Surgical Management of Adnexal Masses in Pregnancy

Background and Objectives: Our objective was to review the surgical management, surgical outcomes, and obstetric outcomes of adnexal masses in pregnancy. Methods: A retrospective review was performed of pregnant women before 20 weeks of gestation who underwent laparoscopy or laparotomy for management of an adnexal mass during the period of January 2005 to June 2012 at a university-affiliated hospital. Results: Thirty-five pregnant women underwent surgical removal of adnexal masses during the 7.5-year study period: 21 (60.0%) underwent laparoscopic surgery, and 14 (40.0%) underwent laparotomy. The left upper quadrant entry technique was used in 20 women. Conversion to laparotomy was required in 2 women because of extensive pelvic adhesions. The mean gestational age at surgery was 15.2 ± 1.9 weeks. All women had undergone ovarian cystectomy. A malignant mass was found in 3 (8.6%) women. The laparoscopy group had a significantly less blood loss (67.4 ± 55.8 vs 153.6 ± 181.0 mL, P = .048) and shorter mean hospital stay (2.8 ± 1.0 vs 3.8 ± 1.1 days, P = .006) than the laparotomy group. One woman miscarried soon after surgery. There was no significant difference in obstetric outcomes between the laparoscopy and laparotomy groups. Conclusion: Surgical management of adnexal masses during pregnancy appears to have favorable outcomes for the mother and the fetus.published_or_final_versio

Second trimester termination of pregnancy after previous classical caesarean section for uterine fibroid

E-poster - EP13: Early Pregnancy: no. EP13.05This journal suppl. entitled: Special Issue: Abstracts of the RCOG World Congress 2013, 24–26 June 2013, Liverpool, United KingdomOBJECTIVES: To report the successful termination of pregnancy in a patient with history of previous classical caesarean section performed because of uterine fibroid obstructing the lower segment. METHODS: The patient had classical caesarean section performed for transverse lie, uterine fibroid 14 months prior to presentation requesting termination of pregnancy at 14 weeks maturity. During the operation, a 16 cm broad ligament fibroid was found posteriorly in the left side. The patient was treated with the following regimen 1. Insertion of hygroscopic cervical dilator the night before 2. Misoprostol 50 microgram vaginally, then 100 microgram vaginally 4 hours after initial dose, then 150 microgram vaginally 8 hours after initial dose, then 200 microgram ...published_or_final_versio

Molecular characterization and phylogenetic analysis of betasatellite molecules associated with okra yellow vein mosaic disease in Sri Lanka

Okra production in Sri Lanka has been severely affected by okra yellow vein mosaic disease (OYVMD), which is caused by begomoviruses and associated betasatellites. These betasatellite molecules commonly determine the development and severity of the disease. Therefore, knowledge about the genetic variability of betasatellites associated with OYVMD could assist okra breeding programs in the selection of resistant varieties. The present study aimed to characterize the betasatellite DNA sequences associated with OYVMD in Sri Lanka and to determine their phylogenetic relationships. Betasatellite DNA of six virus isolates from widely separated geographical locations were sequenced and compared with already reported begomovirus betasatellites. The betasatellite molecules have features common to other betasatellite DNAs: a conserved nonanucleotide TAATATTAC, a coding sequence for the protein βC1, an adenine rich region and a satellite conserved region. Nucleotide diversity among the isolates was relatively low (π = 0.034). A recombination event was detected at a specific region in the genome of all isolates. The isolates shared >96% sequence identity with bhendi yellow vein betasatellites reported from India and phylogenetic analysis confirmed their genetic relationship

f(R) theories

Over the past decade, f(R) theories have been extensively studied as one of the simplest modifications to General Relativity. In this article we review various applications of f(R) theories to cosmology and gravity - such as inflation, dark energy, local gravity constraints, cosmological perturbations, and spherically symmetric solutions in weak and strong gravitational backgrounds. We present a number of ways to distinguish those theories from General Relativity observationally and experimentally. We also discuss the extension to other modified gravity theories such as Brans-Dicke theory and Gauss-Bonnet gravity, and address models that can satisfy both cosmological and local gravity constraints.Comment: 156 pages, 14 figures, Invited review article in Living Reviews in Relativity, Published version, Comments are welcom

The detector system of the Daya Bay reactor neutrino experiment

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A qualitative study of patient satisfaction with follow-up cancer care: The case of Hong Kong

This paper reports the results of a qualitative study that examined the experiences of cancer patients with the intention of incorporating consumer perspectives into the development of quality cancer care in Hong Kong. Altogether, eight focus group interviews were conducted with a total of 41 cancer patients. The results indicate that patients lack clear guidance and support regarding the management of sequelae and surveillance against recurrence. Patients also raised concerns about the lack of access to information, and the lack of health care provider accountability. Any understanding of the scope and goals of follow-up cancer care is obscured when the healthcare environment is not conducive to good doctor-patient communication. Patients are calling for more explicit goals and clinical practice guidelines to serve as frames of reference for both patients and doctors. © 2002 Elsevier Science Ireland Ltd. All rights reserved.link_to_subscribed_fulltex

