Randomised comparison of different insufflation pressures in diagnostic and minor gynecologic laparoscopic surgery

Determine the influence of low-pressure pneumoperitoneum on intraope-rative heamodynamic effects and postoperative shoulder-tip pain [STP] in patients undergoing diagnostic and minor gynecologic laparoscopie procedures. Prospective randomized study conducted in the endoscopic unites at Zagazig and Benha university hospitals. The study comprised 80 women undergoing diagnostic and minor laparoscopic procedures where pneumoperitoneum with high Co2 pressure [13-15 mHg] used in 40 women [group A] and with low Co2 pressure [7-10 mNg] in another 40 women [group B]. There was significant increase in the mean arterial pressure [MAP] in both groups at [5 mm.] after insufflation and tilting the patient to Trendelenberg position but there was significant decrease of [MAP] in [group B] as compared to [group A] [P< 0.05]. Both the frequency and intensity of postoperative shoulder-tip pain were lower in [group B] than in [group A], [[20%], [5.1]] versus [[35%], [7.4]] and the differences were statistically significant, especially at [6, 12, 24, 48] hours postoperatively. There was significant reduction of the mean amount consumed analgesic [declophenac potassium] in [group B] compared to [group A] [75 mg] versus [131.25 mg]. Low-pressure pneumoperitoneum used in diagnostic and minor gynecologic laparoscopic procedures allows more stable intraoperative hemodynamics of the patients and reduction of both frequency and intensity of postoperative shoulder-tip pain, with reduction of postoperative analgesics used

Association between spontaneous echocardiographic contrast in descending aorta and platelet factor 4 and D-dimer in patients with non-rheumatic atrial fibrillation

The aim of this study was to determine the relationship between spontaneous echocardiographic contrast in the descending thoracic aorta and plasma levels of platelet factor 4 [PF4] and D-dimer as hemostatic markers in patients with nonrheumatic atrial fibrillation. This study included 60 patients [mean age, 58 +/- 3 years; 34 males] with non-rheumatic chronic atrial fibrillation who underwent transesoph…geal echocardiography Plasma levels of PF4 as. a measure of platelet activation and D-dimer as an index of thrombogenesis were determined on the day of TEE. 27 patients who had aortic spontaneous echocardiographic contrast [Ao-SEC] were older [61 years vs 57 years; p<0.05 than 33 patients without AoSEC. D-dimer levels were significantly higher in patients with AoSEC than in those without AoSEC, whereas PF4 was not different between the two groups. Although the prevalence of prior cerebral embolism did not differ between the two groups [22% in patients with AoSEC vs 18% in patients without AoSEC], the prevalence of peripheral arterial embolism was r in patients with AoSEC than in those without AoSEC [11% vs 0%; p<0.05]. The LA appendage peak flow velocity was significantly lower in patients with AoSEC than in those without AoSEC. The grade of LASEC and the prevalence of LA thrombi were higher in patients with AoSEC than those without. Although aortic dimensions did not differ between the two groups aortic atherosclerotic grade was greater in patients SEC than in those without AoSEC. Multivariate analysis revealed that mitral regurgitation, LASEC, and aortic atherosclerosis emerged as independent predictors of AoSEC. Search for AoSEC in addition to LA appendage dysfunction with TEE could provide valuable information on prothrombotic state in patients with nonrheumatic AF. Patients with nonrheumatic AF complicated with AoSEC could have enhanced thrombogenesis; therefore, intensive anticoagulation with oral warfarin may be recommended for these patients

Evaluation of selective oestrogen receptor modulators [raloxifene] on bone mineral density, serum lipids and uterine endometrium in early postmenopausal women

This study was to evaluate the effect of the second generation selective oestrogen receptor modulator [SERMs], raloxifene, on bone mineral density, serum lipid concentrations, and endometrial thickness in 100 postmenopausal women. The women were divided into two equal groups of 50 women each, and were randomly assigned to receive 60 mg of raloxifene or placebo daily for 24 months. This study revealed that women receiving [SERMs], raloxifene had significant increases from base-line values in bone mineral density of the lumbar spine, hip, and. total body, whereas those receiving placebo had decreases in bone mineral density. Serum concentrations of total cholesterol and low-density lipoprotein cholesterol decreased in the raloxifene group, whereas serum concentrations of high-density lipoprotein cholesterol and triglycerides did not change. Endometrial thickness were comparable in the raloxifene and placebo groups at all times during the study. The proportion of women receiving raloxifene who reported hot flashes or vaginal bleeding were not different from that in women receiving placebo. Selective oestrogen receptor modulator [SERMs] Raloxifen at a dose 60mg per/day increases bone mineral density, lowers serum concentration of total and low-density lipoprotein cholesterol, while has no effect on the endometrium or the breast

