comparison of foley catheter and intravenous oxytocin versus intravaginal prostaglandin E2 for mid-trimester pregnancy termination

To compare the efficacy, safety and adverse side effects of Foley catheter with intravenous oxytocin versus intravaginal prostaglandin E2 for second trimester termination of pregnancy. This study was carried out on 92 women at King Hussein Medical Center between January 1999 and June 2000. All women were in need of second-trimester uterine evacuation and were divided into two groups: Group 1 consisted of 46 women who were allocated to the cervical Foley catheter plus intravenous oxytocin modality for induction, while group 2 consisted of the 46 women for whom two doses of 3 mg intravaginal prostaglandin E2 at 12 hour intervals were used. Using the t-test, the mean time from initiation of termination to uterine evacuation was not significantly different between the two groups. The rate of successful fetal evacuation at 24 hours was the same. The success rate and the incidence of adverse effects were similar in both groups. The use of a Foley catheter with intravenous oxytocin for mid-trimester pregnancy termination is safe and the success rate is compatible with intravaginal prostaglandin E2

Laparoscopic ovarian electrocautery for clomiphene citrate resistant patients with polycystic ovary syndrome retrospective study

to evaluate the effect of ovarian electrocautery on ovarian response and pregnancy rate [PR] in clomiphene citrate [CC] resistant women with polycystic ovary syndrome [PCO]. Design retrospective study. Setting infertility clinic in a referral center. Patients and methods ninety seven patients with PCO who failed medical treatment with CC underwent laparoscopic ovarian elctrocautery. Hormonal profile, pregnancy rates and pattern of cycles before the electrocautery were compared for the same patient with those after the procedure improvement in the pattern of cycles in for resumption of regular cycles was noted with cumulative PR of 59.8%. There was a significant reduction in the luteinizing hormone [LH] level after ovarian electrocautery while there was no significant change in levels of follicular stimulating hormone [FSH], androstenedione [A], or testosterone [T] our results indicate that laparoscopic ovarian electrocautery is an effective tool to induce ovulation in CC-resistant PCO patients probably through reduction of basal LH levels

Maternal age and pregnancy outcome

This study was carried out to evaluate the risk factors associated with advanced maternal age, and to analyse the relationship between maternal age and the outcome of pregnancy. Method: Over a two- year period [Jan.1993 to Jan. 1995], there were 14615 deliveries after pregnancies of >/= 28 weeks duration at Prince Rashed Ben AI-Hassan Hospital in Irbid, of which 544 pregnant patients were above the age of 40 years. The pregnancy outcome as well as cesarean section rate, malpresentations, multiple pregnancies, antepartum haemorrhage, hypertension, prematurity, fetal distress, stillbirth, neonatal death, fetal congenital abnormalities, small for dates, and large for dates babies of this group were compared with that of the age group below 40. Significant statistical differences were found between the above- and below- 40 year age groups in many of the parameters which include: Cesarean section rate 23.8% versus 5.3% [P<0.001], breech and transverse malpresentations 9.9% versus 3% and 1.8% versus 0.2%, respectively [P<0.001], antepartum haemorrhage 2.2% versus 0.9% [P<0.001], placenta praevia 4.6% versus 0.3% [P<0.001], abruptio placenta 2.7% versus 0.5% [P<0.001], stillbirth 2.31% versus 0.6% [P<0.001], Down's syndrome 1.9% versus 0.1% [P<0.001] and small for dates 6.3% versus 3.6% [p<0.001].This study showed that the increased maternal age is associated with the increased obstetric and perinatal risk in comparison with other age groups. Pre-pregnancy counseling and intensive antenatal assessment is mandatory

Simple or stress sonographic hip screening in the newborn versus simple hip screening at the age of three to four months

The study was carried out to find the most appropriate age and sonographic method to detect developmental dysplasia of the hip [DDH]. 4411 newborns and infants were examined clinically and by simple or stress sonography. The study was divided into three parts. In the first part 1823 newborns were examined by simple sonography at birth and followed up monthly until the age of three months. In the second part 1511 newborns were examined by stress sonography and followed-up until the age of three months. In the third part 1077 infants were examined by simple sonography at the age of three to four months. In part one hip pathology requiring treatment was detected in 85 infants [4.66 per cent]. In 34 infants the diagnosis was made at birth while in the remaining 51 infants hip pathology was detected one to three months after birth. In 22 infants of the latter group, hips were initially of type 1b which, according to Graf, will not deteriorate. In the second part, hip pathology requiring treatment was detected in 88 infants [5.8 per cent]. In 33 infants hip pathology was detected at birth and in 55 it was detected at one to three months after birth. In the third part, hip pathology requiring treatment was found in 14 infants [1.3 per cent]. Simple hip sonography at the age of three months is able to detect all pathological hips and reduce the number of treated infants more than three fold

Outpatient treatment of congenital dislocation of the hip with pavlik harness

In a two years period, 95 children, one month to one year of age with a total of 123 dysplastic or dislocated hips were treated with the Pavlik harness. Full-time treatment in the harness averaged 4.2 months and the follow-up period averaged 13.5 months. Spontaneous reduction was achieved in all but 3 cases, where adductor tenotomy, on day case basis, was performed. All hips were clinically and radiologically normal at follow-up with no incidence of avascular necrosis. Asymmetry of the ossification center of the femoral head was noticed in 7 cases, but at follow-up it disappeared and equal size of both femoral heads was noticed in all cases. It was concluded that treatment with this dynamic device is ideal, not only because it is effective and actually without complications, but because it is practical as well. The harness suits infants because they can lie prone or supine, crawl or sit, and it need not be removed for diaper changes or washing of the infant. The treatment can be carried out on an exclusively out-patient basis

