bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Benefit relationship between Hand Held Ultra-Sound (HHUS) and Automated Breast Ultra-Sound (ABUS) as a complementary scan for Mammography in detection of breast lesions
Authors: Abu El Maati Amal A , Ragheb Samar R , Moustafa Esraa E
Published: October 2021

Aim of the Work

to compare between HHUS and 3D ABUS, according to their benefits and limitations as a complementary scan for mammography in detection of breast lesions.

Patients and Methods

The study was conducted on 30 female patients with breast masses diagnosed by clinical examination or by sonomammography in Radiology Department at Al Sheikh Zayed Aal Nahian hospital and Ain Shams University Hospitals during the period from October 2018 and August 2019. Findings were confirmed by histopathological biopsy or at least 6 months follow up.

Results

Statistically significant difference between ABUS and HHUS time of examination in favor of ABUS with P-value >0.0001 and 95%CI-5.7:-4.4, as ABUS time of examination was (mean+/- SD: 4.1 +/-0.9) and HHUS was (mean +/- SD: 9.2 +/-2.0). In this study; 8 out of 30 were malignant lesions and 22 were benign findings. HHUS showed higher sensitivity than ABUS (100% versus 88%); specificity (86%, 91%), positive predictive value (73%, 78%) and negative predictive value (100%, 95%) respectively. HHUS and ABUS shows nearly perfect agreement regarding lesion classification(benign &malignant).with Cohen’s kappa (κ) 0.85, and also regarding BIRADS classification With Weighted kappa 0.824.

Conclusion

There is a near perfect agreement between ABUS and HHUS diagnostic performance (κ) 0.85,and statistically significant difference in time of examination in favor of ABUS as it is operator independent and provide large scanned area in every single sweep and also aided with computer software, but HHUS still have higher sensitivity than ABUS and that may be attributed to ABUS limitations to evaluate axillary lymph nodes and lack of Doppler, so ABUS may serve as an effective, adjunct, screening tool to mammography and hand held Sonography.
ACR BI-RADS Breast Density and its correlation with breast cancer screening program
Authors: Ahmed Ghada Khaled , Guirguis Mounir Sobhy , Alkaphoury Mona Gamalluldin Alsayed
Published: October 2021

Background

Breast cancer remains one of the leading causes of death in women over the age of 40 years. Breast cancer screening is used to identify women with asymptomatic cancer with the goal of enabling women to undergo less invasive treatments that lead to better outcomes, ideally at earlier stages and before the cancer progresses. Mammography is the best-studied breast cancer screening modality and the only recommended imaging tool for screening the general population of women.

Objective

to correlate the relation between ACR density of breast and breast cancer in screening program.

Patients and Methods

Our study included 40 women of breast cancer were depicted radiologically and histo-pathologically diagnosed after outreaching for screening by Digital Mammography by the Egyptian National Breast Cancer Screening Program in Ain Shams University Hospitals at period from January 2018 to October 2019.Their data were collected from the medical records of the program. Their age ranged between 40 and 65 years.

Results

According to the BI-RADS 5th edition 2013, cases were classified into four classes as follows: 6 were ACR-A (15.0%), 21 were ACR-B (52.5%), 12 were ACR-C (30.0%) and 1 were ACR-D (2.5%), So according to our study results dense breast shouldn’t be considered as a risk factor for breast cancer as we observed that the percentage of breast cancer in our study increases the most with average breast density ACR class B then increases with ACR class C and A respectively.

Conclusion

dense breast is not a risk factor for breast cancer, so further researches are needed to study the relationship between breast density and breast cancer in Egyptian population, to elucidate the role of breast density estimation in prediction of breast cancer considering the genotypical and phenotypical differences of the Egyptian population.
Role of Diffusion Weighted MRI in Assessment of Treatment Response to Chemotherapy in Patients with Osteogenic Sarcoma
Authors: Allah Randa Hussein Abd , Gaber Kareem Mahmoud Mohamed , Ahmed Amal Ibrahim
Published: October 2021

Background

Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. Currently, 10-year overall survival rates are 60% to 70% for all patients and only approximately 20% for patients with metastatic disease.

Aim of the Work

To investigate whether diffusion-weighted imaging (DWI) is useful for monitoring the therapeutic response after chemotherapy in osteosarcoma by comparing the ADC values pre and post chemotherapeutic treatment.

Patients and Methods

This is a retrospective study included 30 patients (18 females & 12 males), their ages range from 7 to 36 years. Mean age 14.8 years. The study was perfotmed Radiology Depaflment at Ain-Shams University Hospitals between September 2018 & Dec 2019.

Resillts

Most of cases about 50 % show partial response according to RECIST criteria.

Conclusion

Chemotheraphy is effective in reducing size, increase tissue breakdown and improvement of cases of osteosarcomas according to results of this study.
Assessment of the role of 18F-FDG PET CT in detection of bone marrow infiltration in comparison to the Bone Marrow Aspirate in Lymphoma patients
Authors: Ghaly Madonna Adel Mikhail , El Shibiny Aida Mohamed , Rahim Susan Adil Ali Abdul
Published: October 2021

Background

18-F-2-Deoxy-D-Glucose Positron Emission Tomography [FDG-PET], combined with multidetector helical Computed Tomography [PET/CT] has emerged as a one of the most important prognostic tools for lymphoma management. Previous studies have indicated that PET/CT is a convenient method for bone marrow assessment in patients with lymphoma. A blind Bone Marrow Biopsy [BMB] has been traditionally used as the golden standard in marrow evaluation despite its invasiveness.

