An audit on hysterectomy for benign diseases in public hospitals in Hong Kong.

OBJECTIVE: To assess the standard of hysterectomy in public hospitals in Hong Kong, so as to improve the quality of patient care and outcome. DESIGN: Clinical audit. SETTING: Twelve Hong Kong Hospital Authority public hospitals. PATIENTS: All patients undergoing hysterectomy for benign gynaecological conditions during the period from 1 July 2002 to 31 December 2002 inclusive. RESULTS: A total of 1330 patients were included for analysis: 934 (70.2%) having abdominal hysterectomies, 184 (13.8%) having laparoscopic hysterectomies, and 212 (15.9%) undergoing vaginal hysterectomies. Uterine fibroids constituted the commonest indication for abdominal (73.7%) and laparoscopic (61.4%) hysterectomies, while genital prolapse was the most common indication (96.2%) for vaginal hysterectomy. The majority of patients undergoing laparoscopic and vaginal hysterectomy (86.3% and 84.8% respectively) were given prophylactic antibiotics, in contrast to only 45.8% of those undergoing abdominal hysterectomy. In all, 85.8% of the abdominal and vaginal hysterectomies performed by trainees were supervised, while for trainees performing laparoscopic hysterectomy, all had specialists as their first assistant. The overall incidence of complications for vaginal hysterectomy was lower than that for both abdominal hysterectomy (P<0.001) and laparoscopic hysterectomy (P<0.05). Infectious morbidity was significantly higher in patients undergoing abdominal hysterectomy without prophylactic antibiotics. CONCLUSION: The overall incidence of complications was lower for vaginal hysterectomies, as compared to both abdominal and laparoscopic hysterectomies, whereas the risk of urinary tract injury was significantly higher for laparoscopic hysterectomy. According to our audit, the level of supervision for the trainees was high. However, routine antibiotic prophylaxis should be more consistently used in the territory.

TL and OSL of SrSO4 phosphors doped with Eu.

The thermoluminescence (TL) and optically stimulated luminescence (OSL) of SrSO4:Eu (0.1 mol%) powder sample were studied. The TL and OSL emission spectrum are measured after irradiation (absorbed dose 100 Gy) of 90Sr source; both of them showed that the emission wavelength is at approximately 375 nm, which indicates that TL and OSL have the same luminescence centres, and the luminescence comes from transitions between the energy levels of Eu2+. The TL glow curves and OSL decay curves illustrate that there is only one main TL peak but two main components in OSL curves. By a comparative study of TL and OSL it is concluded that OSL traps are different from TL traps. The TL and OSL dose responses of SrSO4:Eu phosphor were measured, and it showed that phosphor has similar dose responses for OSL and TL.

Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy.

BACKGROUND: This study evaluated the safety of laparoscopic management for persistent adnexal mass in the second trimester of pregnancy. METHODS: Between April 1994 and March 2003, 67 consecutive women underwent laparoscopic removal of adnexal masses that had persisted into the second trimester of pregnancy in an academic tertiary referral center. Operative complications, pregnancy, and labor outcomes were evaluated. RESULTS: The median gestation was 10.5 weeks (range, 5-25 weeks) at diagnosis and 16 weeks (range, 12-25 weeks) at the time of operation. Only two women required for conversion to laparotomy. Cystectomy was performed for 55 women, oophorectomy for 9 women and fenestration in 3 women. There were no intraoperative complications or major postoperative complications. No women were given tocolytic therapy, and none experienced uterine contractions. There was one spontaneous abortion 6 weeks after the operation, and one patent was lost to follow up. Of the remaining 65 women, the median gestation at delivery was 39 weeks (range, 33-42 weeks), and the median birthweight was 3,160 g (range, 2,220-4,200 g). CONCLUSIONS: Laparosocpic surgery for persistent adnexal masses in the second trimester of pregnancy is safe when performed by experienced surgeons.

Thermoluminescence of MgSO4 doped with Eu and P impurities.

