Assessment of soft tissue reconstruction of the thumb after injuries

Background: This study is to formulate a strategic approach for soft tissue reconstruction of the thumb and study of different modalities of soft tissue reconstruction of the thumb and try to clarify advantage and discuss complication of each modality.Methods: This is a prospective study done on 20 patients with thumb defects and deformities, presented at Menoufia University and Al-Ahrar Zagazig Teaching Hospitals during the period from January 2017 to July 2019. They were 14 Males and 6 females classified according to age, sex, type of trauma, dominant hand, type of flap used for reconstruction.Results: The most type of injury was trauma in all technique accept digital artery perforator (DAP) flap and groin flap of the half patients were trauma (50%) and other half were post burn (50%).  Most patients were early timing of interference in all techniques accept replantation was immediate time of interference (100%) and groin flap was late time of interference (100%). Most patients in Moberg flap had minimal scare complication (60%). Whereas half patients had minimal scare complication in replantation, little flap and DAP flap (50%, 50% and 50%). While half patients had volar contracture, graft complication in thumb cross finger and groin flap (50% and 50%).Conclusions: Replantation is the first choice for thumb amputations proximal to the base of the distal phalanx. It is impossible or fails, other methods of thumb reconstruction. Thumb cross finger flap is an excellent reconstructive technique for larger volar and tip defects of the thumb, up to 2-3 cm2.

Electrosurgical unipolar vessel sealing versus purohit technique in vaginal hysterectomy [a pilot randomized clinical trial]

Background: Vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where possible as it has benefits; quicker return to normal activities, fewer complications, shorter operative time, less blood loss, and a shorter stay in hospital. Also, it is preferred to laparoscopic-assisted vaginal hysterectomy because of fewer bladder or ureteric damage as well as a shorter operating time and learning curve

Aim of the Work: To compare the between using unipolar electrocautery versus Purohit technique in vaginal hysterectomy as regards operative time

Patients and Methods: This pilot prospective randomized clinical trial was conducted at Ain Shams University Maternity and Women.s Hospital during the period from June 2016 to February 2018. This study included patients presenting to the outpatient gynecologic clinic of Ain Shams University Maternity and Women.s Hospital and planned to have vaginal hysterectomy for benign cause

Results: both total operative time and pedicle securing time were significantly longer in the Purohit technique group compared to the unipolar electrocautery group [P <0.001]

Conclusion: using unipolar electrocautery significantly reduces total operative time than using bipolar electrocautery without increasing rate of complications nor does it cause specific type of complications provided that special precautions are taken to avoid thermal effect on nearby structures

Recommendations: using unipolar electrocautery is recommended by well trained hands in suitable patient and should be offered for training by other surgeons of different levels to judge learning curve. Further studies with inclusion of patients having larger sizes of uteri using the same technique. Further settings with higher cautery up to 50W were found to be safe for further analysis

Role of percutaneous microwave ablation in treatment of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established. Hepatitis C virus is also proving an important predisposing factor for this malignancy, the use of minimally invasive Percutaneous ablative technique [e.g. Radiofrequency [RF] and Microwave ablation [MW] has gained great momentum and because of the drawbacks of RF ablation, several groups have successfully proved the efficacious nature of Microwave ablation in the treatment of hepatocellular carcinoma. The aim of this work is to highlight the role, the principles and the applications of percutaneous Microwave Ablation in Hepatocellular carcinoma. The studied group included 30 patients [25 men and 5 women] with hepatocellular carcinoma. All patients underwent microwave ablation for the hepatocellular carcinoma. The results of the procedures will be assessed as regarding sizeand enhancement of the lesion [s] on triphasic CT abdomen before the procedure and at the follow up at one month as well as the Alpha fetoprotein levels. MWA technique represents a safe, fast and efficacious way to perform hepatic ablation in patients with HCC. Initial results are encouraging; however, longer follow-up is needed for further classification of our results

Efficiency of vaginally administered probiotic lactobacillus rhamnosus GR-1 and lactobacillus reuteri RC-14 versus oral metronidazole in the treatment of bacterial vaginosis: randomized double blind study

Background: Bacterial vaginosis [BV] is a relatively complex yet extremely common condition characterized by alteration of the vaginal ecology in which the normal flora, dominated by lactobacilli, is replaced by a mixed bacterial flora. BV is associated with adverse pregnancy outcome, increased risk for pelvic inflammatory disease and abnormal cervical cytology. BV can be treated with antibiotics such as metronidazole or clindamycin, either orally or vaginally. However, there is usually a high rate of recurrence. Probiotics are defined as live micro-organisms which, when administered in an adequate amount, confer a health benefit on the host. The aim of this study was to investigate the efficacy of vaginally administered Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 as probiotics in comparison to the standard oral metronidazole therapy in the treatment of symptomatic bacterial vaginosis

Patients and Methods: The study enrolled 60 women with BV. They were divided into two groups: Group [1] included 30 patients who received oral metronidazole tablets 500mg twice daily for one week and placebo vaginal capsules twice daily for five days. Group [II]: included 30 patients who received oral placebo tablets twice daily for one week and vaginal capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14] twice daily for five days. All participants were evaluated before initiation of treatment then 1 and 4 weeks thereafter. Follow up was based on clinical improvement, pH of vagina, whiff test, absence of clue cells in vaginal smears and Nugent score which is considered the standard for research

Results: After 4 weeks of follow up, the probiotic group had a significantly higher cure rate of BV [88%] than the metronidazole group [51%] [p = 0.01]. In addition, according to the Gram-stain Nugent score more women were assessed with "normal: vaginal micrbiota in the Probiotic group both after 1 week [p=0.05] and after 4 weeks [p=0.01]. Relapse was higher in the metronidazole treated group [4 out of 29 cases, who completed the study accounting for 13.8%] while there was no relapse in the probiotic treated group. Failure of cure was higher in metronidazole treated group [10 cases accounting for 34.4%] than probiotic treated group [3 cases accounting for 12%]

Conclusion: The results of the present study showed that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken vaginally, were effective in treatment, relapse prevention and normalization of the vaginal flora in women with bacterial vaginosis for which we recommend the use of Probiotics as an effective treatment option. Furthermore, testing sensitivity of isolates of BV for metronidazole resistance is recommended to find reasons of less efficacious metronidazole treatment