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Biomedical subjects

M A Ghoneim

Publications and source records attributed to M A Ghoneim.

At least 19 recordsLinked to original sources
PubMed1992

Prognostic significance of flow-DNA analysis and cell surface isoantigens in carcinoma of bilharzial bladder.

Flow cytometric DNA analysis and ABO(H) cell surface antigen expression were studied in 46 patients with cystectomies for carcinoma of bilharzial bladder. The most significant prognostic indicators were the DNA index and the status of the pelvic lymph nodes at operation. Diploid tumors were associated with a low metastatic potential (7.7%) and a better five-year survival (54%) in contrast to aneuploid cases that had a higher metastatic potential (45.5%) and a low five-year survival (21%). The ABO(H) isoantigen status did not correlate with pathologic parameters or the clinical course of these invasive bilharzial bladder tumors as was previously reported.

ABO Blood-Group System↗
PubMed1992

Urethral controlled bladder substitution: a comparison between the intussuscepted nipple valve and the technique of Le Duc as antireflux procedures.

A urethral controlled bladder substitute was constructed from a detubularized, double folded ileal segment in 40 male patients following cystoprostatectomy for bladder cancer. For reflux prevention patients were prospectively randomized to receive either an intussuscepted nipple valve or the ureters were implanted by the Le Duc mucosal trough technique. All patients had normal upper tracts preoperatively. Mean patient age, performance status and stage of cancer were comparable in both groups. Patients were evaluated 6 to 18 months postoperatively. In addition to history taking, assessment included excretory urography, ascending cystography and voiding cystourethrography. During the observation period all patients with nipple valves had normal radiographic appearance of the upper tracts without evidence of reflux. On the other hand, following the Le Duc procedure 12 of 38 renal units (31%) showed evidence of radiographic dilatation. Of the 12 units 11 had stenotic ureters and 1 had reflux. We conclude that nipple valves are more effective in reflux prevention and protection of the upper urinary tract in patients for whom an ileal neobladder is indicated.

Humans↗
PubMed1992

The urodynamic characteristics of different ileal reservoirs: an experimental study in dogs.

Using adult mongrel dogs, the urodynamic characteristics of three types of ileal reservoirs were studied and compared. Segments of ileum of the same length were utilized to construct simple loop pouches (five dogs), DeKlerk pouches (five dogs) and Kock pouches (five dogs). Six to eight weeks after surgery, urodynamic evaluation was carried out. This included determination of the volume/pressure relationship and measurement of the contractions of the circular and longitudinal muscle fibers. Results indicate that the Kock pouch offers the best features in terms of the volume capacity, the volume/pressure relationship and contractile activity. Detubularization abrogated the muscle tone but it did not affect the phasic contractile activity of the circular muscle layer.

Animals↗
PubMed1992

Further experience with the urethral Kock pouch.

In 185 men a urethral Kock pouch was constructed as a bladder substitute after radical cystectomy for cancer. A total of 117 patients was followed for a minimum of 1 year and is fully evaluable. Of the patients 108 (92%) are completely continent during the day, while 85 (73%) are dry at night. Also, 8 patients had an excellent response to imipramine hydrochloride. Stability or improvement in the configuration of the upper tract was noted in 210 renal units (90%). A total of 24 renal units showed evidence of deterioration due to reflux (16) and an anastomotic stricture (8). Stability of the antireflux nipple valve was ensured by creation of a window in the mesentery of the corresponding bowel segment and by anchoring the valve to the wall of the pouch by an additional row of staples. On the basis of this favorable outcome the procedure is recommended for male patients for whom cystectomy is indicated and in whom the urethra can be preserved.

Cystectomy↗
PubMed1992

Further experience with the modified rectal bladder (the augmented and valved rectum) for urine diversion.

