d:\skydrive\Jor\vol48_1 The Egyptian Journal of Hospital Medicine (June 2012) Vol., 48: 334 347

Enhancement of Urinary Bladder Carcinogenesis by the Role of Chronic
Bacterial Infection-induced Inflammation (Imunnohistochemical and
Biochemical studies)
Gabri MS*, Ashmawy AM**, Ibrahim MA*, Hosny RM*
*Department of zoology and entomology, Faculty of Science, Helwan University.
** Department of cancer biology, National cancer institute, Cairo University.

Background: Bacterial infections traditionally have not been considered major causes of cancer.
Recently, however, bacteria have been linked to cancer by two mechanisms: induction of chronic
inflammation and production of carcinogenic bacterial metabolites. The most specific example of the
inflammatory mechanism of carcinogenesis is Escherichia coli infection. E. coli has been
epidemiologically linked to urothelial carcinoma of the urinary bladder by its propensity to cause lifelong
inflammation. This inflammation is in turn thought to cause cancer by inducing cell proliferation and
production of mutagenic free radicals and N-nitroso compounds.
Material and methods: After each 3, 6 and 9 months of daily oral administration of dibutyl amine
(DBA) plus sodium nitrate (nitrosamine precursors) in drinking water, curcuma in grinding diet and
bladder injection with E. coli, rats were sacrificed. The excited bladder were dissected, processed and
stained with H&E and anti-Ki67 immunohistochemical stains. This was followed by Elisa for caspse-3
and statistical analysis.
Results: The current results indicated that E. coli infection in the bladder tissues increases the
carcinogenic ability of nitrosamine precursors through caused marked alteration in the form hyperplastic,
dysplastic and metaplastic urothelium. Also, there was a statistically significant increase in ki67
immunoreactivity in urothelium. However, a statistically significant decrease in the concentration of
caspase-3 in bladder tissue consequently caused the process of carcinogenesis. All these changes were
less marked after curcuma treatment when compared with the group that not treated with curcuma.
Conclusion: Bacterial infection of the urinary bladder may play a major additive and possible role in
bladder carcinogenesis. Rhizome of curcuma may have a protective action during induction of urinary
bladder tumors.
Keywords:Bladder carcinogenesis - E. coli - curcuma DBA - Ki67-Immunohistochemistry - Caspase-3.

Bladder carcinoma is the most common
dividing uncontrollably. This abnormal growth
malignancy of the urinary tract (Ploeg et al.,
results in a mass of cells that form a tumor
2009), where the cells lining the urinary bladder
(Good, 2003). Urothelial carcinomas account for
lose the ability to regulate their growth and start
more than 90% of urinary bladder cancer cases


Full Paper (vol.48 paper# 1)

d:\skydrive\Jor\vol48_2 The Egyptian Journal of Hospital Medicine (July, 2012) Vol., 48: 348 356

Long Coronary Lesions Requiring Long Stents >20 mm. Analysis And Outcome
In Patients Treated At Queen Alia Heart Institute

Marwan Adib Al-Nimri, MD, JBM, JBC, FACC, FSCAI
Correspondence should be addressed to:
Dr. Marwan Adib Al-Nimri. E mail: mtnimri@hotmail.com
P.O. Box 789 Tel 00962799018140 Zip Code 11947 Tareq -Amman Jordan

Objective: To determine the outcome after using long coronary stents >20 mm for long
coronary lesions among patients treated at Queen Alia Heart Institute.
Methods: This is a descriptive, and a retrospective non randomized study which was
conducted at Queen Alia Heart Institute on 900 adult patients who underwent coronary
angiography and intervention for either stable or unstable angina pectoris during the period
between 2006 to 2011. Those patients had coronary intervention using a single long stent for
each long lesion (>20 mm). Their follow up was analyzed and the outcome of these long
stents was studied for in stent restenosis or in stent total occlusion in each specific coronary
artery. A specially designed form was used to record the following data in the involved
patients: age, gender, size and type of coronary stent (drug eluting or bare metal), the
presence of diabetes mellitus, hypertension or hypercholesterolemia, and the status of the left
Results: The total number of patients who had long coronary stent intervention was 900
cases. Four hundred eighty patients (53.3%) had restudy cardiac catheterization within 6-8
months, which showed instent restenosis or instent total occlusion in 90 patients. Males
constituted the majority (88.9%) of the affected patients. Smoking was the commonest
(83.3%) factor associated with instent restenosis followed by Diabetes Mellitus (61.1%).
About half the cases of long instent restenosis was found in left anterior descending artery,
whereas right coronary artery and circumflex artery had almost equal ratios: 23.3% and
22.2% respectively. Long instent restenosis was commoner (33.3%) in ostial lesions and was
the least (14.5%) in mid segment lesions. Bare metal stents were associated with the majority
(77.8%) of cases of instent restenosis. About two thirds of the affected patients had small
caliber stents (2.5 and 2.75 mm diameter).
Conclusion: Instent restenosis or instent total occlusion in long coronary stents is a well
recognized and not uncommon clinical entity. Men are more commonly affected than women.
Ostial left anterior descending artery is more affected than other coronaries. Smoking,
Diabetes Mellitus and the use of bare metal stents of small sized caliber ( 2.75 mm) were

