Evaluation of Different Techniques in Diagnosing Chlamydial Endocervical Infection The Egyptian Journal of Hospital Medicine Vol., 3 : 1- 13 June 2001
I.S.S.N: 12084

Effect of "Ginseng" administration on the structural and
ultrastructural changes produced by restraint stress in the
liver cells of albino rats

Mona A.R. Salem
Histology Dep., Faculty of Medicine AL. Azhar Univer (Girls)


This study aimed to assess the antistress effects of "Ginseng" in cases of chronic
restraint stress by studying the structural and ultrastructural changes of the liver cells.

Fifteen adult male albino rats were used. They were divided equally into 3
groups: control, stress and stress/Ginseng groups. Restraint stress was applied to both
stress and stress/Ginseng groups 4 hours every other day for 4 weeks.15 mg
Ginseng/kg/ was given to stress /Ginseng group every other day for 4weeks.

Examination of liver specimens processed for both light and electron
microscopic study revealed that chronic restraint stress causes fatty degeneration which
may proceed to necrosis of the liver cells. A hepatoprotectective effect of ginseng was


Stress is a force that disrupts the
Restraint stress is a physical
usual physical or psychological state.
stress known to cause anxiety and
emotional upset which play an
stresses have important effects on the
important role in the mechanism of
cardiovascular system (Capel et. Al.,
stress induced changes. Panax Ginseng
has been demonstrated to suppress the

Chronic environmental diverse
agents as exposure to cold, surgical
psychological stress (Takahashi et al.,
injury, excessive muscular exercise,
noise, shaking (oscillation) and restraint
stresses were defined by Ceremuzyniski
endurance for physical and mental
et al., (1991) as stressors.
work, increase non specific resistance to
Stress could be an etiological
stress during a prolonged stay in
factor of some disorders as reduced
psychologically adverse habitants are
activity, behavioral and endocrinal alte -
called "adaptogens". Panax ginseng is
rations, reduced food intake, hypergl -
well known for its antistress and
ycemia, hyperacidity and increased
adaptogenic properties. It has been used
heart rate (Simmons et al .1990).
as a herbal medicine for treating many

Refree : Prof ; Hekmat A.M. Sorour


Full Paper (vol.3 paper# 1)

Effect of ACE inhibitors on Creatinine Clearance The Egyptian Journal of Hospital Medicine Vol., 3 : 14 ­ 20 June 2001
I.S.S.N: 12084

Effect of ACE inhibitors on Creatinine Clearance
and albuminuria in diabetic nephropathy

Mona Hosny Abdel-Salam
Internal Medicine Department
Ain Shams University


30 diabetic female patients were studied for the effect of Ramipril on creatinine
clearance and albuminuria, they all were type 2 diabetes mellitus and were on oral
hypoglycemic drugs. They all had variable degrees of hypertenison. Ramipril was taken
for 3 months in a variable doses between 5 and 10 mg/day. Creatinine clearance and
albuminuria were determined before and after treatment. Patients were divided into 3
Group 1: 10 patients with albuminuria and mild hypertension.
Group 2: 10 patients with albuminuria and moderate hypertension.
Group 3: 10 patients with macroalbuminuria and moderate to severe hypertension.
In our study, Group 1 has made maximum benefit of Ramipril as regards highly
significant decrease (P= .002) of creatinine clearance and of albuminuria which
improved significantly (P=.001).

Group 2 had a lesser success with only decrease of albuminuria significantly
(P=.005) but with insignificant decrease of level of creatinine clearance.

Group 3 with macroalbuminuria did not benefit from Ramipril effect on
albuminuria but there was a significant decrease in creatinine clearance below normal
levels (P=.001).
Conclusion: Early and tight control of blood pressure by Ramipril is needed to achieve a
success in treating diabetic nephropathy with microalbuminuria. In our study, patients
with macroalbuminuria did not benefit from Ramipril treatment.


It has now become obvious that type 2
glomerular filtration rate (GFR). ACE
diabetes must be taken every bit as
inhibitors have beneficial effects on the
seriously as type 1 diabetes, in part
permeability and size-selective function
because of its renal complications.
of the glomerulus; these effects would
Moreover, some recent and encouraging
lead to limited ultrafiltration of
nephropathy and deterioration of renal
(Ruggenenti et al., 1997).
function are to a certain extent

Ramipril Efficacy in nephro -
preventable (Ritz et al., 1999).
pathy (REIN) study found that in

In diabetic nephropathy, angiot -
patients with chronic nephropathies and
ensin ­ converting ­ enzyme (ACE)
proteinuria, ramipril safely reduced the
inhibitors have a greater effect than
rate of decline of the glomerular
other antihypertensive drugs on prot -
filtration rate (GFR) and halved the risk
einuria and the progressive decline in
of doubling of serum creatinine or end-
Refree : Prof . Dr; Adel Afifi

Full Paper (vol.3 paper# 2)

PARAVERTEBRAL AND EPIDURAL BLOCKS FOR POST THORACOTOMY PAIN The Egyptian Journal of Hospital Medicine Vol., 3 : 21 ­ 35 June 2001
I.S.S.N: 12084

Paravertebral And Epidural Blocks For Post Thoracotomy Pain

Fatma A. A. Zorob, Amira M. Nassar, And Tarek El-Said
Anesthesia department, Faculty of Medicine for Girls,
Al-Azhar University.

