Hysterectomy, a comparative study of the different Hysterectomy Routes 2002-2010: a retrospective analysis for 954 patients

Background and aims: The aim of this study is to compare the data of patients and the operating parameters of the five different surgical techniques of hysterectomy (VH = vaginal hysterectomy, AH = abdominal hysterectomy, TLH = total laparoscopic hysterectomy, LASH = laparoscopic supracervical hysterectomy, LAVH = laparoscopic-assisted vaginal hysterectomy). Methods: Patients A total of 954 patients underwent a hysterectomy in the period from January 2002 to October 2010 for benign uterine disease. Material: The data were retrospectively collected from patients’ records and analyzed. The evaluated data included patient’s age, BMI, parities, former operations, indications of operation, duration of hospital stay, operating time, weight of uterus, histopathological report of removed specimen, hemoglobin fall and intra- and postoperative complications. Statistical analysis A statistical analysis was used to examine differences within the five groups concerning the analyzed parameters. Demographic and surgical data were analyzed by ANOVA, Kruskal- alis-, hi-square- or Fisher s test. Results: The average age recorded for all hysterectomies was 47.95 years and the average BMI was 25.85. By comparing all methods, the most common indications for hysterectomy were uterine myoma (65.2%), adenomyosis (11.2%), prolapse (14.8%), hyperplasia of uterus and cervix (2.0%), menstrual disorder (14.8%) and endometriosis (5,0%). The hospital stay was the longest for AH (7.92 days) and the shortest for LASH (3.88). For VH the average hospital stay was 6.74 days, for LAVH 5.85 and for TLH 4.32 days. The shortest operating time was for VH (76.03 minutes) and the longest for LAVH (137 minutes). For AH the average operating time was AH 107.71 minutes, for LASH 106.59 and for TLH 130.24 minutes. The average uterine weight was heaviest for AH 518.58 (170.00- 721.50) grams and lightest for VH 127.77 (59.50-168.50). The average uterine weight for LASH was 244.92 (118.00- 310.00), for LAVH 159.24 (100.50- 181.00) and for TLH 205.11 (114.00- 224.00). The lowest average hemoglobin decrease for LASH was 0.70 g/dl, for AH 1.63 g/dl, where as for VH it was 1.29 g/dl, for LAVH 1.83 g/dl and for TLH 0.82 g/dl. The lowest complication rate was recorded for LASH (2.4%) and the highest for AH (6.6%). The complication rate for VH was 6.3%, which was higher than TLH (2.9%) and slightly lower than LAVH (6.4%). The two well established laparoscopic techniques for hysterectomy (LASH and TLH) showed a lower complication rate than VH and AH. The intraoperative complication rate for hysterectomies operations was 2.9%. The highest intraoperative complication rate occurred at abdominal hysterectomy (4.5%) and the lowest at TLH (1.5%). Postoperative complications are classified into two major groups; major and minor complications. The major postoperative complication rate was 1.8% and the minor postoperative complication rate was 5.9 %. The highest incidence of major complications was recorded by LAVH (6.4%) and the lowest by LASH (1.2%). The lowest minor postoperative complication rate was recorded by LASH (1.8%) and the highest by AH (8.4%). Conclusions Patients with uterine myomas, endometriosis, additional adnexal pathology and high BMI benefit from the laparascopic access route in comparsion to AH and VH. Patients with prolapse, a higher parity score and a low preoperative score benefit from VH compared to LH and AH. VH is a safe natural orfice route for patients with a large number of vaginal delieveries and a low uterine weight. The operation duration is significantly shorter and postoperative results are comparable to laparoscopic hysterectomies. LASH and TLH are minimally invasive methods showing the lowest intraoperative and postoperative complication rate especially for patients with a high preoperative score and a high uterine weight. Laparoscopic hysterectomies showed the lowest hemoglobin decline and the shortest hospital stay and therefore should be the method of choice if VH is not possible. Intraoperative complications correlated with the increase in uterine weight, while no important correlations between BMI, age and uterine weight were observed. The hospital stay was statistically tested against the BMI. However, showed no significant correlation LASH and TLH are associated with a generally lower rate of complications in comparsion to AH and VH. The growing prevalance of obesity, late first delivery and the increase in the preoperative score have contributed to an increased rate of laparoscopic hysterectomies

Evaluation of Laparoscopy Virtual Reality Training on the Improvement of Trainees' Surgical Skills.