Objective

is to compare the results of PET/CT with BMB regarding bone marrow infiltration [BMI] in patients with Hodgkin's Lymphoma [HL] and Non-Hodgkin's Lymphoma [NHL] and to characterize the visual bone marrow FDG uptake pattern by PET-CT

Methods

A cross sectional study including 27 cases of Lymphoma, conducted at Ain Shams University hospitals, the patients were investigated using PET-CT scan and BMB ,the period was between December 2018 till the end of May 2019.

Results

Our study included 27 histologically proved Lymphoma patients, 14 (51.9%) were males and 13 (48.1%) were females, with age ranging from 17 to 69 years (mean 45 years). Among the total cases, 17 (63%) patients had NHL, while 10 (37%) patients had HL. All the patients were evaluated at first by BMB (taken from the dorsal portion of the iliac crest) for initial staging, then the patients underwent PET/CT scan. The study revealed 12 patients (44.4%) had BMI detected by PET/CT imaging; however, only 7 patients (25.9%) were detected by BMB. BMB and 18F-FDG PET/CT scans were concordant for BMI detection in 22 patients (81.5%): positive concordance in 7 patients and negative in 15. Of the 5 discordant cases, four had a focal marrow intense FDG uptake detected by PET/CT and were upstaged as their BMB results were false-negative, one patient had intense diffuse marrow uptake by PET/CT while its BMB was negative (revealed only hyper cellularity with mild dysplasia). The sensitivity, specificity, PPV, and NPV of PET for identifying BMI was 100%, 75%, 58.3%, 100% respectively with a diagnostic accuracy 81.5% with a (p value < 0.05).

Conclusion

18F-FDG PET-CT imaging is more sensitive than bone marrow biopsy for bone marrow infiltration detection in Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma staging.
The Role of High Resolution Ultrasound In Comparison To MRI In The Evaluation Of Painful Knee
Authors: Abdelhameed Hanaa Abdelkader , Ali Khaled Ahmed Mohamed , Elzakzouk Maged Mohamed
Published: October 2021

Background

The knee joint is one of the most commonly injured joints in the body. Because of its complex structure, the joint is subjected to numerous pathologies and due to the recent increase in various sport activities; there has been a parallel increase in sport-induced internal derangements of the knee. Ultrasound is emerging as a viable imaging modality in the assessment of the musculoskeletal system lesions especially in experienced hands

Objective

To evaluate the role of high resolution dynamic ultrasonography as a diagnostic tool in the assessment of different causes of knee joint pain compared to MR imaging.

Patients and Methods

This study included 50 patients with painful knee joints as 32 females and 18 males, 16 patients had bilateral knee examination. Their ages ranged between 5-66 years. The cases was referred to a private radiological center, some of them referred to assess the knee joint pain by ultrasound as a fast and cheapest modality, yet most of the cases referred to evaluate the knee joint by MRI and the ultrasound was done as complementary study.

Results

Comparing between ultrasound and MRI in evaluation of painful knee joints, although the ultrasound has role in evaluation of bursal, synovial and peri-articular soft tissue lesions, the MRI is advised as a primary imaging tool for cruciates, meniscal and ligamentous lesions when clinically suspected.

Conclusion

Ultrasonography is a safe, cheap and efficient tool in the evaluation of the peri articular soft tissues with limited screening role at the internal knee joint cruciate / meniscal derangements as well as some bony lesions involving the bony cortex. It has no role in the intramedullary bony lesions. At this point, we concluded that ultrasonography has an important complementary role with MRI examination in the evaluation of the knee pain of different causes yet it is operator dependent and needs experience.
Role of hepatic Doppler as compared to Fibro-scan in evaluation of post virus C hepatic fibrosis
Authors: Abdallah Randa Hussein , Abdulhafez Essam Mohamed , Soufy Manar Mohamed
Published: October 2021

Background

Chronic infection with hepatitis C virus (HCV) is a disease of global importance with a large burden of morbidity and mortality. hepatitis c virus can cause progressive liver damage which may result in liver cirrhosis and hepato-cellular carcinoma .

Aim of the work

The aim of our study was to examine the efficacy of hepatic Doppler indices, namely hepatic vein wave form, hepatic vein maximum velocity ,hepatic artery RI and portal vein maximum velocity and portal vein wave form for evaluating the degree of hepatic fibrosis in chronic hepatitis C (CHC) patients as compared to transient elastography.