Abstract :
Thoracic anesthesia offers particular challenge. Thoracic patients frequently have a
painful wound after surgery. So analgesia after thoracic surgery is of particular
significance. In the present study we assessed the efficacy of thoracic paravertebral and
epidural blockade on post thoracotomy pain and pulmonary function. Thirty adult ASA
I-III patients undergoing elective thoracic surgery were enrolled in this study. they were
randomly divided into two groups : paravertebral and epidural group (15 patients each).
Both percutaneous paravertebral and epidural catheters were placed preoperatively.
Before chest closure each patient received a bolus dose of bupivacaine (0.25 %)
according to its height. This was followed by postoperative bupivacaine infusion (0.25
%) 0.1 ml kg-1h ­1 in both groups. Also patients were encouraged to take supplementary
doses of morphine from a patient controlled analgesia (PCA). Subjective pain relief was
assessed on a linear visual analogue scale and pulmonary function was measured by
spirometry. Stress responses to noxious stimuli was assessed by plasma levels of
cortisol and glucose. Respiratory variables were recorded throughout the study period.
Also sensory level of analgesia and performance status were assessed in the two groups.
Although we found significantly lower visual analogue pain scores at rest and on
maximal coughing in the paravertebral compared to the epidural group, no significant
difference in patient controlled morphine requirements was noted between the two
groups. Pulmonary function (FVC, FEV1 and PEFR) was significantly better in the
paravertebral group. Meanwhile no significant difference in respiratory variables was
recorded between the two groups. Paravertebral block produced significantly
diminished stress responses to noxious stimuli as manifested by less increase in plasma
cortisol level than in epidural block. Sensory levels of analgesia and performance status
was similar in both groups. Side effects as hypotension, urine retention, nausea and
difficulty in breathing were troublesome in the epidural group. While nausea and
difficulty in breathing were less in paravertebral group. Conclusion : Like epidural
analgesia, paravertebral block deserves to be considered for post thoracotomy pain

Introduction :
Thoracotomy with its associated
nervous system hypersensitivity are
pathophysiological abnormalities prod -
implicated as the main causes of post
uce one of the most damage insult
thoracotomy pain (Sabanathan et al.,
which it is possible to inflict on
1993). Relief of this pain is beneficial to
patients. Severe chest wall trauma,
patient providing comfort, facilitating
damaged peripheral nerves and central
Refree : Prof ; Talaat Abd El-Halim

Full Paper (vol.3 paper# 3)

Serum levels of soluble CD95 in patients with The Egyptian Journal of Hospital Medicine Vol., 3 : 36 ­ 46 June 2001
I.S.S.N: 12084

Serum levels of soluble CD95 in patients with
systemic lupus erythematosus

Magda I. M. El-Mahdy , Fatma A. Mourad* and Wafaa Afify M.H.**

Clinical Pathology , Internal Medicine* and Dermatology** Departments
Faculty of Medicine for Girls, Al Azhar University

The present study was carried out on 30 patients with systemic lupus
erythematosus (SLE) and ten apparently healthy individuals as a control group.Systemic
lupus erythematosus activity index (SLEDAI) was applied to all patients. Anti-double
stranded DNA antibodies (Anti-dsDNA Abs.) , interleukin-18 (IL-18) and soluble
CD95 (Apo-1/Fas) were determined in the sera of all studied subjects. The mean ±SD
SLEDAI in all patients was 15.25± 6.76 . The anti-dsDNA antibodies was positive in
all studied patients (mean ± SD 264.36 ± 114.85 IU/ml). Serum IL-18 showed
significant elevation in SLE patients as compared to the control group (Mean ±SD
246.13± 114.32I U/ml vs. 45.5 ± 7.32 IU/ml ; p < 0.001). Serum Soluble CD95
(sCD95)showed significant increase in all SLE patients as compared to the control
group (Mean±SD 648±116.96 pg/ml vs. 270±50.24 pg/ml ;p < 0.001). Serum sCD95
also showed significant rise in SLE patients with moderate activity as compared to those
with mild activity (Mean ± SD 629.16± 72.54 pg/ml vs. 535 ±35.97 pg/ml; p<0.05).
The serum level of sCD95 in SLE cases with severe activity showed significant
increase when compared to those with moderate activity ( Mean±SD 797.5 ± 41.66
pg/ml vs. 629.16 ± 72.54 pg/ml ; p <0.001).
Anti-dsDNA antibodies showed significant positive correlation with SLEDAI
(r=0.772;p<0.01). IL-18 also showed a significant positive correlation with the SLEDAI
(r=0.670 ;p<0.01).
Soluble CD95 showed significant positive correlation with SLDAI (r=0.865 ; p<0.01),
with anti-dsDNA antibodies (r=0.775 ;p<0.01) and with IL-18 (r =0.722 ; p<0.01).
From these results it was concluded that serum sCD95 is increased in patients with
systemic lupus erythematosus and it is correlated with anti-dsDNA antibodies , with IL-
18 and with the disease activity, so it can be useful marker of disease activity for proper
management and follow up of SLE patients.


