Laparoscopy has proven to be the only diagnostic modality where the findings provide a clear, dependable direction for definitive management of impalpable testes. It allows an accurate diagnosis and simultaneous definitive treatment.

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Surgery and general

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Objectives: This study aims to improve the management processes of polytrauma patients by evaluating the Revised Trauma Score (RTS) in predicting trauma outcomes by studying the incidence of mortality, intensive care unit (ICU) need and duration of hospital stay. Methods: Our study had carried out fifty patients with polytrauma examined at Emergency and Traumatology Department, Tanta University Hospital in the period between beginning of December 2020 to beginning of December 2021. Including all polytraumatized patients with age ≥18 years and excluding patients who arrived dead or who had significant co-morbidity. Results: The mean RTS value for survival was 7.05 (min-max=5.67-7.84), and was 4.73 (min-max=1.96-6.9) in non-survivals. Mean GCS for survival was 13.1 (min-max=8-15), and was 7.13 (min-max=3-13) in non-survivals. The mortality prediction of the GCS, RR and SBP were also compared using univariate logistic regression. The OR of the actual GCS score was 0.492 (p <0.001; 95% CI, 0.338 – 0.714). While was 0.940 (p =0.005; 95% CI, 0.910-0.983) for SBP and 0.892 (p =0.023; 95% CI, 0.809 – 0.985) for RR. When the performances of the RTS in predicting in-hospital mortality was evaluated through ROC analysis, the AUC was 0.919 (95% CI 0.806 to 0.977) (p<0.001). Conclusion: RTS is a good predictor of prognosis among trauma patients.  The lower the RTS is significantly associated with a higher mortality and long hospital stay. Early evaluation of the injury level can be effective in patients' management. The revised trauma score is a reliable indicator of prognosis of polytraumatized patients. Therefore, it can be used for field and emergency room triage.

Background:Palpable Undescended Testis (PUT) represents a common paediatric problem in many premature and some mature infants. There are several surgical techniques to correct PUT either through combined inguinal and scrotal incision or single transverse scrotal incision. This study assessed single high transverse scrotal incision for the management of PUT as regards to feasibility, postoperative success and final cosmetic results.Materials and Methods:One hundred twenty patients were managed at the Paediatric Surgery Department of Tanta University Hospital with PUT during the period from March 2010 to March 2014. They were all operated at the age of 6-12 months. We excluded recurrent cases, and cases older than 12 months. Through high transverse scrotal incision, the layers were divided, and the canal entered through the external ring, dissecting the PUT and bringing it through the incision. Hernia sac, if present, was ligated at the neck. Creation of the dartos pouch was then made through the same incision. All infants were followed-up at 1 month, 2 months and 6 months to detect any re-ascended cases, testicular atrophy and the final cosmetic appearance.Results:A total of 140 PUTs were operated upon in 120 patients. PUT was bilateral in 20 patients, right-sided in 65 cases and left-sided in 35 cases. Thirty testes were located at the external ring; the others were located within the inguinal canal. No cases needed a redo operation, and there was no case of postoperative testicular atrophy.Conclusion:Single high transverse incision was sufficient to deal with PUT especially, in young infants (age 6 months) with no need for conversion in most cases to the traditional two incisions technique, and good long term follow-up and a better cosmetic results.

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Background: The leading cause of death in the first 4 decades of life is trauma, and it remains a serious public health concern in all countries, whether rural or urban areas. While in Egypt damage is several times higher because of misclassification and under-reporting. The aim of this research was to compare between POCUS and other traditional imaging (x-ray, CT) in diagnosis of shock following blunt polytrauma patients and evaluate RUSH protocol in diagnosis of shock and follow up. Methods: This prospective research was conducted on 100 patients aged from 18 to 65 years old, with blunt polytrauma presented with shock and hypotension. All patients underwent full history taking, and radiological investigations when needed, clinical examination according to Advanced Trauma Life Support (ATLS), management was consisted of primary and secondary survey, routine laboratory investigations and RUSH assessment for trauma. Results: Systolic and diastolic blood pressure, respiration rate and heart rate were significant clinical predictors of shock. The time taken by RUSH protocol to assess shock was significantly lower compared to the time taken by Pan-CT and X- rays (P < 0.0001). Conclusions: This study has focused on the point-of-care ultrasound (RUSH protocol) role for the early identification of the causes of shock in the department of emergency medicine. Diagnosis made by RUSH protocol is strongly agree with right medical diagnosis. It demonstrates the high efficacy of (RUSH protocol) in detecting and classifying distinct types of shock aetiology with high accuracy.