effect of hysterectomy on psychiatric morbidity [anxiety and depression]

To evaluate the psychiatric morbidity [anxiety and depression] in women underwent an abdominal and vaginal hysterectomy of a benign indication. This is a prospective observational study which was done in the Obstetric and Gynecology and Neuropsychiatry Departments, Sohag University Hospital. One hundred and two women were scheduled for undergoing hysterectomy after fulfilling the inclusion criteria. All women underwent a thorough history taking, clinical examination and complete psychiatric history. General health questionnaire [GHQ-28] was used to assess women with psychiatric co-morbidity before and after the operation. All women with psychiatric co-morbidity were re-evaluated by Beck depression inventory [BDI] and Hamilton anxiety scale [HAMA] before and after hysterectomy. On screening for psychiatric co-morbidity using the GHQ-28 for the 96 women who completed the follow up protocol of the study 35 [36.46%] scored >/= 4 [Group I] with psychiatric co-morbidity, and 61 [63.54%] scored <4 [Group II] without psychiatric co-morbidity. GHQ-28 was reapplied to all women in group II [post-operatively] where 48 [78.69%] scored >/= 4 [group IIa] and 13 [21.31%] scored <4 [group IIb. Severe anxiety and depressive symptomes were the most common presentation after the operation and represented 8 [40%] and 8 [53.3%], of patients of group I, respectively. In patient, of group II [without psychiatric morbidity] after hysterectomy, depressive and anxiety symptoms was the most common presentation in nulliparous women and was found in 7 [63.64%] and 3 [27.27%], respectively. However, the least depressive and anxiety symptoms was observed in women with parity >/= 5 and was found in 12 [38.7%] and 9 [29.03%], respectively. It is not worthy that the majority of women free from psychiatric co-morbidity was observed in women with parity >/= 5 and represented 10 [32.5%] of patients. It was clear that there was a definite significant relation between hysterectomized women and psychiatric morbidity of a depressive and anxiety nature. So we recommend that before hysterectomy in benign conditions, gynecologists should exhaust great effort of using the available recent less invasive modalities of treatment as first option

Effect of gynecological laparoscopy on intraocular pressure in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia

To evaluate the effect of gynecological laparoscopy on intraocular pressure changes in patients anesthetized with propofol total intravenous anesthesia in comparison to isoflurane inhaled anesthesia. This is a prospective randomized clinical study was done in the departments of Obstetrics and Gynaecology, Sohag University Hospital. Thirty patients underwent an elective gynecological laparoscopy were recruited in this study after fulfilling the inclusion criteria. Patients were divided randomly into two groups; propofol group [n=15] and isoflurane group [n=15]. MAP, HR, peak and plateau airway pressures [Paw], ETco2 and IOP were recorded at the following time points. Tl: before the induction of anesthesia, T2: before pneumoperitoneum, T3: after pneumoperitoneum, T4: at 15°-20° head-down tilt, T5: After return to the horizontal position, T6: after the pneumoperitoneum had been evacuated and lastly T7: in the recovery room, 20 minute after tracheal extubation. Both groups were comparable as regard to their age, body mass index [BMI], duration of the procedure and the preoperative IOP. There were no significant differences in MAP or HR between both groups. After induction of anesthesia, IOP decreased significantly in propofol group [P<0.01] than isoflurane group [P<0.05]. In the isoflurane group, there was a significant increase in IOP after pneumoperitoneum [T3 versus T2, P< 0.05]. Also there was a significant increase in the IOP after head-down position [T4 versus T2, P< 0.01], which exceeded the preoperative IOP value [T4 versus Tl]. In the propofol group, IOP insignificantly increased after pneumoperitoneum and with head-down position. IOP in propofol group was at all times less than isoflurane group. In the recovery room, IOP returned to baseline in the Isoflurane group, but remained insignificantly lower in the propofol group. There was no significant correlation between MAP, HR, IOP values and plateau airway pressures in both groups. Laparoscopic gynecologic surgery with head down position increases IOP within the normal diurnal range. propofol TIVA has an IOP controlling effect during laparoscopy and may be preferred if control of IOP is a must before laparoscopy

Prophylactic B-lynch suture during elective cesarean section in high risk cases of postpartum hemorrhage

This study was aiming at comparing prophylactic B-Lynch suture and classic ecbolics during elective cesarean section [CS] in high risk patients for postpartum hemorrhage. This is a prospective randomized controlled study which was conducted at Sohag University Hospital during the period from July 2005 to April 2007. Twenty three patients with a valid indication for elective CS, who have one or more risk factors for postpartum hemorrhage such as placenta previa, repeated CS, or previous history of postpartum hemorrhage, were recruited. Patients were randomly allocated into two groups. Group A [12 patients] was subjected to B-Lynch suture during their elective CS, and group B [11 patients] received classic ecbolics such as IV oxytocin and rectal prostaglandins El analogue [Misopristol 200 mcg tab.]. Both groups were compared regarding intra- and postoperative blood loss, need for blood transfusion, maternal and neonatal morbidities and mortalities. Both groups were similar with regard to the indication of elective CS, risk factors for postpartum hemorrhage, and preoperative hemoglobin level. Intraoperative blood loss and the need for blood transfusion was significantly higher in group B compared to group A. Also, postoperative blood loss through the weight of a special disposable bed linen was significantly higher in group B than in group A in the first 24 hours. Only one patient in group B had subtotal hysterectomy secondary to severe uncontrollable postpartum hemorrhage. All women underwent C.S. with B-lynch in group A were menstruated and one pregnancy occurred at the end of a year of follow up. B-Lynch suture is an appropriate prophylactic technique [safe, effective, and simple] during elective caesarean section in women with potential high risk of developing postpartum hemorrhage

Vaginal misoprostol for cervical priming before hysteroscopic evaluation of postmenopausal bleeding: is it rewarding?

To evaluate the efficacy of vaginal misoprostol in cervical priming before hysteroscopic evaluation of women with postmenopausal bleeding. This is a prospective randomized controlled clinical study was carried out in the Department of Obst./Gynecol, Sohag University Hospital. Sixty patients had postmenopausal bleeding were recruited in the study. The patients were then randomly allocated into two groups: study group, 30 cases where 400 microg misoprostol were used vaginally 3 hours before the hysteroscopic procedure; control group, 30 cases where 2 tablets vitamin B complex was used 3 hours before the procedure. The following outcome measures were evaluated during the study: base line cervical dilatation, the need for dilatation, time of cervical dilatation in seconds, preoperative side effects of the drugs used and intraoperative complications. The preoperative side effects in the study group were more obvious [30% versus 7%] than in the control group. The mean base line dilatation of the cervix was more [5.02 +/- 1.12] in the study group, when compared with the mean base line dilatation of the cervix [2.83 +/- 0.93] in the control group and this difference was highly statistically significant, P value <0.01. The mean duration of dilatation of the cervix in the study group, was much less [70.56 +/- 21.56 seconds] when compared with the mean duration of dilatation of the cervix in the control group [126.25 +/- 15.48 seconds] and this difference was also highly statistically significant, P value <0.01. Two patients out of thirty [6.7%] were complicated by cervical laceration in the study group compared with 4 patients out of thirty [13.3%] in the control group. However, two cases [6.7%] had false passage in the control group versus no cases in the study group. Misoprostol have a definite cervical priming effect in post menopausal women before hysteroscopy for ease of cervical dilatation and less complication rates. We recommend using misoprostol as a routine priming agent before hysteroscopy in post menopausal women