CaSO4:Eu, MgSO4:Eu and MgSO4:Eu,P phosphors have been prepared and their thermoluminescence (TL) characteristics were studied. A main glow peak due to Eu2+ ions is seen at approximately 146 degrees C and 440 nm and glow peaks at approximately 145 degrees C, approximately 190 degrees C, approximately 260 degrees C and approximately 360 degrees C for 590 nm and 625 nm wavelengths are identified as Eu3+ ion emissions in MgSO4:Eu. Emission spectra in MgSO4:Eu and the MgSO4:Eu,P show that the MgSO4:Eu3+ glow peak at 260 degrees C for 590 nm and 625 nm shifts to 280 degrees C with enhanced intensity while the Eu2+ ion glow peak at 146 degrees C remains but with reduced intensity. The main glow peak at approximately 146 degrees C and 440 nm from Eu2+ ions shows significant difference from the characteristic glow peaks of Eu3+ ions. It is observed that the wavelength of the Eu2+ ion glow peak is inversely proportional to the radius of the cation of the host sulphate in alkaline-earth sulphate phosphors. By contrast the wavelengths of the Eu3+ ion glow peaks remain unchanged in different sulphates. Besides, the glow curve at approximately 146 degrees C obtained using a conventional blue sensitive reader shows simply the first order kinetics. It is concluded that the luminescence centres and distribution of traps related to Eu2+ ions are different from that of Eu3+ ions in MgSO4:Eu and MgSO4:Eu,P phosphors.

Hair concentrations of calcium, iron, and zinc in pregnant women and effects of supplementation.

In this investigation, the concentration levels of hair elements of calcium, iron, and zinc were measured in pregnant women from Tianjin metropolis, China. The subjects were 93 cases of pregnant women who had been suffering from calcium, iron, or zinc deficiency judged by blood tests at the mid-term of the second trimester or early in the third trimester. Of these 93 cases, 82 subjects had their hair element levels measured when the blood tests were conducted. Then, they were supplied with mineral element nutrients of gluconic acidic zinc (noted as Zn-nutrient), gluconic acidic calcium (Ca-nutrient), or/and ferrous sulfate (Fe-nutrient) which were correspondent to the deficient element(s) for more than 2 mo before 84 subjects returned to hospital for further diagnoses and had their hair element levels measured for the second time. Finally, in the third trimester or near-parturient phase, 13 subjects had their hair element levels measured again. Except for the deficiencies of calcium, iron, or/and zinc, these subjects were all healthy without symptoms of any diseases. The concentrations of hair Ca, Fe, and Zn were measured by X-ray fluorescence (XRF) spectrometry. These concentrations of the three hair elements measured at three different times were statistically analyzed. From the analyses, it was clear that hair concentrations of Ca, Fe, and Zn could reflect the effects of supplementation. Also, the mutual resistant effects among Ca-, Fe-, and Zn-nutrients were revealed. However, by appropriate combination, the mutual resistant effects could be depressed and mutual promotional effects might be enhanced. Finally, it could be concluded that mineral element deficiencies might be convalesced by adequate compensations of mineral element nutrients.

Hair and serum calcium, iron, copper, and zinc levels during normal pregnancy at three trimesters.

The hair and serum levels of calcium, iron, copper, and zinc levels were measured in a group of 70 healthy pregnant women and in 66 age-matched healthy controls living in the Tianjin city of the People's Republic of China. The study subjects were classified into three subgroups according to gestational age. The hair concentrations were measured by X-ray fluorescence spectrometry, whereas those in sera were established by atomic absorption spectrometry. The hair concentrations of Ca, Fe, Cu, and Zn in the three groups of gravida were lower or significantly lower than those in controls. In sera, the differences did not show statistical significance in most cases. A deficiency of calcium was observed in subjects in the last trimester of gestation. This reinforces the importance of supplementation with calcium during pregnancy.

Analysis of incidence of childhood cancer in the West Midlands of the United Kingdom in relation to proximity to main roads and petrol stations.

