Unilateral modified Harada-lto procedure for excyclotorsion secondary to unilateral superior oblique palsy

Background: The Fells modification of the Harada-lto procedure is usually performed bilaterally for the correction of excyclotorsion secondary to acquired bilateral superior oblique paresis. Excyclotorsion is not usually a major complaint in true unilateral superior oblique paresis. Occasional cases, however, may find this symptom bothersome and it may interfere with fusion. The purpose of the present study is to determine the effect of the unilateral modified Harada-lto procedure on the correction of symptomatic excyclotorsion in unilateral superior oblique paresis. Method: A retrospective case-note review of patients with unilateral superior oblique paresis undergoing unilateral modified Harada-lto procedures during the five-year period 1988-1993 was performed. Results: Six patients fulfilled the inclusion criteria. Superior oblique paresis was congenital in one case, secondary to trauma in two cases and idiopathic acquired in three cases. There were four males and two females aged from 25 to 63 years and all but one had previous surgery. The mean pre-operative excyclotorsion was approximately 10 degrees (range 8-14 degrees). Mean post-operative excyclotorsion was 3 degrees (range 2 degrees incyclotorsion -10 degrees excyclotorsion). Conclusion: The unilateral modified Harada-lto procedure is an effective surgical treatment of excyclotorsion resulting from superior oblique paresis and may improve sensory and motor fusion.     

Comparative study between different diagnostic techniques in huge splenomegaly cases in El-Minia Province

Fifty four patients presenting by huge splenomegaly were admitted to Tropical Medicine Department, El-Minia University Hospital. Tissue biopsy revealed pure bilharziasis due to S. hematobium in 10 (19%) cases, liver cirrhosis in 23 (42%), mixed schistosomiasis and cirrhosis in 8 (15%), hepatoma in 3 (6%), lymphoma in 6 (11%) and hematological diseases in the form of chronic myeloid leukemia in 2 (3.5%) and thalassemia major in 2 (3.5%) cases. The sensitivity and specificity of abdominal ultrasonography was 100% and 97% in cases of schistosomiasis, 100% and 100% in cases of hepatoma, 87% and 100% in cases of liver cirrhosis, 33% and 100% in cases of lymphoma respectively. There was a positive significant correlation between endoscopic variceal grading, portal vein diameter, splenic vein diameter, size of the spleen and the grading of the portal tract thickenings. The pathological and ultrasonographic diagnosis was the same in 38 (70%) cases. Splenogram was characteristic but not diagnostic in cases of schistosomiasis and liver cirrhosis. It was diagnostic and similar to peripheral blood picture in the 2 cases of chronic myeloid leukemia and was normal in cases of thalassemia major. Splenic aspiration was able to diagnose all cases of lymphomas. It can be considered as a useful adjunct to the usual diagnostic procedures, both in staging and follow up, especially in cases presenting only by splenomegaly.     

PREVALENCE OF MICROALBUMINURIA IN NON-INSULIN-DEPENDENT DIABETES MELLITUS

The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes mellitus. The mean age of patients was 52.1 ± 11.6 years and the duration of diabetes was 8.3 ± 6.8 years. Twenty (40%) patients had microalbuminuria. Microalbuminuria was more common in patients with a longer duration of diabetes (more than 5 years), a poor glycaemic control, and higher systolic blood pressure.KEY WORDS: Microalbuminuria, Diabetes mellitus, Diabetic nephropathy, Chronic renal failure     

Cavernous sinus thrombosis: successful treatment using functional endonasal sinus surgery

OBJECTIVE: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. DESIGN: Case study. PATIENT: A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. INTERVENTION: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. RESULTS: During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. CONCLUSIONS: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.     

Profile of non-compliance in lymphoblastic leukaemia

A nationwide study of intracellular drug metabolite concentrations in children prescribed 6-mercaptopurine for the treatment of lymphoblastic leukaemia was carried out to assess interpatient variability at a standardised dose. Nine children (2% of the total) had completely undetectable metabolites, indicative of non-compliance. Five were adolescents, but otherwise they had no obvious distinguishing characteristics. Not taking any 6-mercaptopurine at all is uncommon, but the problem cannot be predicted. The total number of children who do not comply cannot be determined from this study, but the nine children described represent only a fraction of these.     

