Purpose: A prospective and retrospective work to evaluate management of post-cholecystectomy biliary injuries. Patients and Methods: From March 2000 to February 2010, 419 patients (224 females and 195 males) complaining of post-cholecystectomy biliary injuries were managed using surgery in 135 patients and endoscopy in 317 patients, in addition to percutaneous techniques in 32 patients. Results: Endoscopy was very successful initial treatment of 317 patients (76%), as being less invasive, with low morbidity and mortality, and being competitive with surgery in treatment of mild/moderate biliary leakage (82%) and biliary stricture (74%). Its success increased by 2.8% and 8.3% for leakage and stricture, respectively, by addition of percutaneous techniques. However, surgery was needed for major leakage and massive stricture in 19% and 14% of cases, respectively. Surgery remains the choice in common bile duct transection, ligation, and combined injuries of stones, stricture, and leakage in 60% of cases. Bilio-enteric anastomosis was the procedure of choice, done in 76 cases, with trans-anastomotic stent in 30 cases with unhealthy or small ducts. Stricture was encountered in 5 cases (6.5%), treated by the percutaneous route in 3 cases and repeat surgery in 2 cases. The learning curve seems influential in both endoscopy and surgery. The cumulative experience increased the success of endoscopy from 60% to 95%. Also, surgery improved with decreased morbidity and mortality. Conclusions: Endoscopy was competitive with surgery in initial treatment of simple problems, but in major leak, ligation, transection, and complex problems, surgery plays the main treatment with its invasiveness and high morbidity and morbidity. Cumulative experience influences endoscopic and surgical treatment of such challenging problems.

Background The association of adipocyte-derived proteins, adiponectin and leptin, with the degree of coronary atherosclerosis has not been not been well elucidated. This study aimed to determine the relationship between serum adiponectin and leptin with the presence and degree of coronary atherosclerosis. Methods Seventy patients and 20 matched controls were recruited. Angiographic evaluation of coronary atherosclerosis was carried out by assessing three atherosclerotic indices, severity (transverse disease), extent (longitudinal disease), and pattern (lesion complexity). Results The independent predictors of atherosclerosis severity were larger waist/hip ratio, followed by higher lowdensity lipoprotein-cholesterol, low serum adiponectin level, older age, higher leptin level, current unstable angina, and finally previous myocardial infarction (MI). This model is a good one as indicated by the model-adjusted r2 (50%). For extent index, lower serum adiponectin level was by far the most important independent predictor, followed by higher low-density lipoprotein-cholesterol, older age, and previous MI, whereas higher serum leptin level was only a univariate predictor. The model-adjusted r2 was 65%. For pattern index, the independent predictors were previous MI, lower serum adiponectin level, larger waist/hip ratio, higher serum leptin level, older age, and higher fasting blood glucose level. The model-adjusted r2 was 62%. Conclusion Both serum adiponectin and leptin might play an important pathogenic role not only in the occurrence but also in the severity, extent, and lesion complexity in coronary artery disease patients. Coron Artery Dis 22:264–269 c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background The association of adipocyte-derived proteins, adiponectin and leptin, with the degree of coronary atherosclerosis has not been not been well elucidated. This study aimed to determine the relationship between serum adiponectin and leptin with the presence and degree of coronary atherosclerosis. Methods Seventy patients and 20 matched controls were recruited. Angiographic evaluation of coronary atherosclerosis was carried out by assessing three atherosclerotic indices, severity (transverse disease), extent (longitudinal disease), and pattern (lesion complexity). Results The independent predictors of atherosclerosis severity were larger waist/hip ratio, followed by higher lowdensity lipoprotein-cholesterol, low serum adiponectin level, older age, higher leptin level, current unstable angina, and finally previous myocardial infarction (MI). This model is a good one as indicated by the model-adjusted r2 (50%). For extent index, lower serum adiponectin level was by far the most important independent predictor, followed by higher low-density lipoprotein-cholesterol, older age, and previous MI, whereas higher serum leptin level was only a univariate predictor. The model-adjusted r2 was 65%. For pattern index, the independent predictors were previous MI, lower serum adiponectin level, larger waist/hip ratio, higher serum leptin level, older age, and higher fasting blood glucose level. The model-adjusted r2 was 62%. Conclusion Both serum adiponectin and leptin might play an important pathogenic role not only in the occurrence but also in the severity, extent, and lesion complexity in coronary artery disease patients. Coron Artery Dis 22:264–269 c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background: Primary liver cancer is the fifth most common cancer worldwide and the third most common cause of cancer mortality. Aim of the work: To evaluate the usefulness of serum IL-6, serum VEGF, and VEGF/Platelets ratio in hepatocellular (HCC) diagnosis. Patients and methods: Fifty-eight cirrhotic patients with hepatocellular carcinoma were included in the study (51 males and 7 females) and 18 liver cirrhosis patients without HCC (15 male and 3 females were recruited as a control group. All patients were subjected to full medical history, clinical examination, laboratory investigations complete blood count, liver function tests, AFP, serum IL-6, serum VEGF and calculation of VEGF/platelets ratio. Results: Patients had significantly higher values of AFP (P=0.0001), IL-6 (P=0.004), VEGF (P=0.001) and VEGF/Platelets ratio (P=0.005) than cirrhotic patients without HCC (control group). Sensitivity and specificity of serum IL-6, VEGF and VEGF/Platelets in detecting HCC, was found to be 34.5 % & 94.4%, 43.1 % & 88.9% and 41.4 % & 88.9% respectively. Sensitivity and specificity of serum IL-6, serum VEGF and VEGF/platelets ratio for detection of portal vein thrombosis were 65.5% & 83.3%, 63,8% & 77,8%, and 58,6% & 72,2% respectively. There was significant positive correlation between VEGF and AFP (r=0.794, P=0.0001), VEGF/Plat and AFP (r=0.760, P=0.0001) and IL-6 and AFP (r=0.804, P= 0.0001). Conclusion: Serum IL-6, serum VEGF, and VEGF/platelets ratio are significantly higher in HCC patient than liver cirrhosis patients without HCC. The clinical utility of these biomarkers in HCC diagnosis is still doubtful because their sensitivity is not more than that of AFP. They may have a good role in detection of portal vein thrombosis (tumor invasion).

