Effect of follicular flushing during oocyte retrievalon clinical outcome of assisted reproductive technology

Is to determine whether follicular aspiration and flushing increase the number of oocytes yield and pregnancy outcome over aspiration alone in women undergoing ICSI. Prospective randomized controlled trial. One hundred eighty five infertile women who underwent ICSI were included in the study. They were randomized into two groups 92 cases in [aspiration and flushing group] and 93 cases in [aspiration only group],during the period from September 2011 to September 2013. Controlled ovarian hyperstimulation using long GnRH agonist was the standard protocol, hCG administrated 10000 iu when three or more follicles were at least 18 mm in largest diameter, Trans-vaginal follicular aspiration performed 34-36 hours after hCG trigger. In the aspiration alone group, a 16 gauge single lumen needle used, with suction continue until a small amount of blood stained fluid appeared in the tubing or flow stop, When flushing accompany aspiration of follicular fluid in the study group, the same needle used with a double-way tap allowing flushing of [2 ml] of embty follicleby Earl's medium till oocyte retrieved or maximum two times. The study observed 60.5 % oocyte recovery rate with aspiration only compared with 80.9 % with follicular aspiration and flushing.Operative time [minutes] was significantly longer among flushing group, the retrieval time was 1.3 fold higher among those undergoing follicular flushing. Pregnancy was non-significantly more frequent among flushing. Implantation rates non-significantly more frequent among flushing group than non-flushing group [31.6% versus 26.3%, P= 0.424] and ongoing clinical pregnancy non-significantly more frequent among flushing group [27.4% versus 21.1%, P= 0.31]. Conclusion, flushing non-significantly increase implantation and clinical pregnancy outcome and associated with a significant increase in the procedure time for oocyte retrieval, so patient groups where a small number of oocytes are available for retrieval may represent patients most likely to benefit from follicle flushing as only one extra oocyte may affect the outcome

Nutritional adequacy in patients of the intensive care unit in Suez Canal University Hospital who are tube fed enterally

To assess the actual energy received by the patients of the intensive care unit in Suez Canal University hospital who are enterally fed compared to their estimated daily caloric requirement and to find out the causes of interruption of tube feeding. A descriptive study, to assess the adequacy of enteral tube nutrition intake and the factors that affect its delivery in the critically ill patients in Suez Canal university hospital, by monitoring the patients nutrition by Harris benedict equation [HBE] and laboratory investigations. The study was carried out in the general intensive care unit. All the patients receiving enteral nutrition were included with a target sample size of 92 patients. A date sheet was used to collect informations about the daily nutritional intake along with daily laboratory investigations including baseline values of blood glucose, potassium, phosphorus and blood gases, Urine analysis, CBC, triglycerides, creatinine, BUN, sodium, chloride, calcium, magnesium, coagulation, liver enzymes, billirubin, amylase, total protein, transferrin and transthyretin, twice weekly measurement of blood glucose, potassium, phosphorus and blood gases and once weekly measurement of CBC, triglycerides, creatinine, BUN, sodium, calcium, magnesium, coagulation, liver enzymes, billirubin, amylase, total protein, transferrin, transthyretin and urine analysis. Patients were followed up until enteral feeding withheld or death. Through following up the patients by measuring the daily caloric intake and laboratory investigations, the study showed that 67.4% of the patients were underfed and only 29.3% were adequately fed. The mean cause of feeding interruption was gastrointestinal factors [65.2%], such as vomiting and diarrhea, followed by intensive care unit factors [10.9%], such as surgical procedures and diagnostic procedures. Significant decrease in the values of BUN, total billirubin, total protein [T.protein], magnesium, PH and bicarbonate was found one week after starting enteral feeding. The majority of the included patients were found to be underfed. Gastrointestinal problems as diarrhea and vomiting played a major rule in unsuccessful delivery of adequate energy requirements to the patients

Comparative study of the laryngeal tube versus endotracheal tube in mechanically ventilated anesthetized patients

