bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Strategies of Complex Intracranial aneurysm
Authors: Abdelrahman N N , Habib M A , Shehata T H , Fakhr M A , Alabyad A G , Desouky A E 
Published: May 2020

Abstract

Introduction
Treatment of complex aneurysms is amongst the most challenging for neurosurgeons. Complex aneurysms are those aneurysms that could not be normally clipped or treated by conventional endovascular approaches, labeling an aneurysm complex implies increased risk of worse outcome in terms of natural history and/or therapy.

Aim of the Work
To detect the validity of different lines of management, either surgical or endovascular interventions in treating complex intracranial aneurysms.

Methods
A prospective cohort study for 80 patients diagnosed with complex intracranial aneurysm lesions that were treated in Ain-Shams and Alexandria University hospitals by surgical or endovascular intervention. Clinical evaluation, radiological diagnosis, treatment options were offered for all patients in details and follow-up after six months were recorded and analyzed.

Results
The mean age of patients was 39.6 years, with a male to female ratio of 1:0.87 and the commonest age of presentation was (41-60y age group). Amongst 80 patients with 83 aneurysms, 52 (65%) were non-ruptured and 28 (35%) were ruptured. Initial radiological diagnostic tools were CT brain and the commonest finding was SAH in 28 (35%) patients. CT angiogram showed 74 (89%) of the aneurysms in the anterior circulation and 9 (10.8%) in the posterior circulation. Among the 83 aneurysms 56 (67%) were giant and 20 (24.1%) were large in size. ICA aneurysm were 65 and were further sub-classified to Infra-ophthalmic segment (40.9%), Ophthalmic segment (19.2%) and Supra-ophthalmic segment (18.1%). Aneurysms in the vertebro-basilar system 9 aneurysms were further sub-classified to Infra-pica segment (3.61%), PICA segment (1.2%) and Supra-pica segment (6.02%). In this study 22 (26.5%) aneurysms underwent surgical intervention, 12 had ICA ligation PVO, 7 (31.8%) patients clip reconstruction and 3 (13.6%) did STA-MCA bypass surgery. As for Endovascular interventions 61 (76.2%) aneurysms underwent 78 endovascular procedures and five aneurysms did combined endovascular with surgical procedures. All patients were followed by GOS and mRS score over a period of 6 months.

Conclusion
Patient with ischemic tolerance to BOT, PVO either surgical or by endovascular approach is the first line of management. Surgical clip reconstruction takes the higher hand to endovascular intervention for complex aneurysms with wide neck or those with intracerebral hematoma. Follow-up of all patients post-procedure over a time period is most important for early avoiding any early complications.
Depressed Skull Fracture over Cranial Venous Sinuses
Authors: Moharam H E , Jalalod’din H M , Hefni S M , Abuoun W A H 
Published: May 2020

Abstract

Background
Depressed skull fracture overlying venous sinuses deserves a special attention among skull fractures. It puts high demand on every neurosurgeon, as the management of this kind of trauma carry high risk of mortality. It is considered as one of the most dangerous complications of head injuries. Either it is due to fatal venous bleeding, or disturbing the intracranial pressure via thrombosis or stenosis. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Moreover, it should always be treated with high cautions.

Aim of the Work
This study aims at reviewing available scientific data based on clinical trials about the proper management approaches for the treatment of depressed skull fractures overlying major cranial venous sinuses. Either through surgery or medical and conservative management.

Patients and Methods
The study review yielded 22 relevant papers, with a total number of 85 patients. These patients presented to different institutes, at the period between 1996 and 2017. Diagnosed with depressed skull fracture overlying major venous sinuses. The cases divided according to the way of management as follow: 72% of patients treated with surgical approaches. While 28% of patients treated with conservative care.

