Introduction: A single lumbar hemivertebra can result in a progressive spinal deformity with devastating consequences. Total resection of these hemivertebrae is ideal for correcting these deformities and several alternatives were suggested including anterior and/or posterior approaches. The aim of this study is to evaluate the clinical and radiographic outcome of single stage vertebral column resection (VCR) in children less than 10 years old. Methods: The study was performed between 2000 and 2008 and included 31 patients with a lumbar hemivertebra. The average age was 8 years (range, 6 - 9.5 years). VCR involved laminectomy, excision of the pedicle and hemivertebra, and curettage of both end plates; the gap created was filled with morselized cancellous bone. Short segment posterior instrumentation was performed; the gap was gently closed by compression over the pedicle screws and the remaining autograft bone was placed in the posterolateral gutter. Results: Patients were followed-up for an average of 5.5 years (range 2 – 8 years). The operative time had an average of 235 min (range, 200 – 275 minutes) and the average blood loss was 470 cc (range, 230 - 830 cc). The scoliotic deformity corrected from an average of 43° to an average of 4° postoperatively and an average of 6° at final follow up; kyphosis corrected from an average of 34° to an average of 5° postoperatively and an average of 7° at final follow up. There were no vascular injuries, neurologic insult, implant failure or crank shafting. Conclusion: Single stage posterior VCR with short segment pedicle screw instrumentation is a safe, efficient alternative that offers excellent correction in both sagittal and coronal planes without the need for anterior surgery.

In Egypt, scorpion envenomation is a serious problem. It represents a major cause of morbidity and mortality among children. This study aims to evaluate demographic data, clinical manifestations, laboratory investigations and prognostic indicators of affected children. This work is a prospective hospital based study of scorpion sting envenomation patients. It was performed on 50 children of both sexes. Their ages varied from 1 to 15 years with history of scorpion sting who were presented to Assiut university hospitals from first of August 2011 to first of February 2012. Detailed history, clinical examination and diagnosis of systemic involvements were performed. Hemoglobin concentration, White cell count, Platelet count, Serum urea level, Serum creatinine level and Cardiac enzymes: CPK & LD were measured. Patients were classified according to severity of cases into four grades. This study showed that the most affected age group was from 2 to less than 4 years. Boys affected more than girls. Affection was more in rural areas, during summer and the most common site of sting was lower limbs. Scorpion sting caused a wide range of effects ranging from local pain and parathesia at site of sting to cardiotoxicity, pulmonary edema, encephalopathy and other manifestations. There was a relationship between grade of severity and hospital arrival. There was a significant statistical increase in renal function tests, cardiac enzymes & WBCs number and a non significant reduction in HB concentration. Tachepnea, myocarditis, shock, encephalopathy, and acute pulmonary edema were associated with poor outcome with 18% deaths.

Changing pattern of laryngeal tuberculosis

Objective: To evaluate the role of 3D power Doppler in assessment of adnexal masses vascularity, its ability to discriminate benign from malignant adnexal masses. Then, to determine which one of the 3D power Doppler parameters has the highest reliability for detection of adnexal malignancy. Materials and Methods: A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman’s Health Center, Assiut University, Egypt between October 2012 and October 2013. All patients were evaluated by 3-DPD ultrasound for assessement of tumor vascularization with calculation of vascular indices using Virtual organ computer-aided analysis program. A definitive histopathological diagnosis was obtained in every case to be used as a gold standard. Results: One hundred sixty-one patients were recruited, 115 with benign masses, 46 with malignant masses. The mean vascularization index (16.36 versus 10.98; p0.05), and the mean vascularization-flow index (3.91 versus 2.13; p0.01) were significantly higher in malignant tumors. No significant difference was found in the mean flow index. Chaotic architecture of vessels was significantly associated with malignancy (80.4% versus 6.1%; p0.001) than benign possibility of masses. Also, complex branching pattern of vessels was more significantly present in malignant masses than benign ones (47.8% versus 4.3%; p0.001). 3D power Doppler had a sensitivity of 80%, specificity of 94%, PPV of 84% and NPV of 92% in detection of malignant adnexal masses. Conclusion: Careful evaluation of the architectiure of vessels was the best parameter in evaluation of the masses with 3D power Doppler. Evaluation of branching pattern had a low sensitivity and specificity in detection of malignancy. In spite of no clear cut-off values for vascular indices to be accurate in differentiation of adnexal masses, higher values of vascularization index and vascularization-flow index were strongly associated with adnexal malignancy.

The clinical use of advanced imaging modalities for early determination of infarct size and prognosis is limited. As a specific indicator of myocardial necrosis, cardiac troponin T (cTnT) can be used as a surrogate measure for this purpose. The present study sought to investigate the use of peak and serial 6-hour fixed-time high-sensitive (hs) cTnT for estimation of infarct size, left ventricular (LV) function, and prognosis in consecutive patients with ST-segment elevation myocardial infarction. The infarct size was expressed as the 48-hour cumulative creatine kinase release. LV function at 3 months was assessed using the echocardiographic wall motion score index and LV ejection fraction using radionuclide ventriculography. Adverse outcomes, comprising all-cause death, implantable cardioverterdefibrillator implantation, or hospitalization for heart failure, were recorded at 1 year of follow-up. In 188 patients, the peak and all fixed-time values correlated significantly with the 48-hour cumulative creatine kinase release, wall motion score index, and LV ejection fraction. The hs-cTnT value at 24 hours demonstrated the greatest correlation (r [ 0.86, r [ 0.47, and r [ L0.59, respectively; p 0.001 for all). In the multivariate regression models adjusted for the clinical parameters, almost all were independently associated with the 48-hour cumulative creatine kinase release, wall motion score index, and LV ejection fraction, with the hs-cTnT value at 24 hours having the largest effect. Moreover, all cTnT values independently predicted adverse outcomes, again, with the hs-cTnT value at 24 hours showing the largest influence (hazard ratio 3.77, 95% confidence interval 2.12 to 6.73, p 0.001). In conclusion, not only peak, but all fixed-time hs-cTnT values were associated with infarct size, LV function at 3 months, and adverse outcomes 1 year after STsegment elevation myocardial infarction. The value 24 hours after the onset of symptoms had the closest associations with all outcomes. Therefore, serial sampling for a peak value might be redundant.