Fetal biometric measurements in assessment of gestational age and amniotic fluid index [AFI] in second and third trimester in normal pregnancy in normal Egyptian females

To establish tables and nomograms for biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL] as well as amniotic fluid index [AFI] for 2[nd] and 3[rd] trimester's normal pregnancy in Egyptian females. This cross sectional study included 30 normal pregnant females for each gestational week from 15 to 40 weeks [total number of cases = 780]. They were selected from El Shatby Maternity Univ. Hospital, ultrasound unit. They were subjected to: thorough history taking., clinical examination., and ultrasound assessment using Sono Ace 9900 [Medison] .Any abnormality or conditions that can affect fetal growth and liquor volume were excluded. BPD, HC, AC, FL and AFI was measured using the 4 quadrant technique. The mean values of BPD, HC, AC, and FL in mm were obtained together with Standard of deviation [SD] for each gestational Week from 15 - 40 weeks. All of them showed gradual steady increase with increasing gestational age. Tables and graphs for BPD, HC, AC and FL with mean, SD, 5[th], 50[th], 95[th] centiles for each parameter were established. All mean values of biometric measurements showed good positive correlation with gestational age with [r = 0.96, p < 0.001 for BPD], [r = 0.981, p < 0.001 for HC], [r = 0.944, p < 0.001 for AC], and [r = 0.968, p < 0.001 for FL]. The mean and SD of AFI in cm were obtained for each gestational age. It started from 8.49 +/- 2.1 cm at 15[th] week of gestation, then gradually increased with increasing gestational age until it reached a maximum value of 15.6 +/- 4 cm at 27[th] week of gestation, then gradual decline in the mean AFI noted from 28"' week [mean AFI = 15.5 +/- 3.6 cm] till 40[th] week [mean AFI = 10.2 +/- 3.2 cm]. AFI showed good positive correlation with gestational age 15-27 weeks [r = 0.83, p < 0.001], and good negative correlation with gestational age 28-40 weeks [r = -0.79, p < 0.001]. For assessment of gestational age, fetal growth, and AFI, we have to use tables and charts derived from the same population. Fetal biometric measurements from normal Egyptian pregnant females are strongly correlated with both gestational age and AFI .Amniotic fluid index in same population has good positive correlation with gestational age before 28 weeks and good negative correlation after 28 weeks

dimensional ultrasound evaluation of the uterine cavity before and after myomectomy in cases of multiple fibroids

The aim of this work was to evaluate the role of three - dimensional [3D] transvaginal ultrasonography [TVS] of the uterine body and cavity in cases of multiple myomas going to do myomectomy and its impact on the integrity of the cavity after myomectomy. The present study was carried on 42 patients with multiple fibroids planned for myomectomy. They were divided into two groups; 16 patients [group I] were examined before and within three months after myomectomy by transabdominal, conventional 2D and 3D TVS in multiplanar mode at the coronal view. 26 patients [group 2] who did myomectomies within three months were examined by 3D ultrasound only after the operation. In both groups, the uterus was evaluated for size, shape of the cavity, presence of intrauterine adhesions and any submucous myomas or polyps. The results of the present study showed that the two groups were comparable as regards the age, gravidity, parity and number of myomas diagnosed preoperatively [p>0.05]. Intraoperatively, fibroids were pure interstitial in 75% of patients in group [1] and 80.77% of patients in group [2], however, fibroids were combined submucous and interstitial in 25% and 19.23% of patients in group 1 and 2 respectively with insignificant difference between both groups [P > 0.05]. The uterine cavity was opened in 31.25% and 15.38% of patients of group 1 and 2 with significant difference between the two groups, [p<0.05]. Postoperatively, 3D TVS revealed normal uterine cavity in all patients of group 1 [100%] and in 88.5% of patients in group 2 with insignificant differences between the two groups, p> 0.05. Three patients in group 2 [11.5%] showed abnormal coronal view in multiplanar mode of 3D scan. Two patients showed intrauterine adhesions with cavity distortion in one of them. One patient showed missed submucous fibroid. Preoperative evaluation of the uterine cavity with 3D TVS in patients planed for myomectomy allows better identification of the position of the uterine fibroids, thus, providing surgeons with guidelines for easy removal of the fibroids and avoid distortion of the uterine cavity when it is opened. Also, postoperative 3D evaluation allows early postoperative diagnosis and management of operative complications and insures an intact uterine cavity for subsequent spontaneous pregnancy or pregnancy following assisted reproductive technology [ART]

Color doppler assessment of uterine artery blood flow pattern after uterine artery ligation in uncontrollable postpartum haemorrhage

