ABSTRACT
Diabetes being the most common chronic metabolic disorder has a number of complications that affect various parts of the body. Epidermal growth factor (EGF) is well known for its healing capacity. In this article we review the two way relationship between diabetes and EGF, where the former needs to block the latter’s secretion and reduce its expression on order to produce its notorious complications. On the contrary, the latter is capable of reversing the former’s negative adverse effect on various organs of the body. We also shed some light on different studies in the literature that investigated the role of EGF in the dynamics of diabetes, and gain a deeper insight towards the possible applications of local and systemic treatment with EGF in the management of diabetic complications. We also try to answer some questions: EGF and diabetes; Friends or faux? and will EGF be the future trend in reversing damage caused by diabetes and wound healing.
ABSTRACT
Hysteroscopy has progressed from a speculum used to inspect the postpartum uterine cavity till the present time were different modifications in illumination systems and uterine distension media were introduced. The use of hysteroscopy for assessment of the uterine scar gives the opportunity not only to visualize and diagnosis pathological changes after cesarean section but also it can be used in the management of some changes occurring as a result of cesarean section. This study was carried out during the period from 1/6/1994 to 15/3/1995 on 40 women with previous cesarean section attending the outpatient clinic of Kasr El Aini Hospital for routine follow up or for the appearance of certain symptoms as secondary infertility or menstrual disturbances. The aim of this study is to evaluate the uterine cavity following cesarean section by the diagnostic hysteroscopy which helps in explanation of some complaints occurring after cesarean section and the relation between the presence of intrauterine pathology as adhesions or endometrial fibrosis and these complaints. All women under the study had been exposed to complete history taking, physical examination, gynecological examination and examination by diagnostic hysteroscopy. History of a single cesarean section was found in 28 cases, while the remaining 12 cases presented with repeated cesarean sections. The duration since cesarean section varied from 4 months up to 9 years, with 2 cases less than 6 months, 11 cases between 6-12 months and 27 cases more than 12 months. Indications for cesarean section were as follows: 17 cases for cephalopelvic disproportion, 9 cases for foetal distress, 5 cases for intrauterine infections, 5 cases for previous C.S. 2 cases for antepartum hemorrhage and 2 cases for malpresentations. Intrauterine adhesions were found in all cases done for intrauterine infections [100%] and in 16 of cases done for cephalopelvic disproportion [94.12%], in 4 cases done for fetal distress [44.44%] and in half of cases done for malpresentations [50%]. No mucosal fibrosis was found in cases done for antepartum hemorrhage. Menstrual disorders were present in a number of patients in this study. Amenorrhea was present in 6 cases [15%] and hypomenorrhea was present in 18 cases [45%]. Intrauterine adhesions were present in all cases of amenorrhea, in 15 cases of hypomenorrhea [83.33%] and in 6 cases with normal menstrual cycles [37.5%]. Mucosal fibrosis was present in all cases with amenorrhea and in 14 cases presenting with hypomenorrhea [72.22%] and in 6 of the cases with normal cycles. Evaluation of the scar showed inability to visualize the scar in 5 cases, while fibrosed scar was found in 21 cases [52.5%] and healthy scar was found in 14 cases [35%]. As regards the relationship between the duration since the operative interference and the condition of the scar, it was found that 10 out of 27 cases with the duration since operation more than 12 months had healthy scar [37%], while 17 cases [63%] had unhealthy scars, healthy scars were found in 8 cases [72.7%] among those done between 6-12 months, while 3 cases [27.3%] showed unhealthy scar. Half the cases done since less than 6 months showed healthy scars