Transvaginal ultrasound is a valuable investigation in female stress incontinence

Objectives: To evaluate the role of transvaginal ultrasound [TVUS] in studying the anatomical basis of genuine stress urinary incontinence [SUI] and understanding the causes of success and failure of operations aiming at the treatment of incontinence

Patients and Methods: This study included 15 continent females [Group I, healthy control] and 46 patients complaining of SUI [Group II]. All cases were subjected to full history, physical examination, urodynamic evaluation and TVUS examination. In 42 patients of Group II, TVUS was repeated one year after treatment of incontinence, while four patients were lost to follow-up. In 36 of these 42 cases [85.7%], treatment was successful [Group IIIa], while treatment failed and SUI persisted or recurred within one year in six cases [Group lllb, 14.3%]. We used TVUS to measure the bladdersymphysis distance [BS], the rotational angle [RA], the bladder neck motility [BNM] and the vertical bladder neck descent

Results: While the mean BS was insignificantly shorter in Group II compared to Group I [2.24 +/- 0. 7 cm versus 2.4 +/- 0. 5 cm, p = 0.08], the mean RA, BNM and vertical bladder neck descent were significantly greater in Group II [115 +/- 17[degree], 29 +/- 16[degree] and 1.4 +/- 0.4 cm for Group II versus 94 +/- 15[degree], 20 +/- 5[degree] and 0.34 +/- 0.4 cm for Group I]. The comparison between Groups I and II showed that the TVUS-measured parameters correlated well with the clinical condition. A comparison between Group Illa [BS = 2.2 +/- 1 cm, RA= 100 +/- 19[degree], BNM = 22 +/- 4[degree] and vertical bladder neck descent = 0.38 +/- 0.5 cm] and Group lllb [BS = 2.2 +/- 0.5 cm, RA= 117 +/- 16[degree], BNM = 30 +/- 9[degree] and vertical bladder neck descent = 1.4 +/- 0.3 cm] showed that the TVUS-measured parameters correlated well with the surgical outcome

Conclusions: TVUS is a valuable tool for the diagnosis and postoperative evaluation of SUI and may help in understanding the causes of success and failure of surgical treatment of SUI

effect of no intervention, visual biofeedback, and verbal encouragement on isokinetic knee peak torque

The purpose of the study was to assess the effect of various protocols upon peak torque of the knee flexors and extensors using a biodex system II isokinetic, to support or suppress its use with some neurological cases, especially those with visual or auditory disorders. Twenty-four healthy male [ages 20-31 years] were recruited from national club members to perform three sets of five maximal concentric repetitions of the knee flexors and extensors at 60° per second. Peak torque was measured to assess whether different protocols could result in variations. Essentially the protocol was standardized, with the only variation being the encouragement given; [i] no intervention, [ii] visual biofeedback, and [iii] verbal encouragement. One-way ANOVA test revealed no significant differences between the mean of each group [p>0.05]. However, means were seen to vary slightly [not more than 8.8%]. Results showed no significant differences between different protocols, a finding that can indicate that experiments employing dissimilar protocols could be comparable. Error resulting from protocol variation is not significant, allows the use of isokinetic equipment with neourological patients complaining from combination of symptoms including visual or auditory problems. The biodex system II dynamometer has been shown to be a reliable piece of equipment and sensitive enough to be used with neurological cases even those with lack of visual or auditory feedback

Evaluation of cerebral blood flow during laparoscopic cholecystectomy using transcranial doppler ultrasonography

