Galal Hospital Research Articles

Evaluation of Corrective Rhinoplasty in Cleft Lip Nasal Deformity

Background: Cleft lip nasal deformities are challenging problems in all aspects and there are debates about timing, approaches, techniques as well as types of the used grafts. Objective: Evaluation of the results of corrective rhinoplasty in post cleft lip nasal deformity at Al-Azhar University Hospitals (Al-Hussien and Said Galal Hospitals). Patients and Methods: This is a prospective clinical study which included thirty patients having post cleft lip nasal deformity whom underwent corrective rhinoplasty for cleft lip nasal deformity. These patients were managed at AlAzhar University Hospitals (Al-Hussien and Said Galal Hospitals) during the period from May 2017 to January 2019. Results: The vast majority of the operated upon patients had an obvious degree of satisfaction after 6 months to 12 months of postoperative follow up. Conclusion: Autologous cartilaginous grafts are the most suitable type of nasal grafts, and costal cartilage graft is the most superior between them. Further studies are needed to justify if primary rhinoplasty is beneficial or it disturbs the nasal symmetry and leave scared tissues for a potential future intervention.

Ranibizumab Versus Aflibercept for Treatment of Diabetic Macular Edema

Background: Diabetic macular edema, a manifestation of diabetic retinopathy that impairs central vision, affects approximately 750,000 people in the United States and is a leading cause of vision loss. The increasing prevalence of diabetes worldwide highlights the importance of diabetic macular edema as a global health issue. Objective: The aim of this study is to compare the clinical effects and complications of intravitreal injection of Ranibizumab and aflibercept as anti-VGEFs for treatment of patients with diabetic macular edema. Patients and methods: This cross-sectional comparative study involved 40 eyes of 32 patients approved to have diabetic macular edema. All subjects had age and sex matched and they are collected from the Ophthalmology Department, Al-Agoza Police Hospital and Sayed Galal Hospital at the period of March 2017 to March 2019. Results: Comparison between both groups I and II as regard UCVA and BCVA shows a statistically non-significant difference (P>0.05). Visual acuities before and after 6 months of injection in both groups were compared and showed a statistically significant difference as regard VA change (P < 0.05) in Ranibizumab group (I) and highly statistically significant difference (P <0.01) in Aflibercept group (II). Although the effect of both groups in treatment seems to be comparable, significance of aflibercept was superior to ranibizumab as it showed more success in treatment of DME. Conclusion: Our findings suggest a possible benefit of aflibercept over ranibizumab for treating DME. This study equally suggests better efficacy of aflibercept compared to ranibizumab, in patients with worse levels of initial visual acuity.

Serum Cholinesterase Level as a Biomarker in Detecting Liver Injury in Patients with Chronic Hepatitis C

Background: hepatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation. Objective: the aim of this study is to evaluate serum cholinesterase (CHE) level as a biomarker for detecting liver damage in patients with chronic hepatitis C. Patients and Methods: the current study was carried out on 50 subjects selected from the outpatient's clinic of Internal Medicine Department of Sayed Galal Hospital, Al-Azhar University and admitted to the internal department. The study was performed in the period between July-2014 to July -2019. Results: Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C. Cholinesterase is positively correlated with Hb, platelets and albumin. Cholinesterase is negatively correlated with ALT, AST and ALP, total & direct bilirubin, PT, INR, urea, creatinine and AFP. There is significant increase of cholinesterase among compensated compared with decompensated cirrhotic patients. There is significant decrease of cholinesterase among compensated cirrhotic patients compared with controls. There is significant decrease of cholinesterase among decompensated cirrhotic patients compared with controls. Conclusion: cholinesterase is an excellent biomarker of cirrhosis with good sensitivity and specificity. Cholinesterase shows good correlation with albumin, PT, INR and Child-Puch score. Cholinesterase distinguishes decompensated cirrhosis from compensated cirrhosis well.