CD95 (Apo-1/Fas) is a member
tissues(2). The soluble CD95 molecules
of the nerve growth factor/tumour
are produced either through the
necrosis factor receptor superfamily.
proteolytic cleavage of membrane
The Fas protein denots the CD95
bound receptors or as translation
receptor and is 45 kDa type I membrane
products of alternatively spliced mRNA
(3).Interaction of CD95( Fas) with its
expressed on various normal human
ligand (Fas L) initiates a signal
Refree : Prof ; Dr. Medhat El-Shafei

Full Paper (vol.3 paper# 4)

NONSTERIODAL ANTIINFLAMATORY DRUGS AS A RISK The Egyptian Journal of Hospital Medicine Vol., 3 : 47 ­ 55 June 2001


Nonsteriodal Antiinflamatory Drugs As A Risk
Factor Of Gastro-Oesophageal Reflux
Oesophagitis, And Posterior Laryngitis In Arthritic Patients

Mahmoud A.Saleh M.D*, Khaled H.Abdel Mageed**, Kadry
M.Elsaied **, And Magdy M Elsharkawy**

*Assist. Prof. of ENT, Elminia University, **Lecturer of Internal Medicine,
Ain Shams University.

Non steroidal anti inflammatory drugs (NSAIDs) are known to cause ulcers of the
stomach and to a lesser degree, the duodenum. Consumption of NSAIDs has been
associated with the infrequent occurrence of ulcers at other locations, such as the
jejunum, ileum and colon. Several studies have suggested that consumption of NSAIDS
also constitutes a risk factor for the development of erosive oesophagitis, including
oesophageal strictures. It is now documented that NSAIDS are associated with gastro-
oesophageal reflux disease (GERD). It was found recently that GERD is associated with
a variety of laryngeal conditions and symptoms, of which "reflux laryngitis" is the most
common. AIM OF THE WORK: is to study the effect of NSAIDs on the development
of laryngitis in patients with GERD. PATIENTS AND METHODS: study included 60
patients, 42 males and 18 females aged between 26 ­ 52 years old (mean 37.9), a
detailed history was taken from all patients. All the sixty patients were suspected to
have GERD based on symptoms including acid reflux, Group I: - 40 patients were
receiving daily-recommended doses of NSAIDs for at least one month for a diagnosed
rheumatological disease, Group II: - 20 patients who were diagnosed as GERD, and
were not receiving any NSAIDs for at least one month prior to the present study. The
sixty patients were subjected to upper gastrointestinal endoscopy. Patients who were
diagnosed as GERD with or without oesophagitis were subjected to ENT fibro-optic
laryngoscopy. RESULTS: 42% of all patients with GERD have hoarseness of voice,
30% have recurrent chocking, 53% have excessive throat cleaning. Postglottic oedema,
arytenoid oedema, vocal fold oedema, were all significantly higher in group I than in
group II. CONCLUSION: The chronic use of NSAIDs can be considered as a risk factor
for developing GERD, erosive oesophagitis with or without subsequent posterior
laryngitis. Laryngoscopy may have a predictive value for the occurrence of GERD in
those patients. Patients who were on regular use of NSAIDS, and are symptomatic for
GERD are recommended to start medical treatment for GERD to guard against erosive
oesophagitis and/or posterior laryngitis.

Refree : Prof ; Dr. Mohamed Ramadan Baddar

Full Paper (vol.3 paper# 5)

The Egyptian Journal of Hospital Medicine Vol., 3 : 56 ­ 79 June 2001
I.S.S.N: 12084

Some Pharmacological And Histological Studies On The Effect Of
Neostigmine Injected Intrathecally

Fatma Zorob, Nemat El Baz*, Abd El Mawgood A. Ismaeil**
and Mona Radwan *

Anesthesia and*Pharmacology departments, Faculty of Medicine for Girls
** Histology department, Faculty of Medicine for Men
Al Azhar University