Results
In total surgical intervention showed to be successful in 53 patients, out of 85 patients included in the study, without any intraoperative complication of bleeding. While 6 patients passed away during the surgical interventions. On the other hand, 18 patients who treated conservatively did not need any further intervention. While 2 studies reported the need of medication following surgery. Furthermore, 6 studies reported failure of conservative management, and needed urgent surgical elevation of the depressed fragment that compressing the sinus. Based on the results, the mortality rate over all was 7%; death was mainly due to inability to control the profusely bleeding from the injured sinuses. With a success rate over the surgical cases in 87%. While it was 75% over the conservative cases. However, this pooled data need further statistical analysis to obtain guiding evidence for current practice.

Conclusions
Clinical decision making must be tailored to each patient independently. In the presence of clinical and radiographic evidence of sinus occlusion surgery is preferred. In such instances where there is a clear need for surgery, adequate precautions should be taken, and an expertise in neurotrauma should always be available. Delayed intracranial hypertension is a possible complication and should always be considered in all patients.
Extended Endoscopic Endonasal Surgery to Ventral Skull Base Lesions
Authors: Montaser A S , Ismail M S , Hammad O Y , Fayed Z Y , Prevedello D M 
Published: May 2020

Abstract

Introduction
In the last two decades, Endoscopic endonasal approaches (EEAs) have undergone a significant evolution with a major shift from a transsellar approach to a variety of approaches that can directly access the midline and paramedian ventral skull base. Once the technical feasibility of any surgical approach is established; its safety (assessed through complications), and treatment outcomes (assessed through long-term follow-up) should be addressed.

Aim of the Study
To assess the feasibility, safety, and efficacy of EEA as a minimally invasive approach to ventral skull base lesions.

Methodology and Materials
this is a prospective observational study of group of 30 patients with ventral skull base lesions that were managed via endoscopic endonasal approaches. All patients’ clinical data, radiographic evaluations, procedural detail, complications, and follow-up data were recorded and analyzed.

Results
The mean age of patients was 50.8 years (range: 18-74 years), with a male:female ration of 1:1.72. The most commonly encountered pathological entities in the cohort was meningiomas (43.3%), pituitary adenomas (23.3%). and craniopharyngiomas (13.3%). Postoperative CSF leak was observed in 6.6% of cases and was managed successfully. There were no cases with postoperative infection in the cohort. Other procedure-related complications include transient diabetes insipidus (10%), pneumocephaly (3.3%), Syndrome of inappropriate ADH secretion (3.3%). Gross total resection was achieved in 93.3% of cases. Improvement of preoperative symptoms was recorded in 89.2% of cases. The mean follow-up duration was 17.8 ± 2.7 months.

Conclusion
EEAs provide direct access and better visualization to the ventral skull base without brain retraction and with minimal neurovascular manipulation, leading to less morbidity and mortality. EEA can be considered a feasible, safe, and effective tool on the armamentarium of skull base surgery. EEAs should not be considered as a replacement to the traditional transcranial approaches; rather. EEAs are deemed as a complementary route and a potential alternative to conventional skull base surgery in select cases.
Endoscopic transtuberculum transplanum approach to suprasellar meningiomas
Authors: Elsawy A , Hamada S , Ibrahim H , Yousef O , Elhusseiny H 
Published: May 2020

Abstract

Introduction
Extended endoscopic approaches to suprasellarmeningiomas have been proposed recently as a viable option or alternative to traditional microsurgical transcranial approaches. Endoscopic approaches have been presented as a minimally invasive route to such formidable lesions of the skull base, obviating the need of large craniotomies & brain retraction. Endoscopic approaches were shown to provide comparable rates of gross total resection, in selected cases, better visual outcomes than transcranial approaches, on the other hand high CSF leak rate was a major cornerstone for criticism for endoscopic approaches.

Objective
Assessing the feasibility & safety of extended endoscopic approaches to suprasellarmeningiomas.

Methods
Interventional prospective study including 23 patients harboring suprasellarmeningiomas assessed for gross total resection, visual outcome, CSF leak rates & other surgical morbidities.

