fibrinogen/CRP ratio as a new parameter for the prediction of disseminated intravascular coagulation in patients with HELLP syndrome

Background: The syndrome of Hemolysis, elevated Liver enzymes, and Low Platelet count [HELLP] is a life-threatening variant of preeclampsia, and may be accompanied by disseminated intravascular coagulation [DIC]. Recently the fibrinogen/C-reactive protein [CRP] ratio has been suggested as a measurement that predicts onset of DIC. The authors sought to analyze the fibrinogen/CRP ratio among obstetric patients who developed DIC due to HELLP syndrome

Aim: The aim of this study is to determine if the fibrinogen/C-reactive protein [CRP] ratio could be used as a predictor for disseminated intravascular coagulation in obstetrics patients with the HELLP syndrome

Patients and Methods: this study was conducted as a prospective observational study at Ain Shams Maternity Hospital from November 2014 to November 2016 .The study included Patients diagnosed to have Severe Pre Eclamptic Toxemia SPET according to ACOG [2013].Patients was diagnosed with the HELLP syndrome according to the Martin classification of HELLP syndrome

Results: the results of our study suggest that replacing the use of fibrinogen levels alone with the fibrinogen/CRP ratio would enhance the diagnostic and prognostic power for DIC in patients with HELLP syndrome

Conclusion: in light of the physiologic changes of the coagulation cascade during gestation, the International Society on Thrombosis and Hemostasis ISTH score could not be implemented in pregnant women alone for the diagnosis and prediction of DIC

Recommendations: further evaluation of the fibrinogen/ CRP ratio is required to determine the generalizability of this marker's use in DIC because of causes such as placental abruption, septic abortion, and failed abortion. Furthermore, prospective studies should be performed to determine the best method to predict if there any new method to predict DIC in patients with the HEELP syndrome

Proximally based versus distally based gluteus muscle flap in treatment of end stage fecal incontinence

To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end stage fecal incontinence. Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap [group III] was carried out in ten patients while, a distally based flap [group I] was done in the other ten. Patients were followed up for 6 - 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging [MRI]. Overall, 6/10 patients [60%] in group I and 8/10 patients [80%] in group II were clinically improved with down staging of their incontinence scores from C3 to 0 [P 0.003 and 0.0001 respectively]. This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month postoperatively showed disruption in three patients. Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty

Chest wall reconstruction after excision of primary malignant chest wall tumours: experience of Mansoura University

In this study we present the combined experience of the surgical oncology, general surgery and the cardiothoracic surgery teams in radical treatment of chest wall tumours including the different methods of chest wall reconstruction after excision of the tumours, and the short-term follow-up of those patients regarding clinical, cosmetic and functional state of respiratory dynamics after surgery. 45 patients were operated upon for chest wall tumours [CWT]. Patients were classified into 3 groups: [1] Group 1: including 15 patients for whom no skeletal reconstruction was done. [2] Group 2: including 15 patients, for whom skeletal reconstruction was done by Methyl methacrylate bone cement embedded in double layer of marlex mesh. [3] Group 3: including 15 patients, for whom skeletal reconstruction was done by Marlex mesh alone. There were 3 patients who required postoperative ventilation in group I, none in group II, and one patient required postoperative ventilation in group III, all of them could be weaned from ventilation within 12 hours. 3 patients developed mild paradoxical respiratory movements in group I, none in group II and one patient in group III due to chest wall instability. All the myocutaneous flaps were viable at the time of discharge. All patients expressed satisfaction with the cosmetic results. There was one case of soft tissue infection in group I, one case of infection of the mesh in group II and another patient in group III. They responded to local drainage and antibiotic treatment. We conclude that proper reconstruction of the bony cage and soft tissue covering is possible after wide excision of the tumours, with the aid of a variable number of prosthetic materials and muscle flaps. Satisfactory results regarding tumour recurrence, cosmetic appearance, clinical state, and respiratory functions of the patients after operations were obtained

Percutaneous catheter drainage of liver abscesses

Imaging-guided percutaneous catheter drainage of hepatic abscesses [PAD] was done in 39 patients. Amebic liver abscesses were diagnosed in 18 patients, where 17 patients had pyogenic liver abscesses and 4 patients had indeterminate abscesses. Right lobe abscesses were seen in 32 patients and left lobe abscesses were seen in 7 patients. PAD was successful in 36 patients [92.3%], emergency laparotomy was indicated in one case who developed clinical signs of peritonitis and in two cases the condition deteriorated due to insufficient catheter drainage with C.T. evidence of persistent abscess cavity and both were drained by open surgery. 1- year follow up was available for all patients with no reported abscess recurrence. Complications developed in 4 cases [10.3%] in the form of bacteraemia [3 cases] and pneumothorax [one case]. The catheter drainage time ranged from 3 to 35 days [mean = 16 days]. PAD of hepatic abscesses is an effective, relatively safe and permanent therapeutic method. It can be used as a safe alternative to surgery, except of there is an underlying liver disease

Role of ultrasonography in dagnosis of acute intussusception in children

Intussusception represents the most common abdominal emergency in early childhood. To assess the diagnostic value of ultrasonography in clinically suspected acute intussusception, we compared U.S and barium enema studies in 24 infants and young children. Ninteen cases were diagnosed as intussusception by the presence of the characteristic, sonographic appearance [doughnut and pseudo kidney sign]. All cases were examined with barium enema under fluoroscopic guidance for confirmation of the diagnosis and as a trial for hydrostatic reduction [partial or complete] of the positive cases. The sensitivity of U.S was 100%in detection of the intestinal mass. Complete barium reduction was successful in 14 out of the 19 cases of intussusception. Ultrasound and barium enema compare favourable to each other for the diagnosis of intussusception. However, US is easier and less time consuming