Full Paper (vol.48 paper# 2)

The Effect of Some Aflatoxins on Lymphatic Organ of Albino Rats (Spleen) Histopathological Study The Egyptian Journal of Hospital Medicine (July, 2012) Vol., 48: 357 367

Effect Of Some Aflatoxins On A Lymphatic Organ (Spleen) Of Male
Albino Rats (Histopathological Study)
Nahed Ahmed Omar
Department of Zoology, Faculty of Science, Damietta Branch, Mansoura University.

Background:The present study was planned to compare between two kinds of aflatoxins ( AFB2
and AF Mix) on spleen of male albino rats. Fifty young male albino rats ,each weighing 50g, were
fed on diets containing aflatoxins at concentration of 1.0 ppm either of AFB2 or AF mix. for 2, 4, 6
weeks followed by a withdrawal period of 2 weeks.

Material and Methods:- Rats were randomly divided into 3 groups: the 1st group of 10 rats was fed
on the standard diet. The 2nd and the 3rd groups of 20 rats each were maintained on the standard diet
plus either AFB2 or AF mix. respectively. Ten animals from the latter 2 groups as withdrawal
period. Pieces of spleen were subjected to histological procedures and the obtained sections (6 m
thick) were stained with the haematoxylin and eosin, also, mercuric bromophenol blue stain for
total protein were used in this study.

Results:- Marked histopathological alterations were observed in the studied sections under the
influence of AFB2 and AF mix. It was found that AFB2 induced more alterations. The most
common changes were lymphocytic degeneration, fatty changes with numerous hemorrhagic areas.
The two weeks withdrawal period showed a partial recovery of the developed changes.

Conclusion:- This study indicated that AFB2 has a toxic effect on spleen than the equivalent level
of AF mix. .Great caution must be followed to prevent the possible contamination of our food with
such mycotoxins.
Key words:- Aflatoxins Spleen Histopathology.


Aflatoxins are metabolites of Aspergillus
lymphoid cells of weanling rats showed a
flavus that grow on ground nuts and other
marked reduction in the population and
food stuffs ( Borker, 1966 ; Barnes, 1967),
phagocytic capacity of macrophages due to
and were confirmed to be toxic (Newberne et
AFB1 administration (Raisuddin et al.,1990).
al., 1964).
Aflatoxin B1 was toxic to the systemic

immune system in various animal species
There are two species of Aspergillus which
(Watzl et al.,1999). Also, AFB1 had an the
are known to produce toxins. The isolated
immunosuppressive effect on macrophages
toxigenic Aspergillus flavus produces
after in vivo exposure (Moon et al., 1999).
aflatoxin B1 and B2, whereas the isolated A.
Low level of it inhibited the immune function
parasiticus generally produces aflatoxins B1,
(Blaney and Williams, 1991 ; Chang and Pan,
B2, G1 and G2. Aflatoxin B1 was found to be a
potent hepatotoxic and hepatocarcinogenic
mycotoxin (Cole and Cox, 1981 ; Rastogi et
In rabbits, the addition of aflatoxin B1 to
al., 2001) and caused severe histopathological
normal diet produced hyperglycaemia and
alterations in liver (Rati et al., 1991). At low
decreased liver glycogen (Verma and Raval,
level of aflatoxin B1, the immune function
1992). This was similary met with in
and growth performance in pig were greatly
chickens (Abdelhamid et al,.1995) and rats
inhibited (Chang and Pan, 1992) and induced
(Choi et al.,1981 ; Rastogi et al., 2001). In
liver tumors in rats (Angsubhakarn et al.,
this respect, the elevation of blood glucose
level and the decrease in glycogen in liver by
aflatoxin was attributed to lowering insulin
The effects of long-term treatment of three
level and raising of cortisol (Abdelhamid and
dose levels of aflatoxin B1 (AFB1) on
Dorra,1990). Also, giving rats intraperioneal

Full Paper (vol.48 paper# 3)

Intrvascular coronary ultrasound and pressure wires : The Egyptian Journal of Hospital Medicine (July, 2012) Vol., 48: 386 382

The Current Status of Usage of Complementary Cardiovascular
Devices in Cardiac Catheterization Laboratory in
Queen Alia Heart Institute (QAHI)
Marwan AlNimri*, MD, JBM, JBC, FACC, FSCAI
* From Queen Alia Heart Institute/ Adult Cardiology Department.
Queen Alia Heart Institute/King Hussein Medical Center. POBox: 789 TAREQ,
Amman Jordan. Zip code 11947.E-mail: mtnimri@hotmail.com