Patients and methods

our study was done over period from September 2018 till April 2019 included 40 patients from eldemerdash hospital designed to include all hepatitis c positive patients with any age or sex excluding other cause of liver cirrhosis (negative hepatitis B, negative auto immune hepatitis) in absence of obesity or ascites. hepatic vein maximum velocity, hepatic artery RI, portal vein maximum velocity, TE were performed to all patients. fibrosis was assessed on semi quantitative scoring system (METAVIR score ). we examine the efficacy of each of Doppler indices in differentiating different stages of hepatic fibrosis and their diagnostic accuracy in predicting significant fibrosis and cirrhosis .

Results

on comparing the fibrosis &non fibrosis groups by TE according to Doppler measurement we found statistically significant higher means of the portal vein maximum velocity (PVmax) for the non fibrosis group as compared to the fibrosis group (24.15±9.71 and 15.94±3.35 respectively with p value<0.001) also found significantly lower HAPSV/PVmax ratio for the non fibrosis as compared to fibrosis group (1.58±0.41 and 2.59±1.17 respectively with p value 0.011) finally, we found that there was significant change of the HV waveform pattern for the non fibrosis (normal triphasic ) as compared to fibrosis (monophasic or biphasic ) (x2=4.353 with p value 0.038)
The Role of Elastography in Fibroadenoma of the Breast and Differentiating it from its Mimics
Authors: Massak Marina Essam Fares , Fiky Sahar M. El , Salama Asmaa M
Published: October 2021

Background

Fibroadenomas are one of the most common benign diseases of the breast varying in number and size in all quadrants of the breast. Less than 2% of lesions with the typical ultrasound features of a fibroadenoma, are found to be malignant on biopsy.

Aim of the Work

To evaluate the diagnostic performance of combined ultrasonography and strain elastography and to compare the imaging characteristics of fibroadenomas with other benign and malignant mimics and assess the results by histopathological characteristics.

Patients and Methods

Type of Study: Cross-sectional study. Study Setting: The study was conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months (From March 2020 till September 2020). Study Population: Female Patients with breast lumps.

Results

Ultrasound elastography combined with B-mode ultrasonography had shown variable degrees of sensitivity and specificity. However, in our study it showed high sensitivity and specificity as compared to other studies. The most reliable tool in our study was the strain ratio having the highest sensitivity and specificity.

Conclusion

Strain elastography combined to B-mode sonography improves the diagnostic performance of differentiating benign from malignant well circumscribed breast lesions with an additional benefit of preventing unnecessary biopsies and speeding up the diagnosis of malignant lesions instead of follow up of the patient for early diagnosis of malignancies.
The Role of Whole- Body Diffusion Imaging with Background Signal Suppression (DWBS) in comparison with PET/CT in assessment of lymphoma patients
Authors: Abdallah Randa Hossein , Botros Samer Malak , Othman Amal Ibrahim Ahmed , Aboshanab Mohamed Mahmoud Ibrahim
Published: October 2021

Background

Malignant lymphomas [Hodgkin lymphomas (HL) and non-Hodgkin lymphoma (NHL)] rank third in incidence, of all childhood cancers, Moreover, in adolescents (aged 15-19 years) the malignant lymphomas are the leading cause of cancer. Furthermore, as with many other cancers, the likelihood of an individual being diagnosed with lymphoma increases markedly with age, with the median age at diagnosis being 67 years.

Aim of the Work

To compare between F-18-FDG PET-CT and whole-body diffusion-weighted imaging MR protocol (DWIBS) for initial staging and post chemotherapy evaluation in patients with pathologically proven lymphoma (Hodgkin and Non-Hodgkin).

Patients and Methods

The study is conducted on 32 patients with pathologically proven lymphoma to perform 18-F-FDG PET/CT either for pre-treatment initial staging or for evaluation of response to chemotherapy. A total of 22 had HD (69%) and 10 had NHL (31%). Staging PET/CT and WB-MRI/DWIBS were done at time of diagnosis in 19 of the 32 patients (59.4%), where immediate post-therapy PET/CT and WB-MRI-DWIBS were performed 13 patients (40.6%). Accuracy measures were calculated for PET CT and DWIBS.

Results

Accuracy measures confirm the higher sensitivity and specificity of PET-CT over DWIBS. Results for F-18 FDG PET/CT were clearly superior with statistically higher sensitivity, specificity, accuracy, PPV & NPV (96.3%, 99.16%, 98.43%, 97.5% and 98.75%) compared to (83.95%, 97.91%, 94.38%, 93.15% and 94.74%) for DWIBS results respectively.

Conclusion

F-18-FDG PET-CT remains a cornerstone in the evaluation of malignant lymphoma patients; it has significant higher sensitivity, specificity and overall accuracy compared to WB-MRI/DWIBS in HL and NHL patients, either in initial staging or in post therapy evaluation. WB-MRI/DWIBS in HL and NHL patients, either in initial staging or in post therapy evaluation. WB-MRI/DWIBS despite of its relatively longer acquisition time may provide a complementary tool for FDG PET CT.
MRI Various Sequences in Evaluation of Hypervascular Hepatic Focal Lesions in Cirrhotic Patients
Authors: Maarouf Rania Aly , Fayed Mohamed Khairy Mohamed , Farouk Mohamed Amr , Barakat Mai Mokhtar Kamal
Published: October 2021

Background

Hepatic focal lesions may be benign or malignant and some of the hypervascular focal lesions may be benign. Therapy requires an accurate diagnosis, which in turn relies primarily on appropriate imaging and image-guided biopsy.

