effect of betadine versus chamomile on pain relief and healing process of episiotomy among primiparea

The aim of this study is to examine the effect of betadine versus chamomile on pain relief and healing process of episiotomy among primiparae. A sample of [90] postpartum women were selected from the post partum unit of Elshatby Maternity University Hospital in Alexandria. They were equally divided into two study groups. Each group was instructed to apply one of the intervention modalities: betadine or chamomile for ten days. Three tools were used for data collection. The first was a structured interview schedule to elicit the socio-demographic characteristics of the subjects. The 2nd tool was the healing and pain assessment scale which comprised 2 parts: the Reeda scale [RS] to evaluate the condition of the perineum before and after intervention; and the visual analoge scale [VAS] to assess the pain intensity before and after intervention. The 3rd tool was an observation follow up check list to assess the healing process of episiotomy among the two groups. The results revealed that women using chamomile significantly achieved complete or maximum recovery earlier and faster than women using betadine

Anatomical study of the arterial supply of the superior and inferior lips

The perioral region, being a site for many surgical reconstructive flaps, has become a target for many researches. The aim of the present study was to investigate the arterial supply of both upper and lower lips to provide an anatomical basis for alternatives of reconstruction methods in the perioral region. Forty two cadaveric face sides [21 preserved adult human cadavers] and 8 fresh face sides [4 stillbirths] were dissected after injection of the common carotid arteries with red latex. The facial artery and its branches, supplying both lips were dissected. The origin, course, branches, length, external diameter at their origin and anastomosis of both superior [SLA] and inferior [ILA] labial arteries were studied. The upper lip was constantly supplied by the SLA supplemented by an additional branch from the facial artery in only 10% of specimens. According to the mode of origin of the SLA, four patterns were observed. In type A [66%] the SLA was a side branch from the facial artery, type B [12%], it originated from the lateral nasal artery. It was one of the two terminal branches of the facial artery with either the ILA [type C, 12%], or the lateral nasal artery [type D, 10%]. The level of origin of the SLA was either above [72%], at [16%] or below [12%] the level of labial commissure. The mean distance between the origin of SLA and the labial commissure was 17.59 mm. The mean external diameter of the SLA at its origin was 1.69 mm. Its mean length was 52.19 mm. In 88% of specimens the SLA gave septal and anastomotic branches, while in 12% of specimens the septal branch originated from the facial artery above the origin of the SLA. The lower lip was supplied by the ILA in all specimens. Supernumerary branch from the facial artery proved to participate in the supply in 12% of specimens. The mean distance between the origin of ILA and the labial commissure was 27.5 mm while that for its external diameter at its origin was 1.86 mm. Its mean length was 60.81 mm. Both the SLA and the ILA coursed deep to the orbicularis oris muscle. The present results proved the great potentials for perioral flaps based on SLA or ILA. The vessels are long enough for rotation flaps. They can provide full thickness flap as they supply the entire thickness from skin to mucosa. They have a diameter large enough to allow microsurgical anastomosis. Free anastomosis between the labial arteries across the midline insures adequate nourishment of the donor lip

Anesthetic implications for video assisted thoracoscopic thymectomy in myasthenia gravis

Thymectomy is an established therapy in the management of generalized myasthenia gravis [MG]. However, the optimal surgical approach to thymectomy has remained controversial. There are advocates for transternal, transcervical approaches for "maximal" thymectomy. Video-assisted thoracoscopic thymectomy [VATT] presents new approach to thymectomy. By minimizing chest wall trauma, VATT not only causes less postoperative pain, shortens hospital stay, gives better cosmetic results but also leads to wider acceptance by patients for earlier surgery. Anesthesia for thymectomy in MG is challenging. Currently we are using non-muscle relaxant technique [NMRT] which we adopted in 1994, for maximal thymectomy. In this paper, we present our limited experience with two cases of VATT using two different NMRTs. Two cases of MG underwent VATT under general anesthesia [GA] and one lung ventilation [OLV] using double lumen tube [DLT]. In both cases NMRT was used which encompass, light GA plus thoracic epidural analgesia [TEA] in one case and without TEA in the other case. We believe that the use of NMRT provides good operative and postoperative conditions. In this report we have described two different NMRTs, one with TEA and the other without. Further studies are needed on large number of cases to establish an anesthetic protocol for VATT