Volume homeostasis in schistosomal patients with and without renal involvement

The aim of this study was studying some humoral and renal mechanisms controlling volume homeostasis during volume expansion and volume depletion among schistosomal patients with and without renal involvement. The subjects included in this study were ten non ascitic schistosomal patients [group A], another ten non ascitic proteinuric schistosomal patients [group B], ten control subjects [group C]. All groups were subjected to full history taking, clinical examination and investigations [stool analysis or rectal snip biopsy, urine analysis and urine protein estimation, renal function tests, liver function tests, hepatitis viral markers and percutaneous renal biopsy for nephrotic patients]. Experimental protocol included two studies: study I: this included infusion of isotonic saline [0.9%] in a dose of 40 ml/kg body weight over 30 minutes for acute volume expansion. Study 2: this included the administration of furosemide in a dose of 0.75 mg/kg body weight during one minute. The change in plasma volume after each study was calculated. Estimation of at rial natriuretic peptide [ANP] by radioimmunoassay basally and 1 hour after the study, plasma renin activity [PRA] and plasma aldosterone [PA] were done pre-study as well as, 1,2, and 3 hours post study. Fractional excretion of sodium, urinary sodium excretion rate, free water clearance as well as urinary flow rate were calculated before and after the study. Serum proteins and serum albumin were significantly lower in the schistosomal proteinuric group [group B]. Prothrombin activity showed a significant decrease in both groups A and B. All subjects of the three groups were negative for the studied viral markers. All nephrotic patients [group B] were biopsied and revealed membrano-proliferative type of glomerulonephritis. The percentage increase and decrease in plasma volume after volume expansion and depletion were comparable in the three studied groups with no significant difference. The basal ANP showed no significant difference between the three groups, it showed a significant rise especially in group B after volume expansion and a significant decline after volume depletion in the three groups. Schistosomal proteinuric patients [group B] showed incomplete suppression of PRA after volume expansion, there was a sustained rise in PRA and PA in schistosomal patients [group A] after volume depletion. The basal PA was significantly higher in schistosomal patients [group A] than the controls, it showed a significant decrease after volume expansion in the three studied groups. Fractional excretion of sodium showed a significant rise after volume expansion in the three studied groups, there was a significantly lower value in the first hour interval in all schistosomal patients [group A and B] than that of the control group[C], after volume depletion it showed a significant rise in the first and second hours only in all schistosomal patients [A and B]. Urinary sodium excretion rate showed a significant increase after volume expansion in the three studied groups, but the natriuresis was found to be impaired after the first hour in all schistosomal patients [group A and B] in comparison to the control subjects [group C]. After volume depletion,urinary sodium excretion rate showed a significant increase in the three studied groups. All schistosomal patients [group A and B] showed blunted natriuretic and diuretic response to furosemide when compared to the control group [C]. Free water clearance after volume expansion showed a significant rise in the first hour interval in group A, in the first and second hour interval in B and in the three hours intervals in C. After volume depletion there was no significant difference in the basal, first,second, and third hour interval values between the three groups. Urine flow rate increased significantly after volume expansion and diuretics in the three groups. All schistosomal patients [group A and B] showed significant lower values in the first and second hour after both volume expansion and depletion than the controls. ANP was involved in the regulation of blood volume in schistosomal patients with and without proteinuria. The high basal aldosterone levels in schistosomal patients may be related to impaired metabolic degradation rather than increased production. There was blunted natriuresis and diuresis in schistosomal patients early in the preascitic stage, this may be due to resistance to the properly released ANP. This resistance was related neither to its hypotensive action nor to hyperaldosteronism.The impaired urinary sodium excretion may be related to the increased tubular reabsorption. Schistosomal proteinuric patients tended also to retain sodium inspite of the proper hormonal response, so renal resistance may be a cause. Schistosomal patients tended to retain water and the ability to excrete free water was better in schistosomal proteinuric There was a state of diuretic resistance to furosemide in schistosomal patients with and without proteinuria

comparison of two regimens of intravaginal misoprostol for termination of second trimester pregnancy

The aim of the work was to compare two different regimens of intravaginal misoprostol in termination of second trimester pregnancy. In a prospective study, 60 pregnant women were admitted in the Zagazig University Hospital with the diagnosis of missed abortion of intrauterine fetal death, with gestation between 14 and 20 weeks were recruited into the study with 30 subjects in each group. Women in [group A] were given vaginal misoprostol 200 micro g every 6 h while women in [group B] were given vaginal misoprostol 400 micro g every 12h if women did not abort in 24h, the same regimen was repeated. The mean amounts of misoprostol administered in [group A] was 600 micro g [ +/- 356.22] and in [group B] was 626.67 micro g [ +/- 309.54] arid the difference was statistically insignificant. The mean induction-abortion interval in [group A] was 16.17h [ +/- 10.05] and in [group B] was 14.97h [ +/- 7.41] and the difference was statistically insignificant. After vaginal misoprostol administration, there was significantly increase in the incidence of incomplete abortion rate in [group A] than in [group B]. However there was significantly decrease in the incidences of other side effects [vomiting, diarrhoea, fever, pain] in [group A] than in [group B]. It is concluded that both regimens of vaginal misoprostol 200 micro g every 6h and 400 every 12h were effective in termination of second trimester abortion with less side effects in the first regimen