Cardiac catheterization laboratories are experiencing phenomenal change, as their
volume increases and cases become more complex. In the search for the perfect angiographic
result, interventional cardiologists have explored numerous therapeutic complementary
devices that are used in the cath labs to facilitate achieving this elusive prize.
Unfortunately, these adjunctive interventional devices are lacking in the majority of
cath labs all around developing countries including those in Middle East /North Africa region
(MENA region). In fact, most of coronary interventions here became restricted to
implantation of bare metal stents or drug-eluted stents with or without simple balloon
predilatation or post-dilatation. The limited adoption of complementary devices reflects
concerns of the high costs for these devices, un-suitability for their re-sterilization, having
their own learning curve with compelling continuous need for high level of training.
In this review, we will summarize the evidence base concerning most of the important
therapeutic complementary cardio-vascular interventional devices and comment on
challenges facing the more widespread adoption of their use in MENA region .Hopefully, this
objective analysis would help fostering their further growth and penetration into the markets,
making them part of daily practice.
Key words: Complementary Cardiovascular Devices, Cardiac Catheterization Laboratory
Improvements in basic percutaneous
complementary devices that are used in
coronary intervention (PCI) equipment
the cardiac catheterization laboratories
have largely been bought by the
(cath labs) to facilitate achieving this
availability of bare metal stents (BMSs)
elusive prize. Unfortunately, most of these
(Fischman et al .,1994) and drug-eluting stents
devices are lacking in most cath labs all
(DESs). (Stone et al., 2007) Recent and ongoing
around the MENA region and generally all
progress will make bypass surgery largely
developing countries. Their limited
obsolete within the next several years. (Baim,
adoption reflects concerns of the high
costs for these devices, un-suitability for
In the search for the perfect angiographic
their re-sterilization, having their own
result, interventional cardiologists have
learning curve with compelling continuous
explored numerous therapeutic
need for high level of training both for

Full Paper (vol.48 paper# 4)

Protective effect of Balanites aegyptiaca and Cleome droserifolia on antioxidant defense system against Adriamycin - induced cardiac toxicity in mice The Egyptian Journal of Hospital Medicine (July, 2012) Vol., 48: 383 393

Doxorubicin-induced cardiotoxicity in mice; protection by silymarin
Heba Abdelnasser Aniss a, Ashraf El Metwally Said b, Ibrahim Helmy El Sayed c, Camelia
AdLy a.
a Department of Biochemistry, Faculty of Science (Damietta branch), Mansoura University, Egypt.
b Department of Zoology, Faculty of Science (Damietta branch), Mansoura University, Egypt.
c Department of Biochemistry, Research Institute for Genetic Engineering and Biotechnology, Menofia
University, Egypt.
Background: despite its vast utility in clinical oncology, the use of doxorubicin is limited by a
potentially fatal cardiomyopathy and congestive heart failure. Free radical formation and antioxidants
depletion are mechanisms proposed for this cardiomyopathy. The aim of this study is to compare the
potential antioxidative protective effect of silymarin on doxorubicin-induced cardiotoxicity in
experimental mice.
Materials and methods: four groups (ten animals in each group) of experimental mice were used
as follows: Group 1, mice received only saline (intraperitoneally) and served as a negative control
group; Group 2, mice received doxorubicin (intraperitoneally, 5 mg/kg body weight) in three equal
injections over a period of two weeks for a cumulative dose of 15 mg/kg body weight; Group 3, mice
orally administrated silymarin (200 mg/day/kg body weight) respectively, through an intragastric
feeding tube over a period of three weeks; Group 4, mice treated orally with silymarin plus
intraperitoneally doxorubicin administration with the same protocol of groups 3 and 4. Serum lactate
dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate aminotransferase (ASAT), alanine
aminotransferase (ALAT), malondialdehyde (MDA), total nitric oxide (NO), cardiac reduced
glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT)
were measured in all tested groups.
Results: doxorubicin elevated the activities of LDH, CPK, AST, ALT, MDA and NO in the cardiac
tissue. Cardiac antioxidant enzymes activities SOD and CAT also increased while GPx activity was
decreased. Pre-co-treatment with silymarin prevented the changes induced by doxorubicin
administration. These findings demonstrate the cardio-protective effect of silymarin on cardiac
antioxidant status during doxorubicin induced cardiac damage in mice.
Conclusion: silymarin could be recommended for further investigation as potentially new indication
for clinical application.
Keywords: doxorubicin, cardiotoxicity, silymarin, antioxidant enzymes, oxidative stress.
and irreversible cardiotoxicity (Asmis et al.,
adriamycin is a potent antibiotic, widely used
2005; Patil et al., 2008). DOX-induced
for the treatment of different solid and
cardiotoxicity had been explained by many
hematopoietic cancers. However, in addition to
mechanisms, including the affinity of DOX to
its anti-tumoricidal activity, it promotes several
lipids, calcium alterations and membrane
well-known side effects that include chronic
depolarization, disorder of membranes, free

