AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases inclu...AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.展开更多
Background Data: Recurrent lumbar disc herniation means re-herniation of disc on the same site and at the same level where a previous discectomy had been performed: recurrent lumbar disc herniation occurs in 7% to 24%...Background Data: Recurrent lumbar disc herniation means re-herniation of disc on the same site and at the same level where a previous discectomy had been performed: recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Tow mean surgical options after reherniated lumbar disc are revision discectomy alone or revision discectomy with fusion discectomy alone in recurrent lumbar disc herniation may not be an efficient treatment without fusion. Objective: To evaluate the efficacy and safety of revision discectomy with fusion in management of recurrent lumbar disc. Study Design: Retrospective study reviewed all patient underwent revision discectomy with fusion, they were 40 patients operated for recurrent lumbar disc from September 2014 to April 2018 in Al-Azhar University Hospital Damietta. Pre- and post-operative data collection and analysis of the outcome were completed based on the “Japanese Orthopedic Association score” (JOAs), and radiographic follow-up. Patients and Methods: 40 patients (30 male and 10 female) underwent revision discectomy with fusion as surgical management for reherniated lumbar disc from September 2014 to April 2018. All patients presented with low back pain and radicular pain with mean duration of 18 months. The patients were investigated by standard plain X-ray CT SCAN and MRI of the lumbar spine. All patients had a discectomy and postero-lateral fusion in revision surgery. These patients followed post operatively clinically for improving pain and neural function, and radiologically for disc removal stability and fusion. Results: The age ranged from 30 to 60 years, mean age was 45 years, male to female ratio 3:1. Follow-up ranged from 18 - 30 months with a mean follow-up 24 months. 30 patients had an excellent outcome, 6 patients had a good outcome, 2 patients had a fair outcome, and 2 patients had a poor outcome. Conclusion: Recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Revision surgery when indicated can be done by various techniques. Revision discectomy with fusion for reherniated lumbar disc is effective and safe with confident results.展开更多
Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all pa...Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.展开更多
Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion...Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.展开更多
Due to randomness of wind generator＇s availability, power system planners have big concern on EEG （expected energy generation） and system reliability of power system with wind generators. This paper presents a meth...Due to randomness of wind generator＇s availability, power system planners have big concern on EEG （expected energy generation） and system reliability of power system with wind generators. This paper presents a methodology to evaluate the EEG as well as overall LOLP （loss of load probability）, which is an index for system reliability of multi-area interconnected systems with wind generators, as well as conventional fossil fuel based generating units. The proposed model is also capable of tracking the energy export incorporating the multi-state probability model for wind generator which output varies with time and season.展开更多
Thirty three benthic foraminiferal species belong to 23 genera and 16 families have been recorded from the coral reefs of the Callovian Tuwaiq Formation, Khashm AI-Qaddiyah area, Central Saudi Arabia. Three species： ...Thirty three benthic foraminiferal species belong to 23 genera and 16 families have been recorded from the coral reefs of the Callovian Tuwaiq Formation, Khashm AI-Qaddiyah area, Central Saudi Arabia. Three species： Astacolus qaddiyahensis, Nodosaria riyadhensis, Siderolites jurassica are believed to be new. Nearly all identified foraminifera are of Atlantie-Miditeranean affinity. The foraminiferal assemblage recorded in the present work is mixed of open marine, moderately deep marine conditions associations and shallow to deep lagoon. The reefal part of upper Twiaq Formation may have been deposited in shallow water of lower to middle shelf depth （20-50 m） as indicated by abundant corals and benthic foraminifera. The coral fauna and bearing benthic foraminifera indicated moderate water energy.展开更多
Obesity is a common disorder that has a significant impact on human health as it may lead to many serious diseases and sometimes morbidity.Previous genome-wide association studies(GWAS)confirmed that there is a relati...Obesity is a common disorder that has a significant impact on human health as it may lead to many serious diseases and sometimes morbidity.Previous genome-wide association studies(GWAS)confirmed that there is a relationship between some variants in the first intron of the fat mass and obesity associated(FTO)gene and obesity in adults and children in different ethnic groups.In our study,the association of the FTO rs9939609 and rs17817449 variants with obesity was investigated in Egyptian children and adolescents.We examined rs9939609 and rs17817449 polymorphisms in 100 control and 100 obese cases,we used the restriction fragment length polymorphism(RFLP)technique to genotype the samples.The current study showed that there were no significant differences(P>0.05)between the cases and controls in both variants of rs17817449 and rs9939609 polymorphisms.However,there were significant correlations between rs17817449 and cholesterol and between rs9939609 and LDL.In Current Study although the two variants(rs9939609 and rs17817449)didn’t show an association with obesity,but there was a correlation between the lipid profile and these two variants.展开更多
文摘AIM: To evaluate the efficacy and safety of botulinum toxin type A(BTX-A) in the management of patients with anismus. METHODS: An organized search of published literature was conducted using electronic databases including: Pub Med/MEDLINE, and Cochrane Central Register of Control ed Trials, also an internet-based search using "Google Scholar" service was conducted. Both comparative and observational studies were included. We excluded irrelevant articles, editorials, case reports, reviews, and meta-analyses. The studies that followed the patients less than 6 mo were excluded. Variables collected were demographic data of the patients, technique of BTX-A injection and number of sessions, short-term and longterm clinical improvement, post-injection changes in electromyography(EMG), defecography, manometry, and balloon expulsion test, and complications recorded after BTX-A injection.RESULTS: Seven studies comprising 189 patients were included in the review. The median age of the patients was 41.2 years and female-to-male ratio was 1.3:1. The median dose of BTX-A injected per procedure was 100 IU(range, 20-100 IU). Lateral injection was done in five trails and combined lateral and posterior injections in two trials. Three studies used endorectal ultrasonographyguided technique, one study used EMG-guided technique,whereas the remaining three studies used manual palpation with the index finger. The median percentage of patients who reported initial improvement of symptoms was 77.4%(range 37.5%-86.7%), this percentage declined to a median of 46%(range 25%-100%) at 4 mo after injection of BTX-A. Rates of improvement evaluated by balloon expulsion test, EMG, and defecography ranged between(37.5%-80%),(54%-86.7%), and(25%-86.6%), respectively. Fourteen(7.4%) patients developed complications after injection of BTX-A. Complication rates across the studies ranged from 0% to 22.6%. CONCLUSION: Initial satisfactory improvement of symptoms after BTX-A injection remarkably deteriorated after 3 mo of the procedure. However, repeated injection may provide better sustained results with no additional morbidities. Further analysis of more patients is necessary to conclude the safety of BTX-A for the treatment of anismus.