Uncontrollable postpartum hemorrhage is the most common cause of maternal mortality in developing countries. Uterine artery ligation is considered one of the most convenient method to control the uterine bleeding and to decrease the number of hysterectomies done for postpartum hemorrhage. Color Doppler ultrasound is an established noninvasive technique for assessment of the vascularity of any organ with complete detailed analysis of flow velocity pattern. The aim of this study was to assess the blood flow of uterine arteries in puerperal woman after bilateral uterine vessels ligation for treatment of uncontrollable postpartum hemorrhage compared to normal uneventable vaginal delivery. This study was carried on 44 patients in postpartum period divided into 2 groups. Group I [study]: 24 cases with uncontrollable atonic postpartum hemorrhage treated with bilateral uterine artery ligation. Group II [control]: 20 women with normal spontaneous vaginal delivery. Doppler assessment of blood flow in both uterine arteries in control as well as the study group above and below the level of ligation was done in days 1, 4, 7, 40 postpartum. Measurement included the vascular indices [pulsatility index [PI], resistance index [RI] and systolic diastolic ratio, [S/D], blood flow velocity [peak systolic velocity [PSV], end diastolic velocity [EDV], and the mean velocity. [VM]. Above and below ligation blood flow pattern was compared to each other and to normal puerperium flow. Out of 24 cases of the study group, 4 cases did subtotal hysterectomy following bilateral uterine artery ligation due to insufficient control of bleeding [16.6%], one case of infection, no case of gangrene, no mortality. Control group showed statistically significant decline in all blood flow velocity from day 1 to day 40 postpartum. In study group, above and below ligation cases, showed initial rise of PSV and EDV from DI to D4, and VM D 1-7, then began to decline again after that. However the readings in below ligation group were significantly higher than above ligation group due to obstruction of flow induced by ligation. The flow velocity was still lower in both ligation groups than control mainly on day 1 with less significant difference on day 40 postpartum. The vascular indices in control group showed gradual increase in [S/D], [RI] and [PI] reaching significant increase in the values on day 40 in relation to day 1. Our study revealed that in above and below ligation groups, there was also gradual increase in vascular indices till day 40. With higher values in below ligation group especially on day 1 in [RI] and [PI]. In control group the indices were higher than above ligation on day 1 mainly then no significant difference was observed. In below ligation group, the [S/D] was higher than control after day 1 while no significant difference after that, RI showed no significant difference in all measured values, while the PI was higher in below ligation group mainly on day 7. Then became significantly lower below ligation after day 40. Blood flow velocities gradually decrease and indices gradually increase in normal postpartum period reflecting increase in peripheral resistance of uterine vasculature. Uterine artery ligation can reduce blood flow velocities in above ligation level in first 7 days [compared to control] with subsequent reduction in the blood volume perfusing the uterus above ligation in this period. Uterine artery ligation reduces blood flow velocities on the first 24 hours only in below ligation then normal velocity is reached after that. In spite of reduction of blood flow velocities above ligation level, initial rise was observed from DI to D4 caused by compensatory opening and dilatation of collaterals. Vascular indices [S/D, RI and PI] seem to be less sensitive than blood flow velocities [PSV, EDV, and VM] in assessment of acute vascular compromise like uterine artery ligation. Finally, uterine artery ligation reduces postpartum hemorrhage by reducing flow above ligation without compromising the vitality of the tissues. Hence, hysterectomies and maternal mortality from uncontrollable postpartum hemorrhage could be reduced

Umbilical artery doppler flow velocities and indices in normal pregnancy and its correlation with amniotic fluid index

Is to provide normative data for umbilical artery flow velocity as well as blood flow indices for normal pregnancy, to correlate UA [Umbilical artery] Doppler parameters with gestational age, and finally to correlate these parameters with amniotic fluid index as a measure to amniotic fluid volume. 720 cases were selected form El - Shatby Maternity Univ. Hospital, Ultrasound unit.Ultrasound assessment was done using Sono-Ace 9900 [Medison]. Any abnormal fetal growth, multiple pregnancy or fetal anomalies were excluded to define normal population. Only those with Singleton pregnancy and sure date of the LMP were included. Amniotic fluid index was measured using 4 quadrant technique.Umbilical artery waveform was obtained and the most uniform clear part of the wave-form [including 4-6 cycles] was selected to calculate PSV, EDV, S/D ratio, RI and PI. PSV and EDV showed progressive gradual increase with gestational age starting from 30.26 +/- 11.49 cm /sec and 7.66 +/- 3.64 cm / sec respectively to 51.9 +/- 21.16 cm/sec and 21.63 +/- 8.62 cm/sec. On the other hand, Doppler indices showed gradual and progressive decrease with gestational age. Mean S/D ratio decreased from 4.16 +/- 0.85 to 2.51 +/- 0.5. The mean value of PI decreased from 1.42 +/- 0.17 to 0.91 +/- 0.17. At 15th week, the mean value of RI was 0.74 +/- 0.0 and at 38th week was 0.60 +/- 0.11. PSV and EDV showed good positive correlation [r = 0.955, p< 0.001] and r = 0.932, p <0.001 respectively] with gestational age.While UA flow indices showed good negative correlation -with gestational age [[ for S/D; r = - 0.962, p < 0.001], [for RI, r = -0.944, p = < 0.001], and [for PI; r = -0.951 and p < 0.001]]. The mean and SD of API in cm were obtained for each gestational week. API increases from 8.4 +/- 2.1cm at 15th week of gestation, to 15.6 +/- 4 cm at 27th week of gestation., then gradual decline in the mean AFI from 28th week [mean AFI = 15.5 +/- 3.6 cm] till 38th week [mean AFI =11 +/- 3.5 cm]. PSV and EDV showed good positive correlation with AFI from 15th week to 27th week and negative correlation from 28th to 38th week. While S/D ratio, RI, and PI showed good negative correlation with AFI from 15th week to 27th week and good positive correlation from 28th to 38th week we can conclude that UA flow velocities [PSV and EDV] have good positive and S/D ratio, RI and PI have good negative correlation with gestational age. Gestational age is a critical factor in interpreting UA Doppler velocimetry results in normal pregnancy. AFI showed good positive correlation with gestational age from 15th to 27th week, and good negative correlation till term. UA flow velocities [PSV and EDV] and indices [S/ D ratio, RI and P] have good correlation with API from 15-27 weeks. Umbilical artery flow may not reflect the amount of amniotic fluid in normal pregnancy