Full Paper (vol.48 paper# 5)

d:\skydrive\Jor\vol48_6 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 394 406

-The Evidence For Soybean Products As Cancer Preventive Agents
1 Mohamed E.M. Zowail, 2 Hanaa F. M. Waer, 2 Neamat Hanafi, 1 Eman H. S. Khater and3 Hala
1 Faculty of Science, Benha University.2 National Center for Radiation Research and Technology,
Atomic Energy Authority, Cairo.3 Faculty of science, Ain shams university
Aim of the work: The evidence for specific soybean-derived compounds having a suppressive
effect on carcinogenesis in animal model systems is created, the anti-carcinogenic potential of
soybean was studied against colon cancer. Colon cancer has been induced by dimethylhydrazine
Material and methods: The DMH was dissolved in physiologic saline and the animals were
given subcutaneous injections once weekly for 16 weeks. The possible preventive effects of
soybean on Dimethylhydrazine-induced colon tumors in male Sprague Dawley rats was
investigated. Albino rats were divided into four groups. control group, control soybean powder
group, DMH-treated colon cancer group and the fourth group treated with soybean
Results: In the studied groups the colon was examined macroscopilly to calculate the number of
polyps appeared in each colon. The histological and ultrastructural studies included the
alternations in different component of the colon. The macroscopical examination showed that the
group which was given the soybean alone showed no polyps. On the other hand the group that was
given the carcinogenic agent alone expressed a high number of polyps. The histological and
ultrastructural studies showed that colon cell structure of carcinogenic treated animal groups
underwent cell proliferation, focal cell damage with certain nuclear changes, abundance of fibrous
tissue and lymphocytic infiltration, while the group given soybean as a preventive agent
expressing less number of colon polyps, and induced a moderate changes of different degrees.
Conclusion: It is clear that soy bean component showed a good protective effect against the colon
several advancements in the understanding
Colorectal cancer is one of the most
of the processes in carcinogenesis,
prevalent causes of cancer death in
presently available therapies, including
developed countries. Colon cancer is the
surgery, radiation, and chemotherapeutic
second most common cause of cancer
drugs are still limited for advanced stage
related death (after lung cancer) (Jemal et
colon cancer (Boursi and Arber, 2007).
al., 2004). The etiology of colon cancer is
effective and promising complimentary
environmental, and dietary agents. Despite
strategy for controlling the incidence of

Full Paper (vol.48 paper# 6)

d:\skydrive\Jor\vol48_7 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 407 413

The Use of the Median Raphe of Gastrocnemius to Augment the
Repair of Achilles Tendon Rupture
Abdullah Ali Al-Zahrany
Department of Orthopedics, Taif University, Saudi Arabia

Background and Objectives:
Rupture of the Achilles tendon is a common injury among athletes and even sedentary
individuals. Presence of a gap between the two ends of the disrupted tendon makes the
treatment difficult, however, augmented repair techniques are used in defective Achilles
tendon ruptures and provide excellent functional results in active individuals, but it carries
an incidence of wound complications like tendon adhesion to the skin. In this study we
present an augmentation technique for Achilles tendon rupture that would prevent tendon
adhesion to the skin.
Material and methods: This prospective study was conducted in King Abdul-Aziz
Specialist Hospital, Taif, Saudi Arabia from March 2009 to March 2011 on 12 male
patients with defective Achilles tendon ruptures. We used an apponeurotic strip from the
median raphe of gastrocnemius, and twisted 180 degrees on itself from medial sides, to
allow its smooth external surface to lie next to the skin and cover the rupture site, and the
plantaris tendon was incorporated in the repair site.
Results: Twelve male patients with a mean age of 37 years (27-55) were diagnosed as
having a ruptured Achilles tendon. Ten patients had been injured during sports activities the
other two cases occurred during walking. The mean duration of ruptures before surgery was
(20 days) ranging from 3 to 40 days. The mean follow up was 22 months (11- 35) There
were no re-ruptures. Three patients had skin necrosis and managed by debridement
followed by secondary sutures and satisfactory healing was achieved. There were no tendon
adhesion to the skin and the skin over the tendon was movable. All patients returned to their
activity after 6- 14 months (mean 8 months).
Conclusion: augmented operative repair of Achilles tendon ruptures is a reliable treatment
method for active patients and the repair is preferred to prevent tendon adhesion to the skin.

