Clinicopathological study of benign ovarian tumuors

Background: The incidence of ovarian tumor amongst gynecological admissions have been reported to vary from 1-3 %. About 75% of these tumors have been found to be benign. Ovarian malignancies represent the greatest clinical challenge of all the gynecological malignancies. During the reproductive years most of the ovarian tumors encountered are benign. About 2/3 of the ovarian tumors are encountered in this group only. The chance that an ovarian tumor is malignant in a patient younger than 45 years is 1 in 15. The differentiation of the benign from malignant tumors can go wrong even with imaging modalities.CA125 along with ultrasound are useful in differentiating benign from malignant tumors. Histopathological examination is gold standard for diagnosis of ovarian neoplasm.Methods: The present study includes consecutive cases of histopathologically proven ovarian tumors of 3 years from June 2010 to May 2013 reported by the Department of Pathology of our tertiary care center. It includes total 150 cases. After careful study of gross findings, appropriate bits were taken from received ovarian specimen, followed by routine paraffin processing to make H and E stained slides. Special stains were used wherever needed.Results: Majority of the cases 91 (60.67%) were benign, 53 (35.33%) were malignant and 6 (4.0%) were borderline. Surface epithelial tumours were the most common type (68.13%) of ovarian neoplasm in this study. Most of tumours in our study occurred in the age group of 21-40 years. Mucinous cystadenomas were most common benign surface epithelial tumour and most common benign tumors overall. There were 22 cases of benign germ cell tumor, all were mature teratoma. All the sex-cord stromal tumours were diagnosed in women older than 40 years. Most common benign lesion in our study is surface epithelial tumour and in age group of 21-40 years. 84% patients studied had symptoms at presentation, out of which 26% of patient presented with dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.Conclusions: Most of ovarian neoplasm are benign with mucinous cystadenoma being commonest entity. Commonest age group is 21-40 years. Commonest benign germ cell tumor is Mature cystic teratoma. Commonest clinical symptom is dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Alirocumab and cardiovascular outcomes after acute coronary syndrome

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Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN