Hepatic Expression of the Proliferative Marker Ki-67 and p53 Protein in chronic hepatitis C (A histopathological and immunohistochemical study) The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 1 - 11

Hepatic Expression of the Proliferative Marker Ki-67 and cell cycle p53
Protein in chronic hepatitis C (A histopathological and
immunohistochemical study)

Azza Hegazy1, Nashwa A. Zaki2 Sameh seif3 and Nagwa Abd-Wahab4

Pathology1, Biochemistry2 , Tropical Medicine3 & Community Medicine4
Departments, National Hepatology and Tropical Medicine Research Institute


Abstract

Aim and background:

To evaluate hepatic expression of the nuclear proliferative marker Ki-67 and the cell cycle
marker p53 oncoprotein in chronic hepatitis C in relation to the advanced stages of liver
fibrosis in HCV positive Egyptian patients.

Material & Methods:

Paraffin-embedded liver biopsy specimens were studied from 21 untreated patients with
chronic HCV infection. All patients were HCV antibody positive, as determined by a
commercially available enzyme-linked immunosorbent assay kit. Patients having other
etiologies for chronic liver disease including HBV infection were not included in this study.
Liver biopsies were obtained percutaneous. All biopsies were fixed in formalin, embedded in
paraffin, and sectioned by microtome with a thickness of 5 m. Routine specimen processing
involved staining slides with hematoxylin and eosin (5 levels), Masson's trichrome stain (5
levels), for a total of 10 levels per specimen All levels were screened. All specimens were
examined by two pathologists, and classified by consensus for all abnormal histological
findings. The histological activity index (or histological grade) was determined using Ishak
grading scheme22 expressed as a semiquantitative score for portal inflammation (0-4), lobular
activity sporadic lytic foci (0-4) and parenchymal confluent necrosis (0-6), and piecemeal
necrosis(0-4). The extent of fibrosis (or histological stage) was determined using Ishak score
(0-6). Steatosis was scored according to Keliner et al 2005, from grade 0 to 3; where S0 = no
steatosis or less than 5% (low or medium power evaluation) of parenchymal involvement by
fatty changes, S1 (mild) = 5%-33%, S2 (moderate) = >33%-66% and S3 (severe) > 66% of
the hepatocytes are involved by fatty changes. Expression of p53 and Ki67 were determined
by immunohistochemistry, using avidin-biotin-peroxidase.

Results:

Liver histology: The studied group (n = 21) involved 16 males and 5 females (male to female
ratio 3.3:1). The histopathological findings of HCV infection, including portal lymphoid
infiltration, periportal piecemeal necrosis, lymphocyte infiltration of the lobules,
hepatocellular necrosis, steatosis and fibrosis, were studies. The age ranged from 31 to 59
years old with mean of 44.86 8.74, males 76.2%, females 23.8% .P53 expression was
positive in 52.4% and negative in 47.6%. cytoplasmic localization dominated over nuclear
expression. Ki 67 was negative in 81% of cases and positive in19%
of cases, all cases in stage 6 were positive for p53 while there were no difference in the other
stages of fibrosis, and this relation was statistically significant.
There was no relation between the grade of necro-inflammation and the expression of p53,
and this result was statistically non significant.There was a relation between the percent of
1


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The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 12 - 20

Role of Maternal Serum Procalcitonin, Interleukin-6 and hs-C Reactive
Protein in Prediciton of Subclinical (Intrauterine) Infection in Preterm
Premature Rupture of Membranes

Amany M.E. Abd Elmegeed*, Sabah I. Abd Elreheem*, Al-Shimaa Allam Abd
Ellatif**, Inas Mahmoud Hamdy**, Eman El-Shohat Ebrahem***
Clinical Pathology* Obstetrics and Gynecology**
Medical Biochemistry***
Departments, Al-Azhar University
Faculty of Medicine for girls


Abstract

Objective:
To evaluate the role of procalcitonin (PCT), high senstive C-reactive protein (hs-CRP) and
Interleukin-6 (IL-6) for prediction of subclinical intrauterine infection in pregnant women
with preterm premature rupture of membranes.

Methods:
Twenty patients with preterm premature rupture of membranes PPROM (study group) and
twenty apparently healthy pregnant women (control) group between 26-34 weeks of
pregnancy were enrolled in this study.
In all cases analysis of serum procalcitonin by high performance liquid chromatography, Il-6
by ELISA method and hs-CRP by nephelometry were done. Culture of vaginal bacteria was
done for study group only.

Results:
Procalcitonin levels in the PRROM group were significantly higher than in healthy pregnant
women (median 1.95 versus 0.39-Interquartile range 1.375 versus 0.213 P0.001). A
significant correlation was observed between PCT and hs-CRP (r=0.510; P0.031) and
leucocytosis (r=0.544- P 0.013). Also IL-6 levels were significantly higher in cases of
PPROM compared with control group (median 40.01 versus 5.55 Interquartile range, 45.88
versus
4.22 P 0.001). No significant correlation was present between PCT and IL-6

Conclusion:
Determination of PCT, hs-CRP and IL-6 in mother's blood sample can be useful for
diagnostics of PPROM cases suspected of intrauterine infection. However PCT more valuable
and specific.

Key words:
Preterm premature rupture membranes, Procalcitonin:
Interleukin 6, high sensitive C-reactive protein

Introduction
weeks of gestation (Bloom and

Associates, 2001).
Preterm premature rupture membranes
Despite recent advances in perinatal care,
(PPROM) defined as rupture of
PPROM continues to lead to important
membranes before labor and prior to 37
obstetric complications beginning a high-
weeks. It complicates 2-3 percent of
risk period for both mother and fetus
pregnancies that have not reached 37
(Mateus et al., 2010; Pasquier and Doret,
2008).

12

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d:\skydrive\Jor\vol42_3 The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 21- 32

RELATION BETWEEN PLASMA LEPTIN LEVEL AND LEFT
VENTRICULAR FUNCTION IN OBESE FEMALES WITH INSULIN
RESISTANCE


Dina Mohamed Abaza1, Hoda Abd El Basset2, Nagwa Moustafa Mohamed Hassanein3
Mohamad saied salem4. and Hala Mohamed Ali Abd El Salam5
Endocrinology department1, General Medicine department2, Clinical Pathology department3
(Al Azhar University for girls). Cardiology Department. Air force hospital4, Clinical
Pathology department , National Nutritional Institute5.


Abstract

An association between obesity and cardiac mass has been recognized for almost two decades,
whereas the precise nature of the association remains elusive Theoretical consideration have long
suggested that it may be mediated at least in part by insulin resistance (Mc, Nutly ,2003).Several
studies have found an association between insulin resistance and left ventricular
hypertrophy.(Lacobellis et al,2003)
In human, production of leptin( an adipocyte derived peptide), has been linked to obesity, insulin
and insulin sensitivity (Leyva et al, 1998) .It was considered that alteration in plasma concentration
could constitute an additional component of metabolic syndrome of cardio-vascular risk(Leyva et al,
1998
).

Aim of the work:

The aim of this work was to evaluate the relationship between obesity, insulin resistance, leptin and
left ventricular mass and function in young obese females with insulin resistance.

Subjects and methods:
Sixty five premenopausal females aged 25-45 years with no history of diabetes or hypertension was
participated in this study. Twenty were non obese and forty five were obese .Fasting serum glucose,
insulin and leptin were assessed and homeostatic model assessment HOMA-IR score was calculated.
According to HOMA-IR obese premenopausal females were divided into 2 subgroups: - Subgroups
1
: (Insulin sensitive group or IS group) included 20 obese females with HOMA-IR <3.8.And
Subgroup 2: (insulin resistance group or IR group) included 25 obese females with HOMA-
IR3.8.Echocardiography was done for all females participated in the study to evaluate L.V mass and
function.

Results:
Waist circumference (WC), serum insulin, serum leptin and HOMA-IR were significantly higher in
obese group compared to non obese group (p<0.05, <0.05, <0.001 and <0.00l respectively) and
between IR and IS subgroups (p<0.05, <0.05, <0.001 and <0.00l respectively).As regard
Echocardiographic studies left ventricular mass(LVM) and left ventricular mass corrected t height 2.7
(LVM/h2.7 )were significantly higher in obese group compared to non obese group (p<0.05) and
between IR and IS subgroups (p<0.05 for both),while the ratio between peak transmitral E and A
wave velocity(E/A ratio) was lower in obese group compared to non obese group (<0.05), it was also
lower in IR subgroup compared to IS subgroup (p<0.05).There was positive significant correlation
between LVM and LVM/H2.7 and serum insulin (p<0.05)and serum leptin (p<0.05) in IS subgroup
while the correlation was highly significant between both and fasting leptin (p<0.001) in IR subgroup

Conclusion:
Obesity is a clinical syndrome associated with hyperinsulinemia, hyperleptinemia and insulin
resistance Abnormalities of LV diastolic function and mass occur frequently in obese patients.
Hyperleptinemia can be an early sign for left ventricular dysfunction in obese females.

21

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Effect of some botanical materials on certain biological aspects of the house fly, Musca domestica L The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 33 - 48


Effect of some botanical materials on certain biological aspects of the
house fly, Musca domestica L.

Nabawy A. I. Elkattan, Khalafalla S. Ahmed, Saadya M. Elbermawy and Rabab
M. Abdel-Gawad
Biological and Geological Sciences Department, Faculty of Education, Ain Shams
University.


Abstract

The effects of Lantana camara (leaves), Pelargonium zonale (leaves), Cupressus macrocarpa
(leaves), Cyperus rotundus (whole plant) and Acacia nilotica (seeds) powders on some
biological aspects of house fly, M. domestica L. were tested. The effects of three lethal
concentrations LC25, LC50 and LC75 on the larval duration, pupation percent, pupal weight,
pupal duration, adult emergence percent, sex ratio, adult longevity, and fecundity were
determined. The induced malformed larvae, pupae and adults were recorded and
photographed. The powders of the five plants were found to have promising effects in
controlling this insect.

Keywords: Musca domestica; Lantana camara; Pelargonium zonale; Cupressus
macrocarpa
; Cyperus rotundus; Acacia nilotica; Biological studies.

Introduction


The successful use of plant products in the
The house fly, Musca domestica L., is a
control of certain insect species depends
serious pest to livestock and a public
on contained substances that inhibit the
health pest that acts as a transmitter of
developmental process of those insects
many human and animal diseases
(Kristensen and Jespersen, 2003). From
(Emerson et al., 1999; Douglass and
these points of view, the aim of this
Jesse, 2002; Mian et al., 2002).
research was to study the effect of some

plant materials on the house fly population
House fly has been successfully controlled
and the possibility of using these materials
by the application of various insecticides,
as larvicides for controlling the insect by
but reports of insecticide resistance in this
treating insect's breeding places.
insect have been amply found (Kaufman

et al., 2001; Shono and Scott, 2004). For
Material and methods
this reason, alternative house fly control

strategies, including the use of botanical
Insect rearing
insecticides have been studied (Wang-
Jian et al., 2005; Ghoneim et al., 2007;

Musca domestica L. colony was obtained
Pavela, 2008; Sripongpun, 2008; Tarelli
from the Medical Insect Research Center,
et al., 2009).
Dokki, Giza. The adults were allowed free

access to sugar and cotton pads soaked in
Plants and plant products are recently
milk powder dissolved in water (10%
considered alternatives to conventional
w/v). Larvae were reared according to the
insect-control agents as they constitute a
method described by Pavela (2008) and
rich source of bioactive chemicals, against
Huang et al. (2008) on a mixture of
number of species including specific target
sterilized bran (38 g), milk powder (2 g)
insects, and are often biodegradable to
and water (60 ml), and maintained at
non-toxic
products
(Hashem
and
272C and 705% relative humidity
Youssef, 1991).
(RH).


33

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Invasive And Noninvasive Mechanical Ventilation For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 50 - 63

Invasive and Noninvasive Mechanical Ventilation For Acute
Exacerbations Of Chronic Obstructive Pulmonary Disease: A
Comparative Study.

Abd-Hay I. Abd-Hay; Ahmed S. Alsaily* and Essam A. El-Moselhy**

Departments of Chest, Anesthesia* and Community Medicine**
Faculty of Medicine, Al-Azhar University

Abstract

Introduction
: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a
frequent cause of hospitalization and intensive care unit admission. Respiratory failure from
airflow obstruction is a direct consequence of acute airway narrowing. Aim of the study: It
was to compare the efficacy of noninvasive mechanical ventilation (NIMV) against
conventional mechanical ventilation (CMV) in patients with acute exacerbation of COPD.
Patients and methods: Forty patients with acute exacerbation of COPD were recruited in the
present study. A comparative, hospital based study design was used. All the cases were
examined; clinically and laboratory. The patients were divided into two groups each include
20 patients. Group A received NIMV in the form of continuous positive airway pressure
(CPAP) and group B with CMV. Results: There were statistically significant decreases in
respiratory rate, heart rate and diastolic blood pressure after 6 hours of CPAP in comparison
to baseline parameters in group A. While, there were statistically significant increases in
PaO2 and SaO2 after 6 hours of CPAP in comparison to baseline parameters. In group B there
were statistically significant decreases in respiratory rate, heart rate, systolic blood pressure
and diastolic blood pressure after 6 hours of CMV in comparison to baseline parameters.
While, there were statistically significant increases in pH, PaO2, and SaO2 and a statistically
significant decrease in PaCO2 after 6 hours of CMV in comparison to baseline parameters.
Further, comparison of respiratory rate and hemodynamic parameters in both groups showed
statistically significant decreases in respiratory rate, heart rate, systolic blood pressure and
diastolic blood pressure in group A in comparison to group B. Finally, failure rate was 35.0%
in group A (NIMV) compared to 5.0% in group B (CMV) with statistically significant
difference. Conclusions and recommendations: Noninvasive mechanical ventilation is a
safe and effective means of improving gas exchange in patients with acute exacerbations of
CPPD. If patient not respond to NIMV, CMV should be used. Further studies are needed to
evaluate the appropriate selection of patients and to find the best level and schedule of
ventilation.
50

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d:\skydrive\Jor\vol42_6 The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 64 - 72

Role of Rosemary Leaves Extract as A Protective Agent Against
Azathioprine-Induced Toxicity in Rats

Hala M T El-Mougy*, Gehan A Youssef**
Medical Biochemistry*and Physiology** Departments,Faculty of Medicine (Girls) Al-
Azhar University.


Abstract

Background: Rosemary is widely found along the coasts of the Mediterranean Sea. Its leaves or
extract were found to have a high antioxidant and anti-inflammatory activity. It is also used as an
antispasmodic, analgesic, anti-rheumatic and expectorant. These actions are mainly due to its content
of essential oils. Azathioprine (AZA) is an immunosuppressive drug. It is widely used in many
diseases. A major drawback is the occurrence of side-effects, especially acute pancreatitis.

Aim of the work:
This work was done to study the effect of dietary supplement of rosemary leaves
as a strategy for amelioration of the side-effects of azathioprine.

Material and Methods:
Thirty-two adult male albino rats were used in this study. They were equally
divided into four groups. Group I: control group, group II: rosemary group, the animals were given a
daily oral dose of rosemary leaves extract. Group III: azathioprine group, the animals were given a
single dose of AZA intraperitoneally. Group IV: rosemary azathioprine group: the rats were given
daily doses of rosemary leaves extract then azathioprine in the last day of the experiment as in the
previous regimen. The experiment continued for ten days. Blood samples were taken from all groups
and examined for tumour necrosis factor alpha, serum amylase enzyme, C-reactive protein and renal
function tests (serum urea and creatinine).

Results
: Rosemary significantly decreased the levels of tumour necrosis factor alpha, serum amylase
enzyme and serum urea and C-reactive protein in rosemary AZA group compared to AZA group .

Conclusion
: The aqueous rosemary leaves extract has the ability to ameliorate the biochemical
pathways of the side-effects of azathioprine, so it is advisable to give it concomitantly to patients
treated by azathioprine.

Key words
: azathioprine, rosemary, anti-inflammatory activity, antioxidant.

