Endometrial Progesterone and Estrogen Receptors in Relation to Hormonal Levels in Women with Unexplained Recurrent Miscarriage / Receptores endometriais de progesterona e estrogênio em relação aos níveis hormonais em mulheres com aborto recorrente inexplicável

Abstract Objective Recurrent miscarriage has been linked to hormonal disturbance due to dysregulation of its receptors rather than to the availability of the hormone. We aimed to investigate endometrial expression of progesterone and estrogen receptors in relation to serum and endometrial hormonal levels in unexplained recurrent miscarriage. Methods The present case control study included 20 cases with unexplained recurrent miscarriage and 20 parous women as controls. Ovulation was confirmed using an ovulation kit and 10 to 12 days after detecting the urinary luteinizing hormone surge, all women were subjected to a blood sample and to an endometrial biopsy. Progesterone and estrogen levels were measured in serum and in endometrial tissue and receptor concentrations were in the endometrial sample. Results Women with recurrent miscarriage showed significantly lower concentration of receptors in both the cytoplasm and the nucleus of endometrial tissue compared with controls. The nuclear/cytoplasm ratio of progesterone receptor was significantly higher in cases compared with controls, implicating that recurrent miscarriage is probably linked to nongenomic activity of the hormone; this was also significant for estrogen receptor. Serum progesterone and estrogen hormonal levels were comparable between groups while both hormones were significantly reduced in the endometrium of recurrent miscarriage cases. Receptors significantly correlated with endometrial hormonal level but not to serum level. Conclusion Recurrent miscarriage might be linked to reduced endometrial progesterone and estrogen receptors and appears to be more related to nongenomic activity of progesterone. Endometrial receptors expression correlates to tissue hormonal level rather than to serum hormonal level.

Primary pilonidal sinus repair: the outcome of 5 different techniques. can a modification be near ideal or provide a benefit?

Although various surgical treatment procedures for pilonidal sinus disease have been evaluated, no clear agreement has been reached as to which one is optimal for the lower incidence of wound infection, wound dehiscence and recurrence rate, almost certainly because there is none. This study was intended to investigate the outcome among five different selected primary closure techniques and to investigate the possibility of decreasing the operation costs by omitting the subcutaneous suture usage in some primary techniques. Prospective study considering morbidity and recurrence as the main outcome measures. This study included 94 patients: 84 male and 10 females with chronic pilonidal sinus disease who were operated on. All underwent excision and primary closure under spinal [64- 61 males, 3 females] or general anaesthesia [30 patients 23 males, 7 females] between May 2004 and February 2007. Patients were prescribed IV prophylactic antibiotic. 5 different techniques were done. They were simple closure technique in the midline, full-thickness z-plasty flap, semi-open, semi-closed closure techniques, musculofascial flap, and the modified musculofascial flap. Early wound complications with delayed wound healing had occurred in seven patients. Two patients had wound dehiscence [one due to haematoma in the modified group and the 2nd due to wound deep infection in the group of musculofascial flap]. A case of seroma occurred in the modified group. Four cases [4.25%] had minor wound breakdown due to superficial wound infections. They were one case in the simple closure method, one in the musculofascial flap, the third in the full thickness z-plasty and the fourth in the modified musculofascial flap procedure. Late postoperative complications: One patient suffered from late wound dehiscence in of the modified group due to infected haematoma. Two cases of recurrence had occurred. One of the superficial wound infections in the simple closure technique. The 2[nd] case was that of the deep wound infection in the musculofascial flap no recurrence has occurred in either the full-thickness z-plasty flap, the semi-open, semi-closed closure, or in the modified group.No significant difference in operation time, time of wound healing, time to return work, patient's or surgeon's satisfaction and cost effectiveness. Best treatment is still unclear. A perfect operation for pilonidal sinus disease should be simple with short hospital stay and low recurrence and complication rate associated with minimal pain, cost effective and have short off work time. Judging the results of the different procedures is difficult because there are no enough significant differences to prefer one to other procedures. Further investigations into the whole medical, financial and social aspects of these procedures for the treatment and management of pilonidal disease are still required

Early oral feeding in patients undergoing elective colonic anastomosis

Recent evidence seems to indicate that immediate postoperative feeding if feasible is safe after either laparoscopic surgery or laparotomy. This study is done to assess the safety, outcome of early oral feeding and shows factors affecting early postoperative feeding after colorectal procedures. Between June 2005 and April 2008, 120 consecutive patients underwent elective colonic anastomosis were then randomized into 2 groups. Early feeding group began fluid on the first postoperative day and regular feeding group were managed in the traditional way- nothing by mouth until the resolution of the ileus. The majority of patients [75%] tolerated the early feeding. The time to first passage of flatus [3.3 +/- 0.9 d vs. 4.2 +/- 1.2 d] and stool [4.1 +/- 1.2 d vs 4.9 +/- 1.2 d] were significantly sooner in group 1. Hospital stay is significantly shorter in early feeding group [4.2 +/- 0.2 d vs. 6.9 +/- 0.5 d]. Operative time and amount of blood loss had a significant impact on tolerability of early feeding while age, gender, type of operation, and previous abdominal operation had no significant impact. Early oral feeding after colorectal surgery is safe, tolerated by the majority of patients. Operative time and amount of blood loss has impact on the tolerability of early feeding

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Correction of secondary deformities of the cleft lip nose

