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BACKGROUND: Myelomeningocele (MMC) is one of the most common developmental anomalies of the CNS. Many of these patients develop hydrocephalus (HCP). The rate of cerebrospinal fluid diversion in these patients varies significantly in literature, from 52% to 92%. MMC repair conventionally occurs in the post-natal period. With the technological advances in surgical practice and fetal surgeries, intra uterine MMC repair IUMR is adopted in some centers. Cerebrospinal fluid shunting has numerous complications, most notably shunt failure and shunt infection. Studies have suggested that patients with greater numbers of shunt revisions have poorer performance on neuropsychological testing. There is also good evidence to suggest that the IQs of patients with MMC who do not undergo shunt placement are higher than that of their shunt treated counterparts. AIM: In this study, we are trying to identify strong clinical and radiological predictors for the need of ventriculoperitoneal (VP) shunt insertion in patients with MMC who underwent surgical repair and closure of the defect initially. This will decrease the overall rate of shunt placement in this group of patients through applying a strict policy adopting only shunt insertion for the desperately needing patient. METHODS: Prospective clinical study conducted on 96 patients with MMC presented to Aboul Reish Pediatric Specialized Hospital, Cairo University. After confirming the diagnosis through clinical and radiological aids, patients are carefully examined, if HCP is evident clinically and radiologically a shunt is inserted together with MMC repair at the same session after excluding sepsis or cerebrospinal fluid (CSF) infection, (GROUP A). If there are no signs of increased ICP, MMC repair shall be done alone (GROUP B). Those patients shall be monitored carefully postoperatively and after discharge and shall be followed up regularly to early detect and promptly manage latent HCP. Multiple clinical and radiological indices were used throughout the follow-up period and statistical significance of each was measured. RESULTS: Shunt placement was required in 45 (46.88%) of the 96 patients. Eighteen patients (18.75%) needed the shunt as soon as they presented to us (GROUP A), because they were having clinically active HCP. Twenty-seven (28.13%) patients were operated on by MMC repair initially without shunt placement because they did not have signs of increased ICP at the time of presentation. Yet, they developed latent HCP requiring shunt placement during the follow-up period (GROUP B2). Fifty-one patients of the study population (53.13%) underwent surgical repair of the MMC without the need of further VP insertion and they were followed up for 6 months period after the repair without developing latent HCP (GROUP B1). Patients of GROUP B were the study population susceptible for the development of latent HCP. Out of 78 patients in GROUP B, only 27 patients (34.62%) needed a VP shunt. CONCLUSION: In our study, we found that the rate of shunt insertion in patients with MMC is lower than the previously reported rate in the literature. A more thorough evaluation of the patient’s post-operative need for a shunt is mandatory. We suggest that we could accept postoperative (after MMC repair) ventriculomegaly provided it does not mean any deterioration in the patient’s clinical or developmental state. We assume that reduction of shunt insertion rate will eventually reduce what has previously been an enormous burden for a significant proportion of children with MMC.

Background The researchers are trying to evaluate the measurement of: Intact parathyroid hormone (iPTH) and serum total calcium (sCa) levels for predicting hypocalcemia after total thyroidectomy (TT). Methods The sample of this single center prospective study consists of (100) patients, where (77) females and (23) males with an age range between (28) and (65) (the mean level is, 48.17 ± 6.54). These selected patients underwent total thyroidectomy (TT) in the general surgery department, Benha university hospital from the period of June 2019 to February 2020. Levels of sCa and iPTH were measured aat several times preoperatively, 10 min, 48 h, 3, 6, 9 months, and 1 year after being after gone TT. Results Among the entire study sample, 23 patients (23%) developed transient hypoparathyroidism and hypocalcemia (˂8.5 mg/dl), none of them developed permanent hypoparathyroidism and hypocalcemia. The cut-off point of PTH has been 10 min after TT was at 23 pg/mL as it was the best compromise between sensitivity and specificity for predicting hypocalcaemia. It has been found that Patients who have a PTH greater than 23 pg/mL can be discharged safely after 24 h. Patients who have PTH of less than 23 pg/mL were observed for an additional 24 h, and the study found that timely treatment initiation is recommended. A PTH ˂ 10 pg/mL measured at 48 h after surgery had a sensitivity, specificity as well as an accuracy of 100%, for predicting hypocalcemia after TT. The accuracy of a single PTH concentration at 48 h was useful for predicting hypocalcemia [Area under receiver–operator characteristic curve (AUC) 1; confidence interval (CI), 95%, 0.85–0.94]. Conclusion Patients with iPTH ˂ 10 pg/mL, and sCa levels ˂ 7.4 mg/dL are at higher risk of developing hypoparathyroidism and hypocalcemia after TT., Highlights • Incidence of Post-thyroidectomy transient hypoparathyroidism ranges between 0.3 and 49%, while permanent hypoparathyroidism is 13%. • Incidence of hypocalcemia following total thyroidectomy ranging between 3% and 40% and is usually transient, while permanent hypocalcemia is ≤ 2%. • Post-thyroidectomy PTH accurately predict hypocalcemia.