Introduction:

inflammatory
diseases,
hepatotoxicity

(Gutierrez et al., 2010).
Rosemary leaves is a common household plant
The effectiveness of rosemary extracts as
grow in many parts of the world as it is cheap
antioxidants have caused their commercial
and claimed to be safe. Its leaves possess a
use. It has a powerful inhibitory action on lipid
variety of bioactivities including antioxidants,
peroxidation production and, a stimulatory
anti-tumours, anti-inflammatory and anti-HIV.
action on the synthesis of cellular antioxidants
It contains a vast number of polyphenolics
(Ahmed and Abdalla, 2010).
including carnosic acid, carnosol, rosemarinic
The activity of rosemary has been ascribed to
acid and ursolic acid (Peng et al., 2007).
the diterpene content, mainly carnosic acid
Rosemary and its constituents, especially
and carnosol (Wijeratne and Cuppett, 2007),
caffeic acid derivatives such as rosmarinic
as well as to the essential oil constituents
acid, have a therapeutic potential in treatment
(Bozin et al., 2007). Carnosic acid provides
and prevention
of bronchial asthma,
protection from the liver carcinogen aflatoxin
spasmogenic
disorders,
peptic
ulcers,
A (Costa et al., 2007).

64


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d:\skydrive\Jor\vol42_7 The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 73 - 84

Role of Circulating CD4+ CD25high Foxp3+ Regulatory T-Cells in Paediatric
Asthma

Ensaf Khalil Mohammed*, Zeinab Farag Asheiba *,
Mervat Mohii El-din Ali**
Departments of pediatric *, Clinical Pathology**
Faculty of medicine for girls, Al-Azhar university.

Abstract

Background:
The role of T-Helper 2 (Th2) cells in the pathogenesis of allergy and asthma
has been well described. However, the immunologic mechanisms that down modulate and
protect against the development of these disorders are poorly characterized. A spectrum of
CD4+ T cells, including, FOXP3-positive CD4+CD25+ T regulatory cells (Tregs) might play a
critical role in regulating these diseases.

Objective:
To investigate the role of CD4+CD25high FoxP3 Tregs in the pathogenesis of
pediatric asthma.

Methods:
The study included 24 asthmatic children, 12 had mild intermittent asthma and
12 were of severe persistent asthma . In addition, 12 healthy subjects were used as controls.
All patients were subjected to clinical examination and laboratory investigations including
complete blood count with differential leucocytic and absolute eosinophilic count, serum
total IgE level by ELIZA and flow cytometry was used to study the frequency of Tregs in
peripheral blood lymphocytes of all studied groups using specific markers: cell-surface CD25
and CD4 expression and cytoplasmic FoxP3 expression.

Results:
It was noticed a significant decrease in CD4+CD25+ % and CD4+CD25 high % in
both mild intermittent cases and severe persistent asthmatic patients when compared to
healthy controls. FoxP3 expression in Tregs was significantly lower in CD4+CD25high T-cells
of mild asthmatic patients when compared to control group. While the FoxP3 expression in
Tregs was non- significantly lower in CD4+CD25high T-cells of severe asthmatic patients
.Tregs cells % was correlated significantly with mild asthma .While it did not show
correlation with severe asthma . An inverse correlation between FoxP3 protein expression
was revealed within CD4+CD25high T-cells and total serum IgE when analyzed for all
subjects. However, when correlation analysis was performed in each studied group
separately, no significant correlation was found between FoxP3 expression and total serum
IgE levels and there was no correlation between FoxP3 protein expressions within
CD4+CD25high T-cells and eosinophilic count was noticed.

CONCLUSION:
The correlation of CD4+CD25high FoxP3 Tregs with asthma pathogenesis
indicates that it is important to evaluate Tregs in allergic asthmatic children. Greater
understanding of the molecular and immunological mechanisms underlying the
CD4+CD25high FoxP3 Tregs might contribute the development of treatment modalities to
influence disease processes of bronchial asthma in children as a future therapeutic target.

Key words:
Asthma, children, CD4+CD25high regulatory T cells, FoxP3, flowcytometry.

73

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The Incidence of Normal Coronary Angiography on Cardiac Catheterization in Jordanians The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 85 - 89
The Incidence of Normal Coronary Angiography on Cardiac
Catheterization in Jordanians


Ziad Khalef Drabaa and Mohammed Holy Majed
Adult Cardiology Department/ Queen Alia Heart Institute/ King Hussein Medical
Center/Jordan



Abstract

Objective: To determine the incidence of normal coronaries on cardiac catheterization and
its pattern of occurrence according to sex and age.

