To explore the impact of therapy, the disease and other contributing factors on bone mass in COPD and bronchial asthma patients, this study was done. It included 68 patients: 39 stable COPD (26 males and 13 females with an age range from 45year to 68 year) and 29 stable asthmatic patients (11 males and 18 females with an age range from 20year to 58 year).COPD was diagnosed on basis of: Medical history. Clinical examination: both general and local chest examination. Plain chest X-ray postero-anterior and lateral views to exclude any other pulmonary diseases. Irreversible obstructive airway dysfunction.Bronchial asthma was diagnosed on basis of: Clinical history. Clinical examination. Plain chest X-ray postero-anterior and lateral views to exclude any other pulmonary diseases. Reversible obstructive airway dysfunction .) . Evidence of variability of the airflow obstruction .All cases were subjected to1-thorough medical history stressing onA - History of smokingB- Medication history.2- Full clinical examination: general and local chest examination3- Quality of life assessment by using Short form –12V2 (SF-12V2) questionnaire.4-Nutritional assessment through:A) Anthropoemetric measures1. Body weight2. Body mass index3. Triceps skin fold thickness4. Arm circumference5. Midarm muscle circumferenceB) Peripheral blood lymphocytic count .C) Serum albumin.5- Spirometric pulmonary function testing this was done for all patients. It was carried out using computerized pulmonary function device (ZAN 1100) before and 20 minute ,after inhalation of 400 ug of salbutamol using MDI.6- Radiological investigations(a) Plain chest x ray .(b) Estimation of bone mineral density (BMD) was done by using dual energy x- ray Absorptiometry (DEXA).7- Laboratory investigations:a) Arterial blood gas analysis.b) Complete blood picture (CBC).c) Serum parameters: Serum phosphorus, calcium and alkaline phosphatase, Estradiol-E2 for male patients, Parathyroid hormone, Cortisol and OsteocalcinFor exclusion of coexisting renal, hepatic or thyroid diseases kidney function tests ,hepatic function tests, T3 (Triiodothyronine) and T4 (Thyroxin) were done.The results of this study showed:• The frequency of osteoporosis in the studied COPD patients was significantly higher at the femoral neck than at the spine (P<.01) as 28 COPD patients have osteoporosis only at the femoral neck and 3 have osteoporosis at both the femoral neck and the spine.• In the studied COPD patients BMD and T score of the femoral neck are significantly lower than BMD and T score of the spine (P<.01 and P<.01),but on the other hand Z score is significantly higher at the femoral neck than at the spine (P<.05).• Z score of the spine is significantly lower in COPD patients who received systemic steroid medications when compared with those who have never received steroids (P<.05).• COPD patients with history of steroid medication had a significantly lower 17 estradiole when compared with those who have never received steroids (P<.05).• In COPD patients there was a significant positive correlation between Z score of femoral neck and TSF, MAC,IBW% and BMI (P<.05) and a highly significant correlation with AC, albumin and lymphocytic count (P<.01), but there was a non significant positive correlation between Z score of the spine and all of the nutritional assessment parameters.• In COPD patients there was a non significant positive correlation between Z score of both the femoral neck and spine and PCS and non significant negative correlation with smoking index.• In COPD patients there was a highly positive correlation between Z score of the femoral neck and 17estradiole (in males) (P<.01) and a highly significant positive correlation between Z score of the spine with and PTH (P<.01).• In COPD , there was a highly significant positive correlation between Z score of the femoral neck and Z score of the spine with FEV1% (P<.01).