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Objectives Cleft sternum is an infrequent anomaly which typically drags parents' attention since birth with subsequent surgical repair in early years of life but few cases ask for surgical consultation at adulthood. We report 3 cases during the last 10 years in whom we use only a release oblique osteochondrotomy incision to primary repair the cleft without the need for a prosthetic material or bone graft. Methods A retrospective descriptive study for three cases of congenital complete cleft sternum surgically repaired between 2004 and 2014 at cardiothoracic surgery department, Assiut University, Egypt. Surgery was done through a vertical midline incision, removal of the redundant skin, and the sternal edges were defined. Pectoralis muscle flap were created on both sides. A sliding cartilage flap was created between the second and fourth costal cartilages, and the sternal bars from both sides were advanced to meet in the midline followed by sternal approximation with stainless steel sutures of appropriate size. Results Mean ages of cases we have operated were 17.6 years ± SD 1.52. All patients recovered smoothly, extubation was done in the operating room and with no need for postoperative mechanical ventilation. Chest wall movement was stable completely. Patients were discharged between 4th – 6th days postoperatively according to pain tolerance. Cosmetic results were acceptable for all patients. Chronic pain/neuralgia were not reported in 2 years follow up period. Conclusions We propose a simple surgical technique for repair of cleft sternum in adulthood without the need for prosthetic material or bone grafts. In comparison with previous techniques, it offers the theoretical advantage of restoring the anatomy without the risk of infection of the prosthesis or hazards of bone graft.

Objectives Cleft sternum is an infrequent anomaly which typically drags parents' attention since birth with subsequent surgical repair in early years of life but few cases ask for surgical consultation at adulthood. We report 3 cases during the last 10 years in whom we use only a release oblique osteochondrotomy incision to primary repair the cleft without the need for a prosthetic material or bone graft. Methods A retrospective descriptive study for three cases of congenital complete cleft sternum surgically repaired between 2004 and 2014 at cardiothoracic surgery department, Assiut University, Egypt. Surgery was done through a vertical midline incision, removal of the redundant skin, and the sternal edges were defined. Pectoralis muscle flap were created on both sides. A sliding cartilage flap was created between the second and fourth costal cartilages, and the sternal bars from both sides were advanced to meet in the midline followed by sternal approximation with stainless steel sutures of appropriate size. Results Mean ages of cases we have operated were 17.6 years ± SD 1.52. All patients recovered smoothly, extubation was done in the operating room and with no need for postoperative mechanical ventilation. Chest wall movement was stable completely. Patients were discharged between 4th – 6th days postoperatively according to pain tolerance. Cosmetic results were acceptable for all patients. Chronic pain/neuralgia were not reported in 2 years follow up period. Conclusions We propose a simple surgical technique for repair of cleft sternum in adulthood without the need for prosthetic material or bone grafts. In comparison with previous techniques, it offers the theoretical advantage of restoring the anatomy without the risk of infection of the prosthesis or hazards of bone graft.

Uniportal video-assisted thoracic surgery (VATS) is the emerging technique in the modern thoracic surgery practice in Assiut University Hospitals in Egypt we try to keep up with the cutting edge of knowledge to deliver the best available service to our patient. So we invite Dr. Diego Gonzalez-Rivas the world pioneer surgeon in uniportal VATS approach to initiate a uniportal VATS program starting with a workshop with live surgery. The workshop was attended by 84 thoracic surgeons from all across Egypt with a high motivation for adopting the technique in the everyday practice. We believe that uniportal will be the first choice approach for thoracic surgeon in Egypt in the upcoming year.

