, rate of solidification of molten Al, and proper annealing process will lead to reduction of the overall fuel, water, and electricity consumption and metal losses will be minimum.     

The cavernoso-anal reflex： response of the anal sphincters to cavernosus muscles＇ stimulation

Aim： To prove the hypothesis that cavernosus muscles＇ contraction during coitus affects the reflex contraction of anal sphincters. Methods： Electromyographic response of external and internal anal sphincters to ischiocavernosus and bulbocavernosus muscle stimulation was studied in 17 healthy volunteers （10 men, 7 women, mean aged 38.3 ± 11.6 years）. The test was repeated after individual anesthetization of anal sphincters and the two cavernosus muscles,and after using saline instead of lidocaine. Results： Upon stimulation of each of the two cavernosus muscles,external and internal anal sphincters recorded increased electromyographic activity. Anal sphincters did not respond to stimulation of the anesthetized cavernosus muscles nor did anesthetized anal sphincters respond to cavernosus muscles＇ stimulation. Saline infiltration did not affect anal sphincteric response to cavernosal muscles＇ stimulation.Conclusion： Cavernosus muscles＇ contraction is suggested to evoke anal sphincteric contraction, which seems to be a reflex and mediated through the ＂cavernoso-anal reflex＂. Anal sphincteric contraction during coitus presumably acts to close the anal canal to thwart flatus or fecal leak.     

The Effect of Esophageal and Gastric Distension on the Crural Diaphragm

Background The mechanism of prevention of gastric reflux into the esophagus is not exactly known. The lower esophagus has a barrier function provided by the lower esophageal sphincter. We investigated the hypothesis that the crural diaphragm shares in the barrier function not only mechanically but also actively through a crural–esophageal–gastric reflex action. Methods The study was performed during repair of abdominal ventral and incisional hernias in 20 subjects (11 men, 9 women; age 38.6 ± 4.8 years). The electromyographic response of the crural diaphragm to individual balloon distension of esophagus and stomach was recorded by means of a needle electrode inserted into the crural diaphragm and connected to an electromyographic apparatus. The recordings were repeated after separate crural, esophageal, and gastric anesthetization. Results The crural diaphragm exhibited basal motor unit action potentials, which decreased on esophageal distension (P < 0.001) after a mean latency of 17.3 ± 2.8 SD ms. The crural diaphragm response to esophageal distension did not occur after the crural diaphragm or esophagus was anesthetized. Gastric distension effected an increase of crural diaphragm electromyographic activity with a mean latency of 18.4 ± 4.6 ms; this effect could not be achieved after the crural diaphragm or stomach was anesthetized. Conclusions The crural diaphragm has a resting tone that relaxes after esophageal distension and contracts after gastric distension. This sphincter-like action of the crural diaphragm appears to be a reflex and is mediated through the esophagocrural inhibitory and gastrocrural excitatory reflexes. The crural diaphragm seems to share actively in the gastroesophageal competence mechanism.