Sub-urethral Mini Sling versus Transobturator Vaginal Tape for Treatment of Female Stress Urinary Incontinence, One Year Follow-up

Background: Stress urinary incontinence (SUI) is a common problem in women, which accounts about 50% of all incontinent women and affects the quality of life. The mid-urethral sling is the mainstay of SUI treatment over the last years. Tension-free vaginal tape (TVT), has been used as minimally invasive procedure for SUI. Objective: To compare outcomes of sub-urethral minisling and transobturator tape (TOT) for treatment of female SUI, one year follow up regarding operative time, length of hospital stays, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence. Patients and Methods: This comparative study has been conducted in Al-Hussein and Sayed Galal Hospitals; Al-Azhar University; Cairo; Egypt and it included 96 cases, 8 patients missed communication data, 9 refused to participate, 34 in minisling group and 45 in transobturator tape (TOT) group. This a retrospective study for follow up of operated cases during the period from July 2015 to June 2018 at the Urology Department, Al-Hussein, Sayed Galal University Hospitals; Cairo; Egypt. Results: In our study, the minisling operation was associated with nearly the same hospital stay of transobturator tape (TOT). We had early recurrence rate among minisling operation. Finally, the transobturator tape (TOT) operation was associated with less recurrence rate and recurrence time postoperatively compared to the minisling. Conclusion: Minisling when compared to transobturator tape (TOT) for treating SUI; transobturator tape (TOT) yielded better outcomes regarding the postoperative 1 year follow up compared to the minisling.

COMPARISON BETWEEN SUPERFICIAL CERVICAL BLOCK AND MORPHINE TO REDUCE ANALGESIC REQUIREMENTS DURING AND AFTER TOTAL THYROIDECTOMY OPERATIONOPERATION

Background: More than 230 million people undergo surgery each year worldwide, and the number is increasing annually. Surgery causes commonly postoperative pain that should be alleviated as soon as possible to reduce suffering, and to promote the healing process and rehabilitation, and to prevent complications. Pain after thyroid surgery is regarded as being of moderate intensity and short duration. However, during the first 24 h after surgery, some patients require opioid and non-opioid analgesics. Objectives: The aim of this work was to compare the effect of superficial cervical block combined with general anesthesia, intravenous morphine in patients undergo thyroidectomy operation as regard as the heamodynamics intraoperative and post-operative analgesia. Patients and Methods: After obtaining the approval of the Al-Azhar University Ethical Committee, eighty patients of American Society of Anethesiologists (ASA) physical status I or II, scheduled for thyroidectomy operation under general anesthesia were enrolled in this randomized, prospective, clinical trial study. Information about the study were given comprehensively both orally and in written forms to the patients. All patients gave their written informed consents prior to their inclusion in the study. The study was carried out in Al-Azhar University Hospitals (AL- Hussein &Sayed Galal Hospitals). Eighty patients were randomly divided into two equal groups: Group {A} received a bilateral superficial cervical block (15ml per side) with bupivacaine 0.25% after induction of general anesthesia, and Group {B} recived morphine (0.1 mg kg body weight) 15 minutes before induction of general anesthesia. Results: The results of the present study revealed that mean arterial pressure (MAP) and heart rate (HR) were significantly lower in Group (A) compared with group (B). Pethidine requirements during the first 24 h after thyroidectomy were significantly reduced in Group (A) compared with Group (B). At post-operative care unit (PACU) admission, pain scores were significantly lower in Group (A) than in Group (B). Pain scores decreased in the two groups during the 24 h after surgery. Thirty-four patients (42.2%) developed post-operative nausea and vomiting (PONV) in the post-operative care unit (PACU), 8 patients in Group (A), 26 patients in Group (B). Conclusion: Bilateral superficial cervical plexus block (BSCPB) was an effective technique to reduce analgesic requirements during and after thyroid surgery and improved the anethetic outcome more than intravenous injection of morphine.

Serum Cholinesterase Level as a Biomarker in Detecting Liver Injury in Patients with Chronic Hepatitis C

Background: hepatitis C virus can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, HCC and the need for liver transplantation. Objective: the aim of this study is to evaluate serum cholinesterase (CHE) level as a biomarker for detecting liver damage in patients with chronic hepatitis C. Patients and Methods: the current study was carried out on 50 subjects selected from the outpatient's clinic of Internal Medicine Department of Sayed Galal Hospital, Al-Azhar University and admitted to the internal department. The study was performed in the period between July-2014 to July -2019. Results: Sensitivity of cholinesterase is 100%, its specificity is 100% and its accuracy is 100%, in predicting liver injury in patients with chronic hepatitis C. Cholinesterase is positively correlated with Hb, platelets and albumin. Cholinesterase is negatively correlated with ALT, AST and ALP, total & direct bilirubin, PT, INR, urea, creatinine and AFP. There is significant increase of cholinesterase among compensated compared with decompensated cirrhotic patients. There is significant decrease of cholinesterase among compensated cirrhotic patients compared with controls. There is significant decrease of cholinesterase among decompensated cirrhotic patients compared with controls. Conclusion: cholinesterase is an excellent biomarker of cirrhosis with good sensitivity and specificity. Cholinesterase shows good correlation with albumin, PT, INR and Child-Puch score. Cholinesterase distinguishes decompensated cirrhosis from compensated cirrhosis well.