Background and objectives: The primary objective was to evaluate the benefit of training with virtual reality simulation. The secondary objective was to describe the short-term skill acquisition obtained by simulation training and to determine the factors affecting its magnitude. Materials and Methods: We prospectively performed a three-stage evaluation: face, constructive, and predictive to evaluate the training with a laparoscopic simulator with haptic feedback. The participants (n = 63) were divided according to their level of experience into three groups: 16% residents; 46% specialists and 38% were consultants. Results: Face evaluation demonstrates the acceptance of the design and realism of the tasks; it showed a median score of eight (IQR 3) on a Likert scale and 54% of participants (n = 34) gave the tissue feedback a moderate rating. Constructive evaluation demonstrates the improvement of the participants in the training session and the ability of the designed task to distinguish the experienced from the inexperienced surgeon based on the performance score, at task I (transfer of pegs) and II (laparoscopic salpingectomy). There was an improvement in both tasks with a significant increase in score and reduction in time. The study showed that those with a high score at the pre-test recorded a high score post-test, showing a significant pair-wise comparison (Z) and correlation (p) showing a significant statistical significance (p < 0.001). The predictive evaluation demonstrates the beneficiary effect of training four weeks afterward on the practice of surgeons addressed with five questions. It showed an improvement regarding implementation into daily routine, performance of procedure, suturing, shortening of the operative time, and complication management. Conclusions: Virtual reality simulation established high ratings for both realism and training capacity, including clinical relevance, critical relevance, and maintaining training enthusiasm

Mucinous Cystic Neoplasm of Pancreas in a Pregnant Woman Presenting with Severe Anemia and Gastric Bleeding: Case Report and Review of the Literature

Mucinous cystic neoplasms of the pancreas are uncommon and especially their occurrence during pregnancy is an extremely rare event which necessitates an individualized and interdisciplinary management. A 33-year old woman was referred to our department during her third trimester of pregnancy (34th week of gestation) with severe anemia and tarry stools. Based on gastroscopic findings, our interdisciplinary team suspected a gastrointestinal stromal tumor and therefore indicated a prompt delivery via cesarean section completed with an oncological resection of the neoplasm. Histological examination subsequently showed a mucinous cystic neoplasm of the pancreas with no evidence of malignancy. To review the prevalence of mucinous cystic neoplasms and to discuss diagnosis and treatment during pregnancy. Moreover, we critically value the indication of preterm delivery and the oncological procedure in the perspective of outcome for mother and infant. A bleeding gastrointestinal tumor during pregnancy represents a life-threatening risk for mother and infant and requires an immediate interdisciplinary treatment. The urgency and radicality of the therapy should be adapted according to individual findings. As our patient&#39;s tumor was suspected of having a malignant progression, an extensive surgical intervention was necessary

From PET Bottles Waste to N-Doped Graphene as Sustainable Electrocatalyst Support for Direct Liquid Fuel Cells

Direct liquid fuel cells represent one of the most rapidly emerging energy conversion devices. The main challenge in developing fuel cell devices is finding low-cost and highly active catalysts. In this work, PET bottle waste was transformed into nitrogen-doped graphene (NG) as valuable catalyst support. NG was prepared by a one-pot thermal decomposition process of mineral water waste bottles with urea at 800 °C. Then, NG/Pt electrocatalysts with Pt loadings as low as 0.9 wt.% and 1.8 wt.% were prepared via a simple reduction method in aqueous solution at room temperature. The physical and electrochemical properties of the NG/Pt electrocatalysts are characterized and evaluated for application in direct borohydride peroxide fuel cells (DBPFCs). The results show that NG/Pt catalysts display catalytic activity for borohydride oxidation reaction, particularly the NG/Pt_1, with a number of exchanged electrons of 2.7. Using NG/Pt composite in fuel cells is anticipated to lower prices and boost the usage of electrochemical energy devices. A DBPFC fuel cell using NG/Pt_1 catalyst (1.8 wt.% Pt) in the anode achieved a power density of 75 mW cm−2 at 45 °C. The exceptional performance and economic viability become even more evident when expressed as mass-specific power density, reaching a value as high as 15.8 W mgPt−1

Evaluation of Laparoscopy Virtual Reality Training on the Improvement of Trainees’ Surgical Skills

