Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Hepatic Expression of the Proliferative Marker Ki-67 and cell cycle p53 Protein in chronic hepatitis C (A histopathological and immunohistochemical study)1111678510.21608/ejhm.2011.16785ENAzza HegazyPathology Department, National Hepatology and Tropical Medicine Research InstituteNashwa A. ZakiBiochemistry Department, National Hepatology and Tropical Medicine Research InstituteSameh SeifTropical Medicine Department, National Hepatology and Tropical Medicine Research InstituteNagwa Abd-WahabCommunity Medicine4 Department, National Hepatology and Tropical Medicine Research InstituteJournal Article20181016<strong>Aim and background:</strong>
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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<strong>.</strong>
<strong>Material & Methods:</strong>
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 µm. 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 scheme<sup>22</sup> 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 <strong>Keliner et al 2005</strong>, 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.
<strong>Results:</strong>
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 steatosis and the expression of p53 as percent of positivity increases with the increase of the percent of steatosis, and this result was statistically significant using independent sample t test and regression test.All negative cases for P53 have negative Ki67 but this rule is not applied on positive cases for P53, and this relation was not statistically significant
There was no relation between the grade of necro-inflammation and the expression of Ki67, and this result was statistically non significant.
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<strong>Conclusion:</strong>
Hepatic expression of the nuclear proliferative marker Ki-67 and the cell cycle marker p53 oncoprotein in chronic hepatitis C in relation to advanced stages of liver fibrosis in HCV positive patients are expressed in a considerable present of cases which should be cansdidates for follow up for early detection of hepatocellular carcinoma. Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Role of Maternal Serum Procalcitonin, Interleukin-6 and hs-C Reactive Protein in Prediciton of Subclinical (Intrauterine) Infection in Preterm Premature Rupture of Membranes12201678810.21608/ejhm.2011.16788ENAmany M.E. Abd ElmegeedClinical Pathology Departments, Al-Azhar University
Faculty of Medicine for girlsSabah I. Abd ElreheemClinical Pathology Departments, Al-Azhar University
Faculty of Medicine for girlsAl-Shimaa Allam Abd EllatifObstetrics and Gynecology Departments, Al-Azhar University
Faculty of Medicine for girlsInas Mahmoud HamdyObstetrics and Gynecology Departments, Al-Azhar University
Faculty of Medicine for girlsEman El-Shohat EbrahemMedical Biochemistry
Departments, Al-Azhar University
Faculty of Medicine for girlsJournal Article20181016<strong>Objective: </strong>
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.
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<strong>Methods:</strong>
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.
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<strong>Results:</strong>
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
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<strong>Conclusion:</strong>
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.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101RELATION BETWEEN PLASMA LEPTIN LEVEL AND LEFT VENTRICULAR FUNCTION IN OBESE FEMALES WITH INSULIN RESISTANCE21321679110.21608/ejhm.2011.16791ENDina Mohamed AbazaEndocrinology department (Al Azhar University for girls).Hoda Abd El BassetGeneral Medicine department (Al Azhar University for girls).Nagwa Moustafa Mohamed HassaneinClinical Pathology department3 (Al Azhar University for girls)Mohamad Saied SalemCardiology Department. Air force hospitalHala Mohamed Ali Abd El SalamClinical Pathology department , National Nutritional InstituteJournal Article20181016An 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 <strong><em>(Mc, Nutly ,2003).</em></strong>Several studies have found an association between insulin resistance and left ventricular hypertrophy<strong><em>.(Lacobellis et al,2003)</em></strong>
In human, production of leptin( an adipocyte – derived peptide), has been linked to obesity, insulin and insulin sensitivity <strong><em>(Leyva et al, 1998</em>)</strong> .It was considered that alteration in plasma concentration could constitute an additional component of metabolic syndrome of cardio-vascular risk<strong><em>(Leyva et al, 1998</em></strong>).
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<strong>Aim of the work:</strong>
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.
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<strong>Subjects and methods:</strong>
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: - <strong>Subgroups 1</strong>: (Insulin sensitive group or IS group) included 20 obese females with HOMA-IR Subgroup 2: (insulin resistance group or IR group) included 25 obese females with HOMA-IR≥3.8.Echocardiography was done for all females participated in the study to evaluate L.V mass and function.
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<strong>Results:</strong>
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, 2.7 (LVM/h<sup>2.7 </sup>)were significantly higher in obese group compared to non obese group (p<0.05) and between IR and IS subgroups (p2.7 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
<strong>Conclusion:</strong>
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.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Effect of some botanical materials on certain biological aspects of the house fly, Musca domestica L.33481679410.21608/ejhm.2011.16794ENNabawy A. I. ElkattanBiological and Geological Sciences Department, Faculty of Education, Ain Shams University.Khalafalla S. AhmedBiological and Geological Sciences Department, Faculty of Education, Ain Shams University.Saadya M. ElbermawyBiological and Geological Sciences Department, Faculty of Education, Ain Shams University.Rabab M. Abdel-GawadBiological and Geological Sciences Department, Faculty of Education, Ain Shams University.Journal Article20181016The effects of<em> Lantana camara</em> (leaves),<em> Pelargonium zonale</em> (leaves),<em> Cupressus macrocarpa</em> (leaves), <em>Cyperus rotundus </em>(whole plant) and <em>Acacia nilotica </em>(seeds)powders on some biological aspects of house fly, <em>M. domestica</em> L. were tested. The effects of three lethal concentrations LC<sub>25, </sub>LC<sub>50</sub> and LC<sub>75</sub> 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.