Objectives

The purpose of this study is to study the role of MRI in characterization of hypervascular hepatic focal lesions in cirrhotic patient on unenhanced, dynamic contrastenhanced and diffusion weighted MR images for better patient management plan.

Patients and Methods

This study was conducted at Radiology department at Ain Shams University hospitals. About 70 patients were included (17 females & 53 males) and their age ranged from 14 to 87 years.

Results

DW MRI in the liver is a relative new and increasingly used imaging technique. It has the advantage that it can be obtained during a single breath-hold; it provides unique information that reflects tissue cellularity and organization. The ADC maps can also provide quantitative measurements of tissue water diffusibility, which can be used not only for disease assessment, but also for the evaluation of disease response to treatment.

Conclusion

Conventional MRI sequences combined with dynamic MRI and DWI provide further more accurate diagnoses for hepatic focal lesions, especially for hypervascular hepatic focal lesions which requires the necessity for injecting the contrast material and through the different pattern of enhancement and washout, we could be able to reach the definite diagnosis for these hepatic focal lesions and so stating management as early as possible which reflect on increasing the prognostic criteria for hepatic focal lesions.
Role of Recent Advances of Diffusion Weighted MRI in Assessment of Therapeutic Response of Rectal Cancer
Authors: Mohamed Yasser Ali , Zeid Ahmed Abdel Aziz Abo , Azab Enas Ahmed , Hussein Rasha Salah ElDin , Hassan Mona Ahmed Abo EL-ELa
Published: October 2021

Aim of the work

The purpose of this study is to determine the role of DWI-MRI in the pretreatment prediction and early response monitoring to neoadjuvant treatment in rectal cancer.

Materials and Methods

The study included 24 patients with pathologically proven cancer rectum and who were subjected to neoadjuvant chemo-radiotherapy. Each patient was imaged twice on an MRI machine; a base line pre neoadjuvant treatment and 8 weeks after finishing the neoadjuvant treatment. We focused on the feasibility of DWI as well as the morphological changes according to size (maximum craniocaudal dimension).Conventional sequences were viewed first to identify the lesion and measure its size (maximum craniocaudal dimension) then DWI images were viewed. The ADC parameter was calculated. Results were compared before and after neoadjuvant therapy.

Results

The ADC values before and after NACT were significantly higher in the responder group, suggesting that ADC values might be useful in assessing the good response before surgery.

Conclusion

In conclusion, the present study demonstrates that adding DW MR imaging to conventional MR imaging yields better diagnostic accuracy than use of conventional MR imaging alone in the evaluation of treatment response to neoadjuvant CRT in patients with locally advanced rectal cancer.
Assessment of therapeutic response of lymphoma patients by PET/CT
Authors: Ahmed Aya Y , Nagi Mona A , Sheikh Radwa H. El
Published: October 2021

Background

Lymphoma compromises а histologically heterogeneous group of cancers derived from the cells of the immune system. The hallmark of the disease is the enlargement and proliferation of lymph nodes or secondary lymphoid tissues.

Aim of the Work

to evaluate the role of Positron emission tomography in the assessment of response to therapy in lymphoma patients: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment.

Patients and Methods

This cross sectional study was conducted on 20 Patients with different types of lymphoma recruited and enrolled from Ain Shams university hospital.

Results

PET/CT and Contrast enhanced computed tomography were concurrent in results in 55% of cases during treatment and 75 % at the end of treatment with CT sensitivity of 61.1%, specificity of 92.2% and accuracy of 76.2% during treatment in comparison to 100 % sensitivity and specificity of PET/CT.While sensitivity of CT at end of treatment is 57.5% with specificity of 86.7% and accuracy of 71.6%.

Conclusion

PET/СT using 2-deoxy-2[18F]fluoro-D-glucose is considered one of the best oncologic imaging modality at the time being with valuable applications in lymphoma.It is very efficient with least possible pitfalls and false results compared to either of its components alone and to side by side reading of separately acquired PET and СT. It is becoming а standard modality for lymphoma providing а new vision to management and treatment plan.
High Resolution Ultrasound of the Tibial Nerve in Diabetic Peripheral Neuropathy
Authors: Metwally Eman Soliman , Ali Khaled Ahmed Mohamed , Abdel-Baqy Reham Shaaban Ahmed
Published: October 2021

Background

The main role of this study was to highlight the value of musculoskeletal ultrasound in the diagnosis of nerve affection in patients with diabetic peripheral neuropathy. This was evident by the significant correlation between cross sectional area and all study parameters with sensitivity and specificity of 90% and 100% respectively.

Objectives

Our study aims to highlight the value of newer ultrasound imaging techniques in identifying morphological changes of the tibial nerve in the patients with diabetic peripheral neuropathy.

Patients and Methods

During a period of ten months duration started in November 2019, 40 subjects were enrolled in this study. 20 diabetic patients with clinical manifestations of DPN had undergone nerve conduction study of both lower limbs then compared to 20 healthy control subjects as regard the ultrasound examination of TN bilaterally. The study was conducted according to the stipulations of the ASU ethical and scientific committee. The privacy of participants and confidentiality of data were guaranteed during the various phases of the study.