Most of the ruptures of the Achilles
condition which is difficult to treat if there
tendon are sport related specially in males
is a gap between the two disrupted tendons
who are active intermittently "weekend
ends (Maffulli et al, 2011). A relatively
warriors" and it is usually a disabling
hypovascular area exists approximately

Full Paper (vol.48 paper# 7)

d:\skydrive\Jor\vol48_8 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 414 428

Effect of Grape Seed Extract on Oxidative Damages in Gamma
Irradiated Rats
Abdelgawad.A. Fahmi1, M.A.El- Desouky1, Neama M. El-Fatih2, Wissam.A.Mohamed1
1 Chemistry Department, Faculty of Science, Cairo university and 2 Radiation Biology Department,
National Centre for Radiation Research and Technology (NCRRT), Cairo, Egypt
Back ground: Ionizing radiation is known to produce deleterious effects in the living
Aim of the work: The aim of this study is to evaluate the possible protective effect of the
chemical constituents of grape seed extract on oxidative stress induced by gamma rays.
Materials & Methods: Rats were subjected to 8 Gy fractionated doses of gamma radiation,
grape seed extract 100 mg/kg body weights were daily administrated before and within
radiation exposure. All parameters were investigated at 1st and 14th days post last radiation
Results: The results revealed that administration of grape seed extract to irradiated rats
significantly ameliorates the changes induced in antioxidant system. TBARS (lipid
peroxidation index) were significantly decreased when compared with their equivalent
values in irradiated rats.
In conclusion, the administration of grape seed extract to irradiated rats might provide
substantial protection against oxidative damages due to its free radical scavenging and
antioxidant properties of its ingredients. It could be suggested that, grape seed extract may
have a potential benefits to people receiving radiotherapy.
Key words: Grape seed extract, -Irradiation, Oxidative Stress, Mitochondria, and
Antioxidant Enzymes.
Radiation damage, is to a large extent
to ionizing radiation induce oxidative
caused by over production of reactive
stress in different tissues (Saada et al.,
oxygen species(ROS)
2003; Said et al., 2004). ROS and
disruption of membrane lipids leading to
oxidative stress may contribute to
subsequent formation of peroxide radicals
radiation-induced cytotoxicity and to
(Rajapakse et al.,2007). Experimental
metabolic and morphologic changes in
studies have demonstrated that exposures
animals and humans during radiotherapy,

Full Paper (vol.48 paper# 8)

d:\skydrive\Jor\vol48_9 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 429 438

Management of Severe Hallux Valgus Using Combined Proximal
Closing Osteotomy with a Distal Soft Tissue Reconstruction
Abdullah Ali Al-Zahrany
Department of Orthopedics, Taif University, Saudi Arabia

Background: many surgical procedures were described for correction of hallux valgus and the
type of operation is based upon; foot length, width and redressibility of the transverse arch, hallux
valgus evaluation of possibility of its passive redression and radiographic examination of foot.
Aim of the work: To evaluate the results of hallux valgus surgery combining the distal soft tissue
reconstruction (DSTR) or modified McBride procedure and proximal closing wedge osteotomy of
the first metatarsal base.
Patients and methods: This prospective study, was performed in King Abdul-Aziz Hospital,
Taif, Saudi Arabia. The study was approved by the local committee of human research, and all
patients gave written informed consent to participation. Ten patients (8 women and 2 men) with
mean age of 28 years (18-40 years) were included in the study with 16 surgeries. The mean
postoperative follow-up was 36 months (28 48). The operative technique performed in these
patients was a combination of DSTR with closing osteotomy of the first metatarsal base.
Results: The mean pre-operative intermetatarsal 1-2 angle (IMA) revealed by radiographs was
surgically corrected from 20.3 degrees at the baseline to the mean degree of 7.9. The mean pre-
surgical hallux valgus angle (HVA) was 44.9 degrees proved by radiographs was surgically
improved to 11.7 degrees, and 3 years after operation it reached 12.3 degrees (mean). Ninety
percent of patients were satisfied with their surgical results and cosmetic improvements were
achieved in 93.7 % (15/16 feet in 9 patients).
Conclusion: The combination of wedge osteotomy of the first metatarsal base and the distal soft
tissue reconstruction (DSTR) or modified McBride procedure is suitable in the treatment of
young patients having severe forms of hallux valgus and minimum arthritic changes in
metatarsophalangeal joint with increased IMA.
Hallux valgus is a forefoot condition in
which the 1st metatarsal is medially deviated
metarsophalangeal (MTP) joint that can be
and the hallux is laterally deviated creating a
painful, especially with footwear (Bosch et

Full Paper (vol.48 paper# 9)

d:\skydrive\Jor\vol48_10 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 439 451

