Acupuncture for management of idiopathic chronic pelvic pain: is it an effective therapeutic modality?

A prospective randomized clinical study. Department of Obstetrics and Gynecology and Department of Anesthiology and Algesiology, Sohag Faculty of Medicine, Sohag University Hospital. To evaluate the efficacy and safety of acupuncture for the management of idiopathic chronic pelvic pain. Thirty six patients with idiopathic chronic pelvic pain were recruited for this study fulfilling the inclusion criteria. The patients were randomly allocated into two groups [18 patients each].Group I subjected to acupuncture treatment and group II received Celebrex 200mg once daily for six weeks. The protocol of acupuncture consisted of standardized set of acupuncture points twice weekly for 30 minutes with electrical stimulation over 6 weeks based on traditional Chinese Medicine organ and meridian theory. A visual analogue scale [VAS] was used to assess the severity of pain before the start of treatment and two weeks, four weeks and six weeks after treatment. The pain was also assessed one month and three months after stoppage of treatment in both groups. Visual analogue scale was significantly reduced after 6 weeks of treatment in both groups [2.2 +/- 0.881 versus 7.6 +/- 0.15 before treatment in group I, P<0.01 and 4.6 +/- 0.109 versus 7.8 +/- 0.24 before treatment in group II, P<0.05]. However, the decrease in the pain level after 6 weeks of treatment was more statistically significant in group I than in group II [2.2 +/- 0.881 versus 4.6 +/- 0.109, P<0.05]. The pain was completely relieved in 66.6% after one month and in 55.5% after three months of group I versus 16.6% and 11.1% of group II respectively, this difference was statistically significant [P<0.01]. No change in the level of pain after one month was encountered in one case of group I [5.6%] and in 7 cases [38.9%] of group II and the difference was statistically significant [P<0.05]. This study could conclude that, acupuncture is an effective and relatively safe therapeutic modality for the management of idiopathic chronic pelvic pain

Pregnancy spacing after primary cesarean section: its impact on uterine scar strength and mode of delivery

To evaluate the strength of uterine scar in pregnancy following primary cesarean section [CS] and its effect on the mode of delivery, and subsequently to define the safe interval of pregnancy spacing after primary CS. Ninety cases were recruited from the outpatient clinic of Sohag University Hospital [SUH] during the period from Feb. 2005 to Jan. 2006. All had singleton pregnancy in the third trimester and previous one uncomplicated CS for a relative indication done in the emergency sector of SUH with no other risk factors in the current pregnancy. The patients were allocated into 3 groups, G I [13 patients] who got pregnant within 6 months after CS, GII [27 patients] who got pregnant 6 months to one year after CS, and G III [50 patients] who got pregnant after more than one year of CS. During every antenatal visit, in addition to the routine evaluation, ultrasonographic measurement of the lower uterine segment [LUS] was done and a thickness < 3 mm was considered to be abnormal according to Tanik et al [1996]. Elective CS was done for those with thin LUS [<3mm] or for those who developed other complications of pregnancy. Otherwise, patients were allocated for the trial of vaginal delivery. The patients characteristics showed that most of the patients were primiparous, noneducated and from rural areas with a mean age of 28 +/- 3.7. The LUS thickness at 36 weeks was found to have a thickness of <3mm in 9 cases [69%] of GI, 7 cases [26%] of GII and 5 cases [10%] of GIII. A LUS of >/= 3mm was detected in 4 cases [30%] of GI, 20 cases [74%] of GII and 45 cases [90%] of GIII; the differences were statistically significant. With regard to the mode of delivery, 92% of patients in GI were delivered by CS [elective+emergency] compared to 20% in GIII where 80% of patients were delivered vaginally, and the difference was statistically significant. This study can conclude that the interval of 6 months or more after CS can be considered safe for pregnancy to be allowed and the safety increases with more than one year interval. An interval of less than 6 months does not seem to be safe; the LUS is frequently too thin to stand for trial of vaginal birth. Sonographic measurement of the thickness of the LUS is considered a reliable method for determining the strength of the scar and the mode of delivery

effect of cigarette smoking on the standard semen parameters and leukocyte contamination in infertile men

To investigate sperm quality and levels of seminal leukocytes in a group of infertile men with history of cigarette smoking. A prospective clinical study. Sohag University Hospital. Fifty two infertile men were enrolled in this study during the period from June, 2004 to December, 2005. After thorough history taking and examination, they were allocated to 4 groups. Infertile smokers [n = 20] divided into 2 groups, group 1[n=12] who had normal genital examination and group 3 [n=8] who had varicocele and infertile men who were non-smokers [n = 32] divided into 2 groups, group 2 [n=21] who had normal genital examination and group 4 [n=l 1] who had varicocele. A healthy fertile non-smokers [n = 13] as a control group. Genital examination, Scrotal Doppler Ultrasound when needed and standard semen analysis. Sperm parameters [concentration, motility and normal forms] and seminal leukocytic counts. Smoking was associated with 48% increase in seminal leukocyte concentrations [P < 0.0001], On the other hand, abnormal genital examination was associated with 29% decrease in sperm concentration, a correlation which was statistically significant [P = 0.005], Differences in standard sperm variables between infertile smokers and non-smokers men were not statistically significant. Our study demonstrates a strong correlation between smoking and increased seminal leukocytic counts. Smoking metabolites may cause sub-clinical inflammation of the male reproductive tract and recruitment of leukocytes. Activation of these leukocytes may result in oxidative stress and damage to the sperm