Recent Articles

The most commonly used procedure for root surface debridement is mechanical scaling and root planing using hand instruments. Periodontal files are used as a part of treatment introduced in subgingivally pockets. The difficult lies in stablishing an analogy of this depth measurement to the probe by a PCP 12 and the corresponding input of this files at the same distance. The authors present new files, similar to Hirschfeld, have been modified with external marking at 12mm, allowing the Periodontist this analogy, and facilitating the process. On the other hand a specific small diameter PHenriques 6 and PHenriques 7 files, to instrument more easily this complex region. Consist of a series of 3 blades, and its sharp edges in 270 degrees around the active tip, reaching the root trunk, fornix and neighbor´s surfaces. They are extremely useful especially in Class III involvement and sharpening in the same way as conventional files.

Gastric carcinosarcoma is a rare biphasic tumor that consists of both carcinomatous and sarcomatous components. Clinical presentation and neoplastic markers are not specific for the disease. Moreover, CT scan cannot distinguish among gastric carcinoma, sarcoma or carcinosarcoma, so it is essential to perform histopathological and immunohistochemical analysis on biopsy specimens or resected tissue to ensure a correct diagnosis. A 72-year-old woman was transferred to our Department from another hospital with a diagnosis of a bleeding tumor localized on the lesser gastric curve, infiltrating the left hepatic lobe. The mass was treated as a gastric malignant mesenchymal neoplasia (gastro-intestinal stromal tumor versus sarcoma) infiltrating the liver. Owing to the bleeding, no further invasive examinations, such as fine needle aspiration biopsy, were planned. Furthermore, no neoadjuvant chemotherapy could be administered before surgery due to persistent anaemia. The scheduled surgical procedure was an atypical gastric resection with “en bloc” hepatic resection. This operation included upper polar and lesser curve resection, with tubulization of the stomach along the greater curve, as well as left lateral hepatic sectionectomy. Histopathological examination and immunohistochemical staining confirmed the diagnosis of gastric carcinosarcoma. This is first report of gastric carcinosarcoma with local liver infiltration, treated with surgical resection.

Objective: A rare case of possible hereditary predisposition to autoimmune neuropathy Background: This case report is of a patient who presented two episodes of Facial paresis in her live without ascertained apparent causes. Bell’s palsy is commonly known as peripheral idiopathic facial nerve palsy, because in the most cases the triggers remain unknown (1). Case Report: I want to present a case of a 34 year old woman who we will call A.B. and who came to us to evaluate the severity of the sequelae of a Bell´s palsy and any eventual need for cosmetic measure. But she had another Bell´s Palsy 9 years ago, so I started to investigate the most common and treatable causes of Facial paresis. I found a significate increase of anti-bodies against ganglioside GM2. When I explained to her that these anti-bodies is commonly related with several neurological diseases, she started to investigate her family history and she found that his father’s brother died of GuillainBarré syndrome about 40 years ago.

Introduction: Giant thoracic aortic aneurysms are rare. Most of the reported cases are not a known complication of aortic coarctation repair. Otherwise intra-operative aneurysm ruptures are rare cases but a potentially fatal complication in open heart surgery. Case report: In this article, we report the case of a 23-year-old patient with a giant ascending and arch aneurysm associated with a Standford type A chronic aortic dissection. In the patient’s history a coarctation repair at age of five years old was noted. During an open heart surgery for ascending aorta and hemi-arch replacement under cardiopulmonary bypass, aneurysm rupture occurred before aortic cross-clamp. A successful intraoperative and post-operative management was performed. The course was uneventful. The patient was extubated without neurological damage. Moreover, there were no kidney function deterioration, no digestive and limbs ischemia. Conclusion: Intra-operative aneurysm rupture is rare but is a major operative complication whose successful repair depends on an integrated intra-operative management. Cerebrovascular and heart protection are the main determinants of patient survival. Also, the surgical team’s prompt response is the key to the successful execution of the procedure.