Dual Effect of Sacral and Lower Limb Neuromodulation in Urge
1 Marwa M. Eid MD; 2Basant M. Elnady, MD ; 3Fatma M. Abdel Aty MD; 4Dalia Desouky
MD .
Lecturer of Surgery1 Physiotherapy faculty of physiotherapy Cairo university, lecturer of Rheumatology
and Rehabilitation2 faculty of medicine Benha university , lecturer of Pediatric3 Physiotherapy faculty of
physiotherapy Cairo university, and lecturer of Public Health and community medicine4 faculty of
medicine Menoufiya university,Egypt.
Purpose: To investigate the effect of posterior tibial nerve electrical stimulation (PTN) and sacral surface
therapeutic electrical stimulation (SSTES) in the treatment of overactive bladder.
Patient and method: Sixty patients were included in this study. Their ages ranged from 14-62 years. They
were divided into two equal groups.
Procedures: Group(A)received 12weeks of treatment with sacral surface electrode and posterior tibial
nerve electrical 15 min three times /week for12 weeks while group (B)received pelvic floor exercises for
15 minutes 3times/week for 12 weeks.
Results: this study revealed that the bladder volume at first desire to void for group (A)as well as for
group(B); showed no statistical significant difference, bladder stability in (A)group showed a highly
statistical significant improvement with a percentage 48.69% while for group(B) non significant and by
comparing both groups post-treatment, there was a statistical significant difference between groups with
high percentage of improvement of the bladder stability in group(A) more than group(B). Maximum flow
rate was significantly improved post-treatment, for group (A) with a percentage of improvement 25.2%
while, for group (B)it was with a percentage of improvement 12.37%, and by comparing both groups post-
treatment there was a statistical significant improvement in group(A) more than in group (B).
Conclusion PTN and sacral surface therapeutic electrical stimulation (SSTES) produced objective
improvements include urodynamic changes specially bladder stability, and maximum flow rate.
Keywords: Urge incontinence, Neuromodulation, Dual, sacral, lower limb.
Overactive bladder symptoms (urgency,
with overactive bladder also suffer from sleep
frequency, nocturia and urge incontinence) are
frequent complaints of patients attending urology
embarrassment due to incontinence and
and gynecology clinics. In many patients, the
disruption to social and work life. Quality of life
cause for these is idiopathic with no obvious
scores (QOL) are consistently reduced in this
underlying neurological abnormality. Patients

Full Paper (vol.48 paper# 10)

d:\skydrive\Jor\vol48_11 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 452 471

Cytological And Histochemical Studies On Rat Liver And Pancreas During
Progression Of Streptozotocin Induced Diabetes And Possible Protection
Using Certain Natural Antioxidants
Hanaa F. Waer*, Seham A. Helmy**
*Atomic Energy Authority. National Center For Radiation Research and Technology, Biology Department
*(King Khaled University Faculty of Science University Center for Girls)
**Suez Canal University, Faculty of Veterinary Medicine, Department of Cytology and Histology.
Background: Diabetes mellitus is a major endocrine disorder and growing health problem in most
countries. Diabetes manifested by experimental animal models exhibits high oxidative stress due to
persistent and chronic hyperglycemia which increases the generation of free radicals, streptozotocin
(STZ) provides an animal model of type 1 diabetes. Thereby depleting the activities of antioxidative
defense systems with alteration of antioxidant activities of enzymes such as green tea and curcumin .
Aim : Biochemical histological and histochemical investigations were carried on to revel the effect of
STZ on the liver and pancreas cells. Natural antioxidants were used as a new way for ameliorating
diabetic effect on the cells
Material and methods: Diabetes was induced by a single intraperitoneal injection of freshly prepared
STZ dissolved in 0.05M of sodium citrate buffer, pH = 4.6, (STZ; 45 mg/kg B.wt.).Three days after
degeneration of beta cells, diabetes was induced in all animals. After induction of diabetes, diabetic and
normal animals were kept in metabolic cages separately. Green tea (EGCG) and curcumin are used as
natural antioxidants to improve the disorders and structural changes induced by STZ. Cellular and
histochemical investigations were carried on the changes induced in the pancreatic and hepatic tissues.
Body weight, level of serum glucose and insulin were calculated in the control and treated groups. For
detecting the degeneration of both hepatocytes and pancreatic cells of diabetic rats, tissue samples from
diabetic and treated rats were collected and pathologically examined.
Results: The present investigations reveled that there was a detectable amelioration on the injures induced
by STZ on both hepatocytes and pancreatic cells using green tea or curcumin with a detectable dose level.
Also it can be observed that the ameliorated effect induced was a time dependant. Conformation of these
results from histochemical detection of polysaccharides and DNA contents were detected by PAS and
Feulgen reactions.
Conclusion: Curcumin and green tea look to have a powerful effect against diabetic cell injury induced in
both rat liver and pancreas. The ameliorating effect seem to be time dependant.
KEY WORDS: Biochemistry, Liver, Pancreas, Pathology, STZ, histochemistry.