Laparoscopic procedures are common nowadays. They have many advantages, however, they carry special risks in certain cases due to the associated cardiac and pulmonary dysfunction as well as CO2 retention. The aim of this work is to evaluate the effect of one of these procedures; namely laparoscopic cholecystectomy; on cerebral blood flow [CBP] using transcranial Doppler [TCD] ultrasonography to determine the right middle cerebral artery velocity [MCAV] which is proved to correlate well with CBF. Sixteen patients classified as American Society of Anaesthesiologists [ASA] physical status I, and II were included in the study. Their heart rate [HR], mean arterial pressure [MAP], end-tidal carbon dioxide concentration [PETCO2], arterial carbon dioxide tension [PaCO2], and MCAV were recorded before CO2 insufflation, then 10, 20, 30 and 40 minutes after insufflation, and again 10 minutes after peritoneal deflation. Significant increase [P<0.01] in MCAV in all the recorded values was found. This increase was attributed mainly to the accompanying rise in PaCO2. The present study concluded that CBF was increased significantly in laparoscopic procedures utilizing C02 as the insufflation gas. ft is recommended to avoid pneumoperitonium or to use it with extreme caution in patients with suspected or documented intracranial injuries due to the potential for significant increase in intracranial pressure [ICP] and alterations in cerebral perfusion pressure [CPP]

Comparison between percutaneous retrogasserian glycerol rhizolysis and percutaneous radiofrequency trigeminal gangliolysis for management of trigeminal neuralgia

Approximately 70% of trigeminal neuralgia [TN] patients are well controlled by medical management. Although they are well controlled initially, many of them will become non-responders and the majority of patients will eventually fail medical management. The aim of this work is to study the difference between 2 of the minor surgical procedures used for treatment of trigeminal neuralgia, namely, percutaneous retrogasserian glycerol rhizolysis [PRGR] and percutaneous radiofrequency trigeminal gangliolysis [PRTG]. Thirty two patients with intractable trigeminal neuralgia, had failed medical treatment were included in the study. The patients were divided into 2 equal groups according to the procedure used, PRGR group and PRTG group under fluoroscopic guidance. It was found that PRTG had faster onset of action, higher success and lesser failure rates than PRGR. Recurrence rates after 6 months and one year were 6.25% and 18.75% for PRTG and 12.5% and 25% for PRGR. The incidence of keratitis was higher with PRTG than PRGR while no case of anaesthesia dolorosa was reported in both techniques. In conclusion, both techniques are effective with relative advantages and disadvantages to each. PRTG disadvantages include requirements for a cooperative patient and access to radiofrequency equipment. Its great merits include high initial success rates and modest rate of recurrence. PRGR has a lesser initial success rate and a higher rate of recurrence than with the thermal therapy. It requires less patient cooperation and minimal equipment and appears to be associated with lower incidences of corneal anaesthsia and keratitis

comparison of bupivacaine 0.25% with ropivacaine 0.2% and 0.375% for caudal anaesthesia in children

Thirty- nine boys aged 3-7 yrs. ASA I. undergoing inguinal hernia repair were randomly allocated in this double-blind study. After induction of general anaesthesia, patients were given caudal injection [1 ml/kg] of bupivacaine 0.25% [B 0.25 group], ropivacaine 0.2% [R 0.2 group], or ropivacaine 0.375% [R 0.375 group]. The clinical effectiveness, the degree of motor block and any adverse effects were determined. Data were available for 36 children. The groups were comparable for demographic data and duration of surgery. The onset time of block was similar for B 0.25 and R 0.2 groups, but it was shorter for R 0.375 group [7.2 +/- 1.2 min, P<0.05]. A significantly longer [P <0.05] duration of analgesia was observed in the R 0.375 group [366 +/- 72 min], whereas the B 0.25 group [246 +/- 64 min] and the R 0.2 group [[268 +/- 81 min] were comparable. There was no difference [p >0.05] in the number of patients who did not require postoperalive analgesia in all groups. The degree of motor block was significantly lower [P <0.05] in the R 0.2 group than in the two other groups at 1.2 and 3 hours postoperatively. The mean time to first voiding was longer [P<0.05] in R 0.375 group compared to the two other groups. The mean time to first ambulation was significantly shorter [P< 0.05; in R 0.2 group compared to the two other groups. No significant difference was detected in the incidence of vomiting between the three groups. These findings suggest that caudal administration of 1 ml/kg of 0.2% ropivacaine provide equivalent analgesia to 1 ml/kg of 0.25% bupivacaine with less degree and duration of motor block. On the other hand ropivacaine 0.375% provides longer duration and better quality of analgesia but more intense motor block