OBJECTIVES: To investigate whether there is an excess of leukaemias in 0-15 year old children among those living in close proximity (within 100 m) of a main road or petrol station. METHODS: Data for 0-15 year old children diagnosed between 1990 and 1994 in the United Kingdom West Midlands were used. Postcode addresses were used to locate the point of residence which was compared with proximity to main roads and petrol stations separately, and to both together. Odds ratios (ORs) were calculated with solid tumours as a control, and incidence ratios (IRs) with population density as a control. RESULTS: The method based on solid tumours as a control showed ORs of 1.61 (95% confidence interval (95% CI) 0.90 to 2.87) and 1.99 (95% CI 0.73 to 5.43), for those living within 100 m of a main road or petrol station respectively. When population was used as a control, the estimated IRs for leukaemia were 1.16 (95% CI 0.74 to 1.72) and 1.48 (95% CI 0.65 to 2.93) for residence within 100 m of a main road or petrol station respectively, but neither reached significance at the 95% level. Results for residence in close proximity to both a main road and petrol station were inconsistent, but there were few. The influence of socioeconomic factors as represented by the Townsend deprivation index on leukaemia incidence was not significant and the results were not explicable on the basis of impact of social class. CONCLUSIONS: The results are suggestive of a small increase in risk of childhood leukaemia, but not solid tumours, for those living in close proximity to a main road or petrol station. This increase in risk is not, however, significant and a larger study is warranted to establish the true risk and causes of any increase in risk.

A comparison of the Hamamatsu NIRO 500 and the INVOS 3100 near-infrared spectrophotometers.

Near-infrared spectroscopy is a technique used for non-invasive measurement of cerebral oxygenation and a number of commercial devices are currently available for use. We compared measurements of cerebral oxygenation made with two near-infrared spectrophotometers--the Somanetics Invos 3100 cerebral oximeter and the Hamamatsu NIRO-500 near-infrared spectrophotometer. Hypoxia was induced in six healthy male volunteers with and without occlusion of scalp blood flow. Oxygen saturation, end-tidal carbon dioxide tension, regional cerebral oxygen saturation, change in regional cerebral oxyhaemoglobin concentration and change in regional cerebral total haemoglobin concentration were measured. The INVOS 3100 displays cerebral oxygen saturation directly. The NIRO-500 displays change in total haemoglobin concentration and oxyhaemoglobin concentration, and the cerebral oxygen saturation was calculated offline. Statistical analysis disproved the assumption that the INVOS 3100 and the NIRO-500 were measuring the same changes in cerebral oxygenation. Neither machine can be confirmed for reliability against a gold standard and operational difficulties mean that neither can be recommended for routine clinical use.

Following the recovery of naso-pharyngeal cancer patients by trace elements in hair using statistical pattern recognition methods.

This article describes a study where the recovery of nasopharyngeal cancer (NPC) patients was traced by trace elements (TEs) in hair of these patients. These patients whose concentrations of TEs in hair were studied are volunteers who were divided into three groups B, C, and D. Group B was made up of volunteers who had just been diagnosed as having NPC, group C and group D were made up of volunteers who had been diagnosed as having NPC after 3 and 6 mo, respectively, of treatment. For comparison, a control group, namely group A, which was made up of volunteers from healthy persons was added to this study. By implementation of statistic pattern recognition methods, it has been found that the concentrations of TEs in hair can remarkably reflect different recovery phases of NPC patients.

Evaluation of personal exposure to monoaromatic hydrocarbons.

OBJECTIVES: To evaluate the personal exposure of members of the general public to atmospheric benzene, toluene, and the xylenes, excluding exposure from active smoking. METHOD: 50 volunteers were equipped with active air samplers for direct measurement of personal exposure to monoaromatic hydrocarbons (MAH) and an activity diary was completed during each sampling period. Exposures were also estimated indirectly by combining activity data with independent measurements of hydrocarbon concentrations in several microenvironments. RESULTS: Personal exposure were generally well in excess of those which would be inferred from outdoor measurements from an urban background monitoring station. A wide range of sources contribute to exposure, with indoor and in car concentrations generally exceeding those measured at background outdoor locations. Environments contaminated with tobacco smoke were among those exhibiting the highest concentrations. Personal exposures determined indirectly from activity diaries/microenvironment measurements were well correlated with those determined directly with personal samplers. Personal 12 hour daytime exposures to benzene ranged from 0.23-88.6 ppb (mean 3.81 ppb), with 12 hour night time exposures of 0.61-5.67 ppb (mean 1.94 ppb) compared with an annual average concentration of 1.18 ppb at the nearest suburban fixed site monitoring station. The excess of personal exposure over fixed site concentrations was greater for benzene and toluene than for the xylenes. CONCLUSION: A wide range of sources contribute to personal exposures to monoaromatic hydrocarbons with exposure duration being as important a determinant of total exposure as concentrations. Exposures generally exceed those estimated from concentrations measured by background fixed point monitors. Microenvironment sampling combined with activity diary information can provide satisfactory estimates of personal exposure to these compounds.

