use of Sengstaken - Blakemore tube to control postpartum hemorrhage: Ain Shams University experience

To evaluate the efficacy of Sengstaken - Blakemore tube to control cases of intractable postpartum hemorrhage [PPH]. Cases of intractable PPH admitted at Ain Shams University Maternity Hospital from April 2005 to December 2006 and managed by Sengstaken-Blakemore tube after exclusion of other causes of PPH are reviewed. Eighteen cases were managed by Sengstaken-Blakemore tube. The most common cause of PPH was uterine atony in 10 cases [56%] followed by coagulopathy in 5 [28%] and placenta accreta in 3 [17%]. Twelve cases [66%] were delivered vaginally and six cases had a cesarean section. The procedure successfully arrested the bleeding in 16 out of 18 cases [88.8%]. All six cases delivered by cesarean section had additionally internal iliac artery ligation before applying the Sengstaken-Blakemore tube However, in cases delivered vaginally, tile balloon was used first in order to avoid laparatomy. The mean blood transfusion unit given was 4.5 units of packed RBCs and 2.1 units fresh frozen plasma. Time mean volume of maximum balloon inflation was 225 ml and the mean duration of application was 33 hours with a mean blood loss through the drainage tube of 233.3 ml. The two unsuccessful cases followed vaginal deliveries and both were salvaged by undergoing supravaginal hysterectomy after failure of internal iliac artery ligation in controlling bleeding. The application of Sengstaken-Blakemore tube in selected cases of intractable PPH appears to be simple, safe and atraumatic sparing patients an unnecessary difficult surgical intervention

Sublingual administration of misoprostol for treatment of postpartum hemorrhage

To examine the effectiveness and safety of high-dose sublingual misoprostol for treatment of postpartum hemorrhage compared to methylergometrine by means of a double blind randomized clinical trial. After active management of third stage of labor, 94 women with atonic postpartum hemorrhage were randomized between misoprostol treatment [4 x 200 ug sublingual and IV saline] or four placebo tablets and IV 0.25 mg methylergometrine injection. The primary outcome variable was the measured blood loss >/= 500 ml in one hour after enrolment. The significance level was chosen at P < .05. The measured blood loss > 500 ml in one hour after enrollment was not significantly different between misoprostol and ergometrine groups [p = 0.77]. Other estimations of blood loss showed no significant differences between the groups, though, more patients in misoprostol group needed additional uterotonics to stop their bleeding [27 [57.45%] vs. 16 [34.04%], p = .04]. With misoprostol side-effects were increased, namely shivering and pyrexia > 38.5°C [p = .01]. compared with methylergometrine, misoprostol provides nearly equal effect against postpartum hemorrhage but associated with more side effects and more demands of additional uterotonics

use of Sengstaken - Blakemore tube to control postpartum hemorrhage: Ain Shams University experience

To evaluate the efficacy of Sengstaken- Blakemore tube to control cases of intractable postpartum hemorrhage [PPH]. Cases of intractable PPH admitted at Ain Shams University Maternity Hospital from April 2005 to December 2006 and managed by Sengstaken Blakemore tube after exclusion of other causes of PPH are reviewed. Eighteen Cases were managed by Sengstaken- Blakemore tube. The most common cause of PPH was uterine atony in 10 cases [56%] Followed by coagulopathy in 5 [28%] and Placenta accreta in 3 [17%] Twelve cases [66%] were delivered vaginally and six cases had a cesarean section. The procedure successfully, arrested the bleeding in 16 out of 18 cases [88.8%]. All six Cases delivered by cesarean section had additionally internal iliac artery ligation before applying the Sengstaken- Blakemore tube. However, in cases delivered vaginally, the balloon Was used first in order to avoid laparatomy The mean blood transfusion unit given was 4.5 units of packed RBCs and 2.1 units fresh frozen plasma. The mean volume of maximum balloon inflation was 225 ml and the mean duration of application was 33 hours with a mean blood loss through the drainage tube of 233.3 ml. The two unsuccessful cases followed vaginal deliveries and both were salvaged by undergoing supravaginal hysterectomy after failure of internal iliac artery ligation in controlling bleeding. The application of Sengstaken- Blakemore tube in selected cases of intractable PPH appear to be simple safe and atraumatic sparing patients an unnecessary difficult surgical intervention

