Results of distraction compression and compression distraction in segmental defects of tibia with the use of Ilizarov's external fixator

To compare the results of distraction-compression and compression-distraction in segmental loss of tibia by Ilizarov extent fixator and to see the functional end results of each procedure. Comparative study. This study was carried out in the Department of Orthopaedic, Nishtar Hospital, Multan from April 2008 to March 2010. A total of 30 cases were included in the study. Gap non-union in tibia is a frequently encountered problem in open tibial injuries. Their treatment have been unsatisfactory until the introduction of distraction histeogenesis by Ilizarov, before the end results were often amputation. Gap non-union of up to 5 cm can be managed by initial compression, later on the LLD is addressed and distraction histeognesis whereas gap of >5 cm are amicably managed by segment transport i.e. distraction and later compression between the transported segment to other end of the fracture. Both methods are excellent if the limitations and principles are followed. Our recommendations are gaps of < 5 cm to be managed and compression-distraction of gaps of >5 cm to be managed with distraction compression mode of treatment

Follicular fluid endothelial inflammatory and coagulation markers in good and poor responders to controlled ovarian hyperstimulation for ICSI procedures

Granulosa cells have endothelial like function and can produce many proteins charactetritic to endothelial activity. Evaluation of these protein products allows understanding of the microfollicular environment to be reflected on better safe management for controlled hperstimulation for poor and good responders during artificial reproductive techniques. To compare levels of markers of inflammation and endothelial dysfunction [C-reactive protein, CRP and von Willebrand factor antigen, vWF] and the poor response to induction of ovulation during controlled ovarian hyperstimu-lation [COH] for ICSI procedures. 78 infertile patients were assigned for ICSI [intracytoplasmic sperm injection] procedure. The patients were divided according to their resoponse into group A [poor responders] who have yielded only five or less follicles of 18mm or more in size, and group B who have adequate response to controlled ovarian hyper stimulation. The follicular fluid from the two groups was tested for markers of inflammation; C-reactive protein [CRP] and marker of endothelial damage; vonWillibrand Factor [vWF]. The main cause of infertility in poor responders is ovulatory [polycystic ovary syndrome]. The body mass index and age is higher significantly in the poor responders. Both markers studied have higher level in the follicular fluid from the poor responders than normally responding patients [but statistically significant only for CRP]. The levels of the two markers have a positive correlation to the body mass index which is significantly higher in the non responders. The granulose cells have endothelial like activity and produces many proteins that have effect on the microenvironment of the growing follicles. CRP and vWF are markers for inflammation and endothelial stress which are produced in follicular fluid of the poor responders to controlled hyper stimulation in amounts more than the normally responding ones. Further studies are needed to deeply understand the value of proteins produced by granulosa cells for efficacy and safety of ovulation induction during artificial reproductive techniques

Combined urethral stent and suprapubic diversion versus urethral splent only in distal penile hypospadias repair

This comparative study was conducted on 82 patients who had underwent different types of hypospadias repair at Urology Department, Faculty of Medicine, El-Minia University, between Mars 2003 to May 2005. All patients were subjected to careful clinical examination, urine analysis and culture in presence of high bacterial count, bl. Picture and abdomino-pelvic ultrasound. Patients were divided into two similar groups and were subjected to hypospadias repair operations; group [1] with combined urethral stent and suprapubic tube and group [2] with a urethral splint only. Complications of hypospadias repair as fistula, meatal stenosis, urethral stricture and others were lower in patients with suprapubic diversion accompained with urethral stent than in those with urethral splint only. We recommend the use of suprapubic diversion and urethral stent in hypospadias repair operations as a routine work