Ahmed Khairy Makled

Three-dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding

The aim of this study was to evaluate the efficacy of 3D power Doppler angiography (3D‐PDA) for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding (PMB).

Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

STUDY OBJECTIVE Because laparoscopic ovarian cystectomy of endometriomas is known to adversely impact patient ovarian reserve, the search for other techniques of surgical management is ongoing. The present study was undertaken to evaluate laparoscopic cyst deroofing as a feasible alternative. STUDY DESIGN Prospective, randomized clinical trial (Canadian Task Force classification I). SETTING University maternity hospital. PATIENTS Women diagnosed with unilateral or bilateral ovarian endometriomas. INTERVENTIONS Patients were managed with either laparoscopic ovarian cystectomy or cyst deroofing. MEASUREMENTS AND MAIN RESULTS A total of 122 women with endometriomas were randomized to either laparoscopic cystectomy (group 1) or laparoscopic cyst deroofing (group 2). The primary endpoint was the effect on ovarian reserve based on changes in anti-Müllerian hormone (AMH) values. At 1 month postsurgery, anti-Müllerian hormone values were significantly decreased (p < .001) from preoperative values, from 4.25 ± 0.87ng/mL to 1.66 ± 1.02ng/mL in group 1 and from 4.2 ± 1.69ng/mL to 2.15 ± 1.48ng/mL in group 2. In addition, antral follicle count and ovarian volume decreased significantly (p < .001) in both groups by 1 month postsurgery. The decreases in these 3 parameters were more significant (p < .001) in group 1 than in group 2. CONCLUSION Laparoscopic cyst deroofing of endometriomas appears to be a promising alternative to laparoscopic cystectomy, with less postoperative decrease in ovarian reserve; however, the higher rate of endometrioma recurrence warrants future clinical research to determine the optimal surgical management of endometriomas.

Bupivacaine in transverses abdominis plane block for postcesarean section either blindly or ultrasound guided

Study objective To compare the effectiveness of blind transverses abdominis plane (TAP) block versus ultrasound-guided TAP block for pain relief after a cesarean section. Background For decades, postoperative analgesia for cesarean deliveries was either systemic drugs, with their adverse effects such as nausea, or epidural analgesia, which would hinder ambulation. The TAP block was introduced by Rafi. It is a novel technique in which blockade of the sensory nerves to the anterior abdominal wall is performed by a regional anesthetic. This is a regional analgesic technique that blocks T6-L1 nerve branches and is increasingly playing a role in postoperative analgesia for lower abdominal surgeries. Patients and methods Sixty American Society of Anesthesiology I and II multiparous pregnant women aged 25 and 30 years old with BMI between 20 and 25 kg/m 2 planned for elective cesarean section (CS) at 38 weeks were allocated randomly to two groups of 30 patients each. Group B received bupivacaine 2 mg/kg of 0.375% solution per side to a maximum dose of 150 mg landmark guided. Group U received bupivacaine 2 mg/kg of 0.375% solution per side to a maximum dose of 150 mg ultrasound guided. Postoperatively, women were asked to document the degree of pain they experienced at 30 min, 1-, 4-, 6-, and 12-h periods. Printed copies of the visual analogue scale (VAS) between ′no pain′ (0) and ′very severe pain′ (100 mm) were given to patients and they were taught how to fill them. We assessed the patient clinically for pain and prescribed pethidine 100 mg intramuscularly if the patient complained of severe pain (VAS<60 mm). The time of analgesia was documented in the patient′s form. Any local complications of the TAP block were also recorded.