Analysis of trace elements in the hair of volunteers suffering from naso-pharyngeal cancer.

This article describes a study where the trace elements (TEs) of four groups of volunteers were analyzed. The volunteers were divided into four groups A, B, C, and D. Group A was made up of healthy subjects, group B was made up of volunteers who had just been diagnosed as having naso-pharyngeal cancer (NPC), group C was made up of volunteers who had been diagnosed as having NPC after 3 mo of treatment, and group D was made up of volunteers who had been diagnosed as having NPC after 6 mo of treatment. In all groups, 11 trace elements in hair were analyzed. Our study shows that the concentrations of zinc (Zn), copper (Cu), manganese (Mn), and cobalt (Co) in group B are less than that of group A, whereas the concentration of titanium (Ti) in group B is higher. Our results also show that the difference in the level of TEs between group A and the other groups is dramatically decreased as the time of the treatment is increased. This may be a reflection of successful treatment.

Multielement analysis in serum of thyroid cancer patients before and after a surgical operation.

Concentrations of trace elements Zn, Cu, Fe, Mn, Mg, and Sr in the serum of 50 thyroid cancer patients and 50 healthy controls were analyzed comprehensively by Pattern Recognition Analysis Method. Based on the Principal Component Analysis Method, Zn, Cu, and Sr were found to be the principal elements with significant variations between patients and healthy controls. According to the Mahalanolis Distance Decision and Nonlinear Mapping Methods, the trace elements levels in the serum of cancerous patients were found significantly different from that of controls. For 16 thyroid malignant tumor patients who underwent surgery, sample points of patients after surgery were directional away from corresponding points before surgery. However, an overlapping was found and separation between two groups of points was not complete. This finding suggests that there may be a latency period for the restoration of trace element levels after removal of the malignant tumorous tissue.

Pattern recognition analysis to the variation of nasal-pharynx cancer patients' trace element levels in samples of hair, whole blood, and tissue.

Pattern recognition has been used in this paper to analyze trace element levels in patients diagnosed with nasal-pharynx cancer (NPC) and in healthy control subjects. Trace elements such as Zn, Cu, Fe, Mn, and Mg have been tested in samples of hair and whole blood. Through Mahalanobis Distance Decision analysis, we have achieved good classification effects in whole blood samples: Efficiency for distinguishing patients in 96% and that of healthy controls is 90%. Classification hair samples is inferior to whole blood: Decision accuracy for patients is 58% and healthy controls is 90%. These results are also shown in a nonlinear mapping figure. At the same time, we have also determined 5 trace element levels in 16 other cancer patients' nonneoplastic and cancerous tissue, with no significant difference between them: Decision accuracy of cancerous tissue is 63%, and in nonneoplastic tissue is 50%, hence, we cannot identify them. It can be inferred that there is no idiosyncratic change of trace elements in cancer patients' neoplastic tissue, the change of a cancerous person may occur in the whole body.

Measurement of the elemental composition of nasal-pharynx cancerous tissue with PIXE.

Twenty elements in two samples of nasal-pharynx cancerous tissue (NPCT) have been measured with PIXE. The results show that the element concentrations of calcium and zinc are very high, up to several thousand micrograms/g. Compared with results from other types of cancer patients, trace element concentrations in NPCT seem to be in a special status.

The changes of metabolism balance of zinc and copper in gastric juice with widely varying dietary zinc intake.

The concentrations of zinc and copper in gastric juice of humans who had widely varying dietary zinc intake were evaluated. In order to compare this with zinc and copper levels of normal dietary individuals, we also determined the zinc and copper levels in healthy individuals' plasma and in cancer patient's natural tissue, all of whom had normal diets. The correlation coefficients between zinc and copper were 0.71, 0.45, and 0.55, respectively, in gastric juice, plasma, and tissue of normal dietary subjects. Such correlation changed and was destroyed when there was a high zinc level in gastric juice. When gastric juice zinc level changed from mean value 16.8 mumol/L to 262.5 mumol/L, the correlation coefficient varied from 0.71 to -0.04, and the copper level also varied from mean value 8.96 mumol/L to 4.89 mumol/L. These findings probably give the evidence to suggest that a high zinc level will restrain the copper level and break the balance of the human body's zinc and copper metabolism.