Immediate Outcomes of Trans Radial Approach versus Anatomical Snuff Box Access for Coronary Procedures

Background: Radial Artery catheterization is a fundamental approach that is used as a procedural access in the different catheterization interventions in more than 90% of procedures due to low prevalence of access-related complications. Aim of the work: The aim of the study was to develop and to implement a new radial artery access (located at hand) for performing endovascular interventions. Also, our object to reduce the rate of access-related complications by comparison between the traditional radial access and new trans distal radial approach by history and Doppler investigation and follow up. Materials and methods: This was a clinical trial study that included 100 patients who presented to the Cardiology Departments in El Sayed Galal Hospital to perform planned trans radial coronary angiography and coronary intervention for diagnosis and treatment of ischemic heart events. The study was carried out on 100 patients that were divided into two groups, one group had 50% of patients underwent the procedure through the traditional Trans radial approach and the other half of the patients underwent the procedure through the new approach (The Anatomical Snuffbox). Results: the results revealed that Complication higher in radial but not significant (12% in Snuff- box group and 24% in Radial group). Conclusion: To be proficient with both approaches, the operator needs to understand the differences between these two routes in terms of patient preparation, procedural technique, catheter selection and laboratory setup.

Immediate Outcomes of Trans Radial Approach versus Anatomical Snuff Box Access for Coronary Procedures

Background: Radial Artery catheterization is a fundamental approach that is used as a procedural access in the different catheterization interventions in more than 90% of procedures due to low prevalence of access-related complications. Aim of the work: The aim of the study was to develop and to implement a new radial artery access (located at hand) for performing endovascular interventions. Also, our object to reduce the rate of access-related complications by comparison between the traditional radial access and new trans distal radial approach by history and Doppler investigation and follow up. Materials and methods: This was a clinical trial study that included 100 patients who presented to the Cardiology Departments in El Sayed Galal Hospital to perform planned trans radial coronary angiography and coronary intervention for diagnosis and treatment of ischemic heart events. The study was carried out on 100 patients that were divided into two groups, one group had 50% of patients underwent the procedure through the traditional Trans radial approach and the other half of the patients underwent the procedure through the new approach (The Anatomical Snuffbox). Results: the results revealed that Complication higher in radial but not significant (12% in Snuff- box group and 24% in Radial group). Conclusion: To be proficient with both approaches, the operator needs to understand the differences between these two routes in terms of patient preparation, procedural technique, catheter selection and laboratory setup.

Serum Fibrinogen as Adetection of Severity of Postpartum Hemorrhage

Background: postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth. The most common cause is poor contraction of the uterus following childbirth. However, the placenta being delivered, a tear of the uterus or poor blood clotting are other possible causes. Objective: the aim of the present work was to study the role of serum fibrinogen as a predictor for the severity of postpartum hemorrhage. Patients and Methods: this prospective multicenter study was conducted from February 2017 to October 2017 at Department of Obstetrics and Gynecology, Sayd Galal Hospital, Al-Azhar University. Results: PPH was severe for 43 of the 100 (43%) women included, but not for 75 (57%). Among the women with severe haeb hemorrhage, no women required embolization, 12 ligation of the uterine arteries, and 7 hysterectomy; 7 were transferred to intensive care, 37 received transfusions, and 42 had a postpartum hemoglobin level that decreased more than 4 g litre. None of the women died. Conclusion: the fibrinogen level at PPH diagnosis is a marker of the risk of aggravation and should serve as an alert to clinicians.

