Comparative study of transvaginal sonography and hysteroscopy for detection of pathological endometrial lesions in women with perimenopausal bleeding

Background: abnormal uterine bleeding is a frequent condition in gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of haemostatic substances. In some specific cases with more intense and prolonged bleeding surgical treatment may be necessary

Aim of the Work: this study aimed to estimate the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy compared to the histopathology in evaluation of uterine cavity lesions in peri menopausal women with abnormal uterine bleeding

Patients and Methods: this was a prospective cohort study and it included 50 patients from Obstetrics and Gynecology Outpatient Clinic at Al-Hussein and Bab El-Shearia [Sayed Galal] Hospitals, Al-Azhar University during the period from October 2017 to May 2018

Results: 2D TVS were more sensitive and a little more accurate than hysteroscopy in detecting endometrial hyperplasia, while hysteroscopy showed higher specificity. Hysteroscopy showed highest accuracy for diagnosis of the endometrial polyp and was more sensitive, specific and accurate than 2D TVS in this diagnosis. 2D TVS were more sensitive and accurate than hysteroscopy in the diagnosis of adenomyosis, but both showed same specificity. For differentiating normal from abnormal endometrial cavity both 2D TVS and hysteroscopy showed high accuracy, but U/S was more sensitive and a little more accurate than hysteroscopy, while the last was more specific. Both 2D TVS and hysteroscopy ignore the diagnoses of one lesion when endometrial hyperplasia, endometrial polyp or adenomyosis were found in one case

Conclusion: endometrial hyperplasia was the commonest observed endometrial abnormality in our patient sample and the second most common pathology was the endometrial polyp

One stage repair of hypospadias

This study was done on 63 patients with various degrees of hypospadias, their ages renged from 3 months to 35 years. The location of native meatus was anterior penile in 30, middle in 25 and penoscrotal in 8. Several techniques for correction of hypospadias were used depending on the location of the abnormal meatus. Suprapublic drainage was used in proximal penile and penoscrotal varieties, while urethral drainage was 4% while in proximal shaft and penoscrotal level was 37.5%. Due to low incidence of complication of one stage repair for all types of hypospadias, this should be recommended with selection of the suitable technique for each type

Labral stitch for open repair of bankart lesion. Simple, safe and effective technique

In this study, 32 patients with recurrent traumatic anterior shoulder instability were treated prospectively by vertical apical labral stitch technique. All had many episodes of documented complete anterior dislocation. All were men with an average age of 23 years. The minimum follow up duration was 2 years [range 24-41 months]. The patients were evaluated according to the shoulder instability score of Rowe et al. Rowe score was excellent and good in 94% of the patients and fair in 6%. The limitation of movement did not exceed 5 degrees in forward flexion and 10 degrees for external rotation with the arm to the side. There was no postoperative re-dislocation or reoperation. Apprehension was persistent in two patients. All patients returned to preoperative work

Acupressure versus antiemetic drugs in prevention of nausea and vomiting after gynecological laparoscopy

Postoperative nausea and vomiting [PONV] is a common complication after laparoscopic surgery. The efficacy of currently available antiemetics remain poor together with their side effects and high cost of newer drugs, this leads to increase interest in non-pharmacological methods of treatment. We have studied the efficacy of acupressure at the P6 point versus two antiemetic drugs in prevention of nausea and vomiting after laparoscopy in double-blind, randomized, controlled study. We studied 160 patients undergoing laparoscopy. The anaesthetic technique and postoperative analgesia were standerized. Failure of treatment was defined as occurrence of nausea and vomiting within the first 24 h. after anesthesia. The acupressure reduced nausea and vomiting from 45.2% to 22.2%, while Ondansetron to 15.9% and Metoclopramide to 26.3% compared with control group.Acupressure at P6 point was effective in prevention of PONV after laparoscopic surgery. However, Ondansetron and Metoclopramide also reduce PONV and hospital stay and costs with early discharge

Anti cox II for analgesia and bleeding after day-case adenotonsillectomy

Adenotonsillectomy is performed as a day surgery. We have examined the analgesic utility and incidence of bleeding after intramuscular injection of Anti Cox II, Ketorolac and Pethidine which were given after induction of anaesthesia. Although the analgesic effects of three drugs were comparable in the immediate post operative peroid.The recovery time taken to awake and ambulate for discharge were significantly shorter after Ketorolac and Anti Cox II. Anti Cox II is prefered than Ketorolac due to reduced risk of gastritis and bleeding

Tramadol-bupivacaine versus ketamine-bupivacaine to improve epidural anaesthesia

The study included 45 patients undergoing lower ureteric surgery. The patients were allocated randomly to three equal groups to receive epidural injection of 0.5% bupivacaine [18 ml] with tramadol 100 mg, 0.5% bupivacaine [18 ml] with ketamine 40 mg in 2 ml saline or 0.5% bupivacaine [18 ml] plus 2 ml saline. Onset, duration and quality of anaesthesia, haemodynamic variables, postoperative analgesic requirements and side effects were recorded. The tramadol group recorded the most rapid onset, the most prolonged duration and the highest quality of anaesthesia. It also, provided significantly more prolonged postoperative analgesia when compared with the ketamine and the bupivacaine groups. The ketamine group provided better quality, more rapid onset and longer duration of anaesthesia compared with the bupivacaine group with more prolonged postoperative analgesia.But, it was also associated with some adverse effects as hallucinations which limits its epidural application. The results suggest that the addition of tramadol to epidural bupivacaine can significantly improve the quality of anaesthesia with significant prolongation of the postoperative analgesia without serious side effects

Proteinuria in renal transplant recipients and its role in monitoring the allograft function

Fifty [50] renal transplant recipients were included in this study [30 males and 20 females]. The post transplant period ranged between 2 months and 84 months [mean36.86 +/- 23.92]. The source of renal graft was live related donor [12 patients], live unrelated donor [22] and cadaveric donor [16]. ten healthy volunteers were selected as a control group. The aim of this study is to look at the pattern of proteinuria in renal transplant recipients and to find a relation between the degree and type of this proteinuria and the renal allograft function, a matter which has a great importance for early detection of rejection. These 50 patients were divided into two groups group 1 30 patients with normal graft functions and group 2 20 patients with impaired graft functions. The results of this study showed that the mean value of 24th urinary proteins in both groups was 1.45 +/- 0.07 gm/dl. There was a highly significant difference between group 1 and group 2 regarding the renal functions [blood urea, serum creatinine and creatinine clearance], quantitative 24h. urinary proteins and the pattern of urinary protein electro-phoresis [P < 0.001]. Twelve patients [24%] were found to have signs of chronic rejection Hypertension, oliguria, impaired renal functions leucocyturia, proteinuria and hematuria], where urinary protein electrophoresis showed albumin, IgG, alpha microglobulin and transferrin in a significantly high concentration when these were compared with other renal transplant patients without signs of rejection. It was also found that 14 patinets [28%] had evidence of cytomegalovirus infection [seropositive CMV IgM], all of them had impaired renal graft functions with 24h. Urinary protein excretion which showed a highly significant difference when compared with patients who had seronegative CMV-IgM, with predominant beta 2 [B2] microglobulin excretion [P < 0.001]. urinary tract infection was reported in 7 patients [14%], 4 of them had impaired renal functions with significant proteinuria, predominantly albumin and B2 microglolmllin. Also cyclosporin nephrotoxicity was noticed in 3 patients [6%], the pattern of proteinuria among them showed albumin and IgG in high concentrations