• In the studied asthmatics the frequency of osteoporosis was significantly higher at the femoral neck than at the spine (P<.01) (osteoporosis is present at the femoral neck alone in 10 patient and present in both the femoral neck and the spine in 3 patients).• The studied asthmatics had significantly lower BMD and T score at the femoral neck than at the spine (P<.01 and P.01) but there was no significant difference as regard to Z score.• There was a highly significant difference of Z score of the spine between asthmatics on systemic steroid and those who have never received steroid medications (P<.01) (the lower value is of the systemic steroid group).• The studied asthmatics with history of steroid medications (systemic or inhaled) had significantly lower serum Ca,17 estradiol, and osteocalcin (P<.01, P<.01, and P<.05) when compared to asthmatics with no history of steroid medications.• There was a non significant positive correlation between Z score of both the femoral neck and spine and all of the nutritional assessment parameters in asthmatics.• There was a non significant positive correlation between Z score of both the femoral neck and spine and PCS and smoking index in asthmatics.• In asthma patients Z score of spine showed a significant positive correlation with serum calcium (P<.05).• In asthma patients Z score of femoral neck showed a highly significant positive correlation with serum cortisol, and Z score of spine showed a highly significant positive correlation with both 17 estradiole and serum cortisol (P<.01).• Z score of the femoral neck in asthma patients showed a significant positive correlation with FEV1% (P<.05), but Z score of spine showed a non significant positive correlation with FEV1%.• The frequency of osteoporosis was significantly higher in the studied COPD patients than in the studied asthmatics (P<.01).• In the studied patients with no history of steroid medications, BMD, T score and Z score of the spine and femoral neck were significantly lower in COPD patients than in asthmatics.• In the studied patients with history of systemic steroid medications BMD and T score of the spine were significantly lower in COPD patients than in asthmatics(P<.05 and P<.05).But there was no significant difference between the two groups as regard to Z score.• In the studied patients with history of systemic steroid medications there was no significant difference in BMD, T score nor Z score of the femoral neck between COPD and asthmatic patients.CONCLUSION• Osteoporosis is more common in COPD patients than in asthma patients.• Corticosteroids whether inhaled or systemic affect negatively bone mass in COPD and asthma patients.• Osteoporosis is frequent in COPD patients regardless steroid therapy.• Osteoporosis is infrequent in asthma patients regardless steroid therapy.• In COPD patients, nutritional status, 17 estradiole, steroids and degree of airway obstruction affect the bone mass.• In asthma patients degree of airway obstruction, serum 17 estradiole (in males), serum osteocalcin and systemic steroid affect the bone mass.RecommendationBone mass assessment should be considered in the field of COPD patient’s management especially those with severe disease, malnutrition state or those with history of steroid medications and also should be asked for asthmatics receiving steroid medications especially systemic steroidsلقد أجريت هذه الدراسة لاستيضاح تأثير العلاج والمرض والعوامل الأخرى على كتلة العظم في مرضى السدة الرئوية المزمنة والربو الشعبي.ولقد اشتملت هذه الدراسة على 68 مريضاً:39مريضا يعانون من مرض السدة الرئوية المزمنة ( 26 ذكراً و13 أنثى، وكانت أعمارهم تتراوح بين 45-68 عاما) و29 مريضا يعانون من مرض الربو الشعبي ( 11 ذكراً و18 أنثى، وكانت أعمارهم تتراوح بين 20-58 عاما).وقد تم تشخيص مرض السدة الرئوية المزمنة عن طريق:• أخذ التاريخ المرضى كاملاً.• الفحص الإكلينكى الشامل.• الأشعة السينية على الصدر• الضيق الشعبي الغير مرتجع بالعلاج.وقد تم تشخيص مرض الربو الشعبي عن طريق:• أخذ التاريخ المرضى كاملاً.• الفحص الإكلينكى الشامل.