Evaluation of the effect of sildenafil citrate in pre-eclampsia

This study was undertaken to evaluate the effect of Sildenafil citrate [Viagra] on clinical course, biochemical parameters as well as Doppler ultrasound indices in cases of mild pregnancy-induced hypertension [PIH] and to evaluate the role of Sildenafil, if any, as a new therapeutic modality in mild PIH. The present study was conducted on 60 mild pre-eclamptic pregnant women; they were divided into 2 groups: Group I: included 40 cases and were subdivided into 2 subgroups: Group I A [20 cases] received 100mg sildenafil citrate in 2 daily divided doses for 1 week Group IB [20 cases] received 100 mg sildenafil citrate in 2 daily divided doses for 2 weeks Group II [control]: included 20 cases and were subjected to placebo [iron preparation] and bed rest for 1 week. Both groups were subjected to clinical, biochemical and Doppler ultrasound to assess the changes in blood pressure, uric acid, serum creatinine, serum proteins, serum albumin, ultrasound assessment of amniotic fluid index [AFI] and Doppler ultrasound indices [RI, Pl, S/D ratio] respectively before and after the treatment. The study revealed that there was significant decrease in systolic and diastolic blood pressure measurements and all Doppler indices after the use of 100 mg sildenafil for 1 week in group I A and a more significant reduction after longer duration of treatment in group IB without significant change of all these parameters in group II that was subjected to placebo and bed rest for 1 week. Such discussion is still controversial; the subject is still open for much future validation on larger study groups. It is too early for such preliminary study to arrive at sharp conclusions regarding the clinical utility of sildenafil for amelioration of pregnancy-induced hypertension. However it is convenient to report that at least in the current series, significant lowering of blood pressure and improvement of blood flow indices by Doppler ultrasound was attained by 100 mg sildenafil citrate- The possibility of cumulative effect is still hopeful based on more marked effect of the drug with longer duration of administration

Comparative study of two surgical methods used for rectocele repair

The present study was carried out to evaluate traditional repair of rectocele [posteriorcolpoperineorrhaphy] versus prolene mesh repair of rectocele.The study was carried out on 40 patients divided into two equal group; [I] and [II]. This study wasconducted in Alexandria University Shatby Maternity hospital from May 2005 to April 2006 with an averagepostoperative follow up period of 6 months.It was found that mesh repair of rectocele is superior over the traditional posteriorcolpoperineorrhaphy. This new technique takes less operative time and complications, less post-operativecomplications and a better improvement of patient symptoms.mesh repair of rectocele is a safe technique with a reasonable success and accepted rate ofcomplications. However, more researches are needed to prove the success of this technique over a longerperiod of follow up. It is probable that no single technique can correct all rectoceles because of their diverseanatomic and functional components. Prolene mesh repair of rectocele has a favorable rate of symptomresolution with a low rate ofdenovo symptoms. The technique appears useful for properly informed patientswhose goals are reduced protrusion, improved defecation and avoidance of dyspareunia

Risk factors of puerperal sepsis in Alexandria

Puerperal infections are an important cause of maternal morbidity and mortality in developing nations. Investigators have noted several risk factors for developing puerperal sepsis. However, the relative importance of these risk factors varies and has to be determined for each setting. Therefore the aim of the present work was to determine the risk factors for puerperal sepsis in Alexandria, Egypt. A case-control design was used to study the risk factors of puerperal sepsis in Alexandria. The study included 160 puerperal sepsis cases and 160 controls. Puerperal sepsis cases were recruited from the fever hospital as well as from 3 rural health units and three urban health offices in Alexandria. A pre-designed interviewing questionnaire was used to collect data about risk factors of puerperal sepsis. Logistic regression analysis indicated that very low socio-economic score [OR=6.4], no ANC [OR= 4.5], delivery at a governmental maternity hospital [OR= 203.4], frequent vaginal examinations [OR=5.1], anemia during puerperium [OR= 4.3], unsanitary vaginal douching during puerperium [OR=19.9] and unhygienic preparation of diapers used immediately after delivery [OR= 12.1] were significantly related to the occurrence of puerperal sepsis. Improving infection control measures during delivery, limiting the frequency of vaginal examinations, and avoiding all unhygienic practices related to delivery are strongly recommended

Effect of oral contraceptive pills on some aspects of the immune system

To detect the effect of oral contraceptive pills on some aspects of the immune system. The present study was conducted on forty apparently healthy females who were using combined oral contraceptive pills [OCs] for not less than 2 years. They were compared to an equal number of apparently healthy females who did not use the pills or any other hormonal method of contraception. The comparison included: the cellular immunity [T-cell population and function] and humoral immunity [immunoglobulins, C3, C4]. Significant increase in helper T-cells with significant decrease in suppressor T-cells was demonstrated. H: S ratio was shown to increase proportional to duration of pill use. Impairment of T-cell function was reported by significant increase in MII. The percentage of phagocytes was significantly higher in pill users. The levels of IgA, 1gM, C3 and C4 did not show significant change. IgG levels were significantly higher in pill users. T-cells and their subsets are the primary target for steroid hormone influences. Modulation of T-cell population and impairment of T-cell function have been proved to be related to the duration of pill use. OCs may have a possible role in auto-immune diseases