Predictors of outcome in thymectomy for myastuenia gravis

Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis [MG] however, the optimal selection of patients for surgery remains controversial. The objective of the study is to evaluate the outcome and relevant factors influencing improvement and remission after thymectomy for MG by analyzing patients data. We retrospectively reviewed our experience in the surgical management of patients with MG over the last 10 years, and analyzed if patient's age, sex, preoperative Osserman stage, duration of symptoms and thymic histology influence outcome according to : [a] The dose of pyridostigmine and other drugs as steroids that the patient took before and after thymectomy and [b] the Osserman stage before and after thymectomy, the patients were divided into 4 groups: [1] Patients in remission. [2] Patients with improvement. [3] Patients with no change and [4] patients who were worse. There were 60 females [67%] and 30 males [33%] their age range from 20-67 years with average age 32 years. Most of them presented with Osserman stage IIA [n=36] and IIB [n=42]. Hyperplasia of the thymus was observed in 45 patients [50%], thymoma in 30 patients [33%] and the remaining 25 patients [28%] were atrophic or normal thymus. Computed tomography [CT] had a positive predictive value of 88% in detecting thymoma and of 79% in detecting hyperplasia. Over a mean follow-up of 14 months, a good response to thymectomy was observed in 61 patients [68%] while 29 patients [32%] had bad response. No relation was observed between outcome and sex, poor response is associated with old age, long duration of illness before surgery use of steroids, osserman stage I and IIA and patients with thymoma. The good response to thymectomy was high [69%] and the variable that had prognostic importance were age, Osserman stage duration of illness before surgery and thymic histology

Impact of isolated aortic valve replacement for aortic stenosis on associated functional mitral regurgitation

The impact of isolated aortic valve replacement [AVR] for aortic stenosis [AS] on associated functional mitral regurgitation [MR] remains unresolved. The purpose of our study is to determine the effect of isolated AVR for AS on the severity of associated functional MR, and to assess the predictors of improvement of MR. Our prospective study from October 1999 to June 2003 included 58 patients, 39 males and 19 females with mean age 27.9 +/- 10.7 years [ranging between 15-47 years]. They were all presented with combined rheumatic valvular aortic stenosis and functional mitral regurgitation and all underwent isolated aortic valve replacement. On pre-operative echocardiography studies, 13 patients had mild, 21 had mild to moderate, and 24 had moderate MR. For the entire group of patients, there was improvement in MR severity after AVR in 49 patients [84.5%], no change in 8 patients [13.8%] and worsening in only one patient [1.7%]. According to the grade, after AVR with mild MR, 8 of 13 of patients [61.5%] had improved MR; in those with mild to moderate MR. 19 of 21[90%] had improved MR; and those with moderate MR, 22 of 24 [91.7%] had improved MR. For those patients with preoperative mild MR. the postoperative improvement in the severity of MR was statistically significant [p<0.05]. For those patients with preoperative moderate or mild to moderate MR. the postoperative improvement in the severity of MR was statistically highly significant [p<0.01]. Correlation analysis in our study showed that, the change in severity of MR was significantly associated ith reoperative left ventricular LV] ejection fraction [p=0.027], LV mass [p<0.05] and left atrial [LA] size [p=003]. Patients with moderate functional MR or less degree combined with rheumatic valvular AS should have excellent results with isolated AVR. The lower preoperative LV ejection fraction, the higher preoperative LV mass and the larger LA size preoperatively were predictors of improvement of MR severity after AVR

diagnostic role of mediastinoscopy in isolated mediastinal tuberculous lymphadenopathy

