Ventilatory effects with metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

This study was carried out to quantify and compare the ventilatory effects with the metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Forty patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy [n = 15] and abdominal hysterectomy [n = 25]. Bed side pulmonary function tests were done preoperanvely and at 2, 4, 6 and 8 hours post operatively using portable vitalograph-compact spirometer. Venous blood samples were collected the day before operation and for each of the first 2 post operative days for estimation of serum interleukin-6, C-reactive protein, plasma glucose and white blood cell count. The results of the study showed no differences in demographic characteristics and operating time in the two groups. No major complications were also encountered. The laparoscopic hysterectomy group had a significantly lower febrile morbidity rate [16% vs 46%, P < 0.05] and shorter hospital stay [Median 4 vs 6 days, P < 0.001]. The study showed also that all measurements of pulmonary function tests that require patient effort like forced expiratory volume in one second [FEVI] and peak expiratory flow rate [PEFR] and which are influenced by the strength of the respiratory muscles are better in case of laparoscopic hysterectomy compared to the abdominal hysterectomy group. The study demonstrated a significant elevations of C-reactive protein and interleukin-6 in both groups and this elevation denotes a less intense stress response in the laparoscopic hysterectomy group compared to the abdominal hysterectomy group as the serum interleukin-6 [median 42.2 vs 83.2 pgi, P < 0.001], C-reactive protein [Median 26.1 mglL vs 45.3 mglL, P < 0.001] and white blood cell count [Median 59.5 vs 69.0 10[9]/L, P = 0.009]. No significant difference was detected in plasma glucose [median 40.5 vs 45.6 mmol /L]. So, we can conclude that laparoscopic hysterectomy is very beneficial in keeping the standard of the pulmonary function post operatively and also, it is associated with a less intense stress response than abdominal hysterectomy for benign diseases

Tumour necrosis factor-alpha in patients with severe preeclampsia with and without HELLP syndrome

Tumor necrosis factor-a [TNF- alpha], acytokine produced mainly by macro-phages, is involved in immunoregulation, the modulation of cell growth and differentiation, as well as in the induction of oxygen radicals. This study was designed to investigate whether tumor necrosis factor- alpha [TNF- alpha] is present in maternal plasma in pregnancies associated with severe preeclampsia with and without HELLP syndrome and its concentrations. Fifty patients with severe preeclampsia composed the study group. This group is further subdivided into severe preeclamptic without HELLP syndrome, [n = 37] and severe preeclampsia with HELLP syndrome [n = 13]. A control group composed of 25 pregnant women, some of them were in early labor [n = 11] and the rest [n - 14] were in late pregnancy. Maternal plasma samples for TNF- alpha were taken for all groups. Also, serum creatinine spartate aminotransferase [AST], alanine aminotransferase [ALT] and platelets count to diagnose the presence of HELLP syndrome. TNF-alpha was detected in 80% of the studied group with severe preeclampsia [n = 50], while it was detected only in 13 patients [21%] only in the control groups. Also, the maternal plasma concentration in the severe preeclamptic group was [61 +/- 17] ng/ml and [146 +/- 37] ng/ml in the severe preeclampsic group with HELLP syndrome [n = 13] respectively which were statistically highly significant when compared to maternal plasma levels in the control group [7 +/- 3] ng/ml. There were no positive or negative correlation between TNF- alpha plasma concentrations in both groups and maternal age, gestational age and parity. Also, in the severe preeclamptic group there were no positive or negative correlation between the diastolic blood pressure, the amount of protein urine, the liver enzymes or platelets count and TNF- alpha maternal serum levels. So, we can concluded that tumor necrosis factor-alpha is increased in the plasma of patients with severe pre-eclampsia especially those developing HELLP syndrome. These data are suggestive of a role for abnormal immune activation in the pathophysiologic mechanisms of severe pre-eclampsia with or without HELLP syndrome

Accuracy of ultrasonic age determination and weight prediction in the fetus with preterm premature rupture of membranes

Ultrasonic gestational age determination and fetal weight prediction were performed in 20 patients with preterm premature rupture of the membranes [PPROM], and 10 normal gravides with intact membranes, between the 28th and less than 37 weeks of gestation, to assess of the effect of PPROM on the accuracy of ultrasonic age estimation and fetal weight prediction.All gravides had known menstrual age, and delivered within 24 hours of ultrasonic examination, and the actual birth weight was determined. Using single parameter for gestational age assessment [bipartietal diameters, abdominal circumference or femur length], the bipartietal diameters was the least reliable, as there was significant difference in the mean error between the control and studied groups [p<0.05]. Multiple parameters formulas for gestational age estimation [HC, FL;HC, FL, AC; and HC, FL, BPD, AC], did not appear to add further accuracy to single parameters methods. Using three questions for prediction of fetal weight [BPD, AC, MAD, BPD, FL; and HC, AC, FL], we have found no significant difference in the mean error percent between the control and studied groups. Neither amniotic fluid volume, duration of membrane presence or absence of labor pains affected the accuracy of ultrasonic estimation of gestational age or prediction of fetal weight. It is concluded that PPROM appears to have no deleterious effect on the accuracy of ultrasonic estimation of gestational age and prediction of fetal weight, except when the BPD is used as a single parameter for age estimation

Obstetric performance in obese women, a combined clinical and monitored study during labour

The obstetric performance and pregnancy outcome in 93 obese pregnant women were compared with those of non obese [827] control subjects. There were significant increase, in incidences of hypertension; inadequate pregnancy; weight gain and Diabetes Mellitus. The Frequency of labour abnormality, oxytocin augmentation and primary caesarian section were similar to that of the comparison group. Examination of the infant outcome revealed similar Apgar scores and perinatal mortality in the two groups but fewer low birth weight infants [< 2500 gms] and more macrosomic babies [> 4000 gms] occurred in the obese populations. This increase in birth weight percentile was accounted for not only an increase in the birth weight percentile but also by a significant lengthening of the period of gestation