Background: the use of routine prophylactic antibiotics substantially reduces the rate of post ce-sarean section infection. Aim: to test the efficacy of 2 gram of cefatriaxone as single dose pre op-eratively as extended broad spectrum antibiotics in prophylaxis against post Cesarean section infection in elective operation in low socio economic society. Subjects and Methods: Our study is pilot clinical trial done in Hadhramout government in Yemen to detect the percentage of infec-tion post Cesarean section after use of prophylactic dose of 2 gram of cefatriaxone as single dose pre operatively and relation of base line criteria and surgical character in this regime of prophy-laxis. Results: One hundred women were involved in the study and received the prophylactic dose of cefatriaxone pre operatively half an hour to one hour before Cesarean section and base line character involving, age, BMI parity, number of previous Cesarean section, indication for Cesare-an section, duration of surgery, type of anesthesia, details infection if occurred post Cesarean section, maternal side effect, and any neonatal complication. The percentage of infection after prophylactic dose was 4% and the risk factor was increase of BMI and repeat Cesarean section in 50% of cases without any maternal or neonatal side effects. Conclusion: The use of extended broad spectrum antibiotics was effective in decreasing soft tissue infection post elective Cesarean sec-tion and another study is needed to compare the use of different regime of broad extended spec-trum in either elective or emergency operation.

The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.

The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.

The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.

The objective of this study is to compare the safety and efficacy of laparoscopic ovarian drilling (LOD) utilizing monopolar versus bipolar needle in clomiphene-resistant polycystic ovaries (PCO) in infertile women. This study is a prospective randomized comparative diagnostic trial. The procedures were performed in an endoscopic unit of a tertiary care referral facility and university hospital. Eighty clomiphene-resistant PCO patients were randomly assigned by using a computerized random table into group A and group B for monopolar and bipolar LOD of 40 patients in each group, respectively. The intervention was LOD using monopolar or bipolar needle in groups A and B, respectively. The main outcome measures are resumption of regular menstruation, spontaneous ovulation, and pregnancy. Both groups showed a significant postoperative improvement of menstrual patterns and hormonal profiles if compared to preoperative levels without significant difference between both groups. Spontaneous ovulation resumed in 13 (32.5 %) and 25 (62 %), p = 0.007, while spontaneous pregnancy within 1 year after LOD occurred in 9 (22.5 %) and 18 (45 %) cases (p = 0.033) in both groups, respectively. Both monopolar and bipolar needles are effective tools for LOD in clomiphene citrate (CC)-resistant PCO infertile patients as a second-line therapy. Utilizing bipolar LOD is superior to monopolar LOD due to a significantly higher postoperative incidence of resumption of spontaneous ovulation and spontaneous pregnancy. Theoretical less adhesion formation following bipolar LOD requires a second-look laparoscopy study. In the meantime, spread of bipolar LOD should be encouraged.

Study objective: to evaluate the impact of adolescent first and second pregnancy on fetal and maternal outcomes and to assess the prevalence of obstetric complications among this age group. Design: This is a retrospective hospital-based study, women who attended our hospital for antenatal care between January 2014 and January 2015 were considered for eligibility. Adolescents 20 years old who were presented by their first or second pregnancy were included as a study group and were controlled by women between 20 and 35 years old. Statistical analysis was conducted using SPSS software version 22. Setting: Al-Sabeen hospital in Sanaa city (capital of Yemen). Participants: One thousand and two hundred mothers aged less than 20 years (study group) and 2400 control mother whom age ranged between 20 to 35 years (control group). Interventions and Main Outcome Measures: included women were evaluated for the pregnancy, mode of delivery, obstetric adequacy of antenatal care, complications of complications and fetal outcomes. Results: Among the study group, the prevalence of adequate antenatal care visits was higher than the control group (55% vs. 42.5%, P=0.001). Pre-eclampsia was reported in 10% of adolescents versus 5.8% in control group (p=0.001). No gestational diabetes was diagnosed among adolescents. Antepartum hemorrhage was less prevalent among study group (5%) in comparison to the control group (10.8%). Normal vaginal delivery was less while instrumental delivery and Cesarean section rates were more in adolescent group (35% vs. 60%, 45% vs. 25%, 20% vs. 15%, respectively, p=0.05). The rates of intrauterine fetal death (IUFD) and stillbirth were comparable. Women in the control group tended to deliver newborns weighing > 3.5 kg (15% vs. 7.5%, p=0.001). Conclusion: Adolescent pregnancy is a risk factor for pre-eclampsia, anemia, instrumental vaginal delivery and cesarean section. More frequent antenatal care visits may be warranted in these women.