Role of ultrasound and doppler flow study in management of malignant gestational trophoblastic neoplasia

Forty four patients with malignant gestational trophoblastic neoplasia [GTN] were enrolled in the study. They were followed up by serum B-HCG and abdomino-pelvic ultrasound during chemotherapy. In addition, the last 6 patients recruited in the study were assessed by doppler flow study. The cure rate was 100% for patients with non metastatic GTN [n = 27] and low risk metastatic GTN [n = 12]. For patients with high risk metastatic GTN [n = 5], the cure rate was only 40%. Ultrasound failed to localize uterine lesions in 4 out of 44 patients [9%] one of them had brain metastatases. Positive findings were found in the other 40 Cases [90%] [e.g. enlarged uterus, focal uterine lesion, ovarian thecalutein cysts liver metastases]. There was also regression of the detected lesions with normalization of B-HCG titre in responding patients [33/38] patients while the lesions persisted in patients with resistance to chemotherapy [5 patients]. Doppler flow study diagnosed 6 out of 6 cases of malignant GTN [100%] and the uterine vasculature decreased in 5 cases who responded to chemotherapy and remained high [Low resistance index and high peak systolic velocity] in one case who was not responding to chemotherapy as indicated by persistently high B-HCG. In conclusion, utrasonography and pulsed doppler flow study of the uterus are complementary tools to serum B-HCG in diagnosis and follow up of malignant GTN during chemotherapy. They can help in selection of patients for more aggressive chemotherapy to minimize relapse rate and hence increase cure rate

paracervical block for evacuation of retained products of conception effective?

Complications from general anaesthesia are now the leading cause of death from first trimester abortions. Although paracervical block has been instituted as an alternative for general anaesthesia for ERPC [evacuation of retained products of conception]. Almost all cases in Egypt are still currently done under general anaesthesia. The objective of this study was to quantitate pain relief associated with paracervical local anaesthesia during ERPC. Among 48 patients who underwent the procedure under paracervical block, 11 patients [22.9%] reported grade 1 pain [minimal discomfort], 23 patients [47.9%] grade 2 pain [mild pain but not uncomfortable] and 9 patients [18.7%] needed extradoses of intravenous sedation [diazepam/pethidine]. Only 5 patients [10.4%] could not cope with the pain and needed general anesthesia to complete the procedure. 81% of the patients were generally satisfied with the procedure. Pain score tended to decrease with lower body weight and higher parity, older age and shorter duration of the procedure. In conclusion, local paracervical block is a simple safe and effective option for ERPC operation and should replace general anaesthesia in all but few cases

On the relationship between caries incidence and retention on fluorine in tooth hard tissues during pregnancy and lactation [experimental investigation]

The effect of ingested fluoridated drinking water during the pregnancy arid lactation periods of the caries activity of the teeth of the offsprings and itsretention in the bones and the tooth hard substances is studied. The results indicated that the administration of 50 ppm fluorine in the drinking water during the pregnancy or during both pregnancy and lactation periods have no appreciable effeot in reducing the caries incidence and fluorine retention in the tooth hard substances. These results threw light on the effect of fluoridated drinking water on the caries experience of the deciduous teeth of human being. A great deal of attention has been focused on the possible cariostatic efficacy of prenatal administration of fluorine, sirce part of the enamel of deciduous teeth calcifies prenatally. Katz and Stocky 1 have found that less than 1 M of the fluorine that was administered to the pregnant rats in drinking water, containing 25 ppm F during gestation was transferred to the progeny. Lehman and Mahier 2 reported that placental fluorine transfer in the rats takes place only at high fluorine level, the findings of Maplesden et al,3 have thrown light on the possible difference in ion transference between different types of placental tissues. Gedalia et at 4, 5, have recorded steady increase of fluorine uptake in the developing fetus teeth with advancing age from areas with high fluorine concentration ;0.5-1.0 ppm F] as compared with those from lowered concentrations [0.1 ppm F] in the drinkin-water. As regard to the mammary gland transfer, Buttner and Muhier 6 have observed a mammary gland transfer of fluorine especially after a high fluorine conasumption. Simpson and Tuba 7, have concluded from their study that there is some type of physiological control mechanism that opeiates during lactation and adjust the fluorine concentration in the milk to a nearly optimum leval for infant. The aim of the present investigation is to study experimentally on rats, the effects of ingested fluoridated drinking water during the geststion period and during both gestation and lactation periods on the caries activity of the rat's offsprings, and whether there is a correlation between the fluorine content of the teeth of the mentioned rats and their caries experience