Treatment of menorrhagia associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Menorrhagia is an increasingly common health problem. The Icvonorgestrel-releasing intrauterine system [LNG-IUS] has been advocated for the treatment of menorrhagia as an alicrnativc to surgery. Based on this established indication and theoretical potential of targeted endometrial solution of myoma-related bleeding, we evaluated the efficiency of LNG-IUS in treating selected cases presenting with menorrhagia in the presence uicrinc leiomyomas. This study included 68 patients with history of menorrhagia and U/S proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score [PBAC]. The 5-Dimensional EuroQol [EQ-5D] was chosen as the primary measure of effectiveness on health-related quality of life. Patients were re-evaluated at 3,6,9 and 12 month. Alter 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea [in 11 cases]. No significant effect for the ENG-IUS on the volume of fibroids or the uterine volume was observed. A significant improvement of the quality of life [measured by EQ index] was observed. Side effects were reported in 10 cases. Eight eases required removal of the IUD for different reasons. So this study shows that in selected cases of uterine leiomyomas, LNG-IUS is an effective therapy directed towards the local steroid environment of the endometrium for control of the bleeding with no valuable effect on the myomas themselves

effect of intraabdominal instillation of lidocaine during gynecological laparoscopic procedures

Although laparoscopic surgery is known to cause less postoperative pain when compared to laparotomy, some patients still suffer from excessive pain, especially during the first stages of recovery. The purpose of this study was to assess the effect of intraperitoneal instillation of lidocaine during gynecological laparoscopic procedures on postoperative pain. The study was a prospective, randomized, double-blinded, placebo-controlled trial. This study included 75 patients who underwent gynecological laparoscopic procedures at Women Hospital - Kusr Al-Aini. Patients were randomly assigned either to a study group that received 120mg of lidocaine intraperitonealy at the end of surgery [n=60] or to a control group that received normal saline [NS] in the same manner [n=15]. The fluid was injected with a sterile syringe through one of the laparoscopy ports at the end of surgery. All patients received the same anesthetic technique. Postoperative pain was evaluated according to postoperative analgesic requirements and by Wong-Baker FACES Pain Rating Scale [WBFS] at 15min, 1h, 2h, 4h, 12h and 24h postoperatively. The [WBFS] score was found to be lower for the study group 1h, 2h and 4h after surgery [p=0.023]. There was no difference in the [WBFS] scores at 15min [p=0.9], 12h [p=0.13] and 24h [p=0.11] after surgery. There was no difference in terms of fentanyl administration during surgery or analgesic consumption following surgery between the study and control groups. The results indicated that intraperitoneal installation of lidocaine was effective at reducing postoperative pain and the need for postoperative analgesics following gynecologic laparoscopic procedures

Role of biochemical markers in preeclampsia

To evaluate the relation of serum paraoxonase and lipid profile parameters and Plasma Fibronectin in mild and severe preeclamptic women and it's relation to the anticibated fetal outcome. Prospective controlled trial. Obstetric emergency unit in Kasr Al-Eini Hospital, Cairo University. 120 pregnant patients between 37-40 weeks gestation admitted to Obstetric emergency unit, they are divided into three groups, 40 controls, 40 with mild preeclampsia [PE] and 40 with severe preeclampsia [PE]. All patients in each group were subjected to estimation of maternal serum paraoxonase, lipidogram and plasma fibronectin and to Trans Abdominal Ultrasound for Fetal biometry, Fetal biophysical profile. Neonatal outcome will be assessed by Apgar score at 5 minutes and Neonatal birth weight. Maternal serum triglycerides, total cholesterol, High density lipoprotiens [HDL]-cholesterol, Low density lipoprotiens [LDL]-cholesterol, total cholesterol/HDL-cholesterol ratio, maternal serum paraoxonase. Plasma fibronectin, fetal biophysical profile, Neonatal birth weight, Apgar score 5 min. The results revealed significant elevations in serum triglycerides, total cholesterol, LDL-cholesterol and total cholesterol/ HDL- cholesterol ratio and plasma fibronectin in preeclamptic patients. Meanwhile, significant reduction in paraoxonase activity and HDL cholesterol depending on severity of preeclampsia was found which was directly related with decreased fetal biophysical profile, fetal birth weight and Apgar score 5 minutes especially in severe cases. These results suggest that decreased serum paraoxonase activity as well changes in lipid profile may be responsible for the oxidative stress in the pathogenesis of preeclampsia. It can he concluded that assessment of serum paraoxonase activity and maternal plasma fibronectin may be applied among the parameters used in monitoring pregnant women with PE, as well assessment of severity of PE and evaluation of anticipated fetal outcome. Yet a Randomized controlled trial with larger number of patients is needed

