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Biomedical subjects

M A Ghoneim

Publications and source records attributed to M A Ghoneim.

At least 55 records · Page 3Linked to original sources
PubMed2000

Rapid diagnosis of genitourinary tuberculosis by polymerase chain reaction and non-radioactive DNA hybridization.

OBJECTIVE: To establish a polymerase chain reaction (PCR) assay for the rapid detection and identification of mycobacteria in urine, and to assess the value of such assay in routine laboratory diagnosis of genitourinary tuberculosis. MATERIALS AND METHODS: Urine specimens from 1000 patients with clinical suspicion of urinary tuberculosis were examined. Two assays for the detection and identification of Mycobacterium tuberculosis (M. tuberculosis) complex and mycobacteria other than tuberculosis (MOTT) by non-radioactive DNA hybridization of PCR-product were applied. The first assay used PCR primers and probe derived from M. tuberculosis species-specific DNA insertion sequence, IS6110. The second utilized mycobacterium genus-specific sequence encoding ribosomal ribonucleic acid (16S rRNA). The results obtained by PCR were compared with those obtained by standard microbiological methods, acid-fast bacilli (AFB) stain and culture. RESULTS: Compared with cultures, the sensitivity of AFB staining was 52.07% and the specificity was 96.7%. In comparison to the results of culture, the overall sensitivity and specificity of the IS6110-PCR assay was 95.59% and 98.12% respectively. While the corresponding results for the 16S rRNA gene-PCR were 87.05% and 98. 9%. CONCLUSION: The high sensitivity and specificity in addition to the potential for rapid detection of mycobacteria, makes this test a useful tool in the clinical management of mycobacterial infection in urine. Urine specimens may contain M. tuberculosis and/or other mycobacteria; therefore, there are advantages in using genus-specific primers in parallel with species-specific primers in PCR assay.

DNA Primers↗
PubMed1999

Rectosigmoid urinary diversion: the functional significance of creating an intussuscepted colorectal valve.

PURPOSE: We assess the functional importance of a colorectal valve in patients with rectal urinary diversion. MATERIALS AND METHODS: A retrospective evaluation of 87 patients with an anal sphincter controlled bladder substitute was performed. Of these patients 42 had colorectal valves and 45 did not. Evaluation included serum chemistry studies and arterial blood samples to study the impact of the colorectal valve on homeostasis. RESULTS: There was a statistically significant difference between the 2 groups in pH, carbon dioxide partial pressure, bicarbonate, base excess and chloride in favor of patients with a colorectal valve. CONCLUSIONS: The difference between the groups was reduction of the surface area available for reabsorption when a valve is constructed. This finding is of particular importance among patients with a long life expectancy. Prophylactic alkalization is necessary in cases without valve reconstruction.

Acid-Base Equilibrium↗
PubMed1999

Numerical chromosomal aberrations in muscle invasive squamous cell and transitional cell cancer of the urinary bladder: an alternative to classic prognostic indicators?

OBJECTIVES: To evaluate the prognostic value of chromosomal aberrations in muscle invasive bladder cancer, because they are of diagnostic and prognostic significance in superficial bladder cancer. METHODS: One hundred ninety patients, who underwent radical cystectomy because of squamous cell carcinoma (SCC) of the urinary bladder in 94 cases and transitional cell carcinoma (TCC) in 96 cases, were studied retrospectively. Numerical aberrations of chromosomes 7, 9, and 17, p53 positivity, histologic stage and grade, histologic tumor type, lymph node status, and the presence of bilharzial eggs were investigated as possible prognostic factors. RESULTS: Univariate analysis demonstrated the prognostic significance of all parameters analyzed, excluding chromosome 9. Multivariate analysis revealed only T category (P = 0.01095266), lymph node involvement (P = 0.00054877), and p53 positivity (P = 0.0316974) to be independent prognostic factors in muscle invasive SCC and TCC. CONCLUSIONS: Although chromosomal aberrations are associated with progression-free survival, they are not independent prognostic factors and give the clinician no additional information on patients with muscle invasive bladder cancer.

Adult↗
PubMed1999

Evaluation of the functional significance of the colorectal valve used in rectal urinary diversion in children: a comparative study between cases with and without the valve.