Background and objectives: The primary objective was to evaluate the benefit of training with virtual reality simulation. The secondary objective was to describe the short-term skill acquisition obtained by simulation training and to determine the factors affecting its magnitude. Materials and Methods: We prospectively performed a three-stage evaluation: face, constructive, and predictive to evaluate the training with a laparoscopic simulator with haptic feedback. The participants (n = 63) were divided according to their level of experience into three groups: 16% residents; 46% specialists and 38% were consultants. Results: Face evaluation demonstrates the acceptance of the design and realism of the tasks; it showed a median score of eight (IQR 3) on a Likert scale and 54% of participants (n = 34) gave the tissue feedback a moderate rating. Constructive evaluation demonstrates the improvement of the participants in the training session and the ability of the designed task to distinguish the experienced from the inexperienced surgeon based on the performance score, at task I (transfer of pegs) and II (laparoscopic salpingectomy). There was an improvement in both tasks with a significant increase in score and reduction in time. The study showed that those with a high score at the pre-test recorded a high score post-test, showing a significant pair-wise comparison (Z) and correlation (p) showing a significant statistical significance (p &lt; 0.001). The predictive evaluation demonstrates the beneficiary effect of training four weeks afterward on the practice of surgeons addressed with five questions. It showed an improvement regarding implementation into daily routine, performance of procedure, suturing, shortening of the operative time, and complication management. Conclusions: Virtual reality simulation established high ratings for both realism and training capacity, including clinical relevance, critical relevance, and maintaining training enthusiasm

Microbial Quality of Tilapia nilotica in Egypt: A Review

Fish is considered as important source of animal derived protein, omega-3-fatthy acids, minerals such as calcium, phosphorus, iodine, and vitamins. Among the fish species, tilapia nilotica is the most famous fish in Egypt due to its ease culturing, short production cycle, cheap price, and therefore play fundamental roles in food security, particularly in the human supply of the anumal-derived protein. Fish during its production till delivery to the consumer's table might be exposed to a vast array of microbial contaminants either originated from its surrounding eniveronment or via cross contamination from the angler's hands, during transportation, and storage. Therefore, tilapia might act as a potential source of spreading of foodborne pathogens to the consumers. However, few reports had investigated the microbal quality of tilapia, particularly in Egypt. Therefore, this review was undertaken to report literatures studying the prevalence of some foodborne pathogens in tilapia fish in Egypt, the factors that affect the microbial quality of the fish, and some recommendations in order to extend the shelflife and improve the microbial quality of Tilapia nilotica. This reviw concluded that tilapia is eligible for contamination with a vast array of microorganisms such as enterobacteriacae, Staphylococcus aureus, Shewanella putrefaciens, Corynebacterium urealyticum, Aeromonas hydrophila, and Flavobacterium spp. Therefore, it is highly recommended to have efficient cooking of fish either via boiling, grilling, panfrying, dipping in liquid smokes, irradiation, ozonization, and addition of smone natural addirives such as lemon juice

Effect of the Morphology of Tungsten Oxide Embedded in Sodium Alginate/Polyvinylpyrrolidone Composite Beads on the Photocatalytic Degradation of Methylene Blue Dye Solution

Tungsten oxide nanostructures were modified by oxygen vacancies through hydrothermal treatment. Both the crystalline structure and morphological appearance were completely changed. Spherical WO3&middot;H2O was prepared from tungstic acid solution by aging at room temperature, while rod-like WO3&middot;0.33H2O was prepared by hydrothermal treatment of tungstic acid solution at 120 &deg;C. These structures embedded in sodium alginate (SA)/polyvinylpyrrolidone (PVP) were synthesized as novel porous beads by gelation method into calcium chloride solution. The performance of the prepared materials as photocatalysts is examined for methylene blue (MB) degradation in aqueous solutions. Different operation parameters affecting the dye degradation process, such as light intensity, illumination time, and photocatalyst dosage are investigated. Results revealed that the photocatalytic activity of novel nanocomposite changed with the change in WO3 morphology. Namely, the beads with rod nanostructure of WO3 have shown better effectiveness in MB removal than the beads containing WO3 in spherical form. The maximum degradation efficiency was found to be 98% for WO3 nanorods structure embedded beads, while the maximum removal of WO3 nanospheres structure embedded beads was 91%. The cycling-ability and reuse results recommend both prepared structures to be used as effective tools for treating MB dye-contaminated wastewaters. The results show that the novel SA/PVP/WO3 nanocomposite beads are eco-friendly nanocomposite materials that can be applied as photocatalysts for the degradation of cationic dyes in contaminated water

