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Background: Intertrochanteric fractures involve those occurring in the region extending from the extra capsular basilar neck region to the region along the lesser trochanter proximal to the development of the medullary canal, these fractures account for forty percent of proximal femoral fractures in elderly.Aim of the Work: is to compare intramedullary fixation and hip arthroplasty in treatment of unstable trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome and patient satisfaction.Patients and Methods: The thesis is a prospective comparative randomized study between PFN and Hemiarthroplasty for the treatment of unstable trochanteric fractures in elderly. Patients were followed up at 1, 3, 6, 12 month postoperative, clinical and radiological data collected and documented starting from perioperative data (operative time, blood loss, transfusion).Results: We compared intramedullary fixation and hip arthroplasty in treatment of unstable, comminuted trochanteric fracture in elderly in terms of surgical techniques, clinical and radiological outcome, complications, functional outcome. We did our best to execute it in an objective unbiased scientific manner by allocating patients randomly into two groups using closed opaque envelops. This was confirmed by the mean personal data (Age, sex), side of the fracture, pre-existing comorbidities, and fracture type according to AO classification, both groups were comparable, with no significant difference. Comparison of operative data showed significant difference in operative time, mean operative time was [78.4 min for group 1 Vs 112.6 min for group 2], favoring group 1 as less operative time.Conclusion: Hemiarthroplasty could be valid option in management of unstable trochanteric fractures in elderly, giving the advantage of early full weight bearing, yet it is more technically demanding, require higher surgical experience.

This study aims to identify the impact of regulatory silence on the environmental performance of female students in university cities to determine the extent of its impact on improving environmental performance within university cities, so the problem of the study is the existence of a gap in the application of the effect of the independent variable which is the regulatory silence on the dependent variable It is environmental performance, and the study addressed the concept of organizational silence and the concept of environmental performance and clarifying the impact of organizational silence on environmental performance, as the study also addressed the extent of the impact of the dimensions of organizational silence on the dimensions of environmental performance,In order to achieve the objectives of the study, which is to clarify the concept of organizational silence and how to apply it in university cities, identify the problems that drive individuals to adopt silence and its causes, and identify the impact of organizational silence on environmental performance, the study sample and the data of the study that was carried out through the survey forms where the researcher distributed survey forms to (260) members of administrative labor in the university cities for female students at The University of Ain Shams The ratios of employees in each university city where the number of forms bounced and valid for statistical analysis (241) survey forms, the study found that there is a moral opposite effect to the dimensions of organizational silence (Acquiescent Silence, Defense Silence) in the overall measure of environmental performance, and the presence of a moral expulsion effect For the dimensions of organizational silence (Pro-Social Silence) in the overall measure of environmental performance, The study recommends increased staff awareness and an audit of internal environmental performance.

Background: laparoscopic sleeve gastrectomy (LSG) is one among different bariatric surgeries, which became an effectivetreatment method for morbid obesity. CT may be performed after laparoscopic sleeve gastrectomy to assess acute complications as staple line leakage, abscesses, hematomas, portal vein thrombosis (PVT), splenic injury or infarction.Aim of the study: was to assess the value of multi- detector CT in the evaluation of the suspected early complications of LSG. Patients and Methods: This study was an observational study, included 25 patients who underwent LSG and CT was done for them to detect any suspected complication even in the presence of negative upper gastrointestinal (UGI) series.Results: MDCT detected complication in 15 patients out of the 25 patients (60%), with no mortality. Leakage occurred in 16%, abscess in 8%, hematoma in 8%, splenic injury, splenic infarction and PVT in 4% each. Conclusions: CT is an important imaging tool to diagnose suspected complications of laparoscopic sleeve gastrectomy procedure and should be used to ensure accurate diagnosis or in the case of mismatch between symptoms and routine upper GIT studies.

Purpose: To emphasis the role of MSCT utilizing the remodeling index in assessment of positive coronary remodeling which was associated with plaque rupture and vulnerability. Methods and material: Studied group included 35 patients with positive coronary remodeling. One lesion per patient was assessed, either a solitary lesion or the most significant one. All patients were subjected to history taking and radiological evaluation using a contrast-enhanced 64 MSCT then post processed. Assessment of the plaque causing positive remodeling regarding the site, number (single, kissing, or multiple), relative composition and predominant type in H.U. was performed. Specific measurements at the reference and remodeling segment were taken. Calculation of remodeling index was done. Two comparative groups were made between subjects with remodeling index (RI)