OBJECTIVES: To study the long-term impact of functional isolation of rectal reservoirs on the blood chemistries and acid-base balance of children who underwent this type of urinary diversion. METHODS: A retrospective evaluation of 63 children with rectal reservoirs was performed. Of these, 40 had a colorectal valve and 23 had double-folded rectal reservoirs without a functional isolation valve. Evaluation included serum chemistry and arterial blood sample analysis to verify the impact of the created valve on homeostasis. RESULTS: There was a statistically significant difference between the two groups relative to the value of pH, P(CO2), bicarbonate, base excess, and chloride in favor of those having a colorectal valve. Reduction of the absorptive surface area of the colon is presumably the cause in view of the functional isolation created by the colorectal valve. CONCLUSIONS: In children, the long life expectancy and the benign condition for which they have diversion require the incorporation of the colorectal valve in any form of continent rectal diversion. Prophylactic alkalinization with strict follow-up is a must in those having no valve.

Acid-Base Equilibrium↗
PubMed1999

Response of one-humped camel (Camelus dromedarius) to intravenous glucagon injection and to infusion of glucose and volatile fatty acids, and the kinetics of glucagon disappearance from the blood.

The effects of glucagon injection and infusion of glucose and volatile fatty acids were studied in one-humped camels. Twenty adult male camels were divided into four equal groups. The first group was infused with physiological saline and served as a control. The second group was injected with a single dose of glucagon, the third group was infused with glucose (50%) in sterile saline, and the fourth group was infused with a volatile fatty acid (VFA) mixture. In the first, third and fourth groups, sampling was performed before the beginning of infusions (control time), and at 15, 30, 60 and 120 min post-infusion. Plasma glucagon concentrations were monitored in the second group at 5, 10, 15, 20, 30, 45, 90, 105 and 120 min after injection. For glucagon injection, glucose concentration peaked at 15 min post-injection, and tended to decrease thereafter. Plasma glucose concentrations showed significant rises above the basal value at all times after glucose infusion. VFA infusion had no apparent effect on plasma glucose concentration. After injection of glucagon, the plasma lactate concentration dropped significantly at 15 and 30 min, then increased gradually until it reached the original concentration of lactate at 120 min. However, glucose infusion elevated the plasma lactate concentration only at the end of the infusion period. A decrease in plasma lactate was observed at 60 min after VFA infusion. The present investigation provides evidence that the glucagon level in camels is higher than that in other ruminants and in man, and suggests that this is a probable species specificity, which would explain the higher level of glucose in the blood of camels than in that of other ruminants. The disappearance curve of injected glucagon had, as in other ruminants, an exponential two-compartment function. The hormone was rapidly distributed and was eliminated with a high rate of clearance.

Animals↗
PubMed1999

A case of ileal ureter with proximal antireflux system.

BACKGROUND: The initial experience of constructing a new antirefluxing valve at the uretero-ileal junction with ileal substitution is reported. METHODS: A new antirefluxing valve was constructed at the uretero-ileal junction with ileal substitution by fixing the distal part of the ureter between the psoas muscle and ileal segment (the ileo-psoas tunnel technique). DISCUSSION: The valve created by the technique has been working effectively for preventing the ileo-ureteral reflux. Pre-operative hydronephrosis was improved and the renal function has been well preserved. CONCLUSION: The ileo-psoas tunnel technique is worthwhile when ileal substitution of the ureter is indicated.

Carcinoma, Transitional Cell↗
PubMed1999

A prospective randomized study comparing absorbable and nonabsorbable staples in constructing antireflux valves of urethral hemi-Kock pouches.

OBJECTIVE: To determine the long-term complications associated with constructing an antireflux nipple valve using absorbable or nonabsorbable staples in the urethral hemi-Kock pouch. PATIENTS AND METHODS: Fifty patients (all men, median age 47 years, range 28-73) undergoing construction of a urethral hemi-Kock pouch were randomized prospectively into two equal groups. In group 1, absorbable (polyglyconate) staples were used for the construction, and in group 2 nonabsorbable (metal) staples were used but omitting the staples applied at the tip of nipple valve. Assessment during the follow-up of 6-88 months comprised urine analysis, culture and sensitivity, measurement of serum creatinine, electrolytes and blood gases, and plain abdominal radiography, intravenous urography and micturating pouchography. RESULTS: In group 1, 21 patients were evaluable; a pouch stone was detected in one, extussusception of the valve in one and valve stenosis in one. In group 2, 20 patients were evaluable; pouch stones were detected in six, extussusception of the valve in three and valve stenosis in one. CONCLUSION: Compared with nonabsorbable (metal) staples, the use of absorbable (polyglyconate) staples significantly decreased the incidence of pouch stone formation and improved valve stability in patients with a urethral hemi-Kock pouch.

Adult↗
PubMed1999

Living-related-donor kidney transplantation outcome in recipients with primary focal-segmental glomerulosclerosis.

