Maternal and fetal outcomes in women undergoing caesarean section under general and spinal anesthesia

Background: Both spinal and general anaesthesia used for caesarean section have certain advantages and disadvantages and there is no method which is completely ideal. The most important factors for choice of anaesthesia are; pregnant systemic problems and wishes, the urgency of the operation, and the surgeon and the anesthetists experience

Aim of the Work: These studies aimed at comparing maternal and fetal outcomes in women undergoing elective caesarean section and have spinal anaesthesia with those having general anaesthesia

Subjects and Methods: This study was carried out at Ain Shams University Maternity Hospital during the period from December 2017 to August 2018 after approval of the hospital health ethical committee. It included 186 patients who had C.S and were subdivided into 2 groups according to a randomization scale. On the day of the operation, each randomly received a closed opaque envelope for the selection of the procedure [spinal versus general]

Results: We noted that the mean haemoglobin and haematocrit values at the 24th hour were higher in the spinal anaesthesia group. The estimated blood loss volume was significantly higher in the general anaesthesia group. The median apgar score at the first and the fifth minutes were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer in the spinal anaesthesia group

Conclusion and Recommendations: General anaesthesia could be thought the quickest anaesthesia method in an emergency since it avoids the possibility of a failed regional block. Meanwhile, it is associated with higher possibility of blood loss and low Apgar score. Thus, using spinal anaesthesia for elective caesarean section is recommended provided that adequate maternal hydration is established and sparing general anaesthesia for emergency caesarean sections or whenever spinal anaesthesia is contraindicated [e.g. coagulopathy, sever thrombocytopenia, anticoagulation or sever degree of malformation of spine]

Vaginal probiotic administration in the management of preterm premature rupture of membranes

Background: Preterm premature rupture of membranes [PROM] , refers to rupture of membranes before the onset of labour in women with a pregnancy <37 weeks gestation. It complicates 1-3% of all pregnancies and is responsible for approximately 30% of preterm deliveries

Objective: This study aimed at examining the efficacy of a vaginal probiotic formula in combination with standard antibiotic prophylaxis on perinatal outcome in cases of PPROM before 34 weeks of gestation and comparing them with those treated only with antibiotics

Methods: This is a prospective randomized controlled study conducted at the department of obstetrics and gynecology and its out-patient clinic, El Hussein University Hospital from august 1 st 2017 to august 1 st 2018

Results: During the study period, 73 pregnant women diagnosed as PPROM were invited to participate. Two of them denied, while the remaining 71 women accepted participation in our study [ 2 women of the study group were excluded due to poor compliance to the study protocol and 1 of each group was also excluded due to delivery in the first 48 h after the study entry]. In total 67 women were included in the study. In our study the cases diagnosed as PPROM were divided into 2 groups: Group 1 [ study group ] consisted of 33 cases and group 2 [control group] consisted of 34 cases . There was no statistical significant difference between the two groups as regard mean gestational age at admission , age, height, weight ,parity and gravidy [p value > 0.05]. There was statistical significant difference between the two groups as regard history of PROM with higher cases in control group , gestational age at delivery [weeks] with higher percentage in study group and latency period with highly period in study group [p- value <0.05]. Also, in the present study as regard neonatal outcome there were significant statistical differences between the two groups as regard 1 and 5-minute APGAR score after birth with highest low score in control group

Conclusion: This study demonstrated that the efficacy of a vaginal probiotic formula in combination with standard antibiotic prophylaxis on perinatal outcome in cases of PPROM before 34 weeks of gestation as compared to those treated only with antibiotics

Role of medical management in otitis media with effusion

Introduction: otitis media with effusion [OME] is a common disease characterized by the retention of fluid and inflammatory by-products in the middle ear without any clinical symptom of acute infection

Objective: to evaluate the benefits in the medical management and watchful waiting prior to surgical intervention in patients with otitis media with effusion

Methods: A total of 130 patents with otitis media with effusion, aged newborn - 35 years. All patients received medical treatment: in the form of amoxicillin for 10 days [as second trail therapy], if no improvement amoxicillin clavulanic acid for another 10 days was given [as second trail therapy]. Patients with persistent effusion post medical treatment were followed up for 3 months for spontaneous regression [watchful waiting - third trail therapy]. Patients with persistent effusion after 3 months subjected to surgical management according to the predisposing factor

Results: a total of 86 [66.2%] of our patients showed complete recovery with medical management, of them 38 patients [29.2%] responded after the trial of medical therapy, 26.1% responded after the second course and [35.3%] showed spontaneous recovery on watchful waiting

Conclusion: initial trail of medical therapy with watchful waiting for three months should be practiced prior to surgical intervention

Management of laparoscopic cholecystectomy complications

This article aimed at throwing a light on management of bile duct injuries inflicted during laparoscopic cholecystectomy. The present research included 60 patients, presented with biliary complications after laparoscopic cholecystectomy. They were selected from Al-Azhar university hospitals and Domiate general Hospitals, in the period from March 2003 to March 2006. The results of this work proved that complications of laparoscopic cholecystectomy were well tolerated and the majority of them successfully managed conservatively and those needed surgical interference showed very good results. Although it has some complications, laparoscopic cholecystectomy is advocated to be the procedure of choice in the management of gall bladder diseases [stones] as its complications are tolerated and managed with conservative or surgical treatment with a success rate over 90%

Evaluation of endoscopically assisted abdominoplasty

This study compare between open and endoscopically assisted abdominoplasty in the treatment of abdominal hernias and contour problems in Egyptian patients. The present study included 60 patients who come for abdominal contouring or hernial repair with abdominoplasty. Patients were selected from Al-Azher University hospitals and Domiate General Hospitals. All cases were subjected to full history taking, clinical examination and laboratory investigations and then subjected to open or endoscopically assisted abdominoplasty. The results of this work proved that endoscopically assisted abdominoplasty is better than open technique as regards to aesthetic outcome and decreased morbidity of the procedure. endoscopically assisted abdominoplasty is advocated for those eligible for it and much training courses on the procedure must be planned from time to time

One stage repair of hypospadias

This study was done on 63 patients with various degrees of hypospadias, their ages renged from 3 months to 35 years. The location of native meatus was anterior penile in 30, middle in 25 and penoscrotal in 8. Several techniques for correction of hypospadias were used depending on the location of the abnormal meatus. Suprapublic drainage was used in proximal penile and penoscrotal varieties, while urethral drainage was 4% while in proximal shaft and penoscrotal level was 37.5%. Due to low incidence of complication of one stage repair for all types of hypospadias, this should be recommended with selection of the suitable technique for each type

Developmental stuttering and in voluntary movements in schoolaged children in Cairo

Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for a person's age. Developmental stuttering emerges during the period of rapid language development with two sharp peaks of onset between the ages of 2 to 3 1/2 years and 5 to 7 years. It involves a disruption in the smooth connection of sounds or syllables characterized by multiple interruptions within a word, such as repetitions of sounds, syllables and parts of words, elongation of words and blockades. This study aimed to assess developmental stuttering at its second peak in childhood and evaluate associated involuntary movements. A sample of 932 children [480 boys and 452 girls] aged 5-7 years attending 21 different schools and Kindergartens at different locations in Cairo City were included in the study. Speech, language and hearing development within the normal range, except for stuttering, were insured. Stuttering was considered to be present if 10 or more dysfluencies occurred in every 100 words. Stuttering was detected in 38 children with a prevalence rate of 4.07%. Stuttering severity was found to be 36%, 47.5%, and 15.7% for mild, moderate and severe stuttering respectively. The male to female ratio was 3.2:1. Tics were identified in 26.3% of stuttering children, versus 4.58% non stuttering children with a statistically significant difference in prevalence. Tics in the form of repetitive eye blinks followed by prolonged eye closure were found exclusively in the stuttering group. Left handedness was present in 5.26% of the stuttering children versus 4.13% non stuttering children. In view of the high prevalence of developmental stuttering and significant number of involuntary movements revealed - by the study, a mass screening program for early diagnosis and referral in this high risk group is recommended

modification of the lamellar split technique for management of cicatricial entropion

The aim of this study was to evaluate the result of the modified technique in relation to the lamellar split with evertical reposition of anterior lamella technique. The new superficial tarsotomy technique with everting sutures was used in 21 lids, while the original technique was used in 31 lids with cicatricial entropion. A complete success was obtained in the 21 lids treated with the modified technique, while the original technique gave 80.64% as a complete success and 16.13% as a qualified success [an overall success of 96.8%]. Postoperative complications occurred in 19.1% of cases treated with the modified technique, while they occurred in 54.84% treated with the original technique

Evalution of the role of amniotic membrane transplantation in management of cicatricial entropion

This prospective study was carried out on 52 lids of 49 patients with cicatricial entropion. The lamellar split with vertical reposition of anterior lamella was the technique used in these cases, with an overall success of 98.1%. Good cosmetic results were obtained in all cases with a shorter period of healing with a mean of 15.73 +/- 2.63 days

Role of TIPSS in the treatment of portal hypertension in Egypt

Transjugular intrahepatic portosystemic stent shunting [TIPSS] is an attractive relatively new procedure to correct portal hypertension without direct operative interference. As a radiological procedure that can be done under light sedation and local anesthesia, it poses little hazard to the cirrhotic patient with portal hypertension and impaired liver functions compared to equivalent surgical procedures. However, this procedure is technically very demanding and its quite costly. The present study deals with 9 cases of portal hypertension from the patients of Cairo University Hospitals. Out of this group, 5 patients were Child class B, 3 patients Child class C and only one patient was Child class A. Technical success of TIPSS was achieved in 5 of the investigated patients [55%]. In this connection, it has to be remembered that the bilharzial liver encountered among the Egyptian patients with its thick walled portal vein radicles increase the difficulty of the technique and makes the h and ling of guide wires and catheters very tricky