Immune responses against SARS-coronavirus nucleocapsid protein induced by DNA vaccine

The nucleocapsid （N） protein of SARS-coronavirus （SARS-CoV） is the key protein for the formation of the helical nucleocapsid during virion assembly. This protein is believed to be more conserved than other proteins of the virus, such as spike and membrane glycoprotein. In this study, the N protein of SARS-CoV was expressed in Escherichia coli DHSalpha and identified with pooled sera from patients in the convalescence phase of SARS. A plasmid pCI-N, encoding the full-length N gene of SARS-CoV, was constructed. Expression of the N protein was observed in COS1 cells following transfection with pCI-N. The immune responses induced by intramuscular immunization with pCI-N were evaluated in a murine model. Serum anti-N immunoglobutins and splenocytes proliferative responses against N protein were observed in immunized BALB/c mice. The major immunoglobulin G subclass recognizing N protein was immunoglobulin G2a, and stimulated splenocytes secreted high levels of gamma interferon and IL-2 in response to N protein. More importantly, the immunized mice produced strong delayed-type hypersensitivity （DTH） and CD^8＋ CTL responses to N protein.     

Value of carotid intimal–medial thickness as independent predictor of endothelial dysfunction in uremic patients

Background and aim of the workCardiovascular mortality and morbidity are significantly higher among uremic patients. Although the carotid intimal–medial thickness (C-IMT) as a predictor of endothelial dysfunction (ED) has a prognostic value that has been well demonstrated as an independent predictor of future cardiovascular events, its value in uremic patients need to be re-assisted in our locality. The aim of the work is to investigate a correlation between the brachial artery reactivity test (BART) and the carotid intimal–medial thickening (C-IMT) and their value as independent predictors of endothelial dysfunction in uremic patients.Subjects and methodsThe study involved 70 uremic patients, 40 men and 30 women, 36–56 years old, 40 of them on regular hemodialysis (HD) and 30 on conservative therapy, in addition to 30 healthy persons as a control group. They were selected from the General Medicine and Nephrology Departments, Al-Azhar Assiut University and Assiut University Hospitals over a period of 2 years. All of them were subjected to detailed history, thorough clinical examination, laboratory investigations including complete blood picture, renal function tests (urine analysis, blood urea, and serum creatinine), lipid profile, serum calcium and serum phosphorus, parathyroid hormone (PTH), fasting blood glucose, electrocardiography (ECG), high resolution B-mode ultra-sonography for C-IMT evaluation and brachial artery reactivity test (BART), and abdominal ultra-sonography.ResultsThe results of the present study showed: (1) uremic patients are at an increased risk for carotid atherosclerotic lesions, with significant increase in C-IMT than controls with more significant increase in HD patients. (2) Uremic patients are characterized by impaired endothelium dependent dilatation of the brachial artery (highly significant reduction in flow-mediated dilatation (FMD%)), an abnormality related to the renal failure severity and to the hemodialysis doses. The endothelial dysfunction in the brachial artery was more pronounced in HD patients than in patients on conservative therapy. (3) Significant positive correlation between increased C-IMT and reduction of the brachial FMD%. (4) Significant relation between C-IMT and plaque prevalence and HD duration, while no relations recorded between brachial FMD with HD duration.Conclusion(1) The study confirmed that carotid IMT and brachial artery FMD can be used in interventional studies in which cardiovascular risk is modified and increased in the uremic patients. (2) There was negative correlation between brachial FMD and C-IMT in the uremic patients.     

Comparative analysis of macrophage migration inhibitory factors (MIFs) from the parasitic nematode Onchocerca volvulus and the free-living nematode Caenorhabditis elegans

The macrophage migration inhibitory factors (MIFs) from the filarial parasite Onchocerca volvulus (OvMIF) were compared to the MIFs from the free-living nematode Caenorhabditis elegans (CeMIF) with respect to molecular, biochemical and immunological properties. Except for CeMIF-4, all other MIFs demonstrated tautomerase activity. Surprisingly, OvMIF-1 displayed oxidoreductase activity. The strongest immunostaining for OvMIF-1 was observed in the outer cellular covering of the adult worm body, the syncytial hypodermis; moderate immunostaining was observed in the uterine wall. The generation of a strong humoral immune response towards OvMIF-1 and reduced reactivity to OvMIF-2 was indicated by high IgG levels in patients infected with O. volvulus and cows infected with the closely related Onchocerca ochengi, both MIFs revealing identical amino acid sequences. Using Litomosoides sigmodontis-infected mice, a laboratory model for filarial infection, MIFs derived from the tissue-dwelling O. volvulus, the rodent gut-dwelling Strongyloides ratti and from free-living C. elegans were recognized, suggesting that L. sigmodontis MIF-specific IgM and IgG1 were produced during L. sigmodontis infection of mice and cross-reacted with all MIF proteins tested. Thus, MIF apparently functions as a target of B cell response during nematode infection, but in the natural Onchocerca-specific human and bovine infection, the induced antibodies can discriminate between MIFs derived from parasitic or free-living nematodes.