randomized controlled trial of oral misoprostol for the third stage of labor

To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g. followed by two doses of oral misoprostol 100 micro g 4 hours apart: Group 2 received oral misoprostol 404 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 lU; and group 4 received intravenous infusion of oxtytocin 10 lU plus intramuscular administration of methylergonovine maleate [Methergine] 0.2 ma. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2. compared with 3.2% in group 1 and 3.5% in group 4 [P<.01, and P = .01, respectively]. There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 [5.9%, versus 2.2%: P = .01]. The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 [P < .01 and P = .01, respectively]. Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin

Functional endoscopic sinus surgery [FESS] in patients with hyperreactive airway disease

This Study was conducted as prospective study on 36 asthmatics with evidence of chronic rhinosinusitis. The aim of this study is to study the effect of chronic sinusitis and polypoidal sino-pathy on the lower airways and to elucidate the effect of functional endoscopic sinus surgery [FESS] on the hyperreactive airway disease and asthma associated with chronic sinusitis. The results of this Study 3 months and 6 months postoperativley showed a significant improvement of all major nasal symptoms [P<0.05] [Table 1] except for hyposmia which did not show the same improvement [P>0.05]. In both allergic and non allergic patients 3 months and 6 months postoperatively, there was a significant improvement in the mean asthma symptoms [P<0.05] [Table 2 and Fig. 1], asthma exacerbation [P<0.05] [Table 3, 4]. We concluded that, sinus disease is an aggravating and exacerbating factor in asthma rather than an inducer of asthma and this was proved by improvement of severe asthma markedly after elimination of the offending sinusitis by FESS and by observation of airway hyperresponsiveness in non asthmatic subjects with chronic sinusitis, and by the observation of improvement of airway hyperresponsiveness after FESS due to relief of nasal symptoms and sinus lesions

Ultrasonographic findings of gall bladder in acute viral hepatitis

Thirty patients with acute viral hepatitis were studied for ultrasonographic findings of the gall bladder [GB] and for detection of patients with cholecystitis-like presentations within the first week of diagnosis. Patients were subjected to full history taking, clinical examination, laboratory and serological investigations, in addition to real time abdominal ultrasonography. Serologically, patients were classified into 3 groups: hepatitis-A virus [HAV] group; 16 patients [53%], hepatitis-B virus [HBV] group; 8 patients [27%], and hepatitis-C virus [HCV] group; 6 patients [20%]. The commonest ultrasonographic finding was increased GB wall thickness [GBWT], in 23 / 30 patients [76.7%]. It was more evident in patients with HAV. Twenty out of 23 patients [86.9%] with GBWT,exhibited clinical presentation similar to that of acute noncalcular cholecystitis, the so called; cholecystitis-like presentations. It was concluded that; GB wall thickening with cholecystitis - like presentations seemed to be more common in patients with acute viral hepatitis, particularly; HAV infection. Acute viral hepatitis must be considered as an underlying cause in patients with ultrasonographic diagnosis of acute non-calcular cholecystitis. Ultrasonography follow-up of GB changes associated with acute viral hepatitis is recommended

Vaginal reconstruction with bilateral pudendal-thigh flaps in vaginal atresia

Patients with vaginal atresia require vaginal reconstruction with sensate pliable tissue. Although many procedures using skin grafts, skin flaps and intestinal segments have been described, they all have disadvantages. In the present study, 8 patients with vaginal atresia underwent surgery using the pudendal-thigh flap based on the posterior labial artery. This technique has proved to be simple and reliable with satisfactory functional and cosmetic results

role of interleukin -I inhibitors in patients with bilharzial hepatic fibrosis

This work was designed to assess the partial reversibility of hepatic fibrosis in human after the use of colchicine through its immunomodulation mechanism. Twenty patients were given colchicine at a dose of 0.5 mg twice daily, five days a week for a period of nine months. Patients were assessed before and after therapy by clinical evaluation, parasitological assessment, abdominal ultrasonographic scanning and estimation of serum interleukin-1B. Colchicine was proved to be of value as an antifibrotic agent when used in early cases of schistosomal hepatic fibrosis [grades I and II]] as evidenced by a decrease in liver size and significant reduction in IL-1B level among all patients. Also, estimation of serum IL-1B can be used as a noninvasive, relatively sensitive parameter to assess the fibrinogenic process in the liver and to evaluate the effect of drug therapy