The spinal delivery of the cholinesterase inhibitor neostigmine yields analgesia
and augments the analgesic effect of alpha-2 (-2) agonist.
To assess its activity, histological and pharmacological studies were designed to define
its effect in two species; rats and cats.
Pharmacological assessment of intrathecally injected (it) neostigmine in cats
showed a gradual increase in mean blood pressure (MBP) and heart rate (HR) at doses 2
­ 16 g /kg while a decrease in MBP and HR occurred at doses 32 ­ 64 g /kg. The
intrathecal injection of atropine and phentolamine abolished the increase in MBP and
HR produced by (it) neostigmine (4 g /kg). In spinal cat preparation (it) neostigmine
produced rapid rise in MBP at small (4 g /kg) and large doses (64 g /kg). In this study
neostigmine counteracts the hypotensive effect and bradycardia produced by intrathecal
injection of -2 agonist clonidine.
Histological study was performed on rats. They were divided into 5 groups
representing control and 4 groups treated by neostigmine at 25, 50, 75 and 100 g/kg.
After each injection, the animals were assessed for general behavior, and function.
Arousal, motor coordination and motor tone measurement (A, MC and MT) revealed
that Intrathecal injection of neostigmine resulted in dose-dependent decreased arousal,
and motor coordination, and dose-dependent increase in motor tone.
The quantitative histological and cytochemical data demonstrated an initial
increase in the nucleo-cytoplasmic ratio of the anterior horn cells up to 75 ug/kg
followed by a decline in 100 ug/kg- treated animals. The cytoplasmic RNA content of
the anterior horn cells showed an increase in the optical density that reached a
maximum at 50 ug/kg followed by a decline at higher doses. The Golgi bodies increased
in the cytoplasm of 25 ug/kg treated animals, the level became constant up til 75 ug/kg,
and started to decline at 100 ug/kg. There was no change in the quantity of the
myelinated nerve fibers, however, there was a dose dependent decline in their
stainability with silver.
In conclusion:These results provide an evidence that the adverse events from
neostigmine injected intrathecally appear to be affected by the dose injected which
could be important in clinical practice

Refree : Prof ; Dr. Fathy mattar

Full Paper (vol.3 paper# 6)

Effects of different dose regimens of Milrinone on hemodynamics and Left ventricular systolic function after cardiopulmonary b The Egyptian Journal of Hospital Medicine Vol., 3 : 80 ­ 89 June 2001
I.S.S.N: 12084

Effects of different dose regimens of Milrinone on hemodynamics and
Left ventricular systolic function after cardiopulmonary bypass.

Mohamed Abdel Rahman Salem M.D*, Moh. A. Mourad M.D**, Salah
Kasem M.D***, Ahmad Abdul Monem Emam M.D# .

*Anesthesia department faculty of medicine Menofeyia university, ** Anesthesia
department National heart institute,***Anesthesia department faculty of medicine Ain
Shams university, Cardiology department National Heart Institute#.


Milrinone can improve myocardial systolic function and hemodynamics by
increasing contractility and decreasing afterload, although its appropriate dose regimen
has not yet been established for cardiac surgical patients. Despite milrinone effectively
increases cardiac function after cardiopulmonary bypass, few studies have specifically
evaluated its efficacy during cardiac surgery. We investigated the effects of milrinone
on hemodynamics and left systolic ventricular function in cardiac surgical patients
immediately after emergence from cardiopulmonary bypass (CPB). Forty five patients
undergoing cardiac surgery were studied. They received milrinone (25, 50, or 75 ug/kg)
bolus dose over ten minutes followed by 0.25, 0.5, 0.75 ug/kg/min in three patients
groups. Heart rate, mean arterial blood pressure, pulmonary capillary wedge pressure,
and cardiac index were determined before and after the administration of milrinone and
transesophageal echocardiogram were recorded while constant filling pressures were
maintained by volume reinfusion from the CPB reservoir. All three doses of milrinone
significantly increased CI ( 2.5, 3.1,3.2 L/min/m2 ), HR (98, 96,100 bpm), SV ( 61,66,67
ml/beat) and EF (61, 66, 66%) after 5 min from the milrinone use (p<0.001) and
significantly decreased the MAP (80, 81, 82 mmHg), SVR ( 1127, 965, 928 dyn.s.cm-5)
and PVR ( 183, 165, 157 dyn.s.cm-5) at the same time interval (p<0.001) while the
PCWP and CVP did not show valuable change. The 50- and 75-ug/kg doses produced
significantly larger increases in cardiac index than the 25-ug/kg dose; however, the 75
ug/kg dose did not produce a significantly larger increase in cardiac index than did the
50-ug/kg dose. Two patients receiving milrinone 25 ug/kg developed premature
ventricular contractions. The 75-ug/kg dose was associated with a case of ventricular
tachycardia treated with xylocaine infusion and three cases of severe hypotension (BP
<60 mmHg) requiring phenylephrine infusion and IV fluid replacement. Thus,
milrinone improves hemodynamics and left ventricular systolic function when constant
loading conditions are maintained.

