therapeutic effect of ovarian wedge resection in women with polycystic ovarian disease after unsuccessful ovulation stimulant drugs

To evaluate the effect of ovarian wedge resection [OWR] on clinical features, circulating gonadotropins, insulin, total testosterone and fertility outcome in women with polycystic ovarian disease [PCOD], 15 infertile women attending the infertility clinic of Tanta University Hospital were chosen for this work. All these cases have been previously submitted to ovulation-stimulant drugs [clomiphene citrate, urinary follicle stimulating hormone and human menopausal gonadotropin] but failed to ovulate or conceive. Normal thyroid function, normal serum prolactin levels, euglycemia and normal hysterosalpingogram were found in all studied cases. OWR was done with follow up for 6 months for all cases. They were evaluated by the clinical features [amenorrhea, oligomenorrhea, hirsutism, obesity and fecundity], serum concentration of hormones [LH, FSH, LH/FSH ratio, testosterone, insulin and progesterone] and pelvic ultrasonography. Ten healthy women were selected for reference data collection. This study revealed that the incidence of menstrual disturbance, ovulation and pregnancy rates were improved [86.6%, 86.7% and 53.3% respectively] after OWR. Furthermore, women with PCOD showed hyperinsulinemia before and after operation. Positive correlations between high levels of insulin with both LH and testosterone were found before OWR [r=0.98 and 0.95 respectively; P< 0.05], while no correlation was detected after operation [r=0.21 and 0.25 respectively; P > 0.05]. Total testosterone was increased [> 0.80 ng/ml] in 14 [93.3%] women with PCOD while after operation, it declined to reach a lowest frequency of 6.7% when compared with the other hormonal markers. Also, there was a significant increase of serum progesterone level after wedge resection. We concluded the OWR has a significant role in women with PCOD by improvement of menstrual irregularities, ovulation and pregnancy. Also, serum total testosterone concentration is considered to be the best biochemical marker in the diagnosis and prognosis of PCOD before and after OWR

effect of mode of delivery and types of anaesthesia on fetal welfare

This study was carried out on 60 non complicated healthy full term pregnant females and their neonates to study the effect of the mode of delivery and types of anaesthesia [general or epidural] on fetal welfare. The were divided into 4 equal groups, group I [natural vaginal delivery], group II [vaginal delivery under epidural anaesthesia, group III [elective cesarean section under general anaesthesia] and group IV [elective cesarean section under epidural anaesthesia]. For all of them, the plasma catecholamines and cortisol levels were measured. In groups I and II, the first sample was taken at 4-6 cm cervical dilatation and the second at the time of delivery of the head, while in groups III and IV, the first sample was taken just before induction of anaesthesia and the second sample at the time of uterine incision. Arterial blood gases for all parturients were done at the time of delivery of the head in groups I and II and at the time of uterin incision in groups III and IV. Fetal arterial samples were taken from the umbilical cord for all neonates for measurement of plasma catecholamines, cortisol and blood gases. Also, APGAR score at 1 and 5 min, was recorded. The of this study showed that the maternal catecholamines and cortisol levels increased significantly in group 1 and III while they decreased significantly in group II and group IV. The fetal catecholamines and cortisol increased significantly in groups I and II when compared with groups III and IV, also it increased significantly in group IV when compared with group III. The results of this study showed that the fetal outcome were similar in the 4 studied groups as judged by APGAR score and blood gases analysis. So, the conclusion of this study is that epidural anaesthesia during vaginal delivery or cesarean section may be of value for fetal welfare

role of clinical parameters and laboratory tests for early identification and severity assessment of pregnancy induced hypertension

The purpose of this study is to evaluate the role of the clinical parameters and laboratory tests for early recognition and severity assessment of pregnancy-induced hypertension [PIH]]. Blood pressures, proteinuria, isometric handgrip exercise test, serum uric acid and plasma fibronectin were measured in 100 healthy normotensive primigravid women during the first, second and third trimesters of pregnancy and 7 days postpartum. Of the 100 gravid women, 85 did not develop clinical PIH [no PIH], 11 developed mild PIH and 4 demonstated severe PIH. The systolic, diastolic and mean blood pressures were significantly elevated [p< 0.001] in gravid women who developed PIH when compared to values of the normotensive gravid women from the 12 weeks' gestation onwards. Specificity, for predicting PIH early in pregnancy [13-20 weeks] with blood pressures [130 to 135 / 80 to 85 and MAP 90 to 95 mmhg], ranged from 79.2% to 86.6% and the negative predictive values [NPV] from 84.1% to 88.2%. The diastolic blood pressure had a high relative risk [4.9] among other blood pressure values. The isometric handgrip exercise tarts had a specificity of 90.3% and NPV of 92% with a relative risk [7.4] for PIH. The most significant difference [t=10.12; P< 0.001] of elevated uric acid values between women who developed PIH and the normotensive gravid women was observed form 35 to 35 weeks' gestation after the appearance of hypertension and proteinuria [29-34 weeks]. The specificity and NPV of uric acid were 45.1%, 42.2% respectively with a relative risk [1.5] Fibronectin increased from 83 +/- 15% in the first trimester to 190 +/- 37% of normal at term in women who developed PIH versus 75 +/- 20% to 88 +/- 15% in normotensive women. Fibronectin levels increased [13-20 weeks] earlier than the onset of hypertension and/or proteinuria [29-34 weeks] with specificity of 90.9%, NPV of 89.2% and a relative risk of 8.3. After delivery, fibronectin decreased only in PIH patients [t=9.57; P< 0.001]. A significant positive correlations [P< 0.001] between uric acid and fibronectin with MAP in patients with established PIH were observed

necessity of dextrose infusion in children undergoing adenotonsilectomy

Children undergoing adenotonsillectomy operations may be subjected to unduely prologed pre-operative starvation. The aim of the study was to confirm the necessity of dextrose infusion to avoid starvation-induced hypoglycemia. 60 children scheduled for adenotonsillectomy were divided into two equal groups. First group was operated upon at 10-11 AM and the other one was operated upon at 12-1.30 PM after overnight fast. Blood glucose was estimated at induction of anesthesia, 30 minutes after induction and 4 hours after operation and compared with fasting level. Anesthesia was induced by thiopentone sodium and succinyl choline and maintained by nitrous oxide, oxygen and halo thane. 9% dextrose infusion was started after induction of anesthesia in a dose of one gram per Kg body weight in a formulated rate of infusion. 4 children in group II were hypoglycemic at induction of anesthesia and none was hypoglycemic 4 hours after operation

Sequential changes of serum immunoglobulins and acute phase reactant proteins following anesthesia and surgery

The effects of halothane and enflurane anaesthesia as well as surgery on immunoglobulins and acute phase reactant proteins were studied in 30 patients undergoing minor elective body surface operations. 30 min. Halothane and enflurane anaesthesia alone without surgery produced significant decrease in IgG and IgM. Surgical stimulation produced more significant changes in both groups. No change was observed in the concentration of hapteglobin and a[2]- macroglobulin after 30 min. enflurane anaesthesia before the start of surgery while halothane anaesthesia produced significant effect. However, surgical stimulation markedly decreased their levels significantly in both groups denoting that surgical stress is a factor involved in impairment of immune response