BACKGROUND:Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient’s symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up.AIM:Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia.METHODS:This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017.RESULTS:We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P < 0.05)CONCLUSION:Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.

Background normal sexual activity is an important issue in the quality of life for both males and females. Several diseases were associated with erectile dysfunction, unfortunately, data about erectile dysfunction in cirrhotic patients was scanty. This study was conducted to determine the prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis. Method: a cross-sectional study was conducted on 200 patients with liver cirrhosis they were divided into three groups according to Child score and erectile dysfunction was studied by (IIEF-5) Questionnaire and penile Doppler. Results the prevalence of erectile dysfunction in the cirrhotic patient was 80%. the erectile dysfunction worsens with the worsening of the liver condition (Child C), also 20% of the cirrhotic patients had penile venous leakage which became 28.6% in advance liver cirrhosis (Child C). Multivariate logistic regression showed that advancing in age, Albumin less than 2.8 g/dl, INR 1.7-2.2, Hb>16 g/dl and Child C were predictors of erectile dysfunction in cirrhotic patients. Conclusion Erectile dysfunction was found in 80% of cirrhotic patients. It was more frequently observed in cirrhotic patients having an advanced disease (child C). Patients reporting ED had elevated INR, serum bilirubin, suppressed serum albumin, and elevated level of hemoglobin.

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Background: Colonic and extracolonic staging is critical in colorectal cancer patients and can be assessed with Conventional Colonoscopy (CC), which is accepted as the gold standard for evaluating the colon; however, there is data that indicates that colonoscope localization of cancer is frequently imprecise and depends on distances may be misguiding. Computed Tomography Colonography (CTC), on the other hand, has demonstrated the ability to offer excellent preoperative staging of colorectal cancer, particularly in cases of incomplete CC, and allows examination of the whole colon, even in cases of obstructive lesions; It also enables proper staging of extracolonic cancer spread. The purpose of this study was to compare CTC to colonoscopy in the identification of colorectal disorders in patients with colonic symptoms and signs. Methods: A prospective double blind comparative study was conducted on 50 patients suffering colorectal symptoms and altered bowel habits, bleeding per rectum, abdominal pain, weight loss, unexplained fatigue and loss of appetite. All patients involved in the study were subjected to Preparatory investigations, CT virtual colonoscopy and colonoscopy. Results:The correlation between clinical presentation, colonoscopy, colonographic findings and histopathological results revealed that among 5 abdominal pain cases (2 cases had diverticulum (no finding) and remaining 3 cases had either mass or polyp (adenomatous polyp (moderate dysplasia)) or no finding (no finding) in histopathology). The sensitivity, specificity, PPV, NPV and accuracy of Colonography vs. Colonoscopy in detection of mass in colon was 100%, 93.75%, 90%, 100% and 96.88% respectively. While for colon ulcer they were 44.44%, 100%, 100%, 76.19% and 72.22% respectively. For detecting colon polyp these parameters showed 75%, 100%, and 100%, 95.45% and 87.50% respectively. Lastly, for diverticulum in colon or any abnormality in colon, the result reached 100%. Conclusion: Colonic and extra colonic staging is critical in colorectal cancer patients and can be assessed with Conventional Colonoscopy (CC), which is accepted as the gold standard for evaluating the colon; however, there is data that indicates that colonoscope localization of cancer is frequently imprecise. The technique enjoys higher sensitivity than conventional colonoscopy in detecting colorectal carcinoma, abnormalities resulting from an obstructive lesion, segmental identification of colon abnormalities, and tumour staging prior to surgery.

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