文摘Background Data: Recurrent lumbar disc herniation means re-herniation of disc on the same site and at the same level where a previous discectomy had been performed: recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Tow mean surgical options after reherniated lumbar disc are revision discectomy alone or revision discectomy with fusion discectomy alone in recurrent lumbar disc herniation may not be an efficient treatment without fusion. Objective: To evaluate the efficacy and safety of revision discectomy with fusion in management of recurrent lumbar disc. Study Design: Retrospective study reviewed all patient underwent revision discectomy with fusion, they were 40 patients operated for recurrent lumbar disc from September 2014 to April 2018 in Al-Azhar University Hospital Damietta. Pre- and post-operative data collection and analysis of the outcome were completed based on the “Japanese Orthopedic Association score” (JOAs), and radiographic follow-up. Patients and Methods: 40 patients (30 male and 10 female) underwent revision discectomy with fusion as surgical management for reherniated lumbar disc from September 2014 to April 2018. All patients presented with low back pain and radicular pain with mean duration of 18 months. The patients were investigated by standard plain X-ray CT SCAN and MRI of the lumbar spine. All patients had a discectomy and postero-lateral fusion in revision surgery. These patients followed post operatively clinically for improving pain and neural function, and radiologically for disc removal stability and fusion. Results: The age ranged from 30 to 60 years, mean age was 45 years, male to female ratio 3:1. Follow-up ranged from 18 - 30 months with a mean follow-up 24 months. 30 patients had an excellent outcome, 6 patients had a good outcome, 2 patients had a fair outcome, and 2 patients had a poor outcome. Conclusion: Recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Revision surgery when indicated can be done by various techniques. Revision discectomy with fusion for reherniated lumbar disc is effective and safe with confident results.
文摘Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.
文摘Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.
文摘Due to randomness of wind generator＇s availability, power system planners have big concern on EEG （expected energy generation） and system reliability of power system with wind generators. This paper presents a methodology to evaluate the EEG as well as overall LOLP （loss of load probability）, which is an index for system reliability of multi-area interconnected systems with wind generators, as well as conventional fossil fuel based generating units. The proposed model is also capable of tracking the energy export incorporating the multi-state probability model for wind generator which output varies with time and season.
基金funded by King Saud University, Deanship of Scientific Research, College of Science Research Center
文摘Thirty three benthic foraminiferal species belong to 23 genera and 16 families have been recorded from the coral reefs of the Callovian Tuwaiq Formation, Khashm AI-Qaddiyah area, Central Saudi Arabia. Three species： Astacolus qaddiyahensis, Nodosaria riyadhensis, Siderolites jurassica are believed to be new. Nearly all identified foraminifera are of Atlantie-Miditeranean affinity. The foraminiferal assemblage recorded in the present work is mixed of open marine, moderately deep marine conditions associations and shallow to deep lagoon. The reefal part of upper Twiaq Formation may have been deposited in shallow water of lower to middle shelf depth （20-50 m） as indicated by abundant corals and benthic foraminifera. The coral fauna and bearing benthic foraminifera indicated moderate water energy.
文摘Obesity is a common disorder that has a significant impact on human health as it may lead to many serious diseases and sometimes morbidity.Previous genome-wide association studies(GWAS)confirmed that there is a relationship between some variants in the first intron of the fat mass and obesity associated(FTO)gene and obesity in adults and children in different ethnic groups.In our study,the association of the FTO rs9939609 and rs17817449 variants with obesity was investigated in Egyptian children and adolescents.We examined rs9939609 and rs17817449 polymorphisms in 100 control and 100 obese cases,we used the restriction fragment length polymorphism(RFLP)technique to genotype the samples.The current study showed that there were no significant differences(P>0.05)between the cases and controls in both variants of rs17817449 and rs9939609 polymorphisms.However,there were significant correlations between rs17817449 and cholesterol and between rs9939609 and LDL.In Current Study although the two variants(rs9939609 and rs17817449)didn’t show an association with obesity,but there was a correlation between the lipid profile and these two variants.