We studied the outcome of renal transplantation in 30 patients with primary focal-segmental glomerulosclerosis (FSGS) and in 30 controls in whom renal failure was secondary to nonglomerular renal diseases. All patients received living-related-donor kidneys, and the majority had one-haplotype HLA matching. Within the follow-up period, the mean serum creatinine values were significantly higher in FSGS recipients as compared with the control group (p = 0.02). However, the frequency of acute rejection episodes and the mean blood pressure values were not significantly different between the two groups. There was a tendency of a higher incidence of proteinuria among FSGS recipients in comparison with the controls. Moreover, nephrotic-range proteinuria occurred only in 3 recipients of the FSGS group. Recurrence of FSGS was morphologically documented in 2 recipients 7 and 18 months, respectively, after transplantation. It is concluded that FSGS as the primary disease has a negligible impact on the living-related-donor kidney transplantation in the Egyptian population. Therefore, this disease should not discourage transplantation for this group of patients.

Adolescent↗
PubMed1999

A prospective study of hepatitis C viremia in renal allograft recipients.

In an attempt to study the impact of HCV viremia on renal transplant clinical course and outcome, we prospectively followed 133 HBsAg-negative end stage renal disease (ESRD) patients, in whom HCV-RNA-PCR results were available, from the pre- to post-transplant period. Eighty (60%) ESRD patients tested PCR-positive, of these, 12 (15%) were anti-HCV negative by second generation ELISA. The viremic patients had a longer time on dialysis (p < 0.001), received more blood units (p < 0.001) and had a higher frequency of pre-transplantation liver disease (p < 0.001). Further, 41% of PCR-positive patients gave a history of antischistosomal treatment compared with 23% of PCR-negative ones (p = 0.048). Recipients with and without HCV viremia were followed for a mean of 31.8 +/- 5.8 (range 6-42) months and 29.8 +/- 9 (range 6-41) months respectively, p = 0.14. While the prevalence of HCV viremia increased from 60 to 64% at the last follow-up, the anti-HCV seroprevalence decreased from 63 to 61%. PCR-positive patients had higher rates of both acute (p = 0.005) and chronic (p < 0.001) liver disease after transplantation compared with PCR-negative patients. However, none of our HCV RNA positive recipients developed a fulminant liver disease or hepatic failure until the last follow-up. Stepwise logistic regression analysis identified pre-transplant liver disease (Odds ratio = 2.4; p = 0.07) and a cumulative corticosteroid dose in excess of 15 g at the last follow-up (Odds ratio = 3; p = 0.03) as independent predictors of post-transplant hepatic dysfunction in PCR-positive patients. Azathioprine was discontinued due to hepatic dysfunction in a significantly (p = 0.005) higher proportion of viremic patients compared with the non-viremic ones. There were no significant differences between PCR-positive and -negative patients in terms of frequencies and individual causes of graft and patient losses. Our results demonstrate that HCV infection is extremely prevalent in Egyptian hemodialysis patients and is responsible for most hepatic dysfunctions after transplantation. Although HCV viremia did not negatively affect graft or patient outcome until 31 months post-transplantation, the authors would recommend that a viremic patient should have a liver biopsy before transplantation and be immunosuppressed with caution post-transplantation. A longer follow-up may be required to exclude increased rates of HCV-induced hepatic mortalities.

Adult↗
PubMed1999

Serous lined extramural ileal valve: a new continent urinary outlet.

PURPOSE: We report the functional results following the use of serous lined extramural valve as an antireflux technique and urinary outlet for continent urinary diversion. MATERIALS AND METHODS: The procedure was performed in 18 men and 5 women. The technique entails fashioning 2 serous lined extramural troughs in a detubularized W-shape ileal reservoir. A tapered ileal segment is embedded in 1 trough as an antireflux valve and the ureters are anastomosed to its proximal end. Another tapered ileal segment or the appendix is embedded in the second trough and acts as a continent cutaneous outlet. RESULTS: No operative or postoperative mortality was observed. One patient had prolonged ileus which was treated conservatively. All patients were evaluable with a mean followup of 19 months. All patients but 1 were continent day and night. No catheterization difficulties were reported. Evacuation intervals were 4 to 5 hours. Radiographic evaluation demonstrated a continent compliant reservoir, stable and straight outlet, and absence of pouch and ureteral reflux. CONCLUSIONS: This procedure is technically feasible, surgically versatile, applicable for urinary diversion or conversion and associated with satisfactory outcome.

Adolescent↗
PubMed1999

Orthotopic bladder substitution in women: functional evaluation.