Results

We found that the cross sectional area (CSA) in patients with diabetic peripheral neuropathy (DPN) is significantly larger than the healthy controls. A positive significant correlation was found between CSA and duration of diabetes, HbA1c% and tibial nerve (TN) latency while a negative significant correlation was found with TN amplitude and conduction velocity.

Conclusion

Despite giving significantly larger values in cases than controls, MTNF was found to non-significantly correlated with all studied parameters. In view of the above data, CSA can be adopted as a reliable screening and diagnostic tool for DPN but further work-up is needed to assess its role in the follow up of the disease process. On the other hand, MTNF can be used for description of the morphological changes in a diabetic nerve.
Real time ultrasound tissue Elastography in post-hepatitis chronic liver disease; role, limitations and pitfalls
Authors: Diaa Noha M , Nasr Merhan A , Mohamed Mohamed M , Radwan Shimaa M
Published: October 2021

Assessment of liver fibrosis stage is important in determining the prognosis and treatment strategy in chronic liver diseases. To overcome the limitations of liver biopsy, great efforts have been made to develop and validate non-invasive methods for detecting liver fibrosis, including serological indicators and imaging methods. Among these noninvasive methods, ultrasound-based elastography techniques are increasingly employed to assess parenchymal stiffness. Real-time transient elastography is most accurate one of them and rapidly evolving technique that can reveal the elastic properties of tissues, and display it as real time images. This technique can avoid unnecessary invasive liver biopsy.

Patients and methods

This descriptive study was done on 20 chronic

HCV patients as diagnosed by seropositivity for HCV antibodies and HCV RNA by PCR, Patients were recruited from police hospitals outpatient clinics to find an alternative method to assess liver fibrosis.

Results

showed highly significant agreement between fibroscan scores and biopsy results (p value was < 0.001), the identification of patients with significant fibrosis (F ≥ 2) “F2, 3, 4” We reported that the cut off level of significant fibrosis (F ≥ 2) assessed by the METAVIR scoring system was 10.2 kpa, with sensitivity 86.7 % and specificity 80 %. However, cut-off level of 13.8 kpa for the detection of cirrhosis (F4) with an area under the ROC of 0.913, and a very high sensitivity and specificity (sensitivity 90.1% and specificity 85.7%).

Conclusion

Transient Elastography is an easy and quick clinical non-invasive method to perform. Results are available immediately, and this technique is accurate in predicting significant fibrosis ≥f2. Hence, Transient Elastography could be useful not only to evaluate liver fibrosis as to monitor liver disease progression, but also to monitor anti-viral or antifibrotic therapy effects and to help taking decisions in daily clinical practice.
Epidemiological Aspects and Seasonal Variation of Meningitis in Egyptian Patients: a Single-Center Study at Abbassia Fever Hospital from 2006 to May 2017
Authors: Ibrahim Amany Ahmed , Abdelhakam Sara Mahmoud , AlBalakosy Amira Mahmoud , Hussein Amr Mahmoud
Published: October 2021

Background

As a result of dangerous complications caused by Meningitis, early recognition, and rapid starting of therapy is very important.

Objectives

To have an epidemiological profile of patients admitted with meningitis to Abbassia Fever Hospital from year 2006 to May 2017.

Patients and methods

Meningitis Have a seasonal variations. And this study was done to achieve an epidemiological profile of patients admitted with meningitis to Abbassia Fever Hospital from January 2006 to May 2017. Our study was conducted as retrospective descriptive study at Abbassia Fever Hospital from January 2006 to May 2017. on all of patients admitted to Abbassia Fever Hospital by using data Extraction Sheet.

Results

Meningitis was more common in Adult age group 60.8%. Meningitis was more common in males 64.4%. More common in Cairo 60.1%. in Cairo it is more common in Nasr city 8.8%. Seasonal variation of meningitis cases was demonstrated in this study with the highest incidence in winter and Spring. The most common symptom of meningitic patients were fever 89.2% followed by convulsions 12.1%, vomiting 10.% and then Headache 7.8% The most common sign in meningitic patients were neck rigidity in 66%, Kernig’s sign in 60%, and Brudizinski’s sign in 40% of patients. Patient of meningitis had convulsions 18.6% and DCL 30.4%, the convulsion and DCL are related to ICU admission. 30.1% of patients of meningitis admitted to ICU.

Conclusion

Meningitis is more common in males, more common in Cairo.in Cairo it is more common in Nasr city. Meningitis has a seasonal variation commonly, in winter and Spring.
Accuracy of Endoscopic Ultrasound Guided Fine Needle Aspiration In Sampling Of Pancreatic & Gastrointestinal Lesions Using Capillary Versus Suction Technique
Authors: Dabbous Hany M , El-Gemeie Emad E , Okasha Hussein H , Fan Zhining , Zaky Doaa Z , Khaskia Mohammad Almohamady
Published: October 2021

Background

Endosonography (EUS) evolved from purely diagnostic imaging modality to be a method that allows tissue acquisition and therapeutic intervention. EUS-guided fine needle aspiration (EUS-FNA) permits cytological confirmation of imaging findings and is performed with high sensitivity and specificity in addition to low incidence of adverse events. Standard EUS-FNA involve use of either no-suction or suction techniques. New sampling technique; capillary (stylet slow-pull) technique, involves slow withdrawal of the stylet creating a small negative pressure.