Refree : Prof ; Dr. Ibrahin Abd El- Gany

Full Paper (vol.3 paper# 7)

I.S.S.N: 12084

Study Of The Relation Between Helicobacter Pylori Infection And
Gastric Interleukin (8) In Patients With Chronic Liver Disease

Mohsen M El-Khayat, *Zeinab N Said, Gamal S El-Deeb,
Hany S Sabry & **Mamdoh M Radwan.

Tropical medicine & **pathology departments, faculty of medicine-Menoufia
University, *Microbiology department, faculty of medicine (for girls)
Al Azhar University

Helicobacter pylori (H pylori) is a gram negative spirally shaped bacterium. It is
known to be the most common important cause of gastritis, peptic ulcer, non ulcer
dyspepsia and gastric carcinoma. The frequency and importance of gastric mucosal
lesion in patients with chronic liver disease (CLD) have been increasingly recognized in
recent years. IL-8 a potent leukocyte chemo­attractant cytokine produced by H pylori. It
promotes polymorphnuclear leucocytes (PMNs) and mononuclear cells (MNCs)
accumulation in gastric mucosa.This work aimed to clarify the relation between H
pylori and IL-8 production in various chronic liver disease (CLD) lesions. Eighty
patients were included in this study, 50 with CLD and 30 dyspeptic patients without
CLD. Gastric mucosal biopsies were examined histopathologically for H pylori, cellular
infiltration and associated pathology, together with culture of H pylori and assessment
of IL-8 level in gastric tissue supernatant.
30/50 (60%) CLD patients,10/15 (66.6%) patients with non gastric dyspepsia,
and 14/15 (93.3%) patients with gastric dyspepsia were positive for H pylori. There was
no relationship between the prevalence of H pylori and the aetiology of CLD.
No significant difference was observed in CLD patients' group as regard to H
pylori and Child grading, degree of varices, gastric or liver histopathology. Statistical
difference in H pylori prevalence between patients with CLD and those with gastric
dyspepsia was significant. IL-8 showed significant increase in H pylori positive vs H
pylori negative patients. Positive correlation was found between H pylori density and
tissue IL-8 and cellular infiltration. In conclusion the liver status does not play a role in
the prevalence of H pylori infection, further studies to investigate the relation between
virulent H pylori and IL-8 are needed.


H pylori associated gastritis is
infection, the cellular infiltrate contains
fundamentally a bacterial infection of
effectors of the immune response,
the gastroduodenal mucosal surface and
including CD4+ and. CD8+ T-
as such is characterized by mucosal
lymphocytes, B-lymphocytes, plasma
infiltration of PMNs and MNCs
cells, monocytes, mast cells and
(Yamaoka, et al., 1998). In H pylori
eosinophils (Dixon, et al., 1996).
Refree : Prof ; Dr. Mohamed Fathy Abdel- Wahab

Full Paper (vol.3 paper# 8)



Effect Of Portal Hypertensive Gastropathy On
Electrogastrographic changes &Gastric Emptying Time

*El Bokl ,Mohammed. **Hanan M.. M .Badawy , ***E l Maltawy,
Mohammed A.F,Abdul Mageed, Khalid H**.&Ghali,Sameh M.

*Professor of internal medicine Ain Shams uni.
**Lecturer of internal medicine Ain Shams uni.
***Assistant professor of internal medicine Ain Shams uni.

Abstract :
Background: Dyspepsia is a frequent symptom in cirrhotic patients .
Congestive gastropathy or portal hypertensive gastropathy (PHG) was detected as a
possible cause of sustained dyspepsia in 40% of these patients , and prolonged gastric
emptying time(GE) with decrease gastric wall compliance were detected in cirrhoric
patients .
Electrogastrography (EGG) is a non-invasive method to study gastric
myoelectrical activity from the body surface by electrodes . whereas, an
ultrasonographic method can be used for the estimation of gastric emptying by
measuring what so called half emptying and full emptying times with other parameters.

Aim of this work is to study patterns of EGG & ultrasnographic GE. In cirrhotic
patients with or without PHG . 45 patients were chosen for this study and were
divided into 3 groups ; group 1 is cirrhotic patients with PHG negative upper
gastrointestinal ( U.G.I.T.) endoscopy & group 2 is cirrhotic patients with PHG positive
& group 3 is healthy subjects taken as control .

Results :- we found significant delay in GE in gp. 2 in relation to group 3 (p < 0.05 ).
EGG reveiled power ratio lower in gp. 1, 2 ( 2.01 ­ 1.93 ) respectively compared to
group. 3 (2.63). Also there was highly significint increase in "Dominant frequency" at
rest ( DF ) in group.1 campared to group. 2 & 3 ( p>0.01) where mean of group 1 was
2944.9 , in group 2 was 2477 and in group 3 was 1934 & the power meal at DF was
higher in group 1 than 2 , 3 but siatistically insignificant where the mean in group 1 was
5922.5 & in group. 2 was 4804.8 and was 5087.8 in group 3 (p>0.05)
conclusion :- Delayed gastric emptying by U.S, and changes in EGG records of
cirrohotic patients especially in presence of portal hypertensive gastropathy may explain
dyspepsia frequently occurring with portal hypertensive gastropathy.