Results
23 patients 18 females (78%) & 5 males (22%); mean age was 59 years with range of 37-86 years. Tuberculumsellae meningioma compromised 15 cases (65%), planumsphenoidale 2 cases (9%) &planum/tuberculum 6 patients (26%) of the studied patients. Gross total resection wash achieved in 17 patients (74%).Vision was improved in 80% of patients presenting with visual symptoms & was stable in 20% post-operatively. All patients (100%) without pre-operative visual deficit were able to preserve their pre-operative visual state. CSF leak was the most common compilation occurring in 4 patients (17%). Lumbar drainage was sufficient to control the CSF leak in 2 patients while the other 2 patients required surgical repair of the skull base reconstruct. Transient DI was encountered in 2 patients (9%).

Conclusion
Extended endoscopic approach to suprasellarmeningiomas is safe & feasible. Comparable outcomes regarding gross total resection with superior visual outcome can be attained in carefully selected patients. CSF leak is major limitation of endoscopic approaches, however the introduction of vascularized naso-septal flaps helped overcome this issue.
The Value of Hysteroscopy in Women with Persistently Elevated Post-Evacuation Serum Human Chorionic Gonadotropin (hCG) Level Following Evacuation of Molar Disease
Authors: Bakhat M A H , Fayed S T , Ibrahim A M , Naguib A H , Faris M A 
Published: May 2020

Abstract

Background and rational
Gestational trophoblastic disease (GTD) is a spectrum of trophoblastic diseases that encompass the hydatidiform mole (both complete and partial), as well as the potentially-malignant and malignant forms: invasive mole, choriocarcinoma and placental site trophoblastic tumor. Gestational trophoblastic neoplasia (GTN) refers to persistent elevation of serum levels of human chorionic gonadotropin (hCG). The subsequentmanagement of GTD after evacuation of the uterus relies on serial surveillance of serum hCG levels. When serum hCG levels plateau or rise, chemotherapy should promptly be initiated.

Patients and Methods
This study for accuracy of a diagnostic test. The current study was conducted at Gynecologic Oncology Unit and Early Cancer Detection Unit at Ain Shams University Maternity Hospital during the period between January 2016 and June 2018.

Results
In the present study, the case who had a vascular mass, the patient was 44 years old and she was para 4, so board decision was for TAH. Postoperative serum hCG surveillance for this case showed adequately declining levels. She, accordingly, did not receive chemotherapy. For the 19/44 (43.2%) cases who had a hysteroscopic finding of ‘an empty cavity’ were diagnosed as persistent GTN and received chemotherapy according to the protocol. The remaining 25/44 (56.8%) cases, who had a hysteroscopic finding of ‘remnants’, underwent re-evacuation. Postoperative serum hCG surveillance showed persistently elevated levels in 9/44 (20.5%) cases, who, therefore, received chemotherapy according to the protocol; and adequately declining levels in 16/44 (36.4%) cases, who, accordingly, did not receive chemotherapy.

Conclusion
The hysteroscopy significantly reduced the risk of chemotherapy in women with hydatidiform mole and have persistent post-evacuation elevated serum hCG level and sonographic criteria of invasive disease.
Hysteroscopy in the Evaluation of Recurrent First Trimesteric Miscarriages
Authors: Abdelmageed A I , Alsherbiny M M , Abdelhamed A M , Alsaleem W Y 
Published: May 2020

Abstract

Background
Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the etiology is often unknown and there are few evidence-based diagnostic and treatment strategies. Studies on the etiology, evaluation, and management of RPL are often flawed, uterine factors (acquired and congenital)are responsible for 10 to 50 %of recurrent pregnancy loss,hysteroscopy is the gold standard for evaluation of the eendometrial cavity.

Aim of the work
to evaluate the role of hysteroscopy in the diagnosis of possible uteri.ne congenital and acquired causes of recurrent first trimesteric miscarriages.

Patients and methods
This prospective cohort study was conducted on 164 patients with recurrent (3 or more), first trimester miscarriage planned to undergo office (diagnostic) hysteroscopy to assess the uterine cavity, who attend Ain Shams University maternity Hospital Early Cancer detection Unit during period from July 2018 to December 2018.

Results
the largest proportion 53% of our study population had abnormal hysteroscopic findings, and the uterine septum had the highest prevalence among women with recurrent first trimesteric miscarriages.

Conclusion
In women with recurrent pregnancy loss, hysteroscopy is a useful diagnostic tool in the diagnosis of possible uterine causes of recurrent miscarriages. Uterine septum is the most common congenital uterine abnormality found in patients with recurrent first trimesteric miscarriages.
Serum Amyloid A in Preeclampsia
Authors: Swidan K H , Sweed M S , Abbas A M , Jewi M K 
Published: May 2020

Abstract

Background
Preeclampsia is a common complication of pregnancy and remains a common cause of maternal and fetal mortality. The clinical symptoms of preeclampsia are caused by widespread endothelial dysfunction suggested to be a part of an exaggerated maternal inflammatory response to pregnancy. Since preeclampsia is associated with widespread endothelial dysfunction, proposed to be provoked by an increased maternal systemic inflammatory response, the maternal plasma level of SAA might be expected to be increased when compared to normal pregnancy levels. The maternal plasma level of SAA in normal pregnancy could differ from non-pregnant level due to increased hormone levels, increased adipose tissue and\or secondary to modifications of inflammatory response in normal pregnancy.

Aims
The aim of our study is to estimate the relation between serum amyloid A in pregnant women and preeclampsia.

Methodology
the study conducted this case control study in the emergency room of Ain Shams University Maternity Hospital starting from April 2018 on women with preeclampsia to estimate serum amyloid A in pregnant women with preeclampsia. Members of the control group are healthy, non-smoker pregnant women who had an uncomplicated antenatal course and all arterial blood pressure measurements were normal.

Results
The current study was conducted in Ain Shams University Maternity Hospital in the period between January 2017 and August 2018. A total of 75 women were included in the study. The process of recruitment and handling the study population during the course of the study is shown in the flow diagram (figure 1). In order to avoid any confounding effect for a possible subclinical ongoing pathophysiological process, four women with preeclampsia lacking severe features were excluded following the development of severe features shortly after measurement of serum amyloid A level.

Conclusion
Our data sustain the limited number of studies investigating the SAA levels in both preeclamptic and healthy pregnant women, in which it was hard to reach a consensus regarding the association between SAA levels and preeclampsia. Taken in consideration that an elevated plasma level of SAA in preeclamptic women should be considered pathologic, we believe that the response of relationship between the preeclampsia and SAA levels could be caused by an inflammatory condition associated with preeclampsia. Also, serum amyloid A can be used to discriminate between mild preeclampsia cases and controls and as discriminate between severe preeclampsia cases and controls.

Recommendation
We recommended further investigation on large sample size for the elucidation of the role of SAA in pre-eclampsia neonatal outcome and the possibility of these biochemical factors to be novel markers of such disorders in pregnant women.
Study of the Vascularity of Uterine Septum Using Three Dimensional Power Doppler Ultrasound
Authors: Amer M I M , Hassan N E , Ahmed M E , Elnaggar H M M 
Published: May 2020

Abstract

Background
Uterine anomalies are a relatively common congenital abnormality, with uterine septum being the most common. This is even truer in patients with recurrent pregnancy loss, in whom rates of uterine abnormalities may approach 15% to 27%. Historically, the uterine septum has been approached via laparotomy through either a Tompkins or Jones procedure. These successful, but highly morbid, procedures require laparotomy with significant hospital stays, subsequent cesarean delivery, and have carried a high risk of adhesion formation. More recently, this surgery has been supplanted by hysteroscopy or other minimally invasive methodologies.

