Purohit technique of vaginal hysterectomy in nulliparous women: is it a matter waste of time?

To ease intraoperative access to parauterine space at vaginal hysterectomy, we choose the purohit technique of vaginal hysterectomy using a right angle forceps, electrocautery and 10 mm telescope with light source, to evaluate the role of parity. The study comprised a total of 30 women without prolapse who requested hysterectomy for different benign diseases of the uterus between April 2001 and March 2003. They were grouped to two distinct groups according to parity; group 1 [G1] 14 nuillparous and group 2 [G2] 16 parous women. Exclusion criteria included uterine size above 16 weeks, known pelvic endometriosis and early stages of organ confined malignancy. We compared vaginal hysterectomy success, failure and safety according to parity. Safety was measured from intra and postoperative complications, duration of operation and hospital stay. The overall complication rate showed no significant difference between the two groups as regard to intraoperative and postoperative complications. The mean operative time was significantly longer in nulliparous group [99 SD +/- 55.6 vs 72 SD +/- 32.8 minutes, p<0.05]. However the mean hospital stay showed no significant difference between the two groups [in nulliparous group 6.42 +/- 4.52 and 6.22 +/- 3.92 in parous groups]. The success rate was 85.7% [12/14] in nulliparous group and 87.5% [14/16] in parous group. So, it could be concluded that, using this technique nulliparity was not an obstacle to the vaginal route and, purohit technique of vaginal hysterectomy is not a waste of time in nulliparous women

Reliability of combined hysteroscopy and laparoscopy for management of cornual ectopic pregnancy

Active surgical treatment in the form of hysteroscopy under laparoscopic control was carried out on 15 women with diagnosed cornual ectopic pregnancy over 3 years period. The mean age of the patients was 26.2 years and most of cases were suffering from acute abdomen and vaginal bleeding after a period of amenorrhoea. Transvaginal ultrasound examination revealed an empty uterus, gestational sac separated <1cm from the most lateral edge of the uterine cavity and thin myometrial layer surrounding the sac. Color Doppler mapping of cornual region showed a vascular ring at the periphery. Serial beta hCG quantitative levels were static. General physical and abdominal examinations as well as laboratory profile of all cases were within normal. Patients were scheduled for operation within hours from their attendance, in all cases hysteroscopic management was done by using a small suction cannula for complete removal of the conceptus, avoiding the need for forceps or curette. Performing the procedure under laparoscopic control and injecting vasopressin minimised the risks of bleeding and rupture. The average operation time was 60 minutes and hospital stay ranged from [1-2] days. All patients tolerated the surgical procedure without complication. Based on the preceding results it would appear that this procedure is expeditious and showed immediate evidence of success or failure

Sonographic fetal measurements and umbilical artery doppler velocity for the prediction of gestational age and fetal outcome

Serially performed real time and color Doppler duplex sonographic fetal measurements were conducted on 100 uncomplicated pregnant Egyptian women attending in the antenatal outpatient clinic in EL-Zahraa University Hospital. This current prospective longitudinal study was designed to define the confidence limits and characteristics of growth for different fetal biometric measurements e.g.; biparietal diameter [BPD], binocular diameter, cerebellar measurements, femur length, humerus length, cardiac circumference, pulmonary artery and aortic artery diameters. Also flow velocity waveforms and the ratio of peak systolic to end diastolic [S/D] blood flow velocities in the umbilical artery with Doppler ultrasound in relation to the gestational age was measured in an attempt to predict fetal age, well being, and outcome. These variables were studied longitudinally from 20 to 40 weeks gestation and were found to be significantly increased with advanced gestational age with a decreasing non-variable, non-fluctuating S/D ratio of the umbilical artery. Also, these parameters were found to be highly correlated with each other and with gestational age, and from simple linear regression of.these variables an equation was deduced to calculate the expected GA per weeks if only one parameter is available. Furthermore, the normative data established in the present study may be helpful in the prenatal diagnosis of congenital heart, skeletal defects among their discordant circumference and diameters of the great vessels and long bones. Also, the analysis of the S/D ratio and RI for the umbilical artery may be of a benefit in the antenatal care to ensure fetal well-being and outcome

Significance of subchorionic hemorrhage in cases of threatened abortion

In this work, cases of threatened abortion were prospectively studied to detect the prevalence and significance of subchorionic hemorrhage in cases of threatened abortion. The study showed that 20% of the cases had threatened abortion and there was no significant correlation between the subchorionic hemorrhage and the pregnancy outcome and if it is met accidentally during ultrasonography for cases of threatened abortion, it may not alter the outcome of pregnancy

Ultrasonographic fetal biometrical measurements as a predicator of gestational age

Ultrasonographic examinations were performed to 189 pregnant Egyptian wome in Al-Zahraa and Said Galal University Hospital. Sonograhic identification and measurements of head and abdominal circumference. Liver. Kidney, femur and foot length were preformed between 20 and 40 weeks gestation. A highly significant correlation was found between the previous fetal biometrical parameters and gestational age and also between each other. An equation from each parameter was concluded by using simple linear regression to calculate the expected gestational age per week. A general equation was deduced from all previous fetal parameters to predict the gestational age

recent approach to the surgical treatment of reflux oesophagitis

The rationale of combining proximal gastric vagotomy with Nissen fundoplication in the treatment of reflux oesophagitis due to hiatus hernia is discussed. This was applied to 20 cases over the period of 7 years at Al-Azhar university hospitals 1983-1992. The results were reported with follow up for about 2 years, patients were completely relieved and one had been significantly improved

Femoral hernia in children

A series of 10 femoral herniae in children were diagnosed at Al-Azhar university Hospitals. Seven cases were misdiagnosed as inguinal herniae. The sex incidence, female-male was 5:5. 9 cases occurred in children between 7-11 years. One case presented as intestinal obstruction due to Richter's herniae. All cases has done herniorraphy

Volvulus of the caecum

Five cases of volvulus of the cecum were diagnosed at Al-Azhar University Hospitals during period of seven years. Treatment was derotation and ileostomy in situ. This operation was recommended for cases with viable intestine [two cases]

recent simple method for treatment of pilonidal sinus

A total of 20 patients with chronic pilonidal sinus disease were treated between 1982-1991 at Al-Azhar University Hospitals. A simple method by which the sinus was excised and primary closure was done, where 15 cases healed out without complications and 5 cases have got sepsis and recurrences

Hemorrhoidectomy without pain or discomfort

One hundred and twenty patients were operated upon for their piles. General anesthesia was given to all patients. Half the cases were given in addition caudal anesthesia at the beginning of the operation, and the other half did not have any local anesthesia. The amount of analgesics, general comfort after the operation, and the number of postoperative days, where first bowel opened, were recorded and compared in both series of the study

Abdominal exploration

Exploration of the abdomen of 1180 patients was done during the period 1984-1992 at Al-Azhar University Hospitals and El-Nile Insurance Hospital. Routine examination was done to all abdominal organs where many alternative conditions were found, also many incidental findings were discovered. Results were tabled out and follow up was carried for long periods