Aim of the work

The aim of this study is to compare the quality of samples acquired by capillary technique versus suction technique using 22-gauge needles.

Patients and methods

Patients referred for EUS-FNA for upper gastrointestinal lesions (pancreatic or luminal) were included in the study. Each lesion was sampled twice, the first was taken using suction technique (applying negative pressure suction using standard 10 ml syringe) while the second one by capillary (stylet slow-pull) technique. After sample processing and staining, cytopathologist reviewed the material blinded to the technique used. The quality of samples was assessed regarding 3 aspects; cellularity, sample contamination by blood or mucosal cells.

Results

A total of 51 patients (37/14 males/females, mean age 55.4) referred for EUSFNA were included. Cytological diagnosis was: pancreatic adenocarcinoma in 38/51 (74.51%), Gastrointestinal stromal tumor in 4/51 (7.84%), inconclusive result in 3/51 (5.88%), the rest were solid pseudopapillary neoplasm, Serous cystic neoplasm, Mucinous cystic neoplasm, inflammatory lesions (papillitis, pancreatitis) and metastatic lesion 1 patient for each (1.96%). The sample cellularity score showed no statistically significant difference between both sampling techniques (P = 0.18). Blood contamination score was significantly lower in the capillary technique (P < 0.0001) indicating more blood contamination in suction technique samples.

Conclusion

Both techniques provided comparable diagnostic performance. However, capillary technique showed less sample contamination by blood cells resulting in a slightly better-quality sample.
Evaluation of Lumbar Fusion in Recurrent Disc Prolapse
Authors: Elmor Mohammed Hawary , Hemida Salah Abd Elkhalek , Hammad Omar Yousef , Mostafa Hazem Ahmad , Hamada Salah Mostafa
Published: October 2021

Background

Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy.

Aim of the work

to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy.

Patients and methods

It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&II and III) each group was a fifty patients

Results

the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group

CONCLUSION

Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work
Evaluation of Vertebral derotation in the correction of Adolescent Idiopathic Scoliosis
Authors: Emara Essam A , Taha Hossam S , AbdelGhany Walid A , AbouZeid Ahmed H , Yusuf Mohammad A
Published: October 2021

Background

Adolescent idiopathic scoliosis (AIS) represents a complex three-dimensional deformity. The rotation of the apical vertebrae is primarily responsible for the rib hump that represents the main cosmetic problem for adolescent patients. Correcting rotational deformity and maintaining the normal sagittal profile of the spine is more important than onlycorrecting coronal deformity.

Aim of the Work

to evaluate the efficacy of vertebral derotation using Single Concave Rod Rotation (SCRR) maneuver in the treatment of patients with Adolescent Idiopathic Scoliosis (AIS) by clinical and radiological follow up for 1 year.

Patients and Methods

This prospective analysis was done on 30 patients with AIS, who underwent one stage posterior only corrective surgery with SCRR maneuver between 2016 and 2019 at Ain Shams University Hospitals in order to correct their deformities. All patients included in this study had idiopathic curve between 40 and 80 degrees, with flexibility index < 50%, and their ages were between 10 and skeletal maturity.

Results

Compared to the results obtained by other studies using the same technique, our study included patients with relatively large curve magnitude and the lowest flexibility index, had average coronal correction rate by about 65.5% and minimal correction loss during follow up (-1°). Furthermore, our study included the largest mean preoperative RA. The axial correction rate was average (32.7%) and has the lowest complication rate and better clinical outcome and patient satisfaction among other studies that used SCRR maneuver. However, the mean operating time in our series in the present study was longer than the mean operating time in the literature. The mean amount of blood loss in our study was more than the mean amount in other studies.

Conclusion

Simple concave rod rotation is a good option for correction of the deformed curve in AIS. We can state that simple concave rod rotation with pedicle screw instrumentation and without the use of DVD maneuver could successfully correct both coronal and axial deformity with minimal complication. Adding DVD technique offers a better correction of apical vertebra rotation.
Evaluation of Trans-laminar Facet Screw for Lumbar Spine Fixation and Fusion: A Systematic Review
Authors: Hammad Omar Y , Hamada Salah M , Ismaiel Ibrahim A , El-Etr Walid B
Published: October 2021

Background

Translaminar facet screws are an excellent solution for stabilization of the vertebral motion. It is simple, does not require any specialized equipment, and has the advantages of being a procedure of lesser magnitude, lesser operative time and few complication rate. Recently there is growing interest in this technique to augment the anterior lumbar fusions to achieve global fusion less invasively.