Hepatic tumors: predictive accuracy and role of radio frequency [R.F.] percutaneous thermal ablation on guidance of multiphase spiral-[C.T.] and color doppler U/S.

A retrospective assessment of the use of [R. F.] in the management of [25] patients with hepatocellular carcinoma [HCC] was carried out, The study of multiphase spiral [C.T.] and Color Doppler U/S of these patients and under guidance of both. The mean age was 55 years [99%] were farmers from Lower Egypt. The impact of needle [RE] on the management of these patients at high risk was limited [the lesion more than 6 cm diameter and with ascites]. However, unnecessary operations was avoided in 3 cases proved no changes by follow up until 12 months. The management of the patients was usually determined by other factors rather than by results of [R.F.] only [size of lesions, presence and severity of liver cirrhosis, histology, -number of lesions, early detection, Precise localization, and characterization of Liver lesions and presence or absence of distant metastases]. It was found that the contribution of [R.F.] to the management of the patients with [HCC] at high risk of malignancy [over the age of 55 years and with metastases, more than [4] lesions and with size more than 5 cm] is not significant and direct referral of the operable cases to surgery is justifiable On the other hand, those at lower risk could benefit from this technique, as a positive malignancy will prompt an early treatment and should improve the prognosis of some of these patients

Laparoscopic varicocelectomy

The aim of this work is to determine the efficacy and safety of laparoscopic ligation of the internal spermatic vein [s] cephalad to the internal inguinal ring for symptomatic varicocele. 10 men with unilateral varicocele in 8 cases and bilateral in 2 cases. Diagnosis was based on the history, physical examination and scrotal ultrasound. Laparoscopic ligation was done for sub fertility in 6 patients, testicular pain in 2 patients and testicular atrophy in 2 cases. The spermatic artery was preserved in all cases. The procedure was done on a day surgery basis. The procedure was completed successfully with preservation of the testicular artery in all cases. The average operative time was 50 minutes. No mortality. The morbidity was low and minor; pneumoscrotum in a case. Follow up for 3-6 months showed improvement of the varicoceles with disappearance of pain. Seminal analysis was improved in density by more than 17 millions per ml and motility by more than 33%. No secondary hydroceles were observed. We conclude that, laparoscopic varicocele ablation is simple, safe, and effective with brief convalescence

Role of m. pneumoniae in acute lower respiratory tract infection in children

This study was carried out on 120 children suffering from acute lower respiratory tract infection, their ages ranged from 1-12 years, and 53 healthy children of the same age groups were included as controls. Detection of M. pneumonia was done by culture of nasopharyngeal aspirate on spiroplasma broth [Sp4] and by serologic methods [CF and ELISA]. In this study, M. pneumoniae was detected in 23.3% of all the children suffering from acute lower respiratory tract infection and 7.5% of normal healthy controls. M. pneumoniae infection was most common in the age group 4-10 years [33%] followed by those aging 10-12 years [20%]. The incidence was low in children < 4 years [6.6%] compared to the other groups. The most common symptoms and signs were cough, fever, constitutional symptoms, rales and wheeze. Bronchopneumonic infiltrate and lobar consolidation were the most common radiological findings

Anaemia in diabetes mellitus

Eighty five patients with diabetes mellitus and 25 normal controls were studied clinically together with evaluation of their red cell values, bone marrow picture, serum iron and liver function tests. Normochromic normocytic anaemia was found to be a characterstic feature of diabetics having chronic complications or infections. Macrocytic normochromic anaemia was present in diabetics having ketoacidosis. Possible underlying mechanisms for the present anaemia was discussed. In non complicated diabetics anaemia was not present and serum iron was within normal limits. Conclusion was reached that the presence of anaemia in a diabetic patient is a sign of diabetic complications

Blood viscosity in diabetes mellitus

Eight five diabetics and 25 normal controls of matched age and sex were studied. Estimation of the whole blood viscosity by using the U-shaped viscometer tube was made. Significantly higher blood viscosity was a constant feature for diabetics. Correlation of viscosity to diabetic complications and type of diabetes was carried out. Hyperlipidemia, hyperfibrinogenaemia, increased alpha[2] and beta globulins showed a linear relation to the blood viscosity. Conclusions were reached that the estimation of blood viscosity in diabetics is a rapid, simple and reliable prognostic test for diabetics especially in complicated cases