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The hard nucleus is considered as a piece of stone, so we use high phaco energy in standard phaco to fragment it. A new technique was described in this paper for nuclear fragmentation in Phacoemulsification, which does not depend mainly on phaco energy but depends on osmotic pressure of the nucleus. The nucleus is a living tissue and has its own special anatomical and physiological rules so we tried to fragment these hard nuclei rapidly and safely without phaco energy at all. This study included 20 patients with hard cataract managed by our new technique. 15 patients with hard cataract managed by divide and conquer technique (control group). we aimed to create a groove with two edges, to inject saline 0.9% at one edge and fixate from the other. Also we aimed from this groove to compensate for relative increase in the size of the nucleus after hydration then we used two blunt choppers to divide the nucleus into four pieces. All pieces were similar to gelatinous mass with no sharp borders. We found that corneal oedema, rupture of posterior capsule and mean effective Phaco time were significantly higher in controls versus patients (P 0.019, P 0.026 and P 0.0001, respectively). While there were insignificant difference in macular edema, increase in intra-ocular pressure and visual acuity parameters between patients and controls (P 0.681, P 0.681 and P 0.944, respectively). In conclusion, the hard nucleus has high osmotic pressure if activated it can fragment itself. Fragmentation of the hard nucleus by simple method rendered it more soft, easily aspirated, with less manipulation. This new technique save energy and its related complications.

The knee is the largest joint in the human body , is the most vulnerable for injury ,and so it is protected by a huge amount of collagen condensations forming very strong ligaments ,tendons ,retinaculae , and capsule. In the sagittal plane we have the ACL , PCL , Patellar tendon , and the quadriceps tendon. In the coronal plane we have the MCL , LCL , Biceps tendon , Popliteofibular ligament and the ILiotibial band . Ligamentous bony avulsions occur after injury in children and adolescents as the ligaments are strongly attached to the perichondrium and also occur in adults when there is relative osteopenia at the ligament attachment sites. A large variety of ligamentous bony avulsions inside and around the knee will be discussed , as well as their different mechanisms of injury , operative fixation modalities and postoperative rehabilitations. Special attention is given to ACL avulsion from tibial side , PCL avulsion from tibial side ,and PLC avulsion at the arcuate fibular head fracture. Also patellar tendon avulsion from tibial tuberosity , quadriceps tendon avulsion in transverse fracture patella , popliteus tendon bony avulsion , capsular Segond bony avulsion , and iliotibial band avulsion at Gerdy`s tubercle will be demonstrated.

Aim: to evaluate the results of the extra capsular dissection versus the conventional superficial parotidectomy in the management of benign parotid tumors. Patients and methods: This is a prospective study of a 46 patients who were treated for benign parotid tumors. They were classified equally into two groups; the extra capsular excision group I and the superficial parotidectomy group II. The evaluation of both techniques included the operative details, the post-operative outcome and complications. Results: The mean operative time for superficial parotidectomy was 172 min., while that of ECD was 44.8min. In the superficial parotidectomy group transient facial nerve paralysis was encountered in 6 cases and permanent facial nerve damage in 2 cases. In ECD group, none of patients had permanent nerve damage while 2 patients had transient facial nerve damage. No recurrence has been encountered in both groups during the follow up period. Conclusion: Extra capsular dissection can be done safely in benign parotid tumors with reduction of side effects and preserving the parotid salivary function more than after radical surgery

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Rheumatic heart, Abscess chest, استئصال جزء من المريء, Remove a portion of the esophagus, Fractures of involvement, Install ribs, Partial lung damage, Lung peeling

Rheumatic heart, Abscess chest, استئصال جزء من المريء, Remove a portion of the esophagus, Fractures of involvement, Install ribs, Partial lung damage, Lung peeling