IgA/transferrin ratio for the early prediction of latent liver cirrhosis

The B.C of our study was to assess the level of IgA and transferrin of patients with liver cirrhosis to determine the relation between liver cirrhosis and IgA/transferrin ratio. The study involved 32 subjects classified into patients without liver cirrhosis [n=12], and patients with liver cirrhosis [n=10] as well as a group of normal healthy subjects [n=10] for comparison. In all of these subjects, serum alanine [ALT] and aspartate [AST] aminotransferase activity as well as serum IgA and transferrin level were determined. Our results revealed that the mean values of both ALT and AST activities were significantly high in both groups of patients without liver cirrhosis and with liver cirrhosis [P<0.05], although the activity of both enzymes was relatively higher in patients with liver cirrhosis than in those without liver cirrhosis. Furthermore, the amount of IgA immunoglobulin showed very highly significant decreased values in patients without liver cirrhosis while very highly significant increased values were obtained in cirrhotic patients as compared to their corresponding values in normal group. The concentration of serum transferrin showed insignificant values in cases without liver cirrhosis whereas these values showed moderately significant decreased level in cases of liver cirrhosis. It is of interest that the values of IgA/transferrin ratio, although showed insignificant values in patients without liver cirrhosis these values were significantly high in cirrhotic patients. In addition, it has been found that in liver cirrhotic patients the mean values of IgA/transferrin ratio were nearly 2.5 times as compared to the ratios in normal or non-cirrhotic patients. From the present study, the determination of IgA and transferrin in serum or plasma may open up a very simple and safe way for the early detection of latent cirrhosis. IgA/transferrin>2.5 ratio was found to be significantly increased in latent cirrhosis as compared to patients without cirrhosis or normal subjects. This value can be considered as an indicator of latent cirrhosis in children associated with liver diseases

Correlates of Tc-99m tetrofosmin pulmonary uptake in patients with coronary artery disease and subjected to high dose dipyridamole stress

The stress-lung-to-heart ratio [LHR] of uptake of the tracers during myocardial perfusion imaging [MPI] has been shown to have diagnostic significance for the severity of the disease and left ventricular [LV] dysfunction in patients with coronary artery disease [CAD]. On the other hand, high-dose dipyridamole [HDD] stress myocardial single photon emission computed tomography [SPECT] has greater accuracy for determination of CAD severity than standard dose dipyridamole [SDD] or exercise stress [EST]. To test whether the stress LHR of Tc-99m tetrofosmin [Tc-99m TF] uptake is a determinant of the severity of CAD and left ventricular dysfunction in patients with CAD and subjected to high-dose dipyridamole [HDD] stress. This retrospective study comprised 39 patients with angiographically-proved CAD [group I] and 8 subjects [group II] with negative MPI [gated rest and stress; one-day protocol] and normal coronaries that have been subjected to MPI using Tc-99m TF under HDD [0.84mg/kg over 4 min.]. The LHR of Tc-99m TF uptake was calculated by area of interest [AOI] analysis for the normalized myocardial and right lung counts from the immediate post-stress anterior chest view. The LV transient ischemic dilation [LVTID] was visually-interpreted; while the summed stress score [SSS] and rest LV function parameters were calculated. Further grouping of all subjects into 0-2 vessels CAD [group A] and main stem/3 vessel CAD [group B] was performed. The mean LHRs were 0.48 +/- 0.09 SD and 0.39 +/- 0.07 SD in groups I and II respectively [P>0.05]. The LHR of all subjects showed significant positive correlations with the SSS mid LV volumes and significant inverse correlation with LVEF [P<0.001 each] with no significant correlation with LVTID [P>0.05]. The LHRs were 0.44 +/- 0.08 SD and 0.57 +/- 0.08 SD in groups A and B respectively [P<0.001]. High dose dipyridamole [HDD] is a safe mode of stress to evaluate patients with CAD who are unable to exercise. The lung-to-heart ratio of Tc-99m tetrofosmin [immediately post HDD stress] seems to be a diagnostic marker to elicit the severity of CAD as well as the systolic and diastolic LV dysfunction in such patients