Dyspepsia is a very frequent
hypertensive gastropathy (PHG) was
symptom in cirrhotic patients where
detected as a cause of sustained
dyspepsia in 40% of these patients
Refree : Prof ; Dr.Sami Abdul Fattah

Full Paper (vol.3 paper# 9)

Some Pharmacological The Egyptian Journal of Hospital Medicine Vol., 3 : 126 - 140 June 2001


Some Pharmacological Studies of Ropivacaine in comparison
With bupivacaine

*Hala Mohamed Nagiub, ** Mervat Mohamed El-Mously
Department of Pharmacology*, Anaesthesia & ICU**

The effect of ropivacaine as a recent amino-amide local anaesthetic compared
with bupivacaine on analgesic activities, cardiac contractility, blood pressure, heat rate,
Electrocardiogram (ECG) and toxicity was studied. The result of our study revealed that
ropivacaine Exhibited a less degree of analgesic potency than bupivacain, it increase the
reaction time by 20.6 and up to 167.6%while bupivacaine increased it by 37.32 up to
197.1%. On isolated rabbits heart, ropivacaine and bupivacaine induced a significant
dose dependent ­ve inotropic effect. The cardiodepressant action of ropivacaine was
lesser than that of bupivacaine. IV injection of ropivacaine (0.35-2.8mg\kg) produced
slight increase in arterial blood pressure but in the last dose produce decrease in arterial
blood pressure. Bupivacaine 0.5-1mg\kg produce no significant change in arterial blood
pressure but in the subsequent doses it produces hypotension up to death, this
hypotension may be the beginning effect of high toxic blood level of the drug.
Ropivacaine showed no alterations in ECG apart from significant decrease in heart rate
only in high doses, but on the other hand bradycardia started earlier with bupivacaine
(1mg\kg) and ECG changes were seen after 5 minutes from injecting 2mg\kg which
ended by cardiac arrest. In respect to toxicity, intra peritoneal LD50 of ropivacaine was
found to be 115mg\kg compared to 90mg\kg of bupivacaine. We concluded that
ropivacaine nearly resembles bupivacaine in its local analgesic effect but has a great
margin of safety with less cardiodepressant action.


Ropivacaine is the (s) isomer of
ropivacaine is well tolerated and can be
1-propyl-2, 6, pipecoloxylidide an
administered in large doses before early
amide local anaesthetic with a structure
features of both cardiovascular and
similar to that of mepivacaine and
CNS toxicity are apparent (cederholm,
1997, Scott et al, 1989). In addition,
Ropivacaine shows a high degree of
accidental IV injection of the drug did
sensory motor block separation. At high
not produce serious adverse effects
doses it is an effective anaesthetic,
(Morton et al, 1997). The present study
giving profound sensory and motor
block. At low doses, it has an effective
haemodynamic effects of bupivacaine
analgesic, producing almost exclusive
and ropivacaine on isolated rabbit's
sensory block with minimal motor
heart, BP and ECG of anaesthetized cats
block allowing rapid recovery to full
after intravenous injection of each drug
patient mobilization (kalpokas et al,
in different doses levels to clarify which
1994). Subsequent work showed that
of the drugs is less cardiotoxic.
Refree : Prof ; Dr. Abla M . Helmy Afify.


Full Paper (vol.3 paper# 10)



Protective Effect Of Melatonin, Methionine And Zink On Cadmium
Nephrotoxicity: Histopathologically, Histochemically And AgNORs

Sonia L. El Sharkawy; Hafiza A. sharaf; and Nabila S. Hassan.
The Basic Medical Sciences Department, Pathology Researches, National
Research Center

Cadmium (Cd) is a highly toxic heavy metal that is naturally present in the
environment. Chronic exposure to Cd causes hepatotoxicity and nephrotoxicity. The
present study aimed to study the protective effect of melatonin, methionine and zinc
against histopathological, histochemical and proliferative effects of cadmium on the
kidney of rats. A total of 80 female albino rats were included in this study and divided
into 8 groups. They were injected intraperitonealy with cadmium chloride (CdCl2) (2
mg / kg b.w.), melatonin (10 mg / kg b.w.), methionine (42.8 mg / b.w.) or zinc (20 mg /
kg b.w.) with or without CdCl2 daily for 10 days.
Treatment with CdCl2 induced marked tubular cell degeneration with large areas of
interstitial hemorrhage.There were marked destruction of the brush borders with
decrease in glycogen and protein contents of the degenerated tubules. AgNORs count
significantly increased.
Injection of melatonin or methionine to CdCl2 treated rats resulted in improvement
of Cd-induced histopathological and histochemical changes. AgNORs count
significantly decreased. Zinc injection partially protected the kidney from Cd-induced
In conclusion, melatonin and methionine have a more protective effect than zink
against Cd nephrotoxicity.