Aim of the Work

to evaluate the role of translaminar facet screw in lumber fixation and fusion inclusion different techniques of translaminar facet screw fixation, its advantages and disadvantages. Methodology: This systematic review included a discussion of all available studies meeting the eligible criteria including: well conducted descriptive studies, cohort, articles, accepted manuscripts, clinical trials, analytic studies and the literature of reviews, technical notes.

Results

The small volume of the metal in comparison with pedicle screw constructs provides faster patient recovery and reduce the rate of infection and also provide an adequate area for placement of bone grafts. The low cost of the implants is an added advantage in view of the rising costs of health care.

Conclusion

Translaminar facet screw fixation is feasible, cheaper and effective in lumbar fixation. The technique is not demanding as transpedicular screw with easier learning curve.
Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora
Authors: Elwan Sheriff , Nada Ossama Tarek , Madbouli Eman Mohamed Salah Eldeen
Published: October 2021

Background

Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi. Punctal stenosis is graded according to punctal sizes examined under slit-lamp biomicroscopy into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (<2 mm) and grade 5: Large slit (>2 mm).

Objective

To assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020.

Patients and Methods

This is an observational study, conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, using non-probability (convenience) sample. It included all patients above 18 years old who presented to the Ophthalmology Outpatient Clinic during the months of January and February 2020 with tearing, proved to be epiphora on clinical examination.

Results

Thirty one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other reported causes of epiphora were: Canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%). Punctal stenosis was more common in females (61.5%) with mean age 58.55 years ± 11.67 SD. Punctal stenosis usually presented as bilateral (93.3%). Regarding ocular history 41% of cases were on topical anti glaucoma treatments. Most patients were medically free (54%).

Conclusion

Incidence of epiphora was 1.6% out of patients attending ASU Ophthalmology Outpatient Clinic. Punctal stenosis incidence was reported to be 68.4%. Most of the cases were females, above 63 years, grade one was the most common, with significant association with the long term use of topical anti-glaucoma medications.
Comparison of Intraocular Pressure before and after Laser in Situ Keratomileusis Measured with Applanation Tonometry, Non Contact Tonometry and Rebound Tonometry
Authors: Gaber Fatma Gebreel Ahmed , El- Raggal Tamer Mohamed , Metwally Mohamed Gamil , Abdelmonsef Ebeid Ahmed
Published: October 2021

Background

Measurement of intraocular pressure (IOP) plays a central role throughout ophthalmology. It is part of routine ophthalmologic examinations and important in the management and follow-up of patients with glaucoma. While elevated IOP remains the most important risk factor for development and progression of open angle glaucoma, at least half of the population diagnosed with open angle glaucoma is asymptomatic.

Objectives

The aim of our study is to compare the accuracy of intraocular pressure measurement before and after Laser in situ keratomeulsis (LASIK) surgery using three different types of Tonometers: Goldmann Applanation tonometry (GAT), Non contact tonometry (NCT) and Rebound tonometry (I care), considering the change in the central corneal thickness (CCT).

Patients and Methods

In this study Eighty eyes of 40 patients with mean age of 27.00±6.00 years were scheduled for LASIK..Central corneal thickness before and after surgery was obtained by Ultrasound (US) pachymetry.IOP values were measured before and after surgery using three different types of Tonometers: Goldmann Applanation tonometry, Non contact tonometry and Rebound tonometry.

Results

The results revealed that lower post-operative IOP measurements using all techniques. The least affected technique was Non –contact with IOP change 16%, followed by GAT with IOP change 18%, and finally Rebound with IOP change 19 %, respectively. The percentage of change in CCT between pre- and post- LASIK surgery measured with the Ultrasound pachymetry was statistically highly significant. There was a clinical significant correlation between Percentage of tissue ablation (PTA) and IOP change for GAT, NCT and rebound tonometry. Also, there was a significant correlation between Residual stromal bed (RSB) and IOP change for GAT and NCT. There was no clinical significant correlation between Ablation depth (AD) and percentage of change of IOP measurements pre and post LASIK, except for IOP measured with GAT when AD < 40.00 µm.

Conclusion

Refractive surgery causes significant lowering of IOP as measured using Goldmann applanation tonometry, non contact tonometry and rebound tonometry. The least affected tonometry post LASIK is non contact tonometry. The reduction was correlated to the percentage of tissue ablated. The ideal method to measure IOP in post-LASIK patients would be a device that is free of corneal factors.
A Comparative Study of the Effect of Different Laser Techniques on the Choroidal Thickness
Authors: Haliem Youssef Islam Naief Abdel , El-Said Gaafar Ayman Abd EL-Moneim , Gaber Salman Abd El-Rahman , El-Shinawy Reham Fawzy
Published: October 2021

Background

Retinopathy is a common and specific microvascular complication of diabetes. Clinical and experimental findings suggested that choroidal vasculopathy in diabetes may play a role in the pathogenesis of diabetic retinopathy. Spectral-domain optical coherence tomography (SD-OCT) can analyze choroidal structure and histopathological changes in diabetes.

Purpose

To compare choroidal thickness (CT) before and after panretinal photocoagulation (PRP), modified grid laser (MGP) and combined (panretinal photocoagulation & modified gird laser) using SD-OCT.