<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Invasive and Noninvasive Mechanical Ventilation For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease: A Comparative Study.50631679610.21608/ejhm.2011.16796ENAbd-Hay I. Abd-HayDepartments of Chest, Anesthesia Faculty of Medicine, Al-Azhar UniversityAhmed S. AlsailyDepartments of Chest, Anesthesia Faculty of Medicine, Al-Azhar UniversityEssam A. El-MoselhyCommunity Medicine
Faculty of Medicine, Al-Azhar UniversityJournal Article20181016<strong>Introduction</strong>: 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 consequenceof acute airway narrowing.<strong>Aim of the study</strong>: It was to compare the efficacy of noninvasive mechanical ventilation (NIMV) against conventional mechanical ventilation (CMV) in patients with acute exacerbation of COPD. <strong>Patients and methods</strong>: 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. <strong>Results</strong>: 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. <strong>Conclusions and recommendations</strong>: 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.Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Role of Rosemary Leaves Extract as A Protective Agent Against Azathioprine-Induced Toxicity in Rats64721679810.21608/ejhm.2011.16798ENHala M T El-MougyMedical Biochemistry Department,Faculty of Medicine (Girls) Al-Azhar University.Gehan A YoussefPhysiology Department,Faculty of Medicine (Girls) Al-Azhar University.Journal Article20181016<strong>Background:</strong> 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.
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<strong>Aim of the work: </strong>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.
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<strong> </strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Role of Circulating CD4+ CD25high Foxp3+ Regulatory T-Cells in Paediatric Asthma73841679910.21608/ejhm.2011.16799ENEnsaf Khalil MohammedDepartments of pediatric Faculty of medicine for girls, Al-Azhar university.Zeinab Farag AsheibaDepartments of pediatric Faculty of medicine for girls, Al-Azhar universityMervat Mohii El-din AliClinical Pathology faculty of medicine for girls, Al-Azhar university.Journal Article20181016<strong>Background: </strong>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<sup>+ </sup>T cells, including, FOXP3-positive CD4<sup>+</sup>CD25<sup>+</sup> T regulatory cells (Tregs) might play a critical role in regulating these diseases.
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<strong>Objective: </strong>To investigate the role of CD4<sup>+</sup>CD25<sup>high</sup> FoxP3 Tregs in the pathogenesis of pediatric asthma.
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<strong>Methods:</strong> 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<em>. </em>
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<strong>Results: </strong>It was noticed a significant decrease in CD4<sup>+</sup>CD25<sup>+ </sup>% and CD4<sup>+</sup>CD25 <sup>high</sup> % in both mild intermittent cases and severe persistent asthmatic patients when compared to healthy controls. FoxP3 expression in Tregs was significantly lower in CD4<sup>+</sup>CD25<sup>high</sup> T-cells of mild asthmatic patients when compared to control group. While the FoxP3 expression in Tregs was non- significantly lower in CD4<sup>+</sup>CD25<sup>high</sup> 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<sup>+</sup>CD25<sup>high </sup>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<sup>+</sup>CD25<sup>high</sup> T-cells and eosinophilic count was noticed.
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<strong>CONCLUSION:</strong> The correlation of CD4<sup>+</sup>CD25<sup>high</sup> 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<sup>+</sup>CD25<sup>high</sup> FoxP3 Tregs might contribute the development of treatment modalities to influence disease processes of bronchial asthma in children as a future therapeutic target.
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Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101The Incidence of Normal Coronary Angiography on Cardiac Catheterization in Jordanians85891680010.21608/ejhm.2011.16800ENZiad Khalef DrabaaAdult Cardiology Department/ Queen Alia Heart Institute/ King Hussein Medical Center/JordanMohammed Holy MajedAdult Cardiology Department/ Queen Alia Heart Institute/ King Hussein Medical Center/JordanJournal Article20181016<strong>Objective:<em> </em></strong>To determine the incidence of normal coronaries on cardiac catheterization and its pattern of occurrence according to sex and age.
<strong>Methods:</strong> 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.
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<strong>Results:</strong>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). Womenin 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%).
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<strong>Conclusion:<em> </em></strong>Normal coronaries on cardiac catheterization is a recognized finding in both men and women<strong><em>.</em></strong> Recognition of this issue is essential in order to prescribe proper follow up and appropriate medical therapy with correction of modifiable risk factors.
<strong><em> </em></strong>Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Assessment of vitreoretinal interface and clinically significant macular edema by OCT and fluorescein angiography901021680310.21608/ejhm.2011.16803ENHany Ali YahiaTanta Hospital of OphthalmologySawsan A ShalabyOphthalmology department, Faculty of medicine (for Girls), Al Azhar UniversityElham A HassanOphthalmology department, Faculty of medicine (for Girls), Al Azhar UniversityNihal Adel HassanOphthalmology department, Faculty of medicine, Cairo UniversityJournal Article20181016<strong>Objective:</strong> To assess the changes occurring at the vireoretinal interface with clinically significant macular edema using optical coherent tomography (OCT) and fundus fluorescein angiography (FFA).
<strong>Patients and Methods:</strong> 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.
<strong>Results:</strong> 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.
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<strong>Conclusions:</strong> 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.
Pan Arab League of Continuous Medical EducationThe Egyptian Journal of Hospital Medicine1687-200242120110101Wies procedure combined with anterior lamellar recession in the management of cicatricial entropion of the upper eyelid1031081680410.21608/ejhm.2011.16804ENSawsan A ShalabyOphthalmology department, Faculty of medicine (for Girls) Al Azhar UniversityJournal Article20181016<strong>Purpose:</strong> To evaluate the efficacy of the Wies procedure combined with anterior lamellar recession in the management of cicatricial entropion of the upper eyelid.
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<strong>Patients and methods:</strong> 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.
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<strong>Results:</strong> 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).
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<strong>Conclusion:</strong> 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.