INTRODUCTION Acute myopericarditis is an inflammatory disease of myocardium and pericardium. The disease has variable presentation ranging from mildly symptomatic cases to severe disease manifested by cardiomyopathy with associated risk of sudden cardiac death. However, the association with intramyocardial hemorrhage (IMH) has not been previously described. CASE REPORT We describe an IMH detected by cardiac magnetic resonance imaging, in a patient with classical ‘de novo’ myopericarditis. To the best of the authors’ knowledge, this has not been previously described in patients without associated haematological or connective tissue disorders. CONCLUSION The adverse prognostic signal of IMH in acute myocardial infarction may also be reflected by IMH in acute myopericarditis and lead to adverse ventricular remodeling. The pathophysiology of IMH in myopericarditis is unknown and warrants further exploration.

Behavioral and psychologic symptoms of dementia (BPSD) are frequent and represent a burden for patients and caregivers; in particular, the presence of agitation and aggression (A/A) has an important impact on patients’ quality of life. As psychotropic drugs can induce severe collateral effects, the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) on A/A in geriatric patients with moderate to severe dementia hospitalized in an acute geriatric unit. We enrolled fifty-two acute in-patients with dementia and A/A. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured agitation and caregiver burden with standard clinical scales at baseline and during treatment. In order to evaluate the effect of DT withdrawal, we carried out a telephonic follow-up interview after 1 and 4 weeks from hospital discharge. DT is more effective than ST in the control of agitation, but not in reducing the professional caregiver burden. The use of pro re nata psychotropic drugs was reduced in patients treated with DT. After DT withdrawal, A/A progressively increased. In conclusion we show that DT may be more effective than ST in the control of A/A in acute geriatric in-patients affected by dementia. Our results suggest that, in patients affected by severe to moderate forms of dementia with A/A, DT may be used as a first line treatment, not only in nursing home residents, but also in acute care geriatric in-patients.

Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival. Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020. Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection. Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.

Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction. Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.

The Gumuz is one of the groups of the people, who are living in Mandura district of the Metekkel administrative Zone, Benishangul-Gumuz Regional state. This study aimed to assess and outline the traditional agricultural practices and natural resource management of the Gumuz community in Mandura district of the Metekel zone, Northwestern Ethiopia, in state of Benishangul-Gumuz region. Gumuz communities of the study area have their own agricultural practices and traditional resource management that distinct them from others. It attempted to high-light on the land tenure system, periodical agricultural activates and approaches of the natural resource management of the community. The paper aims to contribute to the understanding of the traditional agricultural practices and natural resource management of the Gumuz society.

Indigenous medicine is a total combination of knowledge and practices that can be formally explained or used in preventation and elimination of physical, mental or social imbalance and relying exclusively on practical experience and observation handed down from generation to generation whether verbally or in writing (Endalew,2007). Most of the populations of the developing countries use indigenous medicine to meet their primary health care needs. Indigenous medicine is known in many countries of Africa to meet some of their primary health care. In Africa, up to 80% of the population uses indigenous medicine. Ethiopia is one part of African countries in which indigenous medicine has long history before the beginning of modern medicine. In Ethiopia, indigenous medicine is highly practiced and many Ethiopian societies depend on the use of indigenous medicine and indigenous healing systems to deal with their health practices. It has been providing both preventative and curative services for Ethiopian peoples. Even today, as various studies have shown that about 90% of Ethiopian still depends on indigenous medicine. This indicate that the presence of two medical systems like indigenous and modern neither of them can adequately address the health care needs of the total population (Assefa,1986). But there is the reason why the majority of people still deep follow the services of indigenous medicine. It is because of accessibility of indigenous medicine compared to modern medicine and most of people have a limited chance of setting modern health care systems (Wondwossen, 2005). In Ethiopia, indigenous medicine is not limited to rural areas, rather also has numerous roles in urban areas of the country, eg. Addis Ababa. In Addis Ababa, there are many indigenous medicine services given by indigenous healers who are categorized into herbalists, Bone Setters, indigenous birth attendants, spiritual healers and magicians. Out of these, our focus…