Continent diversion with the modified rectal bladder was done in 83 patients and 65 are currently evaluable with followup ranging from 6 to 36 months. There was no postoperative mortality and the morbidity rate was acceptable. Renal function and configuration were maintained in most patients (91%). Dessusception of the colorectal valve was observed in 7.6% of the patients. Evidence was provided that this valve is effective in prevention of regurgitation of the rectal contents to the proximal colon. All patients were continent during the day. Enuresis was noted in 6 patients and all of them responded to imipramine hydrochloride therapy. The results support earlier observations that the procedure offers distinct advantages over ureterosigmoidostomy and the simple rectal bladder.

Adult↗
PubMed1992

Percutaneous nephrolithotripsy for renal stones in over 1000 patients.

Over a period of 5 consecutive years, 1039 renal units were treated by percutaneous nephrolithotripsy for stone disease of the kidney. The success rate was 93.7%. Residual stones remained in 4.2% of patients and in 2.1% we failed to remove the stones. The complication rate was 17.8%. Complications were treated conservatively in most cases but nephrectomy was required on one occasion to control severe bleeding. The average hospital stay was 6.9 days. Follow-up of 339 renal units (333 patients), for a minimum of 60 months, revealed minor late sequelae such as pelviureteric junction obstruction in 1 patient (0.3%) and post-catheterisation strictures of the anterior urethra in 4 (1.2%). Stone recurrence was observed in 9.1% of patients. Percutaneous nephrolithotripsy is an effective, safe treatment for renal stones with minimal late sequelae and is still required even in the era of extracorporeal shock wave lithotripsy.

Adolescent↗
PubMed1992

Urological complications following live donor kidney transplantation: effect of urinary schistosomiasis.

Urological complications were studied in 310 live donor kidney transplants. All recipients and donors were investigated for urinary schistosomiasis by examining tissue obtained intra-operatively from the donor's ureter or the patient's bladder. Schistosomiasis was histologically documented in 76 cases (patient's bladder (46), donor's ureter (9), both (21)). The incidence of urological complications was 11/76 (15%) in the schistosomal group and 14/234 (6%) in the non-schistosomal group; this was statistically significant. Among the schistosomal patients, the site of infestation had no statistically significant effect on the incidence of urological complications. No deaths or graft losses were directly attributable either to these complications or to their surgical correction.

Adult↗
PubMed1992

Effects of schistosomiasis on living kidney donors.

Twenty living kidney donors with schistosomiasis were compared with 20 uninfected donors for a mean follow-up period of 42 months (range 12-62). All patients with schistosomiasis had been treated preoperatively with antischistosomal chemotherapy. None of the donors developed any appreciable change in mean systolic or diastolic blood pressure during the follow-up period, though one infected and two uninfected donors had traces of protein in the urine. One uninfected donor developed microscopic haematuria. The two groups has similar reductions in renal function after unilateral nephrectomy. The response of the remaining kidneys to a combined infusion of dopamine and an amino acid preparation was similar in both groups. One infected and two uninfected donors were found to have developed mild hydroureter and hydronephrosis on excretory urography. Schistosomiasis did not significantly affect compensatory hypertrophy of the remaining kidney. We conclude that uncomplicated schistosomiasis in living kidney donors does not adversely affect either the function or the morphology of the remaining kidney, at least during an observation period of up to five years. Schistosomal infection does not seem to alter the adaptive changes in the remaining kidney, provided that the donor had functionally and morphologically intact kidneys and that the schistosomiasis was treated before kidney donation. Longer term evaluation is recommended, however, to confirm the validity of these observations.

Biopsy↗
PubMed1992

[Vesico-ureteral reimplantation in kidney transplantation from living relative donor: extravesical or transvesical? Urologic complications and long-term results evaluation].

Results of two techniques of ureteroneocystostomy were evaluated in a series of 400 consecutive living renal transplantations. In the first 150 patients (group A) PAQUIN ureteroneocystostomy was utilized and in the second 250 (group B) DE CAMPOS-FREIRE technique was performed. Significant urological complications were seen in 13 (8.6%) patients of group A and in 10 (4%) of group B. Bladder leak occurred in 5 patients of group A and in only 1 of group B (P < 0.05). Complications related to ureteral stenosis and ureteral necrosis were comparable in the two groups. High pressure vesicoureteral reflux was demonstrated in 2 of 85 patients of group A and in 15 of 160 of group B (P < 0.05). Abnormalities of intravenous urography were significantly higher in group A. The incidence of immediate and delayed post-transplant urinary infection was not statistically different among the two groups. We advocate the use of DE CAMPOS-FREIRE approach over the PAQUIN reimplantation, not only because of the marginal differences in the incidence of urological complications, but also because of the technical advantages offered by the former approach.