Free oxygen padicals activity, some antioxidants and soluble intercellular adhesion molecule-1 in plasma of insulin dependent diabetics

The lipid peroxide malondialdehyde [MDA], a marker of free oxygen radicals activity [FORs], together with the three potent antioxidants, vitamin E, vitamin C and selenium as well as soluble intercellular adhesion molecule-1 [sICAM-1] were measured in plasma of 40 insulin dependent diabetic patients. Twenty age and sex matched healthy subjects were also studied as a control group. Plasma levels of the three antioxidants were significantly decreased in poorly controlled diabetic cases when compared to well controlled diabetics and controls. Also, vitamin E and selenium decreased significantly in well controlled diabetics compared to control group. Meanwhile, plasma level of both MDA and sICAM-1 increased significantly in diabetic patients compared to controls. In conclusion, FORs generation increased significantly in IDDM, while there was deranged antioxidant status in diabetics. Also, sICAM-1 levels increased significantly in diabetics and all these effects were more pronounced in poorly controlled cases

Comparative study between lamellar body counts and shake test for detection of fetal lung maturity

This study was designed to quantify the amniotic fluid lamellar body counts during the third trimester of pregnancy and compare this count with the bubble stability test in prediction of fetal lung maturity and occurrence of respiratory distress syndrome [RDS]. The study was conducted on 25 pregnant women attending Ain Shams University Maternity Hospital. The patients were in the third trimester and the gestational age ranged from 30 to 37 weeks.The gestational age was determined by the date of the last menstrual period and serial ultrasonography. New born Dubowitz assessment was also performed. Amniotic fluid samples were collected either by ultrasound guided amniocentesis or at the time of caesarean section. The present study showed that the choice of 30,000 particles/ul as a decision threshold for lamellar body counts gives the best prediction of respiratory distress syndrome. The sensitivity and specificity of lamellar body counting were 100%. It is more accurate in prediction of RDS than bubble stability test which have a sensitivity of 77.7% and a specificity of 93.4% at cut off point 2 test tubes positive bubble stability test. The present study showed a highly significant relation between lamellar body counts and bubble stability test, gestational age and birth weight. There was also a linear correlation between lamellar body counts and Apgar score at one and five minutes

Detection of campylobacter pylori by the biopsy unease test in 250 patients suffering from non ulcer dyspepsia

To detect C pylon by using the biopsy urease test [CLO test] [campylobacter like organism]. we chose 250 patients 146 female and 104 male suffering from non ulcer dyspepsia. For every patient upper GIT endoscopy was done 3 times. first time to choose the patient and two antral biopsy for CLD test, second time after one month from the start for CLO test follow-up. The change of colour from yellow to pink means positive CLO test. We found that 69.6%+ve CLO at 20 min and 91.2% at 4h. Follow-up of patients symptoms and correlation with CLO test result showed that 8.8% of patients were-ve CLO test from the start and continued negative for CLO test up to two months. Their dyspeptic symptoms improved after OTT. 91.2% were+ve at start, 61.6% of them become-ve CLO test after OTT [one month period]. 58.8% improved from dyspeptic symptom while 2.8% did not improve up to 2 months. 29.6% of patients showed persistent positivety of CLO test although they received OTT for one month but 2 7.2% improved from symptoms and 2.4% did not improve. After two months the percentage of+ve CLO test increased to 59.2% but 33.6% improved symptomatically, 25.6% did not improve. the percentage of -ve CLO test decreased from 61.6% to 32%: 29.2% improved symptomatically and 2.8% did not improved. In conclusion, CLO test is very useful rapid diagnostic test for C. pylori infection and is very useful in follow-up