Double fractures of the fibula in bimalleolar fractures

Study of eight cases of displaced ankle fractures with double fracture of the fibula showed that these fractures constitute a separate entity with special characteristics. For the second fibular fracture to occur, it is thought that a change in the position of the foot, or a change in the direction of the injuring force or a change in both should occur. These fractures, although rare, are very serious. Closed reduction of the fibular fractures, in spite of internal fixation of the medial malleolus, is difficult and proved unstable in plaster immobilization. Open reduction and internal fixation, especially, of both fibular fractures is necessary if permanent disability is to be avoided. Ankle fractures are unpredictable in presentation. This is especially true concerning the fibular component of these fractures. Lauge-Ha-nsen classification[1], although it gives precise and detailed description of ankle fractures including ligamentous injuries, did not include all possible fractures at the ankle. Large series, classified according to it, showed that between one to seven percent of the fractures could not be classified according to Lauge-Hansen classification[2,6]. Isolated fractures of the posterior tibial edge [Bosworth][7] and Maisonneuve [1840] fracture[8] are examples. Many questions concerning especially the mechanism of injury and the pathological anatomy of the ankle injuries are still unanswered and require more investigations and considerations In this report we present eight patients with ankle fractures where the fibular fracture was double. In the available literature we could not find a report dealing with this entity. This fracture, although rare, is serious. Closed reduction of the fibular fracture proved unstable in spite of internal fixation of the medial malleolus. If permanent disability is to be avoided then proper reduction and internal fixation of medial malleolus and both fibular fractures should be performed

Incidence of osteoarthrosis of the hip in Jordan

The purpose of this study was to verify a long - standing chinical observation that osteoarthrosis of the hip is extremely rare in Jordan. Examination of the. hips on radiographs from barium enemas and intravenous pyelographies of 5,499 patients revealed an overall incidence of osteoarthrosis of 0.43 per cent in people above 40. The incidence rose from 0.16 per cent in people below 50 to values around two percent in people above 80. The incidence of the primary variety was 0.1 percent and the secondary variety was 0.32 percent. It was concluded that osteoarthrosis of the hip, especially the primary variety, is extremely rare in Jordan. The habits of squatting and sitting in this country, which put the hips in extremes of position, conceivably, sustain the health of the cartilage by exposing a wider area to daily use. The incidence of roentgenographic evidence of osteoarthrosis of the hip was studied in the Western countries in random samples of the population[1-6]. The diagnostic criteria used in these epidemiologic studies were not uniform and consequently, the incidence varied greatly [Table I]. Where as Kellgren[4] and Hermodsson[3] found that the incidence, as judged solely by the presence of osteophytic changes, was as high as 20 and 30 percent, Danielsson[2] found that the incidence of primary osteoarthrosis, as judged by structural and / or joint space changes, was only 3.4 percent. In a previous study, Danielsson[1] found that only 1.6 percent of the population above 55 sought medical advice for primary osteoarthrosis of the hip. The difference in the results of both Danielsson's studies was related to the fact that the symptoms of osteoarthrosis of the hip are not always severe and that consequently medical advice is not always sought. On the other hand,Weintraub et al[6], using similar criteria as Danielsson found an incidence of 53.14 percent. When using osteophytic changes as criterion, they found the incidence to be 27.7 percent. of particular interest is the study of Solomon[7], where a highly significant difference in the incidence was found between the Caucasians and the Africans in Johannesburg. He related the low incidence in the Africans to the squatting habit which was common between them. It is a long-standing clinical observation that osteoarthrosis of the hip is rarely seen in this country. The purpose of this study is to verify this clinical observation and to find out the incidence of osteoarthrosis of the hip in Jordan

Diagnosis and treatment of congenital dislocation of the hip in newborn infants in Jordan

Neonatal hip instability, its incidence, diagnosis, and treatment have been studied prospectively in obstetric sections in four hospitals for the period 1974 -1977. During this period, 10,128 newborns were examined personally. Only 6,972 infants were thoroughly evaluated. These children were examined during the first twenty four hours of life and again after three months of age when they were also x-rayed. Forty-seven children with hip instability were diagnosed by neonatal screening; one case was missed but was discovered after three months of age. The incidence was 6.9 per 1,000. All unstable hips were treated upon diagnosis with a Frejka splint. The results were uniformly good in all, but in two cases where a mild asymmetry of the ossification center of the femoral heads was seen, radiograms revealed normal hips two years later. The results of this investigation are compared with those from the literature. The incidence of instability and missed cases, the complications of treatment as well as the causes of discrepancy in various reports in the literature are discussed. Congenital dislocation of the hip occurs in sufficient numbers in Jordan to justify a greater interest in the early detection and proper treatment. Since the pioneer works of Le Damany[1] and Ortolani[2] the modern principles of early diagnosis and treatment have been gradually adopted in most countries. Especially in the last two decades increasing efforts have been made to diagnose early this crippling disease by routine examination of newborn infants. In spite of the good results obtained by the propagators of neonatal screening[3,5] failures have occurred both in the early diagnosis and early treatment with others[6,11]. In some reports, missed dislocations approximate the expected incidence of congenital dislocation of the hips[6,8,11]. On the other hand, it was demonstrated that most hip dysplasias, which are discovered in the first twenty four hours, tend to improve spontaneously. Because of this, the validity of neonatal screening was questioned[12]. Are we treating those hips which will cure themselves and are missing the real problem For this reason, a program of neonatal screening was set up with the following objectives: [a] to verify the validity of the concept of neonatal screening when an orthopedic surgeon carries out the examination; [b] to determine the incidence of congenital dislocation of the hip of newborn infants in Jordan; and [c] to find out if it were possible, by conservative means, to cure the infant completely [of congenital dislocation of the hip] when the treatment is commenced in the newborn