Randomized double-blind clinical trial designed for comparing the tracheal tube [TT] versus the laryngeal tube [LT] in mechanically ventilated anesthetized adult patients undergoing different non-emergency surgical procedure. The comparison included evaluating the ease and success of insertion, adequacy of ventilation, airway sealing, hemodynamic responses and local complications. Ninety two adult patients [ASA I/II] were included in the study and randomly allocated into two equal groups. The two groups of patients were found to be matched as regards age, sex, height, weight and baseline hemodynamic status. As regards ease, and success of insertion, LT was successfully inserted in all attempted cases [100%], with success rate of 91.3% after the first attempt with a mean duration of insertion 18.13 +/- 3.4 seconds [range 12-24 seconds] with no statistically significant difference with those of TT [p > 0.05]. Adequacy of oxygenation and ventilation of LT was found similar to that of TT [p > 0.05]. Oxygen saturation has never fallen below 95% and ETCO[2] tension has never exceeded 40 mmHg in any case of both groups. The peak airway pressure in the LT group were within an acceptable range [12-25cmH[2]O] and when compared to TT no statistically significant difference was found at any of the measurement times [p > 0.05]. Air leak or gastric insulffation didn't occur at any case of LT group at any given time during controlled ventilation by adequate tidal volume and appropriate respiratory rate. The LT was found to provide an airtight seal as the highest airway pressure without leak [leak pressure] was found to be ranging between 25-40cmH[2]O with a mean value of 34.84 +/- 3.97cmH[2]O. Concerning hemodynamic responses to both airway devices, our study revealed that TT induced more rapid [starting at intubation], more intense and prolonged [lasting for at least 10 minutes] increase in heart rate, arterial blood pressure, while the response to LT insertion was significantly in magnitude less and shorter in duration. Local complications at the time of extubation were significantly less in LT group occurring only in 3 patients [6.52%] [cough was the most frequent], while in TT group, these complications occurred in 5 patients out of 46 [10.86%] [cough and blood staining were the most frequent]. Occurrence of local complications during the first 24 postoperative hours, were found to be significantly lower in LT group ETCO[2]: End-tidal CO[2] tension. Mct: Hematrocrit. NIBP: Non-invasive blood pressure. GA: General anesthesia. HR: Heart rate. SpO[2]: Pulse oximetry. Hb: Hemoglobin. LT: Laryngeal tube. TT: Tracheal tube

Towards an Egyptian guideline from screening to treatment of hepatocellular carcinoma [part I]

These recommendations provide a data-supported and based-evidenced approach to the screening, diagnosis, staging and treatment of Egyptian patients with hepatocellular carcinoma [HCC] in which we tried to construct an Egyptian algorithm for our Egyptian HCC patients in terms of type and timing of surveillance, readily available diagnostic tools that suit our means and the proper and efficient timely treatment that suits our resources. They are based on the experience of the authors in the specified topic and the AASLD Policy on the Development and Use of Practice Guidelines. These recommendations suggest preferred approaches to screening [for early detection of cases with hepatic nodule and/or elevated AFP], diagnosis [for accurate diagnosis of HCC cases], staging [for detection of specific category of treatment according the patient's general condition] and treatment [selection of the most suitable treatment option for the patient after his proper evaluation]. In an attempt to characterize the quality of evidence supported recommendations, the Egyptian Guidelines requires a category to be assigned and reported with each recommendation [Table I]

Towards an Egyptian guideline from screening to treatment of hepatocelhilar carcinoma [part II]

These recommendations provide a data-supported and evidence based approach to the screening, diagnosis, staging and treatment of Egyptian patients with hepatocellular carcinoma [HCC] in which we tried to construct an Egyptian algorithm for our Egyptian HCC patients in terms of type and timing of surveillance, readily available diagnostic tools that suits our means and the proper and efficient timely treatment that suits our resources. They are based on the experience of the authors in the specified topic and the AASLD Policy on the Development and Use of Practice Guidelines. These recommendations suggest preferred approaches to screening [for early detection of cases with hepatic nodule and/or elevated AFP], diagnosis [for accurate diagnosis of HCC cases], staging [for detection of specific category of treatment according the patient's general condition] and treatment [selection of the most suitable treatment option for the patient after his proper evaluation]. In an attempt to characterize the quality of evidence supported recommendations, the Egyptian Guidelines requires a category to be assigned and reported with each recommendation [Table 1]