Combined Maternal Serum C3 Activation and Uterine Artery Doppler at 14-20 Weeks as Predictors for Pre-Eclampsia in Primigravida

Background: Preeclampsia is a multisystem disorder of pregnancy, which complicates 3%-5% of pregnancies in the western world. It is a major cause of maternal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Objective: This study was aimed to assess the efficacy of C3 estimation and measurement of bilateral uterine artery Doppler before 20 weeks of pregnancy for prediction of preeclampsia in primigravida. Methods: The study was performed at the Antenatal Care Unit, Obstetrics and Gynecology Department, Sayed Galal Hospital, Al Azhar University on 131 pregnant women at 14-20 gestational weeks during period from July 2017 to December 2017 gestation attending. Results: On follow up the population of the study 131 pregnant women had completed the study that were classified to 119 (90.8%) with no pre-eclampsia and 12 (9.2%) developed preeclampsia, As regards the Patients characteristics there was no statistical significant difference between the two groups as regard age, height, weight, gestational age, SBP and DPB at enrollment (p-value>0.05). There was a significant difference regarding BMI as (p value < 0.05), with more increasing BMI and decreasing gestational age at delivery in preeclampsia group in comparison with the no preeclampsia group. As regards the C3, there was statistically highly significant difference between the two groups regarding serum C3 level as p value <0.05, with lower levels of C3 serum levels in preeclampsia group. Receiver operator characteristics (ROC) curves were constructed for estimating the association between pre-eclampsia and serum C3 level. A significant association was found with serum C3 level being a significant predictor with lower values in cases with pre-eclampsia than in normal cases [area under the curve (AUC) = 0.935, 95% CI (0.878 to 0.9711.35), best cut off (≤53.1), sensitivity of 83.3%, specificity of 100% positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.3%. Conclusion: This study demonstrates that lower level of maternal serum C3 in the early second trimester (14-20 weeks gestation) and abnormal increasing in uterine artery indices (PI and RI) are associated with developing pre-eclampsia several months later in pregnancy.

Three-Versus Two-Dimensional Sonographic Biometry in the Third Trimester of Pregnancy for Predicting Birth Weight and Macrosomia in Diabetic Pregnancies

Background: diabetes is the most common metabolic disorder affecting pregnancy. Its prevalence seems to be growing in parallel with the epidemics of overweight and obesity. It‘s considered a modern epidemic disease that affects about 8.3% of adults (accounts for 382 million people of the global population) and 46% of cases are estimated to be undiagnosed. Recognizing and treating diabetes or any degree of glucose intolerance in pregnancy results in lowering maternal and fetal complications. Objective: our aim is to test the hypothesis that incorporating 3D fractional thigh volume would be superior to conventional 2D biometry for predicting birth weight and macrosomia in diabetic pregnancies. Patients and Methods: the study was done on 160 pregnant women suffering from pre-gestational or gestational diabetes at El-Hussien and Sayed Galal Hospitals. All women were evaluated by full obstetrical history taking, physical examination, pelvic examination, transabdominal ultrasound, routine laboratory investigations and assessment of the route of delivery. Results: one-fifth of the patients had macrosomia, and four fifths had no macrosomia. There were no statistical significant differences between macrosomia group and no macrosomia group in maternal age, parity, body mass index, obesity, diabetes, gestational age and gestational age at delivery. The mean ± SD was lower for the 2D than the 3D projected estimate. Our study showed that there were statistical high significant regarding birth weight at delivery and difference from 2D/3D (p < 0.001). Conclusion: we suggest that 2D sonography should remain the standard of care for predicting birth weight and macrosomia in diabetic pregnancies

Three-Versus Two-Dimensional Sonographic Biometry in the Third Trimester of Pregnancy for Predicting Birth Weight and Macrosomia in Diabetic Pregnancies

Background: diabetes is the most common metabolic disorder affecting pregnancy. Its prevalence seems to be growing in parallel with the epidemics of overweight and obesity. It‘s considered a modern epidemic disease that affects about 8.3% of adults (accounts for 382 million people of the global population) and 46% of cases are estimated to be undiagnosed. Recognizing and treating diabetes or any degree of glucose intolerance in pregnancy results in lowering maternal and fetal complications. Objective: our aim is to test the hypothesis that incorporating 3D fractional thigh volume would be superior to conventional 2D biometry for predicting birth weight and macrosomia in diabetic pregnancies. Patients and Methods: the study was done on 160 pregnant women suffering from pre-gestational or gestational diabetes at El-Hussien and Sayed Galal Hospitals. All women were evaluated by full obstetrical history taking, physical examination, pelvic examination, transabdominal ultrasound, routine laboratory investigations and assessment of the route of delivery. Results: one-fifth of the patients had macrosomia, and four fifths had no macrosomia. There were no statistical significant differences between macrosomia group and no macrosomia group in maternal age, parity, body mass index, obesity, diabetes, gestational age and gestational age at delivery. The mean ± SD was lower for the 2D than the 3D projected estimate. Our study showed that there were statistical high significant regarding birth weight at delivery and difference from 2D/3D (p < 0.001). Conclusion: we suggest that 2D sonography should remain the standard of care for predicting birth weight and macrosomia in diabetic pregnancies