A prospective randomised study on vaginoscopyand H Pipelle versus traditional hysteroscopy andstandard pipelle

Objective: To compare the use of vaginoscopic versus traditionalhysteroscopy in the evaluation of endometrial cavity.Design:Prospective, randomized, single blinded, clinical trial(Canadian Task Force classification I).Setting: University-affiliated hospital in Hong Kong.Patients: Ninety women scheduled for diagnostic hysteroscopyunder no anaesthesia.Methods: Women were randomised to undergo eithervaginoscopic hysteroscopy using the H Pipelle for endometrialsampling (n = 45) or traditional hysteroscopy using the standardPipelle (n = 45). Both procedures were performed under noanaesthesia using a rigid 4.5 mm hysteroscope. Main outcomemeasures analyzed were pain scores using a 10-cm visual analoguescale during hysteroscopy, endometrial biopsy and the overall painsore of procedure, successfulness and duration of each procedure,and adequacy of endometrial sample obtained.Results: The success rate for vaginoscopic and traditionalhysteroscopy were 93.33% and 100%, respectively (P = 0.24).There was no significant difference in the mean pain score andprocedure duration between the two hysteroscopic approaches.Endometrial sampling with H Pipelle was significantly quicker byabout 45 s compared to the standard Pipelle [duration(mean ± SD, min): 1.46 ± 0.72 vs. 2.20 ± 1.19 respectively,P = 0.001] with similar biopsy adequacy. Most women (95.5% inboth approaches) found the procedure acceptable. There was nointra- and postoperative complications.Conclusions: Vaginoscopic and traditional hysteroscopicapproaches are similar in safety, feasibility and women’s painexperience. Shorter duration is needed to obtain an endometrialsampling using the H Pipelle than the standard Pipelle

Randomized Study of Vaginoscopy and H Pipelle vs Traditional Hysteroscopy and Standard Pipelle

Study Objective: To compare the use of vaginoscopic vs traditional hysteroscopy in evaluation of the endometrial cavity. Design: Prospective, randomized, single blinded, clinical trial (Canadian Task Force classification I). Setting: University-affiliated hospital in Hong Kong. Patients: Ninety women scheduled to undergo diagnostic hysteroscopy without anesthesia. Interventions: Women were randomized to undergo either vaginoscopic hysteroscopy using the H Pipelle for endometrial sampling (n = 45) or traditional hysteroscopy using the standard Pipelle (n = 45). Both procedures were performed without anesthesia and using a rigid 4.5-mm hysteroscope. Main outcome measures analyzed were pain scores using a 10-point visual analog scale during hysteroscopy, endometrial biopsy, and overall pain score of the procedure, success and duration of each procedure, and adequacy of the endometrial sample obtained. Measurements and Main Results: The success rates for vaginoscopic and traditional hysteroscopy were 93.33% and 100%, respectively (p=.24). There was no significant difference in the mean pain score and procedure duration between the 2 hysteroscopic approaches. Endometrial sampling using the H Pipelle was significantly quicker by about 45 seconds compared with use of the standard Pipelle (mean [SD] duration, 1.46 [0.72] min vs 2.20 [1.19] min, respectively; p=.001), with similar biopsy adequacy. Most women (95.5% in both approaches) found the procedure acceptable. There were no intraoperative or postoperative complications. Conclusions: Vaginoscopic and traditional hysteroscopic approaches are similar in safety, feasibility, and associated pain. Although the time needed to obtain an endometrial sample using the H Pipelle was quicker than with the standard Pipelle, there is no difference in overall procedure duration. © 2012 AAGL.link_to_subscribed_fulltex

Left upper quadrant approach in gynecologic laparoscopic surgery

Objective. To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period. Design. Retrospective review. Setting. University-affiliated hospital. Population. Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010. Methods. Medical records were reviewed. Main outcome measures. Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications. Results. 143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surgery in the second trimester of pregnancy (16, 11.1%), presence of large pelvic mass (9, 6.2%), previous transverse rectus abdominis myocutaneous flap for breast reconstruction (3, 2.0%), previous periumbilical hernia repair (1, 0.6%) and previous laparoscopic umbilical wound dehiscence (1, 0.6%). In women with previous abdominal surgery, the overall incidence of adhesions between omentum and/or bowel to the anterior abdominal wall in the umbilical region was 58.4%. Twelve (8.3%) patients required conversion to laparotomy. One patient had subcutaneous surgical emphysema over the left upper quadrant entry site. Conclusions. The left upper quadrant approach is an effective, safe and easy technique for peritoneal cavity access in women undergoing laparoscopic gynecologic surgery and should be considered in women with risk factors of periumbilical adhesions and in the presence of a large pelvic mass. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.link_to_subscribed_fulltex