Isolated mediastinal tuberculous lymphadenopathy without a pulmonary parenchymal lesion is still a diagnostic challenge. The diagnostic yield of noninvasive methods is low in these cases. From July 1995 to June 2002, 39 patients with suspected isolated mediastinal tuberculous lymphadenopathy without any demonstrable pulmonary parenchymal lesion and with negative diagnostic noninvasive methods underwent mediastinoscopy as a final diagnostic step for diagnosis. These cases where reviewed retrospectively. The mean age was 36.3 years [range, 9 to 64 years] and 24 were male. The most common symptom was cough in 32 patients and 7 were asymptomatic. In all cases chest x-ray [CXR] and computed tomography [CT] chest showed isolated mediastinal lymphadenopathy with Involvement of the right paratracheal nodal group in 33 cases. In 27 patients [group 1], Multiple biopsies of 2 to 4 mediastinal nodal groups diagnosed tuberculous lymphadenitis in all patients; in 4 of them nonspecific inflammatory nodes were also sampled. The diagnostic yield [sensitivity] in group 1 was 100%. In 12 patients [group 2] who had biopsies of one mediastinal nodal group, the diagnosis could not be established in 3 patients and the diagnostic yield was 75%. In both groups the diagnostic yield of mediastinoscopy was 92%. It was concluded that when used effectively, mediastinoscopy was acceptable as a final diagnostic step in patients with suspected isolated mediastinal tuberculous lymphadenopathy without a pulmonary parenchymal lesion because of its high diagnostic yield

Video-assisted thoracoscopic surgery for first- time primary spontaneous pneumothorax: is it justified?

It is now increasingly under discuss ion whether the indication for treatment of primary spontaneous pneumothorax [PSP] by video-assisted thoracoscopic surgery [VATS] should include first-time episodes. The aim of this study was to evaluate whether VATS is justified at the onset of a first-time PSP. This prospective study includes 67 patients affected by first-time PSP, divided into two groups according to the therapeutic treatment done for them. The first group [34 patients] underwent pleural drainage while the second [33 patients] underwent VATS. Parameters analyzed were as follows: [1] prolonged air leaks [>48 hours]; [2] time required for pleural drainage; [3] time of hospital stay; [4] recurrences. In our study no postoperative compliocaitons occurred in both groups except prolonged air leaks occurred in eight patients [23.5%] in the first group and one patients [3%] in the second. Mean time +/- SD for drainage and hospitalization was, respectively, 6.4 +/- 0.2 and 8.2 +/- 0.6 days in the first group against 3.5 +/- 0.1 and 4.3 +/- 0.2 days in the second group- During follow-up [median 13.2 months], recurrences occurred in 15 patients in the first group [44.1%], and only one in the second group [3%]. In comparison there were statistically significant differences between both groups as regard all parameters [P<005]. We conclude that the use of VATS at first-time PSI' is justified as demonstrated by its safety, shorter hospital stay and very low% age of recurrences

Parasitic infections and maternal awareness of preschool children in Karmouz district, Alexandria

A cross-sectional study was conducted on 256 children and their mothers in a poor urban district to assess the mothers' knowledge and practices as regards parasitic infections and infestations that may be present in their preschool child and to correlate the presence of these infections with their awareness. A pre-designed questionnaire that included sociodemographic data, items to assess the mothers' knowledge about the sources and preventive measures of parasitic infections and infestations and their practices was completed. A stool sample was collected from children and examined using formol- ether techniques. Sellotape technique was used to detect Enterobius vermicularis. Pediculus capitis was diagnosed by the inspection of the scalp. The majority of mothers were found to be aware that their children had a parasitic infection which was significantly associated with results of stool analysis. Appropriate and detailed control methods of parasitic infections and pediculosis must be taught and applied by parents and community. Socioeconomic development, organized health programs and motivation should be undertaken