Surgery for Complicated Stomal Prolapse: Is the Altemeier Technique an Option? A Report of Three Cases / Cirurgia para prolapso de estoma complicado: A técnica de Altemeier é uma opção? Um relato de três casos

Abstract Introduction The incidence of stomal prolapse ranges from 2% to 22%. The risk factors include colostomy, the short length of the stoma, obesity, emergency surgery, and the improper (or even absence of) marking of the preoperative site for the stoma. Complicated stomal prolapse associated with severe mucosal irritation, ischemic changes, or bleeding requires surgical intervention. Objective To describe the use of the Altemeier technique in the management of cases of complicated prolapsed stoma after failure of the local medical measures and manual reduction. Methods Case series of three patients with past history of abdominoperineal resection of rectal cancer and permanent end colostomy presented with irreducible prolapse of the stoma. After the failure of the local measures and manual reduction, urgent surgical intervention using the modified Altemeier technique was necessary. Results The modified Altemeier technique is simple, presents low risk of operative and postoperative complications, besides enabling an early recovery, with a lower risk of recurrence during the first 6 months after the repair. Conclusion Themodified Altemeier technique may be a valid therapeutic modality in the setting of complicated prolapsed stoma.

Resumo Introdução A incidência de prolapso de estoma varia de 2 a 22%. Os fatores de risco incluem colostomia, comprimento curto do estoma, obesidade, cirurgias de emergência, e marcação não adequada (ou atémesmo ausente) do sítio pré-operatório para o estoma. Prolapso de estoma complicado e associado a irritação grave de mucosa, alterações isquêmicas, ou sangramento requer intervenção cirúrgica. Objetivo Descrever o uso da técnica de Altemeier para o manejo de prolapso de estoma complicado após fracasso das medidas médicas locais e da redução manual. Métodos Série de casos de três pacientes com histórico de ressecção abdominoperineal de câncer retal e colostomia terminal permanente apresentaram prolapso irredutível do estoma. Com o fracasso das medidas locais e da redução manual, fezse necessária intervenção cirúrgica de emergência usando a técnica de Altemeier modificada. Resultados A técnica de Altemeier modificada é simples e apresenta risco baixo de complicações operatórias e pós-operatórias, além de possibilitar uma recuperação precoce, com menor risco de recorrência durante os 6 primeiros meses após o reparo. Conclusão A técnica de Altemeier modificada pode ser uma modalidade terapêutica válida em casos de prolapso de estoma complicado.

Does folic acid reduce congenital anomalies and adverse pregnancy outcomes in women received long-term low dose methotrexate?

Background: Methotrexate (MTX) which is folic acid antagonist is used to treat many diseases, including rheumatic, inflammatory, autoimmune disorders or malignancies; it is also used for the medical treatment of ectopic pregnancy and termination of pregnancy. The objective of this study was to assess the impact of folic acid in preventing congenital anomalies (CAs) in the fetus of pregnant that take long-term low dose methotrexate.Methods: The study included 1569 with history of low dose methotrexate therapy <25 mg/week that stopped one month before pregnancy, they were divided into 3 groups; Group 1 comprised 272 pregnant women, Group 2 comprised 367 pregnant women both groups take folic acid 4-5 weeks preconception and for the first 12-13 weeks gestation, the dose in the 1st group was 0.4 mg/day while in 2nd Group 4 mg/day, Group 3 comprised of 930 pregnant disease-matched with no folic acid. Group 4 comprised of 1015 pregnant no underlying autoimmune and no folic acid intake.Results: The overall rate of CAs and cardiovascular CAs were higher in fetuses of Group 3 (OR: 1.7; 95% CI: 1.1-2.7) and (OR: 2.7; 95% CI: 1.4-5.2) respectively compared to the overall rate of CAs and cardiovascular CAs in other groups. Other adverse outcomes as abortion, preterm delivery, preeclampsia, placenta abruption, PROM, low birth weight, admission to NICU, IUGR and IUFD were higher in Group 3 and 4 than in Group 1 and 2. There were no significant differences in umbilical arterial PH. The Apgar scores <7 at 1, 5 min and gestational age at delivery were higher in Group 1 and 2 than Group 3 and 4.Conclusions: There was a certain reduction in methotrexate teratogenic effect on the fetuses with folic acid intake during pregnancy, these pregnancies might benefit from taking of folic acid in high doses before conception and during the first trimester of pregnancy and improvement in fetal and maternal outcomes but the explanation of this effect requires further study.

Assessment of the prevalence of abnormal hysteroscopic findings in infertile women undergoing ART

Background: The endometrium plays an important role in implantation of good quality embryos in ART. Many studies have proved the negative impact of intra uterine pathologies on reproductive outcome whether spontaneous pregnancy or ART, because uterine anomalies may be associated with many obstetric complications such as miscarriage, preterm birth, premature rupture of membrane, malpresentation, postpartum bleeding and retained placenta. Aim of the work: This study aims to assess the prevalence of abnormal hysteroscopic findings among infertile women undergoing ART at Ain Shams Maternity University Hospital over the period from January 2007 to January 2017. Patients and Methods: This descriptive retrospective study was carried out on infertile couples planned for ART who were sent to ECDU for hysteroscopy in Early Cancer Detection Unit (ECDU), Ain Shams University Maternity Hospital. Case reports From January 2007 to January 2017 were reviewed. Results: The most prevalent congenital abnormality was endometrial polyp (18.4%) followed by uterine septum (6.9%). Conclusion: This study concluded that the most common uterine abnormality was endometrial polyp (18.4%), followed by uterine septum in 6.9% of patients. Also, thick endometrium was very common with a prevalence of 12.9%. Therefore, based on this high prevalence of abnormalities, this study is in agreement with the opinion that all women should be offered hysteroscopy, even if they have normal vaginal ultrasound and hysterosalpingography, because this is supposed to increase the detection rate of minor abnormalities, which theoretically will improve the reproductive outcome. Still, further interventional randomized controlled trials (RCT) are needed to verify the positive impact of routine use of hysteroscopy prior to ART

Description of some nematode parasites infecting american cockroach, periplaneta americana in sharkia governorate, egypt

In present study, three known species insect parasitic nematodes were recovered from Periplaneta americana collected from uptown Zagazig City. These nematodes were 1- Hammerschmidtiella dieingi, 2- Leidynema meerutensis, and 3- Thelastoma bulhoesi collected from the hindgut of the host P. americana. These parasites were studied by using light microscope, SEM and TEM

Subclinical varicocele: is there any need for diagnosis and treatment?

This study was done to assess whether there is any benefit from diagnosis and treatment of subclinical varicocele in infertile men with poor semen quality. A total of 208 infertile men without clinical varicocele was examined by color duplex imaging [CDI] and 61 of them were diagnosed to have subclinical varicocele [SCV]. SCV patients were randomly assigned into two groups. Postoperative [one year] spermiogram in group II showed a significant increase in sperm count, but no changes were found in sperm motility and morphology. In group I, sperm parameters remained unchanged after one year of follow up. The pregnancy rate in group I was 13% compared with 14.8% in group II with no significant difference between them. It was concluded that diagnosis and treatment of SCV provided no benefit to infertile men with a poor semen quality