Introduction: Dr. Ponseti has changed the world of Orthpaedics by showing physicians around the world how to treat congenital clubfoot in a safe, minimally invasive, foot-friendly, and highly effective way. This is a preliminary report of the results of Ponseti method since its introduction at Assiut University Hospital, Egypt, early in 2006. Material and Methods: A total of 254 patients (405 clubfeet, including 30 with arthrogryposis, 25 with Myelo-meningocele and 6 with sacral agenesis) have been treated with Ponseti method and studied prospectively by a single orthopedic surgeon since 2006 at our institution. Of these, 321 feet (202 patients) reached full correction and received an abduction brace. Mean follow-up was 10.6 months (1 month to 5.8 years). The mean age at the initiation of the treatment was 5.3 months. Pirani Score averaged 4.5/6. 190 feet were previously untreated, 102 had received non-Ponseti casts, and 20 had been operated upon. Number of casts averaged 4. Local abduction braces were used until recently; the Bangla Brace was introduced through a donation from Walk for Life, Bangladesh. Necessary surgical interventions were recorded. Results at latest follow-up visit were evaluated and recorded as either satisfactory (plantigrade & flexible foot, valgus heel, little/no dynamic supination) or unsatisfactory. Results: 281 feet (87.5%) were satisfactory at the latest follow-up visit (mean 10.6 months). Achilles tenotomy was done in 204 feet (63.5%) only. Ninety-two feet (28.7%) relapsed and were remanipulated, while 13 underwent Tibialis anterior transfer, and 2 needed a midfoot osteotomy. Compliance to bracing was poor. Conclusion: Ponseti method shows promising results in Assiut, Egypt. Further investigation of the considerably low Achilles tenotomy rate is underway. Access to cheap & well-made braces might improve compliance.