Full Paper (vol.48 paper# 11)

d:\skydrive\Jor\vol48_12 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 427 487

Correlation of DNA damage in type 2 diabetes to glycemic control
Sohair I Salem, Safinaz E El-Toukhy, Gamila S M El-Saeed, Maha El-Wassef
Medical Biochemistry, National Research Center
Background: Diabetes is associated with excessive production of reactive oxygen
species (ROS) which can damage cellular macromolecules. The aim of the study was to
detect oxidative DNA damage in type 2 diabetic patients and to correlate it with glycemic
Aim of work: to assess the percentage of DNA damage in patients with type 2 diabetes
and the relation with glycemic control and lipid profile.
Patients and methods: The present work included 28 diabetic patients as well as 25 age
and sex matched healthy volunteers served as control. Single cell gel electrophoresis
(SCGE) was used to assess DNA damage in 28 patients with type 2 diabetes and 25 age
and sex matched healthy controls. Moreover, glycemic as well as lipid profiles were also
estimated in those subjects.
Results: The percent of DNA damage of peripheral blood mononuclear cells was higher
in diabetic patients (45.19.2) compared to healthy controls (3.70 0.85) (p<0.001). The
percent of DNA damage correlated positively with BMI, fasting blood glucose, HbA1C,
serum cholesterol, serum triglycerides, HDL cholesterol and LDL cholesterol (p<0.001) .
However, there was no significant difference in percent of DNA damage between
hypertensive patients (36.2 4.6) and non hypertensive patients (37.24.6). Pearson
correlation analysis showed a significant positive correlation between DNA damage and
body mass index, glycated hemoglobin, total cholesterol, triglycerides and low density
lipoprotein cholesterol.
Conclusion: Type 2 diabetic patients have more oxidative DNA damage than normal
controls and this damage increase with poor diabetic control, obesity and hyperlipidemia.
Thus, DNA damage in the peripheral blood of diabetic patients assessed by comet assay
can be applied as a new and non expensive technique for monitoring patients with type-2

health problems in the 21st century. Its
Diabetes is one of the most challenging

Full Paper (vol.48 paper# 12)

d:\skydrive\Jor\vol48_13 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 483 495

Effect of Ginkgo biloba Leaves Aqueous Extract on Carbon
Tetrachloride Induced Acute hepatotoxicity in rats

Hala A.H. Khattab

Nutrition and Food Science Dept., Faculty of Home Economics, Helwan University

Oxidative stress plays a pivotal role in the pathogenesis and progression of various liver
diseases. Ginkgo biloba leaves extract (GbE) have been proved to be an effective antioxidant, thereby can
contribute to the prevention and treatment of diseases associated with oxidative stress. The present study
aimed to investigate the hepatoprotective effect of GbE on acute liver injury induced using carbon
tetrachloride (CCl4) in rats.

Material and Methods:
Hepatotoxicity was induced in male rats by intraperitoneal (i.p) injection of CCl4
1mL/ kg body weight (b.w.) for every 72 h for 14 days, GbE was administered orally at a dose of 150 mg/kg
b.w., daily started two weeks prior to CCl4 injection and continued until the end of the experiment.

CCl4 caused acute liver damage in rats, as evidenced by significant increase serum enzymes
activities of aspartate and alanine aminotransferase (ALT & AST) and alkaline phosphatase (ALP), and
hepatic malondialdehyde (MDA), as well as significant decrease in weight gain percent, serum total protein
(TP), high-density lipoprotein cholesterol (HDL-C), and hepatic reduced glutathione (GSH). Pretreatment
with GbE prior to CCl4 injection elicited hepatoprotetcive activity by significant decreased the activities of
liver enzymes and hepatic MDA, and significant increased the levels of TP, and hepatic GSH, as well as
induced significant ameliorated in weight gain percent and lipid profile parameters as compared with CCl4
group. Histopathological examination of the liver tissues of CCl4 group represented the presence of hepatic
necrosis associated with cells infiltration and vacuolar degeneration of hepatocytes, while the pretreatment
with GbE overcome these changes, the majority of the cells tend to be normal.

The present findings indicated that the hepatoprotective effect of GbE against CCl4-induced
oxidative damage may be due to its potent antioxidant activity. Therefore, GbE could be of potential help as
a medicament or food supplement for alleviation of liver toxicity.

Key words:
Ginkgo biloba aqueous extract, male rats, carbon tetrachloride, liver enzymes, lipid
parameters, malondialdehyde, reduced glutathione, hepatoprotective.


The liver, due to its metabolic enzymes,
and preventing lipid peroxidation (Han et al.,
plays a vital role in maintaining the homeostasis
2004 and Gedik et al., 2005), and are applied in
of the body via the metabolism of endogenous and
clinical medicine (He et al., 2004).
exogenous molecules and it eases their
Ginkgo biloba L. (Family: Ginkgoaceae), is
detoxification and elimination. Liver function can
be impaired and hepatocytes damaged upon
unprecedented popularity over the past decade,
exposure to drugs, alcohol, infections, or
and the recognition of the important therapeutic
malnutrition (Mroueh et al., 2004). It has been
effects shown by this plant (Guo et al., 2011).
demonstrated that oxygen-derived free radicals
Chemically, the active constituents of Ginkgo
and lipid peroxidation play a critical role in the
biloba leaf are mainly (kaempferol, quercitin and
pathogenesis of various liver diseases (Loguercio
and Federico, 2003 and Das et al., 2005).
Ginkgolides A, B, C, M and J and bilobalide,
Thereby, it has become the key to prevent and
biflavones (ginkgetin, isoginkgetin, bilobetin) and
cure hepatic damage by eliminating free radicals
organic acids such as 4-hydroxybenzoic acid, that