For both unilateral and bilateral cleft lip nasal deformity, the general trend has been toward operation on the cleft lip nose at the time of initial lip surgery. Secondary surgery to further modify the nasal shape is often necessary and many patients desire complete septorhinoplasty in their teen years. The purpose of the study was to evaluate the results of the methods to correct secondary cleft lip nose deformity. This study carried out on 22 patients; [five females and 17 males] with secondary cleft lip nose deformities, their ages ranged from five to 34 years with mean 17.6 years. All of them were admitted to our department at Al-Azher University Hospital, Damietta. There is nasal symmetry with improved nasolabial and nasofacial relationship, improve speech, and airway passage in 17 patients

Treatment of lateral ray polydactyly of the hand [duplicate thumb]

The prime function of the thumb to be in opposition against the other digit and the prerequisites for stable pinch especially a stable metacarpophalangeal ulnar collateral ligament. The purpose of this study was to evaluate the results of the operative treatment of lateral ray polydactyly of the hand and to consider appropriate surgical procedures. Eight patients underwent management of lateral ray polydactyly of the hand [12 individual thumbs] during the period from May 2006 to July 2007. Cases were classified morphologically into three types on the basis of Stelling's classification. In addition, these types were divided into seven types on the basis of radiographic evaluation on the basis of Wassel's classification. All patients were treated in Damietta Al-Azher University Hospital, all of them were treated surgically; three of 12 thumbs retained persistent deviation and required secondary surgery in the form of exploration and tendon repositioning to correct deviation of growth after one year. Four patients suffered from postoperative pain. The pain occurred at that protuberant point

Reconstruction of posttraumatic perineal defects

Posttraumatic perineal defects restrict abduction of the thigh, interfere with sitting, walking, performance of normal excretory and sexual functions and distort the external genitalia. This study evaluates the different methods of reconstruction of perineal defects according to the type of contracture. 24 patients suffering from perineal defect, 16 males and 8 females. Their ages ranged from 6 to 5.8 years with mean of 13.88 years. They underwent reconstruction after releasing of contracture either by skin grafts, Z-plasty or, local flaps from adjacent areas depending on the conditions of the surrounding tissues. In 14 cases release of scar by incision or excision with free skin grafts were carried out, while local flap transfers including skin elongation procedures such as Z-plasty were performed in 5 patients, V-Y plasty in 2 patients and regional flap transfers i.e. pedicled axial local flap transfers were performed in last 3 cases. In this paper, we classify perineal contractures into five types and present our conclusion depending on the criteria for selecting appropriate surgical methods according to contracture types. Our results suggest that there are four key features of surgical methods for perineal reconstruction: size; depth; location and shape

Proximally based lateral forearm fasciocutaneous flap for elbow coverage of post burn defect

Twenty-two patients suffering from postburn contracted elbow, 15 females and 7 males during the period from June 2002 to July 2004. Their ages ranged from 3 to 33 years with mean 17.9 years. All patients' elbow defect after releasing of the contracture were covered by the proximally based lateral forearm fasciocutaneous flap, the split thickness skin graft is applied over the flap donor site in 4 from 22 patients and the remaining 18 patients' flap donor site is closed by suturing the edge. Flap survival was 100 per cent and graft take on the flap donor site was excellent

Fasciocutaneous flaps in resurfacing of chronic ulcers of the buttock and the lower limb

Fasciocutaneous flaps have challenged some principles such as the safe length width ratio, and the concept that flaps should be proximally based in the leg. This article aiming the effectiveness of different types of fasciocutaneous flaps in covering the chronic ulcers of the buttocks and the lower limbs. Fasciocutaneous flaps were used in the treatment of 35 patients suffering from chronic ulcers of buttock and lower limb due to different etiologies during the period from August 2000 and December 2004. 9 patients with buttock ulcer, 15 patients with ulcer of leg and 11 patients with ulcer of ankle and foot. From 35 fasciocutaneous flap performed, 3 flaps were lost due to obesity, atherosclerosis, hematoma formation under the flap and subsequent severe sepsis, in another 3 patients partial skin graft loss from the donor site were recorded

Reconstruction of anterior neck burn deformities

Correction of the anterior neck burn deformities are preventable rather than surgically correctable by splinting the burned neck in extension position during the acute stage of burn at the end of edema stage. This article aims to compare between releasing of contractures with immediate resurfacing with split thickness skin graft in 30 patients and releasing of contractures of the neck and resurfacing with skin flap in 34 patients. Points of comparison were good aesthetic results as determined by the cervicomental angle obtained, the subjective opinion of patients and good range of motion of the neck, complications of surgery as recontracture again, complementary procedure, postoperative splint and its duration. Regarding patients' satisfaction and complications rate patients of group two revealed better aesthetic results and good range of motion rather than in group one. There were four flap failure attributed to bleeding disorder and to technical errors. Anterior neck burn sequelae thus can be safely treated by enbloc resection and resurfacing with flaps rather than skin graft if possible

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

Clear lens extraction with phacoemulsification and posterior chamber intraocular lens implantation

The purpose of this study was to probe into the effectiveness and safety of clear lens extraction with phacoemulsification and implantation of posterior chamber intraocular lens to correct high myopia. Phacoemulsification and implantation of PC-IOL through clear corneal tunnel incision was performed on 50 eyes of 30 high myopic patients. The average age of the patients was 55.9 years [40-67 years] old. The mean spherical equivalent was -18.46 +/- 3.63 D, the mean axial length was 27.71 +/- 1.63 mm and the mean diopter of the IOL was +4.6 +/- 2.4. The study concluded that clear lens phacoemulsification and PC-IOL implantation to correct high myopia is a safe, effective procedure serving as a refractive surgery, due to the good outcome of visual acuity, low incidence of complications as well as high predictability and stability