Methods: This is a retrospective study conducted at Queen Alia Heart Institute in Amman-
Jordan during the period 2006 to 2011. A total number of 5000 adult patients who had
coronary angiography for chest pain, which were reviewed looking for the presence of normal
coronaries, its frequency among males and females and its occurrence according to age
groups.

Results:
The overall incidence of normal coronaries on cardiac catheterization was 17.3%,
with almost equal ratios for males and females (53.9% and 46.1% respectively). Women in
the age group 50 59 years was the commonest category (33.7%) to have normal coronary
angiography, whereas the commonest age group for males was 40 to 49 years. Patients above
70 years of age were very less commonly to have normal coronaries (only in 8.5%).

Conclusion:
Normal coronaries on cardiac catheterization is a recognized finding in both
men and women. Recognition of this issue is essential in order to prescribe proper follow up
and appropriate medical therapy with correction of modifiable risk factors.


Introduction

men.( Jong et al.,1996)

Normal
angiography
on
cardiac
Coronary angiography offers clinicians
catheterization in patients with chest pain
both
diagnostic
and
therapeutic
is still a
opportunities
recognized finding and five times more
as heart disease is the commonest cause of
common in women than in men.( Sullivan et
al.,1994 & Abdelmoneim et al., 2009)
death over all the world, and coronary
angiography is the standard for detection
Some forms of ischemic chest pain may be
of coronary artery disease.( Minino et al.,2007)
caused by abnormalities of the
Many patients undergoing angiography are
microcirculatory vessels(Cannon et al.,1988)
found to have normal coronary arteries.(
other causes for chest pain and normal
Phibbs et al.,1988)
coronary angiography may be due to
In spite of efforts to optimize patient
endothelium abnormality with consequent
selection for cardiac catheterization
spasm.( Nabel et al,1988)
depending
Although acute myocardial infarction is
on the clinical history, results of
generally associated with significant
biochemical blood tests and stress testing,
coronary
the
artery disease, it was reported to occur in
ratio of normal coronary angiography
patients
with
normal
coronary
ranges from 10 to 20%, more in women
angiography. ( Sharifi et al,1995)
than in
Patients with normal coronaries should not
be denied treatment and proper
85

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Assessment of vitreoretinal interface and clinically significant macular edema by OCT and fluorescein angiography The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 90 - 102


Assessment of vitreoretinal interface and clinically significant macular edema
by OCT and fluorescein angiography

Hany Ali Yahia (1), Sawsan A Shalaby(2), Elham A Hassan(2) ,
Wafaa A Madbouly (2), Nihal Adel Hassan(3)


Tanta Hospital of Ophthalmology (1) Ophthalmology department, Faculty of medicine
(for Girls), Al Azhar University. (2) Ophthalmology department, Faculty of medicine,
Cairo University. (3)



Abstract:


Objective: To assess the changes occurring at the vireoretinal interface with clinically significant
macular edema using optical coherent tomography (OCT) and fundus fluorescein angiography
(FFA).

Patients and Methods: Ninety nine eyes of 84 patients suffering from macular edema of
different etiologies were included in this study. They were divided according to the cause of
macular edema into 6 groups. Treatment modalities were done to be evaluated in the follow up.
All cases were followed up at regular visits one week, one month, and six months with routine
ocular examinations. FFA and OCT changes were determined and evaluated at one month and 6
months after treatment.

Results: In diabetic group (40 eyes), there were 22 eyes with different stages of PVD seen by OCT
in comparison to 5 eyes only demonstrated by FFA, ERM seen by OCT of different stages in 14 eyes
while in FFA 10 eyes only, In the RVO group (15 eyes), there were 6 eyes with different stages of
PVD seen by OCT in comparison to no eyes demonstrated by FFA, In the IGS group (10 eyes), there
were 3 eyes with different stages of PVD seen by OCT in comparison to no eyes demonstrated by
FFA, In the CNV group (17 eyes), there were 4 eyes with different stages of PVD seen by OCT in
comparison to no eyes demonstrated by FFA, ERM seen by OCT of different stages in 3 eyes while in
FFA one eye only, In the RP group (10 eyes), there were 2 eyes with different stages of PVD seen by
OCT in comparison to no eyes demonstrated by FFA. In the TME group (7 eyes), there were 3 eyes
with different stages of PVD seen by OCT in comparison to no eyes demonstrated by FFA, ERM seen
by OCT and FFA of different stages in 4 eyes.