Assessment of diagnostic potential of office mini-hysteroscopy in gynecologial diagnosis

To evaluate feasibility of diagnostic office mini-hysteroscopy for gynecological diagnosis. One hundred and fifty patients with different gynecologic problems were examined by transvaginal sonography [TVS]. An informed consent was obtained for examination by office mini-hysteroscopy; a Wolf rigid 2.7 mm hysteroscope was utilized. Endometrial biopsy was taken with vacuum aspiration curette in cases of abnormal uterine bleeding. The study revealed that TVS had sensitivity of 47.3% and specificity 67.2% as compared to 98.7% and 100% respectively for office hysteroscopy in the diagnosis of the whole study cases. In abnormal uterine bleeding, the diagnostic accuracy of office hysteroscopy showed 97% sensitivity and 100% specificity. Mini-hysteroscopic diagnosis of intra-uterine lesions was 100% sensitive and 100% specific. Office mini-hysteroscopy is an accurate, reliable and fast method for evaluation of intra-uterine pathology with minimal morbidity and high patient acceptance. It should be considered an indispensable modality for routine investigation in gynecologic diagnosis

Endomentrial changed in tamoxfen treated brest cancer patients

To assess the effects of tamoxifen therapy in breast cancer patients on the endometrium. Study was conducted on 30 tamoxiten treated and 10 non-treated breast cancer patients who already were surgically treated. Cases and controls were matching regarding age, parity and time since menopause. Thorough clinical and Laboratory assessment was done. Cases and controls were subjected to transvaginal sonography [TVS] and diagnostic curettage. In tamoxiten group: there was significant increase in uterine volume and endometrial thickness. Significant increase in the incidence of endometrial changes was found: 46.7% atrophic endometrium, 13.3% proliferative endometrium, 13.3% simple hyperplasia, 13.3% cystic hyperplasia, 3.3% adenomatous hyperplasia and 10% endometrial polypi. No single case of atypical hyperplasia nor endometrial carcinoma was found. Tamoxifen treated breast cancer patients have increased risk of endometrial hyperplasia and polypi. Hyperplasia being the forerunner of endometrial cancer, such patients should be allotted to the high risk groups for endometrial cancer

Laparoscopic versus conventional surgical treatment of genuine urinary stress incontinence

To compare laparoscopic versus the classical open colposuspension in surgical treatment of GSI. The study was conducted on 20 patients diagnosed to have GSI. P re-operative evaluation entailed stress test, Q-tip test and urodynamic study including combined cystometry and pressure flow study. Ten cases were subject to laparoscopic Burch colposuspension using non-absorbable suture between Cooper's ligament and vaginal vault. Ten cases were subjected to classical open Burch procedure. Post-operative evaluation was done. Clinical and urodynamic tests were rechecked one month after surgery. Operating time was significantly longer in laparoscopic group [3.25 hours] as compared to open group [1.25 hours]. One case of bladder perforation was recognized intraoperatively in laparoscopic group. Analgesic requirement was significantly less in laparoscopy cases. Hospital stay was found to be significantly shorter in laparoscopic group [4.8 days] than in open group [8.1 days]. Two cases of wound infection were reported in cases of open group. Urodynamic studies revealed comparable results in both groups one month after operation, all in favour of restoration of normal continence. One case [10%] of recurrence was found in each group. Laparoscopic Burch colposuspension is a safe and effective procedure for GSJ. Laparoscopic approach provides better visibility, more precise haemostasis, less post-operative discomfort, quicker recovery and shorter hospital stay

Anticardiolipn antibodies in severe pre-eclampsia

To determine the association between anticardiolipin [ACL] antibodies and severe pre-eclampsia One hundred and ten pregnant women were included: 10 normal as a control group and 100 cases of severe pre-eclampsia subdivided to group ha ACL+ve and group IIb ACL-ve. Immunological tests included ANA, LE cells, ACL, LAC and complement 3. Coagulation studies included APTT, platelet adhesion, euglobulin lysis time, prostacyclin and protein C. 28% of pre-eclamptic cases were ACL+ve and 72% were ACL-ve. Significant increase in ACL [IgG and IgM] was found in group ha as compared to controls and group IIb. LE cells were demonstrated in only 2.8% in group Ha. Significant decrease in euglobulin lysis time and protein C was detected in pre-eclamptic patients in both ACL+ve and ACL-ve groups. Thrombocytopenia was detected in 57.1% of ACL+ve cases and 59.7% in ACL-ve cases with non-significant difference. ACL antibody is a sensitive antibody for detecting APS. LAC is considered as a screening test for suspicious APS. Hypercoagulability state is ascribed to protein C and/or prostacyclin deficiency