Adult↗
PubMed1992

Impact of schistosomiasis on patient and graft outcome after kidney transplantation.

In this work the impact of schistosomiasis on kidney transplantation was investigated by comparing two groups of patients, group 1 (Schistosoma-infected cases) and group 2 (control cases). In group 1, schistosomiasis was diagnosed in both donor and recipient in 63 cases, in recipient only in 65 cases, and in donor only in eight cases. Schistosomal infection among kidney transplant recipients was S. haematobium in 17 cases, S. mansoni in 58 cases, and mixed in 53 cases. Schistosomiasis was diagnosed by finding Schistosoma eggs in urine, stools, rectal mucosal biopsy, recipient bladder mucosal biopsy, or in the donor ureter obtained during surgery. Patients and donors with active lesions were treated at least 3 weeks before transplantation by the antischistosomal drugs praziquantel and oxamniquine. Follow-up after kidney transplantation showed no significant difference between the two groups regarding the incidence of acute and chronic rejection. Nevertheless, dose of cyclosporin, HBs antigenaemia, incidence of urinary tract infection, renal stones, ureteric stricture, and urinary leakage were significantly greater among schistosomal patients when compared to control cases. Schistosomal reinfection was observed in 23% of cases at high risk. Antischistosomal treatment did not affect the graft function. We have concluded that schistosomiasis may affect the outcome of kidney transplantation.

Adult↗
PubMed1991

UNME/K1: an IgG2a monoclonal antibody specific to cytokeratin of human urinary bladder squamous cell carcinoma.

The main distinctive feature of carcinoma in schistosomal bladder is keratinized squamous cell carcinoma. Keratins/cytokeratins constitute a multigeneic family of structurally related polypeptide markers for the malignant state of epithelial cells. A monoclonal antibody (UNME/K1) regognizing keratins associated with squamous cell carcinoma of the human urinary bladder was generated at the Urology and Nephrology Center, Mansoura, Egypt (UNME), by fusion of spleenocytes from a BALB/c mouse immunized with a keratin extract (K1) of human squamous cell carcinoma and P3X63Ag8/U1 syngeneic myeloma cells. UNME/K1 was purified by a protein-A affinity column and was of the IgG2a type, as determined by immunoelectrophoresis and gel diffusion techniques. When tested against keratins of different types of urinary bladder tumors using enzym linked immunosorbent assay (ELISA), UNME/K1 reacted only with the high molecular weight keratin of squamous cell carcinoma and showed selectivity towards specific histopathological grades of tumors.

Animals↗
PubMed1991

Optimization of replacement of the ureter by ileum.

Fifty patients for whom an ileal replacement of the ureter was indicated were prospectively randomized among 2 treatment groups according to the surgical technique used. In group 1 the standard operation was performed. In group 2 a tailored and valved (modified) ileal ureter was used. Patients were followed every 3 to 6 months for 12 to 28 months. Kidney functions were evaluated by 99m technetium diethylenetriaminepentaacetic acid scans and by determination of the 24-hour creatinine clearance. Urine cultures were obtained, and urine viscosity and flow rates were measured. A urographic study, including ascending cystography, was done every 6 months. Results indicated that the modified operation is functionally superior to the standard procedure. It provides efficient unidirectional flow of urine from the kidney to the bladder with less mucus secretion. This was ultimately reflected as better renal function when it was quantitated by renography and/or chemical clearance.

Adult↗
PubMed1991

Bladder substitutes controlled by the anal sphincter: a comparison of the different absorption potentials.