Cadmium (Cd) is a highly toxic
tumours (IARC, 1993 ; Waalkes and
element that is naturally present in the
Rchm, 1994). In animals Cd is
environment, including food, water, and
associated with tumours of the prostate,
soil (Sherlock, 1984). It is a trace
testes, lung, and the injection site
element which has no known metabolic
(Magos, 1991 ; Waalkes and Misra,
function. However, it is toxic to cellular
processes by disrupting mitochondrial
The nucleolus plays a vital role in
function (Miccadei and Floridi, 1993 ;
the control of cell proliferation and
Koizumi etal., 1994) and can interfere
protein synthesis, as it is the only part of
with the transport and metabolism of
the nucleus where ribosomal ribonucleic
many essential elements, such as iron
acid (rRNA) is transcribed. The region
and copper (Crowe and Morgan, 1997).
of the nucleolus perform this function is
Cd was recently designated as a human
nucleolar organizer regions (NORs)
carcinogen where it has been linked to
(Egan and Crocker, 1992).These NORs
prostate, lung, and male reproductive
are defined as nucleolar components
Refree : Prof ; Dr. Mona M.El-Tounsy.

Full Paper (vol.3 paper# 11)

The Side Effects Of The Nonsteroidal Anti-Inflammatory Drug (NSAID) Ketoprofen On Histological And Ultrastructural Aspects Of The Egyptian Journal of Hospital Medicine Vol., 3 : 161 -176 June 2001


The Side Effects Of The Nonsteroidal Anti-Inflammatory Drug
(NSAID) Ketoprofen On Histological And Ultrastructural Aspects Of
The Kidneys Of Albino Rats

Amina M. Farag Allah
Zoology Department, Girls College for Arts, Science and Education
Ain Shams University


The present work deals with the effect of the therapeutic dose of the nonsteroidal
anti-inflammatory drug, ketoprofen on the microscopic structure of the kidney of the
albino rat. The present study also sheds light on the risk of using over-dosage either by
mistake or in an unwise attempt at quick relieving the body pain.
The intramuscular therapeutic dose of ketoprofen to albino rat was calculated and was
found to equal 13.5 mg /kg body weight. Fifty adult male albino rats, Rattus norvegicus
were used in the present study. The rats were equally allocated to five groups, each of
10 rats. Rats of the first group were kept as control. Rats of the second & third groups
were injected daily with the therapeutic dose of ketoprofen for four and eight successive
weeks respectively. Rats of the fourth & fifth groups were injected daily with double the
therapeutic dose of ketoprofen for four and eight successive weeks respectively.
In rats given the therapeutic dose of ketoprofen daily for four weeks and sacrificed 24
hours after the last dose, light microscope examination showed that Malpighian
corpuscles and the kidney tubules revealed signs of degeneration.
In rats given the therapeutic dose of ketoprofen daily for eight weeks the histological
changes were in progression. A few numbers of glomeruli were increasingly congested
and shrunken into dense masses of unrecognized structural details. The luminal borders
of the cells lining the proximal convoluted tubules together with their microvilli were
The electron micrographs of ultrathin sections of kidneys of rats given the therapeutic
dose of ketoprofen daily for eight weeks showed that the glomerular capillaries were
disorganized and occasionally their lining endothelium showed degeneration. The
podocytes showed deteriorated and rarefied cytoplasm; and their primary processes
were fragmented. Also, the foot processes appeared occasionally broad. In some cells of
proximal convoluted tubules the microvilli completely disappeared. Occasionally, these
cells gave broad blebs into the tubule lumen which became almost obliterated. The
cytoplasm of few cells lining the distal convoluted tubules became moderately rarefied
and vacuolated.
In animals given double the therapeutic dose for four weeks many kidney glomeruli
were fragmented and showed marked congestion and increased mesangium. The
parietal walls of Bowman's capsules were damaged. The kidney tubules showed
generalized hyalinization. A few numbers of t he tubule lining cells displayed pyknotic
nuclei; some nuclei were karyolysed and even vanished.
In animals given daily double the therapeutic dose of ketoprofen for eight successive
weeks, the glomeruli were sclerotic and necrotic and the kidney tubules showed
generalized hyalinization.
Refree : Prof ; Dr. Hassan Sabri El-Dowi

Full Paper (vol.3 paper# 12)

Comparative Study On The Effect Of Some Histological Techniques On The Quantitative Morphometric Analysis The Egyptian Journal of Hospital Medicine Vol., 3 : 177 - 189 June 2001


Comparative Study On The Effect Of Some Histological
Techniques On The Quantitative Morphometric Analysis

Bassem S. Kotb
Department of Histology, Faculty of Medicine ­ Al-Azhar University (Assuit)