Full Paper (vol.48 paper# 13)

d:\skydrive\Jor\vol48_14 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 496 503

Portal Vein Thrombosis after Splenectomy
Mohamed Al Saeed
Department of Surgery, Taif University, Saudi Arabia

Background and Aim of the work: Splenectomy is a common operation but it carries the
danger of many postoperative complications. One of the most important complications is the
portal vein thrombosis (PVT), which may be fatal due to development of bowel ischemia and
severe portal hypertension. Due to the effect of hypobaric hypoxia and higher liability for
thrombosis encountered in high altitude areas, PVT may represent an actual problem in Taif
province. The aim of this retrospective study is to detect the incidence, pattern of
presentation, laboratory, radiological and results of treatment of cases of PVT following
Methods: In this study, we reviewed all cases of splenectomy performed in King Abdul Aziz
Specialist Hospital, Taif, Saudi Arabia from January 2007 to January 2012. Cases of PVT
following splenectomy were analyzed for incidence, pattern of presentation, laboratory,
radiological and results of treatment.
Results: This study involved 50 patients (40 males and 10 females) admitted in the surgical
department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia from January 2007 to
January 2012. Eight cases of Portal vein thrombosis (16%) out of 50 splenectomies were
identified. These 8 patients included: 4/10 of the patients (40%) suffering from
myeloproliferative (MP), 3 of them (75%) had spleen weight greater than 3,000 g, 3/12 (25%)
of the hemolytic anemia patients, and 1/10 of the patients (10%) operated upon for
Hypersplenism. All patients had splenomegaly with mean weight of 1540 Gms (range 460 to
3850 g). Presenting symptoms included; anorexia in 7/8 cases (87.5%), abdominal pain in 6
(75%), and in all cases there was elevation in D-Dimer level, leukocyte and platelet counts.
All diagnoses were made by contrast-enhanced computed tomography scan, and
anticoagulation was initiated immediately. One/8 patients (12.5%) died from progressive liver
cell failure; the others are alive with no clinical sequalae at a mean follow up of 27 months.
CONCLUSIONS: PVT is a relatively common complication of splenectomy in patients with
Splenomegaly, especially in Taif and related districts in which there is already a higher
incidence of thrombotic disorders. The surgeon has to be with high index of suspicion, for
early diagnosis by contrast-enhanced computed tomography, and prompt anticoagulation for
successful outcome.
Keywords: portal vein, splenectomy, thrombosis.


Full Paper (vol.48 paper# 14)

d:\skydrive\Jor\vol48_15 The Egyptian Journal of Hospital Medicine (July 2012) Vol., 48: 504 510

The Use of Hypertonic Saline in Management of Hemorrhagic Shock
Mohamed Al Saeed
Department of Surgery, Taif University, Saudi Arabia

Background: The most appropriate solution for volume replacement in hemorrhagic shock
is controversial, however, hypertonic saline (HTS) solutions have recently gained widespread
Aim of the work: to study the use of hypertonic saline with the resuscitation fluids in
patients with hemorrhagic shock to evaluate the impact of this solution on the extent of early
bacterial translocation and blood pressure.
Material and method: Forty patients were involved in this prospective study with class II
& III hemorrhagic shock. They were randomized into 2 groups, each of 20 patients. Initial
resuscitation in group I was done by using Lactated Ringer's (LR) solution with or without
blood according to the patient requirements and in the second group of patients (group II),
HTS 7.5% with dose of 4 ml /kg body weight was added to the resuscitation fluids. Regular
monitoring of vital signs was done and blood samples were withdrawn 1, 30, and 90 minutes
after commencement of the resuscitation and sent for blood culture for both aerobic and
anaerobic growths.
Results: The mean arterial blood pressure in the group I before resuscitation was found to be
about 65mm Hg and the mean was raised to 105 mm Hg after 2 hours of resuscitation with
LR blood. The mean amount of LR used in this group to resuscitate the patients was found
to be 40 ml/kg body weight. In group II, the mean arterial blood pressure was found to be 62
mm Hg and it was efficiently controlled by HTS, LR blood and the mean arterial blood
pressure 2 hours after commencement of resuscitation was elevated to 124 mm Hg. The mean
amount of LR used in this group to resuscitate the patients was found to be 18 ml/kg body
weight. The blood cultures were positive in 5% of the patients of group II and in 40% of
patients of group I. Escherichia coli were the most commonly isolated organism.
Conclusion: hypertonic saline was found to be effective for decreasing the rate of early
bacterial translocation to blood and also for more efficient restoring of the mean arterial
pressure in patients with hemorrhagic shock.
Key Words: Hypertonic saline, bacterial translocation, hemorrhagic shock.

Full Paper (vol.48 paper# 15)