Laparoscopic supracervical hysterectomy versus laparoscopically assisted vaginal hysterectomy

To compare laparoscopic supracervical hysterectomy [LSH] with laparoscopically assisted vaginal hysterectomy [LAVH] in terms of indications, pathology, length. and weight of removed uteri, operative time, intraoperative blood loss, intra- and postoperative complications, later on sexual function. Cohort retrospective analysis of consecutive cases [Canadian task force II-3]. Hutzel Hospital, Detroit Medical Center, Wane State University USA, Vert-Pre Nouvelle Clinique, Geneva, Switzerland and Benha University Hospitals, Egypt. Hundred thirty-six: patients underwent LAVH and hundred twenty-three underwent LSH. Our patients in both groups were matching regarding age, indications, and pathology of the removed uteri. Blood loss with LSH was significantly lower than it was in LAVH [mean, 125 +/- 5 vs 149 +/- 7ml. P=0.001]. Patients underwent LSH had significantly shorter operating times [mean. 120 +/- 3 vs 150 +/- 5 min. p = 0.007]. The length of the removed uteri was 14.2 +/- 0.5 cm [range. 5.2-18] in LSH versus 11.8 +/- 0.4cm [5.6-14] in LAVH. Weight of the removed uteri was 280 +/- 6 gm [range. 65-750] in LSH compared to 235 +/- 8gm [range, 59-560] in LAVH group. There was no difference regarding the days of hospital stay in both groups. The number of complicated cases was less in LSH group 3/123 [2.4%] compared to 5/ 136 [3.7%] in LAVH group. Later on sexual function was better in LSH group. After exclusion of preoperative cervical disease LSH can be considered as a safer alternative to LAVH in patients candidates for laparoscopic hysterectomy

Transvaginal sonography and hysteroscopy versus histopathology in postmenopausal bleeding

Transvaginal sonography [TVS] and hysteroscopy were compared with the histopathological results of the Dilatation and curretage [D and C] biopsies in 42 patients attending in Benha University Hospitals with postmenopausal bleeding. Endometrial lesions were detected by histopathology in 23 cases [54.8%], 17 of them were diagnosed by TVS and 14 from the remaining 19 normal atrophic endometrium were diagnosed by it. This gave a sensitivity and specificity of 73.9% and 73.7% respectively and a predictive value as a positive test, as a negative test and efficacy of 77.3%, 70.0% and 73.8% respectively. This efficacy could be increased to 81% by taking in account 5 mm of endometrial thickness as a cut - off level between normal and abnormal endomtetrium with significant difference [P<0.001]. Hysteroscopy diagnosed 18 cases from the 23 endometrial lesions which had been diagnosed by histopathology and 16 from the remaining 19 normal atrophic endometrium. This gave a sensitivity and specificity of 78.3% and 84.2%, respectively and a predicitive value as a positive test, as a negative test and efficacy of 85.7%, 76.2% and 8196 respectively. This study shows that TVS allows detection of an endometrial pathology in the vast majority of cases and as it is easy, relatively cheap, needs no anaethesia and non-invasive it can be used as the first diagnostic step in the investigations of women with postmenopausal bleeding to be supplemented, in the cases needed, by hysteroscopy and histopathological study of D and C biopsy. This will minimize cost, time and complications for the patient

Ultrasonographic versus laparoscopic control of hysteroscopic surgery

This study was carried on 38 patients attending in Benha UniversityHospitals with different pathological intrauterine lesions that needed hystroscopic surgery. The patients were divided into two groups A and B. Group A consists of 28 patients in whom transabdominal ultrasound was used as a control for the hysteroscopic surgery [17 endometrial resections, 5 myomectomies, 4 resections of uterine septum and 2 divisions of intra-uterine adhesions]. Eight cases were done under cervical infilteration anaethesia while the others were done under general anaethesia. Group B consists of 10 patients in whom the old method of laparoscopic control under general anaethesia was used during hysteroscopic surgery [6 endometrial resections, 2 myomectomies, 1 resection of uterine septum and 1 division of intrauterine adhesions]. There were no complications in both groups a part from one perforation which needed no further management in group B due to obscuring of the field by adhesions from a previous pelvic operation. In one case of group A blanching of the peritoneal uterine coat occurred during endometrial resection but actual perforation did not occur. Ultrasound control of hysteroscopic surgery is recommended as it is easy, non-invasive has no special complications or contraindications as for laparoscopy and allows the hysteroscopic surgery to be done under local cervical anaethesia as an outpatient office procedure

Maternal and umbilical cord plasma renin activity in pregnancy induced hypertension

Plasma renin activity [PRA] was determined by radioimmunoassay in maternal and cord blood of 20 women with pregnancy-induced hypertension [PIH] and in 20 normal pregnant controls. The mean maternal PRA among the group of PIH was significantly lower than that of normal pregnancy [P < 0.01]. There were significant negative relationship between maternal PRA and each of the systolic blood pressure [r = - 0.59, P < 0.05] diastolic blood pressure [r = - 0.5, P < 0.05] oedema of lower limbs [r = -0.46. P < 0.05] and proteinuria [r = - 0.61, P < 0.01]. The mean fetal PRA among PIH group was also lower than that of normal pregnancy but with no statistically significant difference [P > 0.05]. There was no significant relationship [r = 0.47, P < 0.05J between maternal and fetal PRA. No significant conelation was found between fetal PRA and any of the other parameters. PRA level is signifcantly depressed in PIH. Apparently this is the result of PIH and PRA is not involved in the pathogenesis of PIH. The trigger of PIH seems to be fetal rather than maternal in origin