PURPOSE: Orthotopic bladder substitution following cystectomy in women has recently been introduced at some specialized centers. Studies of such a procedure should consider the oncological and functional outcomes. We analyzed only the functional results of orthotopic bladder substitution since followup is too short (about 2 years) for a valid oncological assessment. MATERIALS AND METHODS: From October 1994 to November 1997, 60 women with a mean age of 48.3 years underwent standard radical cystectomy and orthotopic diversion (ileal W-neobladder with subserous tunnel in 47 and hemi-Kock reservoir in 13). The oncological criterion was organ confined invasive bladder cancer. RESULTS: There was no perioperative mortality. Postoperative complications included fatal pulmonary embolism in 1 woman, deep vein thrombosis in 2, prolonged ileus in 1 and fistula of the vaginal pouch in 3, which was repaired successfully. Cancer recurred in the pelvis in 2 cases and as distant metastases in 5. Of the patients 43 had been followed for a mean of 20.2 months (range 6 to 36), and 32 were continent day and night, 1 was totally incontinent, 2 had daytime stress incontinence and 6 had nighttime incontinence. Six women had difficulty emptying the pouch spontaneously with concomitant residual urine due to acute angulation between the urethra and pouch. CONCLUSIONS: Orthotopic bladder substitution after standard radical cystectomy in select women provides a satisfactory functional outcome. Failure of complete emptying seems to be due to anatomical rather than functional reasons.

Adult↗
PubMed1999

Sequential bacillus Calmette-Guerin and epirubicin versus bacillus Calmette-Guerin alone for superficial bladder tumors: a randomized prospective study.

PURPOSE: This study was designed to find a new therapeutic modality that may have the same efficacy and lower toxicity than bacillus Calmette-Guerin (BCG) for the treatment of superficial transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Between January 1993 and July 1997 a prospective randomized trial was conducted on 139 patients with stages pTa and pT1 bladder transitional cell carcinoma to compare the prophylactic efficacy and toxicity of sequential BCG and epirubicin (group 1) versus BCG alone (group 2). Group 1 comprised 69 patients who received alternating doses of 150 mg. BCG and 50 mg. epirubicin (1 drug at a time), while 70 patients in group 2 received 150 mg. BCG at each instillation. Treatment was continued for 6 weeks followed by 10 monthly instillations. RESULTS: Therapy was discontinued permanently in 3 group 1 and 12 group 2 patients due to severe side effects, and they were excluded from the study. Among the 124 evaluable patients (96 men and 28 women, mean age 58.2 years) mean followup was 30.4 months (range 12 to 50). Recurrence and progression rates were statistically comparable in both groups. Interval to first recurrence with or without progression was longer in group 1 than in group 2 (log rank p = 0.05). Toxicity and complications were significantly lower with sequential treatment than with BCG alone at rates of 27.3% (18 patients) and 70.7% (41), respectively (p = 0.001). CONCLUSIONS: Sequential BCG and epirubicin are comparable to BCG alone in efficacy and superior in terms of toxicity.

Adjuvants, Immunologic↗
PubMed1998

N-acetylneuraminic acids (nana): a potential key in renal calculogenesis.

N-Acetylneuraminic acids (NANA) promote binding of calcium ions to macromolecules and cells, increase the intrinsic viscosity of glycoproteins and facilitate gel formation in water. Since these properties are crucial in urinary calculogenesis, we evaluated NANA levels in urine and serum as well as their expression in kidney tissues. Using a modified thiobarbituric acid assay, the evaluation of free and bound NANA in 24-h urine samples revealed a ratio of 1.87 in 33 non-stone-formers but a reversed ratio of 0.84 in 41 recurrent calcium oxalate stone-formers. Time kinetics revealed a gradual rise in NANA expression until 48 h of culture and a significantly higher release into supernatants of papillary renal epithelial cells (REC) when compared with cortical REC. To examine NANA distribution in kidney tissues, paraffin-embedded biopsies from five normal and six stone-forming kidneys were labeled with the biotinylated NANA-specific lectins Maackia amurensis (MAA) and Sambucus nigra (SNA). Immunohistochemistry revealed intense luminal MAA reactivity of distal tubular REC and collecting ducts in 96.7% and 91.5% of normal and stone-forming kidneys respectively. By contrast, there was a marked difference between normal and stone-forming kidneys for SNA reactivity (17.7% vs 95%) at the same locations. Finally, the glycocalyx of recurrent stone-formers showed altered sialylglycoside linkages [alpha(2,6) instead of alpha(2,3)] that may indicate an altered REC function. Given the calcium-binding potential of NANA, their increased local concentration within the glycocalyx layer in the distal nephron may either initiate stone formation or facilitate attachment of microcrystals to REC.

