Pubertal development and gonadotrophic hormones among girls with type 1 diabetes mellitus

Background: As a chronic disease occurring in childhood, type 1 diabetes is a factor potentially affecting the pubertal development, including age at menarche

Aim of study: To investigate the effect of type 1 diabetes on pubertal development among adolescents; and to investigate their gonadotrophic hormonal profile

Subjects and Methods: Nineteen Egyptian girls aged [13.8- 21.6] years were recruited into the study. Assessment of Pubertal development according to Marshall and Tanner [1969] was performed; and age at menarche was evaluated. Auxological assessment [weight, height, and body mass index] were performed. Laboratory investigations were done, including HbAlc levels and Hormone assays [basal and post stimulation levels]: Serum follicle- stimulating hormone [FSH], luteinizing hormone [LH], and LH/ FSH ratio was calculated

Intervention: Girls underwent GnRH- analogue test with triptorelin [0.1 mg] administered subcutaneously

Results: The mean age at menarche [13.24+ 1.25] yrs, among the 17 [89.5%] postmenarcheal T1DM girls, showed no significant difference [P>0.05] from the normal population; but still 2 [10.5%] girls did not achieve menarche until after the study period was terminated. Moreover, there was a highly significant delay [P< 0.01] in their attainment of adult sexual maturity Tanner stage V [B5, PH5]. Only 3 [15.8%] T1DM girls, had achieved optimal metabolic control, at [< 7.5%], while the remaining 16 [84.2%] had a statistically significant insufficient metabolic control [9.93+ 1.96] [P<0.00]. Also it was found that basal and stimulated LH and FSH levels were significantly decreased in T1DM girls [P<0.000]

Conclusion: Type 1 diabetes could affect pubertal development of girls, in the form of delay in their attainment of adult sexual maturity stages, Tanner Breast stage [B5] and Tanner Pubic Hair development [PH5]; however, their age at menarche, is within the range of normal Egyptian girls. The disease could alter their growth development, with a decrease in their height than the normal population. LH and FSH were significantly decreased than normal reference ranges

Masimo® Plethysmograph Variability Index as a Tool for Assessment of Fluid Responsiveness in Elective Major Abdominal Surgeries.

Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle. This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery. Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4. Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4. Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.

use of bone graft in reconstruction of the acetabulum in primary hip replacement

Material: Between 1995 and 1998, 28 total hip replacements were performed. Autografting of the acetabulum was performed in all cases. Nineteen patients were females and 9 were males. The youngest patient was 38 years old and the oldest 83. Morselized bone graft was used in 15 hips [53.6%], bone graft and one plate in 8 hips [28.6%] and bone graft and titanium mesh in 5 hips [17.8%]. Acetabular defect was medical cavitary in 15 hips [53.6%], medial cavitary and medial segmental in 3 hips [10.7%], segmental superior in 6 hips [21.5%], segmental superior and anterior in 2 hips [7.1%], and segmental superior and posterior in 2 hips [7.1%]. Method: Posterior approach was used in all cases. Bone graft from the patient's own femoral head was cut into small pieces about 0.5 - 1.0cm manually using bone nibbler after removing the articular cartilage, or as a segment of cortico-cancellous graft. Follow-up period: The average follow up period was 3.9 years. The average modified Harris Hip score was 31.7 points and at the end of follow up 69.8. In 26 cases [92.86%] the graft appeared to be incorporated securely to the acetabulum as determined by radiographic examination. There were two failures [7.14%]. In one hip the cup was migrated 22 mm superiorly and the other cup showed upward migration of 8 mm. Femoral head autograft appears to provide a useful technique for the reconstruction of a severely deficient acetabulum during primary hip arthroplasty