Comparison of narrow band imaging to white light bronchoscopy for evaluation of histopathological biopsy

Background: It is difficult to detect precancerous lesions such as dysplasia and carcinoma in situ (CIS) by conventional white light bronchoscopy (WLB). Narrow Band Imaging Bronchoscopy (NBI) has been reported to detect such lesions more readily. Objective: The objective of the present study is to characterize the appearance of different airway mucosal lesions under NBI mode and to evaluate the role of NBI compared to WLB in diagnosis of premalignant and malignant lesions. Methods: 30 patients presented with radiological changes to chest department in Fayoum University Hospital. They were subjected to full airway examination by fiberoptic bronchoscopy first under WLB then under NBI. Biopsies were taken from susceptible lesions; pathological interpretation was performed. Results: 18 patients (60%) were proved by NBI to have invasive carcinoma compared to 11 patients (36.7%) by WLB. 3 patients (10%) were proved by NBI to have severe dysplasia/CIS compared to 6 patients (20%) by WLB. 3 patients (10%) were proved by NBI to have mild/moderate dysplasia compared to 4 patients (13.3%) by WLB (p value = 0.03). The sensitivity of both WLB and NBI (76.9%) is better than WLB alone or NBI alone (9.1% and 57.1% respectively) in detecting premalignant lesions while the sensitivity of both WLB and NBI (52.6%) is less than WLB alone (55.6%) and better than NBI alone (26.7%) in detecting malignant lesions. Conclusion: NBI can be used in combination with WLB to improve detection of premalignant lesions. It influences biopsy selection and therapeutic planning

Sustainable Microbial and Heavy Metal Reduction in Water Purification Systems Based on PVA/IC Nanofiber Membrane Doped with PANI/GO

Effective and efficient removal of both heavy metal pollutants and bacterial contamination from fresh water is an open issue, especially in developing countries. In this work, a novel eco-friendly functional composite for water treatment application was investigated. The composite consisted of electrospun nanofiber membrane from blended polyvinyl alcohol (PVA)/iota carrageenan (IC) polymers doped with equal concentrations of graphene oxide (GO) nanoparticles and polyaniline (PANI). The effectiveness of this composite as a water purification fixed-bed filter was optimized in a batch system for the removal of cadmium (Cd+2) and lead (Pb+2) ions, and additionally characterized for its antimicrobial and antifungal properties and cytotoxicity effect. The fiber nanocomposite exhibited efficient antibacterial activity, with maximum adsorption capacity of about 459 mg g−1 after 120 min for Cd+2 and of about 486 mg g−1 after 90 min for Pb+2. The optimized conditions for removal of both metals were assessed by using a response surface methodology model. The resulting scores at 25 °C were 91.4% (Cd+2) removal at 117 min contact time for 89.5 mg L−1 of initial concentration and 29.6 cm2 membrane area, and 97.19% (Pb+2) removal at contact time 105 min for 83.2 mg L−1 of initial concentration and 30.9 cm2 nanofiber composite membrane. Adsorption kinetics and isotherm followed a pseudo-second-order model and Langmuir and Freundlich isotherm model, respectively. The prepared membrane appears to be promising for possible use in domestic water purification systems

Polyvinyl Alcohol/Polyaniline/Carboxylated Graphene Oxide Nanocomposites for Coating Protection of Cast Iron in Simulated Seawater

In our daily lives and product manufacturing, metal corrosion causes significant economic losses. Numerous polymeric composite coatings have been shown to be resistant to harsh environments, such as those found in marine environments. In this study, a composite of polyvinyl alcohol/polyaniline blend loaded with carboxylated graphene was explored in the search for long-lasting coatings to resist electrochemical deterioration of cast iron in desalination systems of saltwater. Polyvinyl alcohol/polyaniline/carboxylated graphene oxide nanocomposite was spin-coated onto cast iron samples. Electrochemical impedance spectroscopy (EIS) and electrochemical DC corrosion testing with a three-electrode system were used to study corrosion resistance in uncoated and coated cast iron samples. The results exhibit effective corrosion protection properties. The EIS data indicated better capacitance and higher impedance values for coated samples than bare metal, depicting enhanced corrosion resistance against the saline environment. Tafel analysis confirmed a significant decrease in the corrosion rate of the PVA/PANI/GO-COOH coated sample