Comparative study of two surgical methods used for rectocele repair

The present study was carried out to evaluate traditional repair of rectocele [posteriorcolpoperineorrhaphy] versus prolene mesh repair of rectocele.The study was carried out on 40 patients divided into two equal group; [I] and [II]. This study wasconducted in Alexandria University Shatby Maternity hospital from May 2005 to April 2006 with an averagepostoperative follow up period of 6 months.It was found that mesh repair of rectocele is superior over the traditional posteriorcolpoperineorrhaphy. This new technique takes less operative time and complications, less post-operativecomplications and a better improvement of patient symptoms.mesh repair of rectocele is a safe technique with a reasonable success and accepted rate ofcomplications. However, more researches are needed to prove the success of this technique over a longerperiod of follow up. It is probable that no single technique can correct all rectoceles because of their diverseanatomic and functional components. Prolene mesh repair of rectocele has a favorable rate of symptomresolution with a low rate ofdenovo symptoms. The technique appears useful for properly informed patientswhose goals are reduced protrusion, improved defecation and avoidance of dyspareunia

correlation between the serum testosterone level and insulin sensitivity in patients with pre-eclampsia-eclampsia syndrome

To study serum testosterone level, insulin sensitivity and their correlation in mild, severe pre-eclasmpsia and eclampsia compared to normal pregnant women. The study included sixty patients. All were primigravidae, in 3[rd] trimester, they were divided into two groups, the first was normal control group [15 cases] and the second group [45 cases] was subdivided equally into three subgroups mild, severe pre-eclampsia and eclamptic cases. All cases were subjected to fasting venous blood sampling to measure glucose, insulin, total and free testosterone. The mean fasting serum testosterone [total and free] increased in pre-eclamptic toxemia cases significantly compared to the control group and in between subgroups, P was = 0.027 and 0.000 respectively. The mean fasting insulin level increased in pre-eclamptic toxemia significantly compared to control group and in subgroups p= 0.013. Mean fasting levels of testosterone, [total and free] were significantly higher in primigravidae with pre-eclampsia-eclampsia syndrome than in normotensive women with similar gestational ages. Levels of mean fasting insulin also were significantly higher than normotensive women. So there is positive correlation between hyperandrogenism and hyperinsulinemia or insulin resistance in preeclampsia-eclampsia syndrome

Randomized comparison of glycerol trinitrate and misoprostol for cervical ripening at term

The study was undertaken to assess efficacy and adverse effects of glycerol trinitrate compared with misoprostol for cervical ripening at term. The study was conducted on sixty term pregnant females with unfavorable cervices, Bishop score < 6, referred for induction of labor. They were randomly assigned, and divided into 2 groups: Group [A]: Includes thirty cases where Misoprostol [Cytotec] 200 micro g/tablets will be used vaginally, 50 micro g/6 hours maximally. Group [B] includes thirty cases where Nitroglycerine [Dinitra 5 mg] tablets/ 6 hours, vaginally, two doses maximally. Women were sent to the labor ward for amniotomy or oxytocin, if their Bishop scores improved more than 6 or their cervices were not ripe 24 hours after treatment, then the adverse effects, changes in Bishop scores, progress and outcome of labor were assessed. This study indicated that there was no significant difference as regards Bishop score in between both groups, but the median of Bishop scores 12 hours after PGE[1] analogue [Misoprostol] was higher than glycerol trinitrate. PGE[1] analogue [Misoprostol] group A had shorter mean duration from the start of medication till the start of pain than glycerol trinitrate [group B], the mean was 12.33, 12.12 hours respectively. Also, the time elapsed from induction till delivery was also significant in this group. P=0.001. There was highly significant tachysystole in group A, while headache, dizziness and palpitations were seen only in group B.10%, 10%, 13.3% of cases respectively, low Apgar score after 1 minute was significantly evident in group A compared to group B. Glycerol trinitrate is less effective than PGE[1] analogues [misoprostol] for ripening at term. It causes less tachysystole than misoprostol but headache, dizziness, palpitation are more in glycerol trinitrate group. Further study is needed to determine optimal dose and effectiveness of glycerol trinitrate for cervical ripening