• الأشعة السينية على الصدر لاستبعاد الأمراض الرئوية الأخرى• الضيق الشعبي المرتجع بالعلاج.وقد تم عمل الفحوصات التالية لكل المرضى:• أخذ التاريخ المرضى كاملاً.• الفحص الإكلينكى الشامل.• استبيان قياس نوعية الحياة.• تقييم الحالة الغذائية من خلال قياسات الجسم(الوزن,الطول,مؤشر الكتلة الجسمية,سمك الطية الجلدية للعضلة ذات الثلاث رؤس,محيط الزراع, محيط عضلات منتصف الزراع),عدد الخلايا الليمفاوية بالدم و عن طريق نسبة الألبومين بمصل الدم.• وظائف التهوية الرئوية بواسطة جهاز زان1100 قبل وبعد استخدام موسع الشعب الهوائية.• الأشعة السينية على الصدر لاستبعاد الأمراض الرئوية الأخرى.• قياس كثافة العظام عن طريق مقياس الامتصاص الإشعاعي الثنائى.• اختبارات معملية:o غازات بالدم الشريانىo صورة دم كاملةo نسبة فسفور,كالسيوم,إنزيم الفوسفات القلوي,هرمون 17 استراديول, هرمون الغدة الجار درقية, هرمون الكورتيزول ,والاستيوكالسين).o لاستبعاد مرضى الكبد,الكلى ومرضى الغدة الدرقية تم عمل وظائف كبد و كلى وهرمونى الغدة الدرقية.ولقد أظهرت النتائج الآتى:• في مرضى السدة الرئوية المزمنة وجد فرق ذا دلالة إحصائية عالية عند مقارنة عنق عظمة الفخذ بالفقرات من حيث الإصابة بمرض هشاشة العظام فقد كانت نسبة وجوده أعلى في عنق عظمة الفخذ .• في مرضى السدة الرئوية المزمنة وجد فرق ذا دلالة إحصائية عالية عند مقارنة كثافة العظم ودرجة T لعنق عظمة الفخذ والفقرات فقد كانت قيمهم أقل عند عنق عظمة الفخذ.• في مرضى السدة الرئوية المزمنة وجد فرق ذا دلالة إحصائية عالية عند مقارنة درجة Z لعنق عظمة الفخذ والفقرات فقد كانت قيمهم أكبر عند عنق عظمة الفخذ.• عند مقارنة درجة Z للفقرات في مرضى السدة الرئوية المزمنة المعالجين بالكورتيزون بغير المعالجين بالكورتيزون وجد فرق ذا دلالة إحصائية عالية فقد كانت قيمته أقل في المرضى المعالجين بالكورتيزون.• عند مقارنة 17استراديول بين مرضى السدة الرئوية المزمنة المعالجين بالكورتيزون وغير المعالجين بالكورتيزون وجد فرق ذا دلالة إحصائية عالية فقد كانت قيمته أقل في المرضى المعالجين بالكورتيزون.• في مرضى السدة الرئوية المزمنة وجدت علاقة إحصائية موجبة ذات دلالة عالية بين درجة Z لعنق عظمة الفخذ وكلا من سمك الطية الجلدية لعضلة الترايسبس, محيط عضلات منتصف الذراع ,مؤشر الكتلة الجسمية محيط منتصف الذراع, نسبة الألبومين بمصل الدم وعدد الخلايا الليمفاوية بالدم بينما وجدت علاقة موجبة غير ذات دلالة إحصائية بين درجة Zللفقرات وكل القياسات السابقة.• في مرضى السدة الرئوية المزمنة وجدت علاقة موجبة غير ذات دلالة إحصائية بين درجة Z لعنق عظمة والفقرات وكلا من مقياس الحركة و مؤشر التدخين.• في مرضى السدة الرئوية المزمنة وجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z لعنق عظمة وبين نسبة هرمون 17 استراديول ووجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z للفقرات وبين نسبة هرمون الغدة الجار درقية.• في مرضى السدة الرئوية المزمنة وجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z لعنق عظمة الفخذ والفقرات و شدة المرض.• في مرضى الربو الشعبي وجد فرق ذا دلالة إحصائية عالية عند مقارنة عنق عظمة الفخذ بالفقرات من حيث الإصابة بمرض هشاشة العظام فقد كانت نسبة وجوده أعلى فى عنق عظمة الفخذ.• فى مرضى الربو الشعبي وجد فرق ذا دلالة إحصائية عالية عند مقارنة كثافة العظم ودرجة T. لعنق عظمة الفخذ والفقرات فقد كانت قيمهم أقل عند عنق عظمة الفخذ. بينما لم يوجد فرق ذا دلالة إحصائية عند مقارنة درجة Z لعنق عظمة الفخذ والفقرات.• عند مقارنة درجة Z للفقرات في مرضى الربو الشعبي المعالجين بالكورتيزون بغير المعالجين بالكورتيزون وجد فرق ذا دلالة إحصائية عالية فقد كانت قيمته أقل فى المرضى المعالجين بالكورتيزون.• عند مقارنة الكالسيوم, 17 استراديول والاستيوكالسين في مرضى الربو الشعبي المعالجين بالكورتيزون وغير المعالجين بالكورتيزون وجد فرق ذا دلالة إحصائية عالية فقد كانت قيمتهم أقل فى المرضى المعالجين بالكورتيزون.• في مرضى الربو الشعبي وفي مرضى السدة الرئوية المزمنة وجدت علاقة موجبة غير ذات دلالة إحصائية بين درجة Z لعنق عظمة الفخذ والفقرات وكل مقاييس التقييم الغذائى.• في مرضى الربو الشعبي وجدت علاقة موجبة غير ذات دلالة إحصائية بين درجة Z لعنق عظمة الفخذ والفقرات وكلا من مقياس الحركة و مؤشر التدخين.• فى مرضى الربو الشعبي وجدت علاقة موجبة ذات دلالة إحصائية عاليه بين درجة Z للفقرات و نسبة الكالسيوم بمصل الدم.• فى مرضى الربو الشعبي وجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z لعنق عظمة الفخذ ونسبة الكورتيزول بمصل الدم ووجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z للفقرات و ونسبة 17 استراديول و الكورتيزول بمصل الدم.