Conclusions:
OCT provided us with valuable information on the retinal morphologic changes
associated with ME of different etiologies and analyzing vitreomacular relationship and detecting
macular SRD undetectable on biomicroscopy and FFA.

Keywords: PVD (posterior vitreous detachment), ERM (epiretinal membrane), RVO (retinal
vein occlusion), IGS (Irvin gas syndrome), CNV (Choroidal neovascularization), SRD (serous
retinal detachment), RP (retinitis pigmentosa), TME (tractional macular edema), ME (macular
edema).



90

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d:\skydrive\Jor\vol42_10 The Egyptian Journal of Hospital Medicine (Jan. 2011) Vol., 42: 103 108

Wies procedure combined with anterior lamellar recession in the management of
cicatricial entropion of the upper eyelid

Sawsan A Shalaby
Ophthalmology department, Faculty of medicine (for Girls) Al Azhar University

Abstract


Purpose: To evaluate the efficacy of the Wies procedure combined with anterior lamellar recession in the
management of cicatricial entropion of the upper eyelid.

Patients and methods:
Nineteen patients (24 upper lids) with severe cicatricial entropion, trichiasis, and
tarsal shortening were included in this study. Previous Snellen's operation was recorded in 6 patients (8
eyelids). All cases underwent anterior lamellar recession and wies procedure.

Results:
No residual entropion (no lash-cornea touch) was recorded in all lids (100%). All cases
developed postoperative edema that subsided gradually within one week. Over correction occurred in 2
lids (8.3%), and three eyelids developed infection (12.5%), which healed in few days after antibiotic
therapy. The mean follow up was 9 months (range; 6 to12 months).

Conclusion:
Wies procedure combined with anterior lamellar recession in the management of cicatricial
entropion of the upper eyelid are effective especially for recurrent cases and short tarsus; no lid shortening
developed postoperatively, and gave cosmetically accepted results.

Introduction:
and Rubenzik et al, 1975). Other procedures

included scleral graft, skin graft (Rubenzik et al,
Cicatricial entropion of upper eye lid results
1975 and Reacher et al, 1990), transverse tarsotomy
from loss or scarring of the posterior lamella of
and marginal rotation, and tarsal grooving
the eye lid. Conjunctival scarring is the common
(Snellen's operation)
.
(Wu et al, 2010)
denominator in cicatricial entropion. This

cicatricial scarring may result from chronic
The WHO has approved the bilamellar tarsal
blepharoconjunctivitis,
trachoma,
chemical
rotation procedure (BTR). However, studies
injuries, trauma, chemical burns, any other acute
have shown that recurrence rates after surgery
or chronic inflammatory process, and systemic
can be high (Kerie and Bejiga , 2010).
mucocutaneous disorders as ocular cicatricial

pemphigoid (OCP), and Steven Johnson
This study aim was to report the efficacy of the
syndrome, SJS(Ei Ti et al, 2001, and El-sedfy et al,
Wies procedure (transverse blepharotomy and
2003).
marginal rotation) combined with anterior

lamellar recession in the management of severe
The conventional procedures however, often
cicatricial entropion of the upper or lower
don't affect a permanent cure and my produce
eyelid.
unwanted
complications.
Thus
surgical

management
is
recommended.
Surgical
Patients and methods:
treatments have initial success but long-term

results are poor and recurrences are frequent. a
This study was done in Al Zahraa University
wide variety of operations have been described ,
Hospital, in a period from September 2008 t o
some require grafts as Van Milligen's operation
July 2010. It included, 24 upper eyelids for 19
but it had many drawbacks such as sloughing of
patients (5 patients had surgery for both eyes),
the graft, infection and recurrence(John et al,1992
with severe cicatricial entropion and trichiasis
103

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