Mounir M M Elhao, Ain Shams University. Cairo,Egypt

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<ul><li>Slide 1</li></ul> <p>Mounir M M Elhao, Ain Shams University. Cairo,Egypt. Slide 2 Slide 3 1 January 2014Prof. Dr. Mounir M. F. El-Hao3 Slide 4 1 January 2014Prof. Dr. Mounir M. F. El-Hao4 Slide 5 1 January 2014Prof. Dr. Mounir M. F. El-Hao5 Slide 6 1 January 2014Prof. Dr. Mounir M. F. El-Hao6 Slide 7 Secretory activity diagnosed by five criteria: Endometrial thickness. Vascularity. Prominence of glands. Surface roughness. Tubal ostea Appearance. Depending on the five criteria( sensitivity was 81.9 %) (Mounir Elhao et al,1992.) Slide 8 Thickness. Vascularity. Surface glands These criteria were very sensitive.for diagnosis of ovulation.( sensitivity 90%) The practice of D&amp;C in rarely needed. Slide 9 844 infertile women Fine adhesions.No menstrual disorders. Coarse adhesion,oligohypomenorrhoea. Dense adhesions,Tubular cavity. Complete Occlusion,amenorrhoea. Main causes Curettage,CS,Infections. TTT.Scissors,Diathermy knife. (Sammour,Elhao,Yehya &amp; Saleh,March,1993)Paris Slide 10 Correction of major degree of IUS (Grade 3&amp; 4) With the use of electro cautary needle under hysteroscopic guidance resulted into very poor pregnancy rates.(2cases only)Both of them resuted into missed abortion. Elhao,Lamii,Elnazer,&amp; Hamza.MD Thesis(1996) Slide 11 In 32 cases (43.2% ) G1&amp;2 In 44 cases (56.8%) G 3&amp;4 Recurrence of adhesions after surgical hysteroscopy was in almost 1/3 of cases.maily in G3&amp;4,Mainly after puerpural sepsis. Now the use of scissors under office and routine hysteroscopy gives far more better results.(ongoing study.) Slide 12 Slide 13 Slide 14 50 cases of missed IUCDs threads,hysteroscopy was successful in extraction of 100%(20 cases) of IUCDs While D&amp;C was successful in only 90 % of cases. Maged,Elhao et al.1989. Slide 15 New technique of Hysteroscopic extraction of IUCD,using the telescope oh the hysteroscope and a mini crocodile forceps.from 286 cases of missed threads,236 were found to be intrauterine,and were either successfully extracted (220cases) with diagnostic telescope and mini-crocodile forceps.or left in place after withdrawal of the threads(16 cases.) (Elhao,1990) Slide 16 72 patient wearing IUCDs,41 cases complaining of irregular uterine bleeding.while 31 cases as controls. In the group of AUB 27 cases of the 41 cases had local pathplogy or abnormal position of IUCDs but only one case of the control had local pathological lesion. Elhao et al,1989 Slide 17 In 50 cases of previous CS there were Scar not detected 11 Fibrotic white band 16 Granulation tissue 13 Minute defect. 03 Large defect. 05 Cervicat scar 02 What should we do? Yehya,Sammour,Elhao Slide 18 Slide 19 Slide 20 Slide 21 Slide 22 2-3 %of the population. 20% of repeated miscarriages. Since Edstrom in 1074,described hysteroscopic resection of uterine septum the technique was practiced Elhao,Sammour and Elgammal,MS thesis,(1993.) One of the most satisfactory procedures in hysteroscopic surgery and gynecology. Slide 23 First described by ELDSTROM in 1974 Hysteroscopic management of lateral fusion defects,septate,suseptate,partial bicornuate and uterus bicollis with or without septate vagina was done since early eighties.obstetric performance wasmarkedly improved after this procedure. Electric Knife,loop,or cold scissors. Unipola or bipolar diathermy. With or without anesthesia. Mounir Elhao,Sammour (several studies.) Slide 24 1 January 2014Prof. Dr. Mounir M. F. El-Hao24 The most satisfactory results which were achieved by hysteroscopy.wether by electric knife or by scissors.By routine resectoscope or office. Slide 25 1 January 2014Prof. Dr. Mounir M. F. El-Hao25 Slide 26 On fifty patients with high risk for uterine malignancy,(Diabetic,hypertensive,,obese,infertile,low parity), The study concluded that a negative hysteroscopic finding was considerted conclusive of absence of uterine pathology Also the study concluded that panoramic hysteroscopy is a valid alternative of traditional D and C. (Sammour,Elhao,Eissa,Khalifa and Elmogazi. 1992), Slide 27 Cases were 2 or more D&amp;Cs were performed for irregular uterine bleeding.(33 patients.) Hysteroscopy revealed abnormal intracavitary pathology in 81.8 % of cases examined.(10 myomas,4 polyps, 11 hyperplasia,1 atrophy and cancer in 1 case.) Makhlouf and Elhao,1989. Slide 28 Slide 29 Slide 30 . Traditionally, the resectoscope has played a major role in the resolution of these pathologies, forcing the hysteroscopist to use this large diameter instrument even in the presence of small lesions (Loffer, 1990; Corson and Brooks, 1991; Hallez, 1996; Porreca et al,, 1996; Bettocchi et al,, 1998). The results were excellent, but due to the size of the instruments and hence the need to dilate the cervical canal, the use of general anaesthesia and an operating room were generally required. Slide 31 Seems to have an important role during the procedure.Fluid absorption was less,bleeding was less and vision was better in the pour-8 group. Elhao,Fateen,Mostafa and Taha,MS degree.(1998). Elhao et al, Slide 32 Abdelmaaboud,Faris MD thesis.(2007) Slide 33 76 cases done with 25% dextrose for uterine distetion as a safe and clear medium,However in recent experience its seems unsafe due to operative procedure opening deep sinuses and intravasation of the fluid and causing hyperglycaemia. Elhao,1988. Slide 34 Slide 35 Slide 36 Slide 37 Patients infertile for at least one year with proven PTB by HSG and or Laparoscopy (witout evidence of other major explanation for their infertility.)were subjected to tubal cannulation.using one of many cannulation kits. The study showed recanalisation rate of 77.7% M Sabri,K Lamii and M Elhao,(MD thesis,1996.) Recently,with more experience,a trial on antichlamidial therapy for three month is worthwhile before cannulation. Slide 38 From october 1993 to october 1996.,80 patients prepared for endometrial resection.25 depot provera,25 GnRHa and 30 patients non treatment group. Conclusions were that progestins were cheaper and better than no treament but with more side effects.GnRHa gave better control of menorrhagia,more effective reduction of endometrial thickness and reduction of uterine size,less fluid absorption. Shalaby,Hussein,Elhoussiny and Elhao,(1998.) With more experience.No Need For preoperative preparations. Slide 39 Slide 40 Slide 41 Amer (2006 ). Slide 42 Slide 43 In the last 10 years, technological improvements have led to the production of smaller diameter scopes. This has prompted the industry to develop sheaths which continue to have a final diameter of ~5 mm, includes the working channel and continuous flow features. Slide 44 is satisfactory distension of the uterus. While many different media have been used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy. Slide 45 Saline 0.9%.Best, Office, Bipolar. Glucose 5 %. Glycene.Best operative Unipolar(</p>