Lipid profile in smokers and non-smokers associated with pulmonary emphysema

The changes in lipid profile and lipid peroxidation in smoking and non-smoking subjects associated with emphysema and their effects on heart were investigated. Forty male subjects were selected and classified clinically into four groups; control, cigarette smoking subjects without emphysema, non-smoking subjects with emphysema, and cigarette smoking subjects with emphysema. Serum thiobarbituric acid reactive substances [TBARS] were assessed as a direct indicator of lipid peroxidation. Serum total lipid, total cholesterol, triglycerides, high density lipoprotein-cholesterol [HDL-C], and low density lipoprotein-cholesterol [LDL-C] were evaluated. Serum creatine kinase [CK] activity was assessed as a direct indicator of heart injury. Serum alpha-1-antitrypsin [AAT] level was measured as an indicator of emphysema. As compared to control, emphysematous and non-emphysematous groups showed alteration in lipid profile including significant increase in all lipid components, except HDL-C. In comparison with smoking group without emphysema, all lipid components revealed no significant change in non-smoking subjects with emphysema, while a sign of lipid impairments was high in cigarette smoking group with emphysema as compared to smoking group without emphysema. The level of TBARS and CK activity were higher in the two groups with emphysema as compared to either controls or smoking subjects without emphysema. In contrast, the AAT levels were low in the two groups with emphysema as compared to controls and smoking subjects without emphysema. It is clear from the foregoing findings that emphysema, especially in smoking subjects, was mainly associated with oxygen- derived free radicals that damage lipids in peribronchiolar alveoli of the lung tissues accompanied with elevation in total lipid, triglyceride, total cholesterol, LDL-C levels, that may lead to the high risk of heart diseases

Surgical versus conservative approach of a patient with a single-lactiferous duct discharge using a precise ductal localization technique

This study was done on 23 patients to evaluate the surgical management as being a sure diagnostic method, in all cases, and therapeutic one in most of them. Of these patients, 21 had persistent single duct discharge of the nipple of the breast without a palpable abnormality. Mammography and cytology were done for all patients. It was found that mammography was false negative in 2 out of 4 cases who were found to be malignant after microdochectomy and histopathology. The cytology of the duct discharge showed suspicious and malignant cells in 2 out of these 4 patients [i.e. 2 true positive and 2 false negative cytology]. Thus, the conservative approach using these methods is not safe enough and microdochectomy, using the injection localization technique is a simple and quick method for proper initial management of these cases

Pattern of serum and urinary amino acids in nephropathies

Determination of amino acid pattern in acute nephritis and nephrotic syndrome by paper and gas Liquid chromatography revealed generalized hypoaminoacidaemia and hyperaminoaciduria in both conditions. Restoration of normal pattern was attained on clinical recovery. However, nephrotic cases resistant to corticosteroid therapy failed to attain the normal pattern. It can be stated that determinations of serum and urinary amino acid pattern do have some diagnostic and prognostic value in nephropathies

Clinical significance of selective and non selective proteinuria in nephropathies

Electrophoretic study of serum and urinary proteins was carried out on cases of acute nephritis and nephrotic syndrome. The absolute U/S ratio for albumin and that for different globulin fractions as percentage of U/S albumin ratio were calculated to indicate selectivity and non-selectivity of the proteinuria. In spite of the common features of non-elective proteinuria in both disorders, there is a quantitative difference, albumin as well as globulins were lost in urine in lesser amounts in acute nephritis than in nephrotics. This explains the relatively less derangement of serum protein pattern in the former than in the latter disease. After treatment, in acute nephritic cases that showed complete cure, the proteinuria changed to selectivity. However, in lingering cases, proteinuria was still poorly selective or non-selectives. Also nephrotics with complete remission, regaind normal selective function of nephrons, whereas patients who failed to respond to cortico-steroid therapy, still have a defective function of nephron permeability noted by non-elective nature of the proteinuria. In conclusion, simultaneous study of urinary protein output together with selectivity give an accurate estimate of the renal filleration defect. In addition, restoration of selectivity is a good prognostic sign both in acute nephritis and nephrotic syndrome

Factors influencing postprostatectomy bacteriuria

Some factors which might possibly influence the occurrence of postoperative bacteriuria in 55 patients undergoing prostatectomy were prospectively studied. 36 patients [65%] developed bacteriuria while 19 [35%] had sterile urines. Transurethral resection was associated with a significantly lower incidence [P < 0.01] of bacteriuria [30%] than open prostectomy [70%]. Duration of postoperative urethral catheterisation was significantly longer [P <0.05] in patients with post-prostatectomy bacteriuria than in those with sterile urines. The insignificant factors encountered were the age, preoperative bacteriuria, type of presentation, duration of preoperative urethral catheterisation, size of the prostate, duration of the operation, type of bladder irrigation and occurrence of clot retention