Randomized trial comparing harmonic scalpel hemorrhiodectomy, bipolar scissors hemorrhiodectomy, and conventional scissors excision-ligation technique

The aim of this study was to compare the outcome of the patients receiving hemorrhiodectomy using harmonic scalpel, bipolar scissors, and conventional scissors excision-ligation technique. This study included forty five patients with irreducible prolapsing piles, selected from Al-Azhar University hospital,Damietta branch. between January 2008 to June 2009. They were randomly assigned to receive: 1] Milligan Morgan hemorrhiodectomy; 2] Bipolar scissors hemorrhiodectomy; 3] Harmonic scalpel hemorrhiodectomy. The measured outcomes included: 1]Operative time, 2]Blood loss, 3]postopenative hospital stay, 4]pain 4 scone,5]date of first bowel movement,6]number of nalbuphine HCL injection,7]number of diclofinac potassium injection,8] time need to return to work or normal activity, 9] wound healing, 10] satisfaction scone, 11] postoperative complications including anal stenosis and or flatus incontinence. Both harmonic scalpel hemorrhiodectomy and bipolar scissors hemorrhiodectomy were superior to Milligan Morgan hemorrhiodectomy in term of reduced blood loss. Harmonic scalpel hemorrhiodectomy had the best pain score when compared with bipolar scissors hemorrhiodectomy and Milligan-Morgan hemorrhiodectomy, and patients required significantly less nalbuphine HCL injection after harmonic scalpel hemorrhiodectomy than after Milligan Morgan hemorrhiodectomy also the time required to return to work or normal activity reduced in case of harmonic scalpel and bipolar scissors than Milligan Morgan hemorrhiodectomy so, the patient after harmonic scalpel hemorrhiodectomy had the best satisfaction score among three groups. This study shows that harmonic scalpel hemorrhiodectomy is as good as bipolar scissors hemorrhiodectomy in terms of reduced blood loss and operative time and time to return to normal activity but it is superior because it is associated with less postoperative pain and hence, better patients' satisfaction

Brothers of women with polycystic ovary syndrome: a new group with high risk for type 2 diabetes mellitus and cardiovascular disease

Polycystic ovary syndrome [PCOS] is common endocrinal disorder which is highly inherited and characterized by many metabolic abnormalities. We hypothesized that male relatives of PCOS women would also have metabolic abnormalities. Thus, our aim was to assess insulin sensitivity and metabolic parameters in brothers of women with PCOS and male control individuals. 30 brothers of women with PCOS and 20 male healthy control subjects were included in the study. Brothers and control were subjected to complete medical evaluation with stress on anthropometric measurements, fasting insulin, homeostasis assessment model [HOMA-IR], lipids, plasminogen activator inhibitor-1 [PAI-1], C-reactive protein [CRP] and androgens. Brothers and control individuals were similar as regard to age, MBI, WHR and blood pressure. However, brothers were insulin resistant and had dyslipidemia and dyscoagulability [HOMA-IR, P=0.043, TC P=0.001, LDL-C P=0.002, HDL-C P=0.03, TG P=0.048, PAI-1 P=0.002, CRP P=0.046]. Also HOMA-IR, was correlated significantly with BMI p<0.001, WHR P<0.001, PAI-1 P<0.001, CRP P<0.01, TG, P<0.001, LDL-C P=0.02, HDL-C P=0.019]. Brothers of women with PCOS have a metabolic phenotype consisting of dyslipidemia, insulin resistance, dysmgulability and carry an increased risk of cardiovascular disease [CVD] and type 2 diabetes mellitus [type 2 DM]. Given the high prevalence of PCOS, brothers may represent an important new risk factor for CVD in men and should be considered a well identified group for primary preventive measures

Growth in infants and children with congenital cyanotic and acyanotic heart disease: impact of serum leptin and hemodynamic abnormalities

This work was carried out to study growth parameters, serum leptin and different hemodynamic data in infants and children with cyanotic and acyanotic congenital heart disease [CHD] to delineate any abnormality and the correlation between different studied parameters. The study included 44 patients with CHD divided into 2 groups cyanotic CHD/acyanotic CHD [23/21], the cyanotic group was further subdivided according to pulmonary blood flow [PBF] into patients with decreased PBF/patients with increased PBF [15/8] based on echocardiographic study and cardiac catheterization in some patients. Another 12 healthy children of matched age and sex served as a control group. Patients were subjected to clinical examination, anthropometric measurements according to Roles of Tanner. Laboratory investigations were performed for all the studied groups including arterial oxygen saturation, hemoglobin level, arterial oxygen content and serum leptin level using immunoenzymometric assay. The results showed that patients with CHD had growth retardation compared to healthy Egyptian infants and children of matched age and sex. Height was affected more that weight in both groups while weight and mid arm circumference [MAC] were affected more in the cyanotic group. Body mass index [BMI] was not so affected in both groups. On the other hand, serum leptin level showed no significant difference between both groups and between patients and control group, In addition, arterial oxygen contents showed no significant difference between all the studied groups. The degree of left to right shunt [QP/QS] in patients with acyanotic CHD was negatively correlated with weight standard deviation score [SDs], MAC SDs, BMI SDs and serum leptin level. CHD is associated with reduction in weight, height and MAC. The increased QP/QS ratio in acyanotic CHD is correlated with the degree of retardation in weight, MAC and BMI. Serum leptin levels show no significant difference between groups which exclude the role of leptin in the pathogenesis of weight loss in patients with CHD