One-Site Versus Two-Site Phacotrabeculectomy

Background: surgical treatment for patients with concurrent glaucoma and cataract includes sequential surgery and combined phacotrabeculectomy. When combined surgery is planned, the next issue that must to deal with is whether two-site surgery is better or one-site surgery. Aim: the study aimed to compare the outcomes and to report on the efficacy and safety of the two procedures. Patients and Methods: this prospective randomized comparative interventional study included fifty subjects. Patients were recruited from those who attended to the outpatient Ophthalmology Clinic of Sayed Galal hospital, Al-Azhar University. The study was conducted in the period from October 2016 until May 2018. Patients were randomized into two groups: Group I (n=25), who was subjected to one-site phacotrabeculectomy and Group II (n=25), who was subjected to the two-site procedure performed by one experienced anterior segment surgeon. Results: no significant differences were observed in the main outcome measures of IOP and the need for supplemental antiglaucoma medications between the two glaucoma groups. Conclusion: both surgical techniques were effective in reducing IOP and to eliminate the need for antiglaucoma medications in many eyes over the entire study period.

Microsurgical Reconstruction of Traumatic Lower Extremity Defects in Pediatric Patients: Is Fasciocutanous Flap A Versatile Tool to Replace Musculocutaneous Flap?

The purpose of this report is to evaluate the outcome ofmicrosurgical reconstruction of traumatic lower extremitydefects in children and compare fasiocutenous flaps withmuscle and musculocutaneous flaps. At Al-Azhar UniversityHospitals (Al-Hussien and Sayed Galal Hospitals) in the lasttwo years. 50 free tissue transfers had been performed in 50children. Patients ranged in age from 3 to 16 years old, Thedefect location included the dorsum of foot in 24 cases, medialaspect of foot in 4 cases, lateral aspect of foot in one case,forefoot in 2 cases, heel in 5 cases, ankle in one case, upperthird of leg in 3 cases, middle third of leg in 6 cases, lowerthird of leg in 4 cases and the knee in 2 cases. Flaps used inthis study were myocutenous and muscle flaps (L.D and R.F)in 38 cases, fasciocutenous flaps (A.L.T) in 7 cases, andchiemeric flap (L.D+S.A) in 5 cases. Hospital stay was rangedfrom 5 days to 14 days with an average of 8.8 days. Therecipient's vessels were anterior tibial vessels in 38 cases,posterior tibial vessels in 7 cases, femoral vessels in 2 cases,dorsalis pedis vessels in 2 cases, and popliteal vessels in onecase. The postoperative complications were seen in 13 patientsin the form of venous congestion in three cases, superficialinfection in five patients, delayed wound healing in threepatients, partial necrosis in one case, graft loss in one case,with total flap loss in three cases. One could conclude fromour report that a free fasciocutaneous flap is an excellentoption for lower extremity reconstruction. Our data indicatethat it can be successfully used in all clinical settings, withoutoutcomes equivalent to the more traditional muscle flap.

Prospective Analysis of Pressure Injuries Patients in Relation to Deep Venous Thrombosis

Background: Pressure injuries are a serious complication of multimorbidity and immobility. They are defined as a wound that develops in the upper layers of the skin as the result of sustained, externally applied pressure and then enlarges both radially and into the deeper tissue layers. Objective: It is prospective analysis of the possibilities of occurrence of deep venous thrombosis in pressure injures patients. Patients and methods: This study was conducted to analyze the possibilities of incidence of DVT in pressure injuries patients at AlAzhar University Hospitals; ElHussein and Sayed Galal Hospitals. This study was performed on 30 patients complaining of pressure injuries. The age of the patients ranged from 19 to 59 years and there were 20 males and 10 females. Results: The results of the study revealed that there was no incidence of deep venous thrombosis in 29 patients with pressure injuries during the follow up period. The incidence of DVT of this present research was not statistically significant with only one case of DVT with 0.03% (p = 0.08). Conclusion: From all the above-mentioned data, we might conclude that all patients with pressure injuries had less incidence of deep venous thrombosis. Therefore, we encourage further research and exploration in this promising field that may help in discovering a solution for deep venous thrombosis.