• فى مرضى الربو الشعبي وجدت علاقة موجبة ذات دلالة إحصائية عالية بين درجة Z لعنق عظمة الفخذ و شدة المرض.بينما كانت علاقة درجة Z للفقرات بشدة المرض موجبة غير ذات دلالة إحصائية.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.3- Haemodialysis program.4- Blood pressure pre- and post dialysis was measured.5- Intradialytic body weight gain.6- Routine investigation (to verify the inclusion and the exclusion criteria of our subjects included:a- Complete blood picture.b- Total protein and serum albumin.c- Liver function test.d- Serum Creatinine blood urea level Pre and post dialysis.e- ECG and Echocardiogram.f- Fasting and post prandial blood sugar to exclude DM.g- Calcium (Ca), Phosphorus (P), Sodium (Na), and Potassium (K).Research investigations included:a- Color Wave Doppler Ultrasound for A-V fistula.b- Prescribed dose of Haemodialysis from Kt/v equation.Our result as following:- The mean Kt/v in female was highly significant higher than in male.- The intra access MBFV in male A-V fistula was significant higher than in female.- The intra access MBFV in arm A-V fistula was highly significant higher than in forearm A-V fistula.- The difference among Kt/v and intra access MBFV as regards the age of patients and duration of haemodialysis (dialytic age) was non-significant.- The difference between Kt/v and intra access MBFV in complicated and uncomplicated A-V fistulae was non-significant.- The difference between Kt/v and intra access MBFV in private and university hospitals constructed A-V fistulae was non-significant.- The mean values of Kt/v was highly significant higher in UKM (Watson and nomogram) than in Daugirdas II.UKM method for Kt/v estimation more specific and more sensitive than in Daugirdas II.Conclusions:From the previous results it could be concluded that:- The intra–access blood flow rate was highly significant higher in arm A-V fistula than in fore arm A-V fistula.- The intra–access blood flow rate was significantly higher in male than in female A-V fistula.- Kt/v in female was highly significant higher than in male.Recommendation- We recommend to estimate the Kt/v by UKM (Watson and Nomogram) at least every month:- Regular examination of A-V fistula every 4 – 6 weeks and do Color Doppler if needed.- Construction of A-V fistula in arm if no contra indication.- The recommended ideal intra-access blood flow rate need further study on a wider scale.Summary and ConclusionThis work has been done in the nephrology and dialysis unit, internal medicine department, Zagazig university hospitals.This study included a total number of 25 patients were divided according to site of A-V fistula into two groups;Group I: included 15 patients; 3 of them were females, 12 of them males. Group II: included 10 patients; 4 of them were females and 6 of them were males. Subdivided according to the duration of haemodialysis (dialytic age) into three groups; Group 1 included 5 patients all of them were males, Group 2 included 14 patients 5 of them were females, 9 of them were males, Group 3 included 6 patients 2 of them were females, and 4 of them were males.And also subdivided according to the age of patients into four groups; Group A included 7 patients: (3 of them were female, 4 of them were male) with age ranged 21 - 30 years. Group B included 5 patients (all of them were male), with age ranged 31- 40 years. Group C included 8 patients (1 of them was female, and 7 of them were males) with age ranged 41 - 50 years. Group D included 5 patients (3 of them were female and 2 of them were male) with age ranged 51 - 60 yearsMethods:All patients were subjected to the following:1- Thorough history and Full Clinical Examination.2- Thorough history and Clinical Examination of A-V fistula.The aim of this work is to study the principles, indications, operative technique and the outcome of the commonly performed limited wrist arthrodeses.