Role of radiofrequency ablation in the treatment of colorectal liver metastases

Surgical resection is the standard of care for colorectal metastases isolated to the liver. However, only 10-25% are eligible for resection because of extent and location of the disease in the liver or concurrent medical conditions. Severe series have shown that radiofrequency ablation [RFA] can result in tumor eradication in properly selected candidates. The purpose of this study was to determine the efficacy of RFA for treatment of such lesions. Thirty patients with documented colorectal liver metastases who met the following criteria were considered for RFA: metastases confined to the liver; judged irresectable due to technical considerations or co-morbidity, number of metastatic deposits no greater than 5; and size less than 10 cm. Median follow-up was 26 [range 9-63] months. Overall 1-and 2-year survival rates were 76 and 61% respectively. Median survival was 32 months. Disease-free survival at 1 year was 35% at 2 years 7%. Six patients developed recurrence at the site of RFA; given that the total number of RFA-treated lesions was 69 the local recurrence rate was 9%. RFA can achieve effective local treatment for patients with colorectal liver metastases who were considered unsuitable for surgical treatment

Assessment of a guideline for management of hepatocellular carcinoma [HCC] in Egyptian patients

HCC is the commonest liver malignancy all over the world including in Egypt. Many classification system for management of HCC have been proposed but none of them is implemented worldwide. In this work we propose a guideline for management of HCC which is suitable for the Egyptian patient. The suggested guideline of management includes assessment of four areas: The general clinical status of the patient, the liver status, the tumor status and options of therapy which are suitable for Egyptian circumstances. In one center, this design was prospectively applied on 79 patients who presented with HCC. The HCC patients showed that: Two [2.86%] had non-cirrhotic liver parenchyma, while all the rest had cirrhosis: 7 [10.0%] early stage or Child's A [one early and 6 late Child's A], 28 [40.0%] intermediate stage [Child's B] and 33 [47.14%] terminal end stage [Child's C]. Therapy was applied according to the suggested guideline as follows: surgical resection for four patients [5.71%], radio frequency ablation [RFA] for 6 [8.57%], percutaneous ethanol injection [PEI] for 39 [55.71%], selective arterial chemoembolization for 2 [2.86%], chemotherapy for 6 [5.57%] and symptomatic therapy for 13 [18.75%] patients. After two years of follow up: Fourty four [62.9%] were still living, 20 [28.6%] died while 6 [8.6%] were missed to follow up. Recurrence of HCC was found in 21 [30.0%] cases. The liver status progressed from Child's A to B in four cases out of 7 [57.1%] and from Child's B to C in 24 cases out of 28 [85.71%] within one year. The prognosis of the disease depended on many factors on top of which was the liver functional reserve. Most Egyptian patients with HCC present in a late stage of cirrhosis thus with a bad prognosis as predicted from their clinical status, the liver condition and the tumor status. The progress of the underlying liver disease is more rapid when HCC appears. PEI is a good option of therapy. The predictive factors of good prognosis and improvement in this study were HBV infection and the Child's class. Although the mortality rate was still high [28.5%], but the cost of therapy was reduced due to application of the suggested guideline system. This guideline is simple, easy to apply, covers most HCC presentations, is flexible and may be changed [updated] according to progress in technology, resources of therapeutics, skills of the operators and the patient's presentation. Thus other Egyptian centers can apply this guideline in management of HCC, reevaluating and updating it

Eyolution of living doner liver transplantation in Egypt

To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation [LDLT], aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases [91%]. Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 [68.5%] survived after a median follow-up period of 305 days [range 15-826 days]. They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt