Is unilateral varicocelectomy as effective as bilateral varicocelectomy in management of subfertile patients with bilateral varicocele

Objectives: To compare the results of unilateral and bilateral subinguinal varicocelectomy for patients with primary infertility, including sperm parameters and pregnancy rate.Patients and method: This a retrospective study including 91 men with primary subfertility with bilateral varicocelectomy. The patients were divided into two groups. Group A (46 patients) were subjected to bilateral varicocelectomy. Group B (45 patients) subjected to left varicocelectomy. Patients with unilateral, recurrent, subclinical, secondary varicocele and azoospermia were excluded. All Patients were evaluated with at least two semen analyses with 15 days apart. Follow up schedule for all patients includes physical examination and semen analysis 3, 6, and 12 months postoperatively.Results: Subinguinal varicocelectomy with loup magnification was successfully performed in all 91 patients, with no intra-operative complications occurred. The age ranged between 25 and 39 years (average 32 years),which was not significantly different within the 2 groups. The mean follow up was 7 months. Neither definite hydrocele nor testicular atrophy was detected. Despite considerable changes were noted in sperm concentration, percentage of motility and normal sperm morphology postvaricocelectomy in both groups, there was not a statistically significant difference between the two groups, (P = 0.139, 0.922, and 0.825, respectively and also pregnancy rate (P = 0.14).Concolusions: The semen parameters and pregnancy rate improved significantly in patients who underwent unilateral and bilateral varicocelectomy, with no significant difference between the two groups

Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: A randomized comparative study

Objective: To compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children.Patients and methods: A randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications.Results: Finally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient’s demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value = 0.5).Conclusion: Stone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy.Keywords: Pediatric urolithiasis; Minimal invasive stone management; Flexible URS; ESW

The utility of lung ultrasound in evalu

Aims: To study the role of lung ultrasound (LUS) in the evaluation of bronchiolitis in infants. Patients and methods: 25 hospitalized infants, their mean age (6.94 ± 4.48 months), 7 males and 18 females. All patients underwent chest X-ray (CXR) and lung ultrasound after full clinical examination with suspicion of bronchiolitis and evaluation for corresponding findings. Results: In 25 infants suspected clinically to have bronchiolitis, 11 patients had mild degree of bronchiolitis, other 11 patients had moderate degree and only 3 cases had severe form of bronchiolitis. The chest X-ray and lung ultrasound were done for all patients; the chest X-ray findings were non-specific including lung plethora in 6 patients, hyperinflation in 3 patients and peribronchial thickenings in 1 patient. The lung ultrasound findings were significant and variable ranged from subpleural lung consolidation in 3 cases, compact B-lines in 6 cases, pleural line abnormalities (thickening and irregularity) in 8 cases and small isolated B-lines in 11 cases. On follow-up of infants, the lung ultrasound findings were correlated positively with the clinical course of the disease. Conclusions: Lung ultrasound played an important role in the diagnosis, management and follow-up of infants with clinical suspicion of bronchiolitis

Alkaloids and flavone acyl glycosides from Acanthus arboreus

Phytochemical study of Acanthus arboreus resulted in the isolation of three novel alkaloids: 6-hydroxy-benzoxazolinone, 4-hydroxyacanthamine and acanthaminoside. In addition, a new acyl flavonoid apigenin-7-O-beta-D-(6"-trans-p -coumaroyl)-3"-O-acetyl glucopyranoside was also isolated. The known compounds were identified as apigenin, apigenin-7- O-beta-D-(6"-trans-p-coumaroyl) -glucoside, vanillic acid, lupeol, stigmasterol and sitosterol glucoside. The structures were determined by physical, chemical and spectral techniques