Hossam E. Fadel

The carpal tunnel syndrome--a new complication ascribed to the "pill".

62 patients using oral contraceptives of various types (average of 45.2 cycles) were diagnosed as suffering from the carpal tunnel syndrome (numbness and tingling of the hands along the median nerve) without any other apparent physiological aberation to account for the condition. After ceasing use of the contraceptives all patients improved except that the thenar muscle atrophy found in 16 of the patients continued. 15 patients who re-commenced use of oral contraceptives against medical advice showed signs of renewed exacerbation of the syndrome. Estrogens effect on fluid retention appears to be the cause for this development. It is concluded that patients showing fluid retention tendencies after prolonged oral contraceptive use will be very susceptible to the carpal tunnel syndrome and lower-dose progesterone contraceptive formulas should therefore be sought.

Serum Complement Activity during Normal Pregnancy

IN AN ERA of organ transplantation, the conceptus is looked upon as Natures successful allogenic graft. Implantation of the growing ovum with establishment of an adequate blood supply appears to be the most difficult stage in the retention of the fetal homograft. Abortion in the early weeks of gestation perhaps reflects, in the majority of cases, an immunologic rejection system. Similarly, delivery could be regarded as a timed rejection reaction. Serum complement is known to show specific changes during organ transplantation. It has been shown that, in man, the rejection of a renal transplant is monitored by a drop of the serum complement level. We thought that a study directed to the determination of complement values during the various stages of normal pregnancy may throw some light on the immunologic problems of pregnancy.

Lesions of the suprarenal glands in pre-eclampsia and eclampsia demonstrated in biopsy material

Seven suprarenal biopsies were obtained accidentally from both pre-eclamptic and eclamptic patients. The essential lesions found were focal hemorrhages and necrosis. Similar lesions had. been previously described in the suprarenals in eclampsia in postmortem material, but not in pre-eclampsia. This proves the similar pathogenetic mechanism. It has also been shown that these lesions are reversible in those patients who recover after delivery. The possible pathogenesis of these lesions is discussed.

Development of a steerable hysteroscope: Studies in the baboon

A steerable fiberoptic hysteroscope was developed with an integrated fluid circulatory system and a channel that can be used either for operative procedures or for the passage of a uterotubal occlusive device delivery assembly. The hysteroscope was demonstrated to be a safe and practical instrument for intrauterine observations, using the baboon as the animal model. Postpartum baboons were used for a majority of the experiments since the cervix of most cycling animals could not be sufficiently dilated to permit hysteroscope insertion. Estrogen-progesterone treatment resulted in softening of the cervix enough to allow hysteroscopic examination in 66 per cent of the animals so treated. Hysteroscopy was performed on 18 baboons. In almost all cases the uterotubal junctions were visualized and appeared as small slits or depressions. Measurements of the mean uterine length, fundal width, normal cervical diameter, and the diameter to which the cervix can maximally be dilated are reported for cycling, hormone-treated, and postpartum baboons.

Renal pathologic findings in patients with the clinical diagnosis of pre-eclampsia

SummaryPre-eclampsia was diagnosed in 40 patients after the exclusion — as far as possible — of chronic renal or hypertensive disease. Percutaneous renal biopsies were obtained from those patients. Pathologic examination of the 32 adequate biopsies showed the specific pre-eclamptic lesion in a pure form in only 53.1%. A variety of lesions were seen in the other biopsies: chronic pyelonephritis, chronic proliferative glomerulonephritis, benign nephrosclerosis, and minimal lesion nephrotic syndrome. One biopsy was apparently normal. The high incidence of chronic pyelonephritis (21.9%) was considered an important finding in Egyptian pregnant women. The significance of these findings as regards the response to treatment, and remote prognosis was outlined.

Hypertension and the oral contraceptives: a report of 19 patients.

19 women ages 25-43 who developed hypertension after prolonged use of oral contraceptives (3-8 years) were studied at Ain Shams University (Cairo) between 1966 and 1969. All patients complained of paresthesia and burning pain in the hands of a median nerve distribution. 17 patients became mormotensive when the pill was discontinued. All patients displayed symptoms of carpal tunnel syndrome and many showed evidence of salt and fluid retention. Salt retention was felt to be of prime importance and causally related to the estrogen component of oral contraceptives.

The Human Uterotubal Junction: A Scanning Electron Microscope Study During Different Phases of the Menstrual Cycle**Supported by the Contraceptive Development Branch, Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, under Contract NIH-NICHD-2233.

Uterotubal junctions from surgically extirpated human uteri were examined. The specimens were obtained during different phases of the menstrual cycle. The interstitial portions of the tubes together with the cornual areas were dissected, excised, and their luminal surfaces exposed. The specimens were then processed for scanning electron microscopy. The surface epithelium of both the cornual endometrium and interstitial endosalpins. Ciliated cells were more numerous in the endosalpinx. Cyclic changes in ciliated cells were minimal, while cyclic secretory activity was demonstrated, especially in the endometrium. The transitional area between the endometrium and the endosalpinx was characterized by a marked increase in the number of ciliated cells, and a tendency of the secretory cells to assume a flattened, polygonal shape. These morphologic features suggest a possible role in the transport and/or maintenance of spermatozoa and/or ova.

Effect of Oral Contraception on Blood Pressure

The effect of oral contraception on blood pressure was studied in women attneding a family clinic in Cairo UAR. The blood pressure was recorded serially in 110 women on 3 types of contraceptive pills during a period of 6 months. 50 women were using SH 840 (ethinyl nortestosterone acetate 1 mg + ethinyl estradiol .05 mg) 33 women were using Lyndiol 1 (lynestrenol 1 mg. + mestranol .1 mg) and 27 were using Eugynon (norgestrel .5 mg + ethinyl estradiol .05 mg). For control there were 100 women fitted with IUDs. The mean blood pressure at the end of 6 months was slightly lower than the pretreatment levels in women on oral contraceptives. However many patients disclosed a tendency to develop hypertension by isolated elevated blood pressure readings. Most of the elevations occurred in the first 3 months. Sodium and fluid retention is thought to play an important role in the pathogenesis of this oral contraception-related hypertension. It is concluded that hypertension should be considered a contraindication to the use or continued use of the pill.