1- Early versus late brachial plexus reconstruction in brachial plexus birth palsy Introduction; Timing of surgical intervention for obstetric brachial plexus palsy is still a depadable issue for most microsurgeons. This study aims at ellucidating the results of surgical intervention before and after the age of one year. Materials and methods; From January 1998 to September 2010, 100 patients suffering from brachial plexus birth palsy were treated by surgical reconstruction of brachial plexus. Patients were evaluated for functional recovery by Toronto scale. Follow up period was 1-8 years. Results; Functional results were compared as regards the age, type of reconstruction (neurolysis vs grafting vs neurotization). Conclusion; The earlier the surgical intervention, the better results, however this was not statistically significant untill the age of one year. 2- Late tendon transfer around the shoulder in neglected obstetric brachial plexus palsy cases Different surgical protocols for correction of internal rotation deformity secondary to OBPP have been described. It has been well identified that secondary bone changes starts at 2 years age and are complete at 4 years. Tendon transfer has been advocated to be performed before age of 4 to reverse these bony changes. Tendon transfer has been done for older age group instead of corrective osteotomy to obtain better function rather than cosmetic correction, where most patients complain of incomplete internal rotation. The need for anteriror release should be tailored according to each case. Tendon transfer can be performed in older age group with completed secondary bone changes. 3- Recovery of hand function after microsurgical reconstruction of brachial plexus birth palsy Introduction and aim of work; One of the most difficult missions is restoration of hand function in total obstetric brachial plexus palsy. Materials and methods; From January 1996 to June 2003, 39 total obstetric brachial plexus palsy were treated at The Reconstructive Microsurgery Unit, Assiut university by microsurgical reconstruction. Different techniques were used according to nature of lesion, avulsion or rupture. This included neurolysis, grafting and neurotization. Patients were evaluated and followed up for at least 4 years. Results and conclusion; Using Toronto scale, results were compaerd regarding type of lesion, age at surgical intervention and technique of reconstruction. 4- Results of Intercostal nerves neurotization in obstetric brachial plexus palsy cases Introduction and aim of work; Intercostal nerves are well known donor nerves for neurotization in brachial plexus surgery. The aim is to elucidate the results of using intercostal nerves for different recepient nerves. Materials and methods; From January 1998 to June 2006, 38 patients with OBPP were treated by intercostal nerves neurotization. The recepient nerves included musculocutaneous nerve (20 cases), Lateral root of median nerve (15 cases), Radial nerve (5 cases), Medial root of Median nerve (4 cases), Lateral cord (3 cases), Axilary nerve and ulnar nerve (2 cases each), suprascapular nerve (one case). Patients were evaluated using Toronto scale. Results and conclusion; Results were compared as regard number of intercostal nerves used, age at surgical intervention, and recpient nerve.

Background: Aluminum (AL) is toxic to the central nervous system, and Nigella Sativa (NS) reduces lipid peroxidation by its antioxidant activity. Objective: This study was carried out to investigate the histological changes in the cerebellar cortex of rats after AL treatment and to detect any possible protective role of NS when given concomitantly with AL. Materials and methods: This study was carried out on 25 adult male albino rats, each one weighing 100 g. They were divided into five groups: Control group (5 rats) received no treatment, Group I (NS treated group) (5 rats) received nigella sativa oil only at a dose level of 1ml/kg orally for 1.5 month. Group II (AL-treated group) (5 rats) received aluminum chloride daily in a dose of 320 mg/kg/L added to the drinking water for 1.5 month. Group III (AL + NS) (5 rats) received NS with AL for 1.5 month in the same dose of AL and NS of the two previous groups. Group IV (withdrawal) (5 rats) received AL only without NS in the same previous dose of AL for 1.5 month and then animals left without treatment for another 1.5 month . The animals of each group were randomly divided into two subgroups; the first was processed for light and the second for transmission electron microscopic study. The sections of the cerebellar cortex for light microscopic study were stained with Hematoxylin and Eosin and Toluidine blue (semithin sections). Morphometric and statistical analysis were conducted. Results: The NS treated group showed non-significant changes compared to control. After AL administration, the cerebellum exhibited degenerative changes in Purkinje cells and in granular layer as well as significant reduction in the number of Purkinje cells and prominent perineuronal spaces in the molecular layer around basket and stellate cells and in the Purkinje cell layer. Ultrastructurally, some of the few encountered Purkinje cells showed swollen mitochondria with ruptured membranes and cristae. Granule cells were rich in mitochondria which were variable in size and shap in addition to presence of irregular areas of degeneration. Concomitant administration of NS with AL displayed an observable protection against these changes. Withdrawal group showed degenerative changes and a significant difference compared to NS + AL group. Conclusion: NS may have a protective role against AL-induced cerebellar toxicity in humans.