Three dimensional ultrasound assessment of fetal growth

The aim of this study is to determine the diagnostic value of 3Dimensional ultrasound [3DUS] brain volume, thigh volume and the ratio between together with 2 dimensional Ultrasound [2DUS] parameters in the assessment of fetal growth in high risk groups, namely preeclampsia and diabetes and its relation to neonatal outcome. Prospective controlled trial. Obstetric emergency tin it in Kasr Al Eini hospital, Cairo University Hospitals. Pregnant patients between 37-40 weeks gestation within 72 hours of delivery with one group as low risk control group, second group as preeclamptic pregnant patients and a third group as diabetic pregnant patients. All patients had conventional 2DUS for fetal biometry Amniotic Fluid Index [AFI], placental grading and 3DUS for fetal brain volume, thigh volume, calculating ratio between. Neonatal parameters after delivery are collected in the form of birth weight. Apgar score at five minutes and Neonatal Intensive Care Unit [NICU] admissions. 2DUS parameters and 3DUS fetal volume, thigh volume and ratio, neonatal parameters in preeclamptic and diabetic groups in comparison to controls. In comparison between the preeclampsia group and the controls, thigh volume is significant to differentiate between both groups. A strongly positive correlation was found between thigh volume with neonatal birth weight and Apgar score 5 min in preeclamptic patients. A strongly Negative correlation was found between 3DUS Thigh volume with NICU admissions in preeclamptic patients. When comparing the diabetic group to the controls, 3DUS parameters are all insignificant in differentiating both groups. Fetal thigh volume can diagnose foetal growth restrict and can predict babies with high risk of NICU admissions alter delivery. However a Randomised controlled trial is needed with larger number of patients

Use of three dimensional ultrasound for nuchal translucency measurement in early pregnancy

To evaluate the role of three dimensional ultrasound in Nuchal translucency measurement in the first trimester. Prospective cross sectional study. Forty eight women pregnant in their first trimester were subjected to conventional and there dimensional ultrasound examination by two sonographers at a time using Vulson 730 machine. Scanning was saved and re-evaluated for nuchal translucency measurement. There was a good agreement between two and three dimensional altrasound. There was a positive correlation between nuchal thickness [NT] and crown rump length [CRI] [p<0.01]. There were negligible clinical differences in measurements of NT and CRL between the different observers. Only two cases had NT = 6 mm and both aborted. Nuchal translucency measurement is feasible, safe and accurate. This technique is potentially useful in fetuses that are not in all optimal position for standard 2D nuchal translucency measurement

effect of a non-steroidal aromatase inhibitor anastrazole on symptomatic uterine leiomyomata in premenopausal women

To evaluate the effect of a non-steroidal aromatase inhibitor anastrazoIe on symptomatic uterine leiomyomata in premenopausal women. This was a prospective intervention study carried out at Kasr El-Aini hospital. 48 premenopausal women with symptomatic uterine leiomyomata were enrolled and treated with anastruzole 1mg daily for three cycles of 28 day each. The effect of treatment was evaluated on leiomyoma and uterine volumes, endometrial thickness, gonadotrophins, estradiol and hematocrite levels, menstrual pattern, severity of leiomyoma-related symptoms and adverse effects. The effects of leiomyoma location, size and age of participants on tumor volume changes were evaluated. 40 women with 52 Ieiomyomata finished the study. Anastrazole resulted in a mean 52% reduction of leiomyoma volume [173.7 to 83.3ml, p<0.00.], a 29% reduction in total uterine volumes [290.2 to 205. 1ml, p<0.001] and an increase of the hematocrite levels [34.3% to 38.1%, p<0.001] at the end of treatment. Leiomyoma location had no significant effect on volume decrease. Leiomyoma volume decreased in women aged older than 40 years [p<0.001], whereas no significant difference was found in women younger than 40. The size of large Ieiomyomata [greater than 50mm] decreased significantly [p<0.001], Less difference was observed in small leiomyomata [50mm or less] [p=0.01]. No difference were detected in hormonal status. Aromatase inhibitor, Anastrazol was useful in the management of symptomatic Leiomyoma without causing serious hypoestrogenic adverse effects. Further clinical trials are warranted regarding long-term administration

role of endometrial-subendometrial blood flow distribution assessed by power doppler in the prediction of pregnancy in women with unexplained infertility undergoing intrauterine insemination

The aim of this study was to investigate the role of endometrial-subendometrial blood flow assessed by power Doppler in the prediction of pregnancy in patients with unexplained infertility undergoing intrauterine insemination in clomiphene citrate induced cycles. Prospective clinical study. University teaching hospital. One hundred thirty five patients with unexplained infertility undergoing intrauterine insemination in clomiphene citrate induced cycles were recruited. Transvaginal ultrasound was performed on the day of Human chorionic gonadotrophin [HCG] administration to determine the uterine artery resistance index [RI] and pulsatility index [PI] by pulsed Doppler and to detect the blood flow in endometrial-subendometrial area by power Doppler. Pregnancy occurred in twenty one patients [21/129] [16%]. The [RI] and [PI] were similar in pregnant group and non pregnant group. Pregnancy occurred in 31% of patients with endometrial and subendometrial flow [7/22], in 19% of patients with subendometrial flow only [13/68] and in 2.5% of patients with absent endometrial and subendometrial flow [1/39]. The detection of the blood flow in the endometrial-subendometrial area by power Doppler may be a useful marker in prediction of pregnancy in patients with unexplained infertility undergoing intrauterine insemination