Background: Anastomotic leakage (AL) considered as the most feared complication after colorectal resection surgery increasing morbidity, mortality and risk of recurrence among these patients. Therefore, early detection of AL is crucial. Biomarkers as procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WCC) provide an easy, safe and efficient methods for early detection of AL and follow up of the patients after discharge.Methods: This study included 130 patients presented with colonic or rectal cancer in the period from January 2018 to January 2021. This study was conducted in general surgery department, faculty of medicine, Benha university hospital. CRP, PCT and WBC count were measured pre-operatively, first, third, fifth and 7th day post-operative to detect the change in their levels when AL was diagnosed either by clinical, radiological or operative measures.Results: Among 130 patients, only 10 patients had AL. On POD-3, CRP and WCC values were significantly increased in AL patients while PCT was significantly elevated only from POD-5. The best cut-off value for CRP on POD-3 was >30.1 mg/l, reaching 90% sensitivity and 100% specificity for detecting AL while for WCC was >7.1× 109 cell/l, with 90% sensitivity and 72% specificity. The best cut-off value for PCT was in POD-5 which was >1.7 ng/ml with 100% sensitivity and 84% specificity.Conclusions: The analysis of CRP and WCC on POD-3 together with PCT serum concentrations on POD-5 is crucial for early detection of anastomotic leakage in either open or laparoscopic colorectal resection surgery.

Objective To describe the diagnosis and management of uterine artery pseudoaneurysm after caesarian section. Design Case report. Setting Department of Obstetrics and Gynecology. Patient A 25-year-old woman developed uterine artery pseudoaneurysm after caesarian section. Intervention Uterine artery pseudoaneurysm after caesarian section was diagnosed on ultrasonography, computerized tomographic angiography and treated by bilateral internal iliac artery ligation. Main outcome measure Uterine conservation. Result Fertility preservation was achieved in the woman. Conclusion(s) Diagnosis and management of uterine artery pseudoaneurysm after caesarian section are important to prevent life-threatening hemorrhage caused by pseudoaneurysmal rupture.

Background Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation. Methods Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified. Results Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions. Conclusions Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases.

Waste concrete aggregates (WCA) are produced by crushing demolished concrete elements. WCA differ from fresh aggregates due to the cement paste attached to the surface of the original aggregates after the process of recycling. The highly porous cement paste and other contaminations contribute to the lower particle density and higher porosity, variation in the quality of the WCA and the higher water absorption. This paper presents some of the results of an investigation on the possible application of WCA in bituminous pavement. The laboratory investigation was divided into three distinct phases. At first all the physical properties of material such as coarse aggregate, fine aggregate, filler and bitumen were determined. The second phase consists of preparation of Marshall test specimens. The third and last phase consists of testing of specimens to obtain Marshall test properties. At first three specimens were prepared with bitumen content 5% for black stone (Type A), 5.5% for white stone (Type B), and 6.5%for WCA from black stone (Type C) and 7% for WCA from white stone (Type D). Five bitumen contents were used with increment of 0.5% for type A, B, C and D. Then the specimens were tested and Marshall stability were obtained 88.7kN, 10.5kN, 10.1kN and 9.2kN at optimum bitumen content 6.2%, 63.7%, 8.1% and 8.3% for mix type A, B, C, and D respectively. Amount bitumen per cubic meter of mix are 154 kg, 153.4 kg, 188 kg, 175.8 kg for mix type A, B, C and D respectively. Marshall test properties of mixes with WCA are satisfactory but required bitumen are 1.08, 1.31,1.34 times more for mix type B, C, and D than that of time A. Aggregates types C and D are acceptable from the consideration of strength properties. The investigated results indicate that the bituminous macadam base course with WCA from white stone give satisfactory results when they are constructed using dense grading, good compaction for medium traffic road.

Background Neoadjuvant systemic therapy has become a valuable strategy in the multidisciplinary treatment approach to breast cancer. There are conflicting results regarding the effect of neoadjuvant chemotherapy (NAC) on estrogen receptor, progesterone receptor, and human epidermal growth factor 2 (Her2) status in breast cancer. Aim The aim of this study was to shed some light on the effect of NAC on the biomarkers of breast cancer cells in patients with invasive cancer breast. Patients and methods A total of 22 female patients with breast mass that proved to be malignant by tru-cut biopsy underwent HR, Her2, and Ki67 assessments following administration of NAC and excision of the tumors, which were sent for histopathological assessment and assessment of the aforementioned markers. Changes were analyzed according to the type of the tumor, the grade, the hormone receptor status, and Her2 status of the tumor. These patients were managed in the General Surgery and Pathology Department, Faculty of Medicine, Benha University Hospital, during the period from January 2015 to June 2016. Results This study show that tumor cells that are hormone receptor negative and those that are Her2 positive are more sensitive to NAC with an obvious effect on proliferation index rate and higher rate of achieving complete pathological response. Infiltrating lobular carcinoma of the breast is associated with poorer response to NAC in comparison with duct carcinoma. The higher the grade of the tumor, the poorer the response to NAC. Conclusion The study shows that the breast cancer cells that are hormone receptors negative, Her2 positive, duct carcinoma, and lower grade tumors are more responsive to NAC.

We report a child in whom a fistula connected the descending thoracic aorta to the right atrium. This is a previously unreported cardiac malformation. The patient was initially misdiagnosed as having a patent ductus arteriosus (PDA). On clinical examination and auscultation, the problem was different from PDA in that the continuous machinery murmur was better heard on the right parasternal area and posteriorly on the left. Surgical ligation of the fistula through a left thoracotomy abolished the murmur.