The emergence profile of propofol sedation compared with dexmedetomidine injection during ultrasound-guided oocyte pickup for in-vitro fertilization

Background The purpose of this study was to assess the quality, the recovery, and side effects of propofol sedation compared with dexmedetomidine in a very short minimally invasive procedure such as ultrasound-guided oocyte pickup for in-vitro fertilization. Patients and methods Sixty-two female patients undergoing ′ultrasound-guided oocyte pickup′ were randomly enrolled in the study, conducted in a specialized center (Elite Fertility Center, Cairo, Egypt). The emergence profile of sedation with propofol+fentanyl versus dexmedetomidine +fentanyl was compared. The sedation level was assessed and titrated to an Observer′s Assessment of Alertness/Sedation (OAAS) score of 1-2 (responds only after mild prodding or no response to prodding or shaking). Recovery was assessed objectively by OAAS and subjectively by visual analog scale (VAS). Results There is no significant difference in intraoperative parameters regarding the heart rate, the mean arterial blood pressure, the respiratory rate, and SpaO 2 between group D (dexmedetomidine) and group P (propofol). Yet the induction time to the desired level of sedation was significantly shorter in group P compared with group D. Most of the group D patients returned postoperatively to an OAAS score of 5 earlier than group P patients. Group D showed a significantly lower VAS as compared with group P at 1 and 2 h postoperatively, whereas there was no significant difference in the VAS between the two groups at 3 h postoperatively. Conclusion Both propofol and dexmedetomidine are useful and safe for short-period procedural sedation; yet dexmedetomidine has a more rapid induction time of sedation than propofol, better analgesic effect with similar hemodynamic effects, better preservation of respiratory function, and rapid recovery. Thus, dexmedetomidine is a good alternative for short-period procedural sedation such as in ultrasound-guided oocyte pickup.

Prenatal three-dimensional ultrasonography in diagnosing fetal renal anomalies

Objective To evaluate the accuracy of prenatal three-dimensional (3D) ultrasound in the diagnosis of fetal renal anomalies. Patients and methods Fifty-four pregnant women with suspected fetal renal anomalies detected during routine two-dimensional (2D) ultrasound screening after 14 weeks of gestation were rescanned by 3D ultrasound to refine the diagnosis of renal anomalies. The prenatal 3D ultrasound findings were then compared with the postnatal sonographic findings. Results The 3D ultrasound provided additional information in 25 anomalies (46.3%) and was equivalent in 29 anomalies (53.7%). The prenatal 3D ultrasound detected 29 cases (53.7%) of parenchymal renal disease, 20 cases (37%) of hydronephrosis, three cases (5.6%) of a single renal cyst, and two cases (3.7%) of megacystis and hydroureter because of a posterior urethral valve. Two extrarenal anomalies (i.e. Arnold–Chiari malformation and talipes equinovarus) were detected only by 3D ultrasound in conjunction with the bilateral two cases of hydronephrosis. Prenatal 3D ultrasound was equivalent to the postnatal ultrasonography finding in 48 out of the 52 live birth cases (92.3%). Conclusion 3D ultrasound can be used in combination with standard 2D ultrasound imaging to increase the diagnostic accuracy and provide more data than that found on 2D ultrasound.

Measurement of lower uterine segment scar thickness two-dimensional and three-dimensional ultrasonography transabdominaly

Objective The aim of the study was to assess the accuracy of transabdominal two-dimensional (2D) and three-dimensional (3D) ultrasonography in estimating the thickness of a caesarean section (CS) scar. Design Cross-sectional study. Setting Ain Shams University. Participants and methods Pregnant women of at least 36 weeks’ gestation having had at least one previous CS, with singleton pregnancy and cephalic presentation, were recruited. All had transabdominal 2D and 3D ultrasound for assessment of the CS scar. Intraoperative assessment of the scar was carried out and compared with ultrasound. Results Both 2D and 3D ultrasound were able to detect scar defects but 3D ultrasonography of 2.25 mm or less was the best cut-off level for predicting uterine scar defects (highest diagnostic accuracy) with a sensitivity of 80%, a specificity of 100%, positive predictive value of 100% and negative predictive value of 99%. Conclusion Both 2D and 3D ultrasound are capable of predicting weak scars in women with previous CS but 3D sonography had higher accuracy.