Pathological Fracture of Lower Limb in Children

Background: pathological fractures in children occur from many aetiology. The physician has to develop an individual strategy for management and rehabilitation, considering the biology of bone and the biomechanics at the fracture site to detect pathology of lesion and to reach perfect bone healing. Time-efficient protection and reconstruction of the child’s musculoskeletal system is the aim of the orthopaedic surgeon’s intervention. The whole strategy must be individualized to every situation. Objective: The goals of managing a child’s pathological fracture are all based on establishing a diagnosis. Fracture management is then based on five points:(a) relief the pain; (b) achieve local control of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture healing; and (e) restoration of function. Patients and Methods: Our study was done over 20 cases of pathological fracture of lower limb in children in Al-Azhar University Hospitals (Al-Hossin and Saeid Galal hospitals) from January 2016 to December 2018. Imaging and radiology reports were used to determine fracture types. Complete fractures were classified to four major types: transverse, spiral, oblique and comminuted. In our study we use the Musculoskeletal Tumor Society (MSTS) scoring system to assess functional outcome for each patient. For lower extremity function, the MSTS used a 0-5 scale for the following variables: motion, pain, stability, deformity, strength, functional activity and emotional acceptance. Results: According to our study no patients with fractures underwent amputation, affection of neurovascular structures, or tumour progression on therapy. Pathologic fracture was not an indication for any of the amputation procedures, only the tumour pathology in an indication. Two patients refused surgery. Only one patient had a local recurrence after limb salvage surgery, and underwent no further surgical intervention.

Pathological Fracture of Lower Limb in Children

Background: pathological fractures in children occur from many aetiology. The physician has to develop an individual strategy for management and rehabilitation, considering the biology of bone and the biomechanics at the fracture site to detect pathology of lesion and to reach perfect bone healing. Time-efficient protection and reconstruction of the child’s musculoskeletal system is the aim of the orthopaedic surgeon’s intervention. The whole strategy must be individualized to every situation. Objective: The goals of managing a child’s pathological fracture are all based on establishing a diagnosis. Fracture management is then based on five points:(a) relief the pain; (b) achieve local control of the pathological lesion; (c) skeletal stabilization, preservation of growth, and maintain anatomical alignment; (d) fracture healing; and (e) restoration of function. Patients and Methods: Our study was done over 20 cases of pathological fracture of lower limb in children in Al-Azhar University Hospitals (Al-Hossin and Saeid Galal hospitals) from January 2016 to December 2018. Imaging and radiology reports were used to determine fracture types. Complete fractures were classified to four major types: transverse, spiral, oblique and comminuted. In our study we use the Musculoskeletal Tumor Society (MSTS) scoring system to assess functional outcome for each patient. For lower extremity function, the MSTS used a 0-5 scale for the following variables: motion, pain, stability, deformity, strength, functional activity and emotional acceptance. Results: According to our study no patients with fractures underwent amputation, affection of neurovascular structures, or tumour progression on therapy. Pathologic fracture was not an indication for any of the amputation procedures, only the tumour pathology in an indication. Two patients refused surgery. Only one patient had a local recurrence after limb salvage surgery, and underwent no further surgical intervention.

Role of Platelet-Rich Plasma injection during Modified Radical Mastectomy

Background: platelet-rich plasma (PRP) is a human plasma product enriched by platelets, growth factors, and fibrinogen with high hemostatic and healing properties. Objectives: The aim of this study was to evaluate the effect of autologous PRP on wound healing in women undergoing modified radical mastectomy (MRM). Patients and Methods: In this randomized and controlled trial, 100 females were admitted to El Sayed Galal hospital, Egypt from October of 2017 to August of 2018 for MRM. The patients were randomly assigned to two groups. The intervention group received PRP after surgery, whereas the control group received the usual care. All patients were evaluated at baseline, five days, and 2 weeks after surgery. The primary endpoint used the REEDA scale for assessing the changes in wound healing. The secondary outcome measures used were the Vancouver scar scale (VSS). All scale scores were analyzed using a repeated measures test for the variance. Results: At the end of the study, the PRP group showed a greater reduction in the edema ecchymosed discharge approximation (REEDA) score compared to the control group (85.5% reduction in the PRP group; 72% in the control group) (P < 0.001). Furthermore, patients treated with PRP experienced a 93% reduction in the VAS score at the end of follow-up, but the control group only observed a 79% reduction (P < 0.001). Conclusions: It seems that applying PRP is an effective therapeutic approach for wound healing, and faster wound healing is expected due to the presence of more platelets and growth factors.