Quantitative morphometric studies are commonly used nowadays in histological
and pathological labs and researches. The aim of the study was to evaluate the possible
effect of the histological techniques on the morphometric results and determination of
correction coefficients of morphometric parameters in dependence on the histological
procedure used.
The organs and cells subjected to study were ; human RBCs (lack of nuclei), albino
rats liver cells (active cells) and albino rat uterus (for gross study and its muscles and
fibers content). Three techniques were selected; fresh cells (blood smear and liver cell
print), frozen technique and paraffin sections fixed in neutral buffered formol (common
histological technique). Quantitative morphometric analysis parameters selected were
diameter, perimeter, area and area percent. The obtained results were statistically
analyzed by using student paired t-Test. The study showed statistically significant
changes in quantitative morphometric results under the effect of histological techniques
used. Frozen technique increased the morphometric results , while paraffin technique
decreased them when compared with those of fresh data. Also the morphometric data of
gross area and perimeter of organs affected by their fibrous elements. The study
concluded that all quantitative morphometric results must be corrected by a coefficient
factor which depends on the organ and technique used before analysis and evaluation of

In the last few years, as a result of
provide important diagnostic and
introduction of computer vision (Image
prognostic information.
Analyzer), the quantitative histological
Quantitation requires skill in
techniques and interactive morphometry
object selection and the quality control
study becomes common on many
of the whole measuring system. The use
histological and pathological research
of quantitation as a black box can result
in dramatic errors.
The reproducibility of the measure -
The quantitation subdivided into 3
ments depends on the tissue or cells and
subdivisions, morphometric analysis
staining methods. A number of tech -
(e.g., count, distance, diameter, perime -
nical factors may cause random errors,
ter, area, area percent volume etc.,),
such as quality of the slides, magnify -
color densitometric analysis (e.g.,
ication, definition of the cells to be
measured and measuring protocol.
Having quantified cell and tissue
enzymatic activities colors as in depth
features, multivariate analysis may
or distribution) and the kinetic analysis
result in a better discrimination of two
(e.g., velocity, types of motion,
or more groups under study and can
amplitude, pattern of motion etc.).
Refree : Prof ; Dr. Hassan Sabri El-Dowi

Full Paper (vol.3 paper# 13)

Effect of experimentally induced diabetes mellitus on serum leptin level and the role of insulin replacement therapy The Egyptian Journal of Hospital Medicine Vol., 3 : 190 - 208 June 2001


Effect of experimentally induced diabetes mellitus on serum
leptin level and the role of insulin replacement therapy

Nabil A. Soliman

Department of Zoology, Faculty of science, Zagazig University.

The regulation of circulating leptin concentration is multifactorial and still
understood. Therefore, the present study was designed: (1) to demonstrate the effect of
gender on leptin concentration in intact control rats, (2) to evaluate the relationship
between serum leptin concentration, serum insulin level and body weight in control rats
and streptozotocin (STZ) diabetic rats (untreated and treated with insulin). A total
number of 48 healthy adult albino rats of both sexes (24males& 24 females) were used
in this study. The animals were divided equally into four groups, each group was
subdivided equally into -male and female subgroups. Group 1(G1): served as control
group, group 2(G2): experimental diabetics group (not treated) and group 3(G3) & group
4(G4): experimental diabetic group treated with insulin for 2 and 21 days. These groups
were examined for the following parameters: body weight, blood glucose level, serum
insulin and leptin concentration. It was found that serum leptin level was significantly
higher in female than in male control group. However, this difference could not be
detected in between male and female rats in all other studied groups. Moreover, a strong
positive correlation was found between leptin concentration and insulin hormone level,
and body weight in control male and female rats. STZ-induced diabetes associated with
a significant rapid decrease in circulating leptin concentration (G2), this decrease was
accompanied with a significant decrease in both serum insulin level and body weight,
then, it was rapidly reversed by insulin treatment for 2days (G3) and 21 days (G4).
There was also a positive correlation between serum leptin concentration, body weight
and serum insulin level in this diabetic group. However, leptin was found to change in
an inverse proportion to the variation in blood glucose concentration in both male and
female diabetic groups. The direct relationship of serum leptin concentration to serum
insulin concentration and the inverse relationship of leptin concentration to blood
glucose level were preserved in both male and female insulin replacement therapy
In conclusion, in adult albino rats, several factors are involved in the regulation of
circulating leptin level such as gender, body weight, blood glucose level and serum
insulin concentration.


The discovery of the obese gene in
al., 1996). Leptin was first described as
the mouse and its conserved homologue
an adiposity derived signaling factor,
in humans has led many researchers to
which, after interaction with specific
work hardly to find out the factors
receptors, induces a peleiotropic respo -
which could regulate the expression of
nse including control of body weight
leptin gene and in turn could regulate
and energy expenditure. Although
metabolism and behavior ( Saladine et
research has moved ahead rapidly there
Refree : Prof ; Dr. Maged M.M.

Full Paper (vol.3 paper# 14)