Adult↗
PubMed1998

Numerical aberrations of chromosomes 7, 9 and 17 in squamous cell and transitional cell cancer of the bladder: a comparative study performed by fluorescence in situ hybridization.

PURPOSE: Since squamous cell differs from transitional cell cancer regarding histopathology, clinical outcome and etiology, the underlying genetic effects of these 2 tumor types may also be different. We compared numerical aberrations of chromosomes 7, 9 and 17 in bilharzial squamous cell carcinoma, and bilharzial and nonbilharzial transitional cell carcinoma by fluorescence in situ hybridization, and correlated the findings to p53 positivity of the 3 tumor types. MATERIALS AND METHODS: Cystectomy for invasive bladder cancer was performed in 169 men and 51 women with a mean age of 54.8 years (range 28 to 83). Of the 220 patients 100 (45.4%) had histologically verified bilharzial squamous cell carcinoma, 61 (27.7%) bilharzial transitional cell carcinoma and 59 (26.8%) nonbilharzial transitional cell carcinoma. Using fluorescence in situ hybridization cystectomy specimens were evaluated for numerical aberrations of chromosomes 7, 9 and 17, and p53 detection was performed by immunohistochemistry. RESULTS: Aberrations of chromosome 7 were observed in 79% of the bilharzial squamous cell carcinoma specimens, and 100% and 93.2% of bilharzial and nonbilharzial transitional cell carcinoma specimens, respectively (p = 0.00011). Aberrations of chromosome 9 were seen in 92% of squamous cell carcinoma specimens but in only 52.4% and 60.9% of bilharzial and nonbilharzial transitional cell carcinoma, respectively (p < 0.00001). Aberrations of chromosome 17 were found in only 29% of squamous cell carcinoma specimens, compared to 83.6% and 84.7% aberrations of chromosome 17 in both transitional cell carcinoma groups, respectively (p < 0.00001). The p53 over expression was similar in all 3 tumor types with 82% for squamous cell carcinoma, and 73.7% for bilharzial and 81.3% for nonbilharzial transitional cell carcinoma (not significant, p = 0.5285). CONCLUSIONS: Our data show clear differences between chromosomal patterns of invasive bilharzial squamous cell carcinoma and invasive bilharzial or nonbilharzial transitional cell carcinoma but similar frequencies of p53 over expression in all 3 tumor types. However, aberrations of chromosome 9 were observed in all analyzed groups, which confirms the 2 pathways in the oncogenesis of squamous cell and transitional cell carcinoma at the cytogenetic level as suggested by molecular studies.

Adult↗
PubMed1998

Primary adenocarcinoma of the urinary bladder: a report of 185 cases.

OBJECTIVE: To evaluate the outcome after the treatment of primary non-urachal vesical adenocarcinoma and to determine the significant prognostic factors. PATIENTS AND METHODS: The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow-cytometric DNA analysis. The mean follow-up of the treated patients was 3.1 years. Disease-free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox's proportional hazards analysis was used to determine prognostic factors. RESULTS: The overall 5-year disease-free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement. CONCLUSIONS: Radical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.

Adenocarcinoma↗
PubMed1998

Study of effect of optimization of dialysis and protein intake on neuromuscular function in patients under maintenance hemodialysis treatment.

This study was carried out on 22 patients on maintenance hemodialysis. Among them, 20 patients were males and 2 were females, their age ranged from 12 to 50 years. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling following the nomographic approach for calculating their Kt/V values. Their nutrition was assessed by measuring skin folds, midarm circumference, laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Also their neuromuscular functions were assessed by clinical examination and neurophysiologic study. Dialysis dose was readjusted to achieve a target Kt/V value of 1.3 for patients on 3 times weekly dialysis and 1.6 for patients on twice weekly dialysis. Also, their nutrition was reviewed to achieve nPCR 1.2 g/kg/day and caloric intake 30-40 kcal/kg/day through diet manipulation and support. The patients were assessed finally after 3 months on targeted dialysis and nutrition by thorough clinical, laboratory and neuromuscular assessment. Analysis of neurophysiologic data showed significant improvement in electromyography. Furthermore, fatigue test showed significant (p = 0.002) decreases in muscle fatigue after optimization of dialysis dose and patients' nutrition. From this study, we may conclude that in dialysis patients, even when asymptomatic and clinically stable, neurologic deficits do exist and using area kinetic modeling to improve dialysis and patients' nutrition is valuable in improving their neuromuscular functions.

Adolescent↗