Percutaneous Fixation of Split Fracture Tibial Plateau

Background: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. The management of the fracture depends on several factors such as fracture configuration, concomitant soft tissue injury, the patient's age, activity level and bone quality. Tibial plateau fractures may be divided into low energy or high energy fractures. Low energy fractures are common in older patients due to osteoporotic bone and are typically depressed fractures. High energy fractures are commonly the result of motor vehicle accidents, falls or sportsrelated injuries. Split tibial plateau fractures may be treated by closed reduction and percutaneous fixation using cancellous screws and washers, with very good results as recommended by many authors.Objective: the aim of this study was to evaluate the results of closed reduction under fluoroscopic control and percutaneous fixation with cancellous screws 6.5 mm and washers of split type of tibial plateau fractures. Methodology: twenty patients were included in this study; they were admitted to the Department of Orthopedic Surgery, Sayed Galal Hospital and luxor International Hospital, from October 2016 to April 2018. On admission all patients were assessed by history taking, clinical examination and radiological assessment. The mean age of patients in this study was 37.15 ± 11.4 years. Age was ranged from 20 to 55 years. There were 13 males (65 %) and 7 females (35 %). 11 patients (55 %) had right side tibial plateau fracture, while only 9 patients had left side tibial plateau fractures. Results: 12 (60 %) patients had traffic accidents as a mechanism of injury, 4 (20 %) were falling from height, 4 (20 %) had direct trauma. Associated fractures of the head of fibulae was present in two patients (10 %), other associated fractures were Colles' fracture (5%), femoral shaft fracture (5 %) and fracture tibia (5 %).The time till operation varied from two days to five days, but the majority of the cases were done within the first two to three days after admission. The mean duration of follow up was 6.5 ± 2.86 months, ranging from six to eight months. After follow up period the result were assessed according to Rasmussen's grading system, eighteen patients (90%) had excellent results, and two patients (10 %) had good results. Conclusion: tibial plateau fractures represented only 1% of all fractures. If not appropriately treated, the consequences may be severe and have a great social impact. Early mobilization is an important factor in treatment of intra articular fracture, as immobilization result in death of chondrocyte. Percutaneous reduction and fixation technique is a simple procedure if facilitates, equipment and experience are available.

Evaluation of Diagnostic Cerebral Angiography at Al-Hussein Neuro-Intervention Unit

Background: digital subtraction angiography (DSA) is important diagnostic tool for evaluation of cerebral vasculature and provides essential information regarding hemodynamic status and collateral circulation in patients with stroke and vascular malformations, so it is ideal imaging method of choice for diagnosis of cerebrovascular diseases. Aim of the Work: to register all cases undergoing diagnostic cerebral angiography in Al-Hussein University hospital, neuro-intervention unit performed by a neuro-interventional team and evaluate the results, and outcome of this procedure. Materials and Methods: the present study is single-center study included all patients subjected to diagnostic cerebral angiography during period from 2006 to 2018. The study protocol was approved by the local Ethics Committee in Al-Azhar University. The patients had been recruited from Al-Hussein and Sayed Galal Hospital outpatient's clinics, internal departments and stroke units, which indicated for diagnostic cerebral angiography. Results: in the present study the mean age of patients with arterial stenosis was (55.47 ±8.80), 1049(51%) of them were males, 1009(49%) were females. In our study, mild stenosis was present in 254 (12.3%), moderate stenosis in 525 (25.5%), severe stenosis in 567 (27.6 %), subtotal occlusion in 315 (15.3%) and total occlusion in 397 (19.3%) of the patients which detected by DSA. Conclusion: arterial stenosis is more common than cerebral aneurysms and AVM in the patients who subjected to DSA. The presence of hypertension and diabetes mellitus were found to be significantly more prevalent among patients with arterial stenosis. However, the prevalence of hypertension and smoking were more prevalent in cerebral aneurysms.