Design

Comparative prospective non-randomized case study, included 30 eyes of 30 patients from both sexes aging from 15 to 60 years. All patients were from Ain-Shams University Hospitals outpatient clinics. Patients were divided into 3 equal groups:

Group A

Patients with PDR underwent PRP, Group B: Patients with macular edema (ME) underwent MGP, Group C: Patients with PDR&ME underwent combined (PRP & MGP). All cases underwent SD-OCT with CT measurement before and at 1 & 3 Mns after laser therapy with assessment of best corrected visual acuity (BCVA).

Results

Mean age of participant was 50.83 ± 5.34 (SD). The mean CT in group A at baseline was 329.00 ± 36.08 μm (SD). This was increased to 336.40 ± 35.64 μm at 1 month then was decreased to 309.10 ± 38.87 μm at 3 Mns after laser therapy. This was showed highly statistically significant difference (P-value = 0.000). In group B the CT at baseline was 328.90 ± 19.69 μm. This was decreased to 313.90 ± 17.83 μm & 288.90 ± 23.10 μm after 1 & 3 months respectively with highly statistically significant difference

(P-value = 0.000). While in group C the mean CT at baseline 329.80 ± 21.06 μm. This was decreased to 318.10 ± 19.25 μm, 300.40 ± 17.98 μm at 1 & 3 months after combined laser respectively. This was showed highly statistically significant difference (P-value = 0.000). There was no statistically significant difference between the studied groups regarding preoperative and postoperative (after 1&3 Mns) CT. There was no statistically significant difference observed between the studied groups regarding preoperative BCVA (P-value = 0.437). While P-value showing highly statistically significant difference between the studied groups regarding postoperative BCVA (P-value = 0.000).

Conclusion

The Choroidal thickness decreased in all 3 studied groups; suggesting that all laser techniques may reduce choroidal vascular permeability or cause atrophy of choroidal vessels over a 12-week period.
Optical Coherence Tomography Angiography Acute of Non-Arteritic Anterior Ischemic Optic Neuropathy
Authors: Ibrahim Karim Ahmed Hussein , Aleem Mohamed Ahmed Abd Al
Published: October 2021

Background

Anterior ischemic optic neuropathy (AION) is divided into arteritic anterior ischemic optic neuropathy (AAION) which accounts for 15% and Nonarteritic anterior ischemic optic neuropathy (NAION) which accounts for 85% of cases. Non-arteritic anterior ischemic optic neuropathy (NAION) is an ischemic change involves the 1 mm thickness of the optic nerve head (optic disc). It affects around 10 cases per 100,000 per year in the age group over 50.

Objective

To assess the optical coherence tomography angiography peripapillary area pattern in diagnosed non-arteritic acute ischemic optic neuropathy patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision.

Patients and Methods

We enrolled 20 patients in cases group and 10 patients in control group were enrolled to assess the OCTA peripapillary area pattern in diagnosed NAAION patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision compared to the pattern seen in the normal control group OCTA, FFA and VF (centralized 30-2 SITA strategy) were done to the cases group. But FFA and VF were excluded in the control group.

Results

The results of our study show statistically significant difference found between the two studied groups regarding central circle perfusion density, middle circle perfusion density (superior, inferior and nasal) and outer circle perfusion density (superior and temporal) while no statistically significant difference found between them regarding middle circle (temporal) and outer circle (inferior and nasal).

Conclusion

So according to this study in cases of NAION (acute stage), we can depend on perfusion density within the middle and outer circle of Early Treatment Diabetic Retinopathy Study (ETDRS) grid put on the disc and peripapillary area. As, these are the areas affected by decreased perfusion density. While, there is increased perfusion density within the central and middle circles, which could be due to, diffuse disc edema.
CYP1B1 Gene Mutation Impact on Prognosis of Primary Congenital Glaucoma
Authors: Mohammad Noha S , Rashad Saad M , el Maamoun Tarek A , Zaki Osama K , Mohamed Thanaa H , Fawzy Samah M
Published: October 2021

Background

Primary congenital glaucoma (PCG) is a leading cause of childhood blindness in Egypt. The discovery of the underlying genetic causes has led to far greater understanding of disease mechanisms. Cytochrome P450, family 1, subfamily B, polypeptide 1(CYP1B1) gene mutations usually inherited in an autosomal recessive manner are one of the major etiologies behind PCG. Gene screening aids early diagnosis of PCG which is a key factor in managing and preventing blindness from the disease.

Aim

This study aims to screen for CYP1B1gene mutations in PCG patients and study its possible impact on surgical outcome of PCG.

Methods

Twenty-four PCG patients enrolled in this study underwent trabeculotomy, and were followed up at a 3 month interval for a year. Patients’ demographic details were recorded, and their genomic DNA was screened for CYP1B1 mutations. Genotypic impact on surgical outcome was compared between the group of patients who harbored mutations and the group unsolved with mutations.

Results

Six different disease causing CYP1B1 mutations were identified in 13 (54.17 %) of affected patients who exhibited more surgical failure at the last follow up visit.

Conclusion

This study further endorses CYP1B1 mutations as a possible etiological and prognostic factor for PCG.