Delayed sternal closure: a life saving maneuver after open heart surgery

Sternal closure following open heart surgery may lead to life-threatening respiratory and hemodynamic embarrassment. To avoid a fatal outcome in these situations, sternal closure was postponed in seven patients by suturing the skin edges only. This maneuver, in a setting of optimal inotropic and ventilatory support allowed five patients out of seven [4 males and 3 females age at operation was 25 years and the mean weight was 60.8 kg] to survive. The diagnosis was rheumatic heart disease with different valve lesions in five patients and congenital heart disease [Fallot tetralogy] with previous shunt in two patients. The mean cross-clamp time was 95.8 minutes and the mean bypass time was 131.4 minutes. The indications for delayed sternal closure [DCS] was massive post bypass mediastinal bleeding in five patients and tamponade like symptom in two patients [myocardial edema]. The time of secondary sternal closure ranged from 8-24 hours. The overall morbidity was represented in two patients in the form of superficial wound infection. By this procedure, the life of any patient could be saved with cardia or respiratory embarrassment following open heart surgery

Effect of light on fertility: an experimental study

To assess the influence of various light-dark cycles on the reproductive system of sexually immature male albino rats, 64 immature rats were included in this study. The rats were grouped into 4 equal groups: Group I: exposed to long photoperiod, Group II: exposed to short photoperiod. a Group III: exposed to complete darkness Group IV: control group exposed to natural day light. These groups were divided into 2 equal subgroups and received treatment for 1 and 3 months respectively. The rats were sacrificed following daily exposure, blood was collected, and plasma was separated and used for determination of L.H.-and testosterone by RIA. The testes were dissected, weighed and prepared for histological study. The rats exposed to long photoperiod had reached puberty earlier than the control. While those exposed to short photoperiod and complete darkness remained immature. Testicular weight and number of round spermatids had significantly increased in long photoperiod group compared with control, while those exposed to short photopericd and complete darkness group had significantly reduced testicular weight and less number of round spermatids compared with controls. LH and testosterone were significantly increased in Icng photoperiod group compared with control, short photcperiod and complete darkness group. The alterations observed in short photoperiod and complete darkness exposed rats were presumably due to inhibitory effect of melatonin on the neuroendocrine gonadal axis in those animals

Incidental prostatic carcinoma: incidence and follow-up study

The incidence of incidental prostatic carcinoma has been studied in a series of 110 prostatectomy specimens, diagnosed clinically as benign prostatic enlargement without any clinical, laboratory or radiological evidence of malignancy. Age varied from 52-80 years. Pathological examination of serial sections of each specimen revealed two groups, the first group formed of five cases, small in size [less than 3 mm in diameter], localized without any infiltration of prostatic tissue. They were diagnosed as well differentiated adenocarcinoma. The second group formed of four cases, with larger size up to 8 cm in diameter. They were diffuse and infiltrating prostatic tissue. Two cases were diagnosed moderately differentiated adenocarcinoma, and the other two were poorly differentiated. Follow up study was done for three years, the first group showed no evidence of local recurrence or distal spread, one of the moderately differentiated cases showed local recurrence after one year, but the poorly differentiated cases died within six months

Serum sodium level in children receiving home-mixed oral rehydration solution

This study aimed at studying the serum sodium level in infants receiving home-mixed oral rehydration solution [ORS] for the prevention and treatment of dehydration caused by acute infantile diarrhea. It included 100 infants aged from 2-18 months, having received ORS at home during the last 24 hours. All cases were subjected to full clinical examination and to a questionaire about the amount, the reconstittution of ORS as well as any other food or additional fluids adminestered with it. The questionaire included also an inquiry on the source of knowledge of the mothers about ORS and feeding practice during diarrhea. Measurement of serum sodium proved that it ranged from 120-170 with a mean of 142.2 +/- 10.36 m Eq/Litre a value which though still within normal range was significantly higher than that reported for normal controls of matching age. Only 6% of patients showed a serum sodium level above 150 m Eq/Litre and all were asymptomatic. A positive correlation could be found only between serum sodium level and the degree of dehydration. The results were discussed