Objective
To assess the relation between the vascularity of uterine septum and obstetric performance with Transvaginal 3D Power Doppler Ultrasound.

Patients and Methods
Early Cancer Detection Unit and Ultrasound and Fetal special care Unit in Ain Shams University Maternity Hospital (ASUMH). Recruitment took place between May 2017 and November 2018. Cross-sectional study. The study included 30 cases of women with uterine septum. Intervention: Transvaginal 3D power Doppler ultrasound was done to all cases with septal volume and vascularity assessment using VOCAL system and Histogram facility. The study included 30 patients with septate uterus, twelve of them suffered from 1ry infertility while the other eighteen suffered from recurrent abortion.

Results
There was statistical significant difference between the two groups regarding vascularity (VI, FI, and VFI) of septum (P &lt; 0.05).

Conclusion
The vascularity of septate uterus is variable. The power Doppler indices shows that septate uterus in cases with recurrent abortion is highly vascular while in cases with 1ry infertility shows low vascularity. Highly vascular septum may be a site of implantation which may be a cause of recurrent abortion thus; excision of the septum may help prevent recurrent abortion, while low vascular septum may prevent implantation which may be a cause of infertility thus; incision of the septum may help in treatment of infertility. Correlation with histopathologic features of septum may be required to decide the best management of the septum.
Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled trial
Authors: Elguindy A , Hemeda H , Esmat M , Nawara M , Metwally A M F 
Published: May 2020

Abstract

Objective
The Aim of the study is to compare between transverse and longitudinal uterine incision in abdominal myomectomy regarding intraoperative blood loss Design: A randomized Controlled interventional study.

Setting
Ain Shams Maternity teaching hospital.

Patients and methods
52 patients undergoing abdominal myomectomy for single myoma were involved The patients were randomized into two groups that showed no significant difference in demographic data, characters of myoma or indication of surgery

Results
Our results proved that there was no significant difference between both incisions regarding intra-operative blood loss, need for blood transfusion, post-operative Hgb drop, operative time or incidence of postoperative fever.

Conclusion
Transverse uterine incision for myomectomy does not cause more blood loss than longitudinal incision. There is no difference between both incisions in operative time or postoperative complications Trial identifier: NCT03009812, MY-789
In Depth Analysis of Maternal Mortality in Ain Shams University Maternity Hospital in 2014-2017
Authors: Elqady O S , Riad A A M , Abdellah I E S 
Published: May 2020

Abstract

Background
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.

Aim of the Work
is to determine outline and asses the magnitude and the factors contributing to maternal mortality, especially the avoidable factors and to evaluate the possibility of prevention of such factors, to decrease the incidence of maternal mortality to the least possible value, and finally to make some recommendations and comments for possible preventive measures.

Patients and Methods
This retrospective study was be done to detect accurate prevalence and most common causes of maternal deaths in Ain Shams maternity hospital over the last four years from 1 January 2014 to end of December 2017. Ain Shams Maternity hospital is one of Ain Shams University teaching hospitals located at Abbaseya district serving large population area, producing its governmental medical services by low fees and nominal prices.

Results
The substandard care cases were only (21) cases from total of (161) mortality cases representing (13.043%) from total mortalities, so MMR was (0.4937) per 1000 live births. This was the real MMR that the hospital and health system might had the ability to prevent their occurance.

Conclusion
For improving maternal heath, four essential elements should be done: adequate primary health care at all levels, and an adequate share of the available food for girls from infancy to adolescence, and family planning universally available, to avoid unwanted or high risk pregnancies. After pregnancy begins, good prenatal care, including nutrition with efficient and early detection and referral of high risk patient. The assistance of a trained person for all women in child birth, at home or in the hospital. Women at higher risk must all have effective access to the essential elements of obstetric care.