A comparative study of the absorption potentials of the simple rectal bladder (10 patients), modified rectal bladder (20) and ureterosigmoidostomy (10) was done with intrarectal instillation of 22sodium. Results indicate that absorption is significantly greater among patients with ureterosigmoidostomy. The emptying patterns of ureterosigmoidostomy and the modified rectal bladder were also studied by ascending scintigraphy with 99mtechnetium. Evidence was provided that in cases with ureterosigmoidostomy the isotope is distributed throughout the entire colon. These studies proved the role of the colorectal valve in preventing reflux of urine from the rectum to the proximal colon. Consequently, the surface area of colonic mucosa exposed to urine is decreased and the rate of reabsorption is limited.

Absorption↗
PubMed1991

Urethral controlled bladder substitution: a comparison between Parks S pouch and hemi-Kock pouch.

To study the effect of the configuration of ileal reservoirs on the urodynamic features, 12 S bladders and 12 Kock pouches were compared. Volume capacity and pressure characteristics were studied 6 months postoperatively. The mean capacity of the reservoirs was 500 +/- 83 ml. for the S bladder and 536 +/- 56 ml. for the Kock pouch. The amplitudes of phasic contractions at 50%, 80% and 100% capacity were similar in both groups. However, the frequency of these contractions was higher in the S bladder. The intraluminal pressure at full capacity was 31 +/- 15 cm. water for the S bladder and 39 +/- 20 cm. water for the Kock pouch. The similar urodynamic features of the S and Kock pouches indicate their ultimate expansion into reservoirs of close physical characteristics and urodynamic behavior.

Humans↗
PubMed1991

Cytokeratin shedding in urine as a biological marker for bladder cancer: monoclonal antibody-based evaluation.

Cytokeratin shedding into urine was measured using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) in 282 individuals. Samples included urine from normal controls, patients with urogenital conditions and bladder cancer patients. A monoclonal antibody prepared against cytokeratins extracted from a hyperkeratotic low grade squamous cell carcinoma (UNME/K1) was used in the assay. The results indicated reasonable levels of sensitivity (83%), specificity (67%) and overall accuracy (70%) in the detection of bladder cancer. The levels of sensitivity in detecting squamous and transitional cell carcinoma patients were 87 and 73% respectively. The low level of specificity was due to a high frequency of false positive results (55%) within the urogenital controls; this suggests that further immunochemical and immunohistopathological analyses of associated urothelial cytokeratins are required.

Adenocarcinoma↗
PubMed1991

Schistosoma haematobium-induced glomerular disease: an experimental study in the golden hamster.

Information regarding glomerular lesions related to Schistosoma haematobium infection in man or animal are extremely lacking and disputed. The objective of this experimental study was to investigate glomerular lesions in S. haematobium-infected golden hamsters. In this work, 53 hamsters were infected with S. haematobium cercariae and 18 animals of similar age and sex served as controls. Hamsters were infected either with 50, 200, 300, 400 or 600 cercariae and sacrified after 8, 9, 10, 14, 18, 24 or 32 weeks. Infected and control hamsters were subjected to laboratory examinations including serum creatinine, serum albumin, total protein, serum cholesterol, total urine protein as well as histopathologic evaluations. Kidney biopsies were examined by light microscopy, indirect immunofluorescence and by electron microscopy. Significant proteinuria, hypoalbuminaemia and hypercholesterolaemia were observed in all but 5 S. haematobium-infected, but in none of the control hamsters. Renal impairment was observed in 5 hamsters. Histopathologic evaluations showed IgG, circulating anodic antigen and circulating cathodic antigen deposits in the renal glomeruli. By electron-microscopic examination, these deposits were seen mainly in the subendothelial, mesangial and paramesangial areas. Amyloid deposits were also seen in the renal glomeruli, tubular basement membrane and in the interstitium. A correlation was found between the extent of amyloid deposition and the duration but not the intensity of schistosomal infection. We have concluded that S. haematobium infection can lead to glomerulopathy in golden hamsters.

Animals↗