Unlike other rodents, organogenesis is shown to be completed during the fetal period in the spiny mice. Rodent submandibular salivary glands are characterized by a highly specialized portion of the ductal system called granular convoluted tubules (GCT), whose secretory cells synthesize a variety of growth factors. These factors may have a functional role in cell migration, proliferation and maturation within not only salivary glands but also other organs. Absence of the granular convoluted tubules from the submandibular gland of laboratory mice in the first week postnatally is documented, and the structure of such gland in the spiny mice has not been mentioned previously. So, The present work aimed to study the structural difference of the submandibular salivary gland in the spiny mice, in comparison to the corresponding age of laboratory mice. Material and Method: Tissue specimens of submandibular salivary gland were collected at the 7 th postnatal day from both species, and then processed for light and electron microscopic examination. Immunohistochemical study using epidermal growth factor (EGF) and chromogranin (CgA) was done. Results: On the contrary to laboratory mice aged one week postnatally, spiny mice submandibular gland of the same age showed well developed secretory unites and ductal system including the GCT. Conclusion: Well developed neonate spiny mice submandibular gland (early appearance of granular convoluted tubules) may refer to the role of growth factors in organogenesis. Keywords: Spiny mice, salivary gland, neonate

Background: Age-related changes in the retina are often accompanied by visual impairment. Oxidative injury and inflammation are intimately involved in the aging process and the development of age-related diseases. Green tea has been shown to have antioxidant and antiinflammatory effects on various types of cells. It contains a series of polyphenols called catechins and has been applicable for disease prevention and treatment. Aim of the study: to investigate the effects of green tea intake on age related changes in retina. Material&Methods: 30 female albino rats were divided into three equal groups; group I (control adult):6 months old, group II (aged):18 months old, group III (green tea treated): 12 months old rats received green tea daily at a dose of 300 mg/kg body weight in 1.5 ml distilled water orally by a gastric tube for 6 months. Retinal specimens from all groups were processed for light and electron microscopical examination. Statistical analysis was carried out to measure the retinal thickness in the three studied groups. Results: There were a degenerative changes in some layers of the retina.The ganglion cells appeared more vulnerable to age-related loss than other retinal cells. A significant reduction in the Retinal thickness was observed with ageing. Also, there was a significant increase in astrocytes number. After treatment with green tea, a recovery of both structural changes and retinal thickness was observed. Conclusion: Aging induced marked changes in the retina.These changes were mostly normalized after intake of green tea.

Electrocution induces several alterations of the heart, skin, blood vessels, muscles, and nerves. The main objective of the present study was to investigate possible alterations of the sciatic nerve of rats exposed to 220 V for 5 seconds by light and transmission electron microscope (TEM). Electric current was applied on the thigh region near by the gastrocneamus muscles of rats. The Sciatic nerve and the muscles were taken immediately fixed in 10% Neutral buffered formalin and 4 % cold glutraldehyde and processed for both light and TEM and stained by toulidine blue and lead acetate respectively and photographed by image soft ware. Light microscope showed irregularity of the shape with elongation of the sciatic nerve compared to the control. Moreover, annulations of the myelin sheath were detected. Mast cell infiltration were observed around the myelin sheath and suggested a response of the nerve tissue to injury may occurred. TEM showed the myelin sheath of non-exposed rats had no remarkable changes morphologically. The thickness of myelin sheath of non-exposed nerves was ranged from 1.41+ 0.7 micron. While the exposed nerve had remarkable increase in the thickness and was 1.69 + 0.8 micron. The exposed nerves had fragmentation either in localized area of the nerve and appeared bulby or onion-like or totally surround the whole nerve. No changes were observed in Schwann cells. Mast cells were detected around the affected nerves and had shown empty vesicles and suggested degranulation occurred. These results can be a helpful tool in forensic toxicology .