Endometrial cryoablation with ultrasound visualization in women undergoing hysterectomy.

STUDY OBJECTIVES: To evaluate tissue effects of cryosurgical endometrial ablation in women just before hysterectomy, characterize ultrasound monitoring of freezing, determine the feasibility of a new probe-angling procedure, and assess the safety profile by monitoring serosal surface temperatures. DESIGN: Single arm safety study enrolling ten women at two centers (Canadian Task Force classification II-2). SETTING: Two clinical sites. Patients. Ten women scheduled for hysterectomy. INTERVENTION: Hysterectomy with a new cryosurgical device (First Option, CryoGen, Inc., San Diego, CA) that achieves surface temperatures below -90 inverted exclamation mark C to freeze endometrium. MEASUREMENTS AND MAIN RESULTS: The freeze protocol involved angling the probe toward each cornu. Maximum ice front diameter at the end of the first angled freeze ranged from 24 to 34 mm, and maximum ice ball diameter at the end of the second freeze ranged from 28 to 37 mm. The margin between the advancing ice front and serosal surface was monitored by ultrasound. In all cases the margin was safe and no reduction in serosal surface temperatures occurred. Depth of necrosis ranged from 9 to 12 mm as determined by tetrazolium staining and electron microscopy, and there was no full-thickness myometrial destruction. Total endometrial destruction was achieved. CONCLUSION: Cryosurgical ablation of the endometrium with the First Option system with angled freezes and ultrasound monitoring appears to be feasible and safe given our preliminary data.

A new medium for determining the total plate count in food.

SimPlate for Total Plate Count-Color Indicator (TPC-CI, IDEXX Laboratories, Inc., Westbrook, Me.) is a new medium that incorporates the redox dye resazurin to detect and quantify bacteria in food. Enumeration is achieved by the most probable number method using a SimPlate device. Viable bacteria are detected in each well of the SimPlate device by the biochemical reduction of resazurin, which is blue, to the pink resorufin or the clear dihydroresorufin indicators. Results after 24 h of incubation for TPC-CI are highly correlated with standard plate count agar after 48 h of incubation. Correlation coefficients from studies conducted at five laboratories ranged from 0.94 to 0.98 in side-by-side comparisons against standard plate count agar. Four additional test sites, using alternative methods for determining the aerobic plate count in food, reported similar results in comparison studies (r = 0.91 to 0.97). The slopes from linear regression analysis at all sites ranged from 0.91 to 0.98, with y intercepts ranging from 0.11 to 0.84. Samples used for the validation of TPC-CI included raw food products (i.e., liver and grains), which may contain natural enzymes that interfere with enzyme-based detection methods. No interference was seen from the foods tested. These results suggest that TPC-CI is a suitable alternative to existing plate count methods and has reduced incubation time.

Comparison of the SimPlate total plate count method with Petrifilm, Redigel, conventional pour-plate methods for enumerating aerobic microorganisms in foods.

The SimPlate Total Plate Count (TPC) method, developed by IDEXX Laboratories, Inc., is designed to determine the most probable number of aerobic microorganisms in foods. The 24-h test was compared to the conventional plate count agar (PCA) method, the Petrifilm Aerobic Count plates, and the Redigel Total Count procedure for enumerating microflora in 751 food samples. Results using the SimPlate TPC method were highly correlated (r > or = 0.96) with results from other test methods. Slopes (0.96-0.97) were not significantly different from 1, and y intercepts (-0.03-0.08) were not different from O. The SimPlate has a high counting range (> 1600 most probable number per single dilution), thus requiring fewer dilutions of samples compared to other methods evaluated. Some foods, e.g., raw liver, wheat flour, and nuts, contain enzymes that gave false-positive reactions on SimPlates. Overall, however, the SimPlate TPC method is a suitable alternative to conventional PCA, Petrifilm, and Redigel methods for estimating populations of mesophilic aerobic microorganisms in a wide range of foods.

Comparison of the SimPlate coliform and Escherichia coli test with Petrifilm, three-tube MPN, and VRBA + MUG methods for enumerating coliforms and E. coli in food.

SimPlate for coliforms and Escherichia coli (CEc) is a new method for the detection and quantification of coliforms and E. coli in food. Internal validation of the method was carried out at IDEXX Laboratories (Westbrook, ME) with 180 food samples representing a variety of different food matrices and compared against three-tube MPN (most probable number), VRBA (violet red bile agar) + MUG, and Petrifilm (E. coli count) methods. SimPlate CEc was highly correlated with each of these methods for the quantification of coliform bacteria (r > or = 0.90). An insignificant number of food samples were found to contain E. coli; therefore, no meaningful correlation data could be generated. Four hundred forty-four additional food samples were tested at five collaborating laboratories for the presence of coliforms E. coli using SimPlate CEc and either VRBA + MUG or Petrifilm (E. coli count). Regression analysis of data from SimPlate for CEc versus Petrifilm E. coli count plates generated correlation coefficients (r) of at least 0.89 for total coliforms and at least 0.90 for generic E. coli. Correlation coefficients between SimPlate for CEc and VRBA + MUG data were at least 0.90 for coliforms and at least 0.86 for E. coli. SimPlate for CEc demonstrated better recovery of E. coli than Petrifilm when high populations of bacteria were present. E. coli was not detected in 20 or 50 (40%) raw milk samples tested by the Petrifilm method due to the presence of interfering coliform and noncoliform bacteria. It is concluded that SimPlate for CEc is a suitable alternative for determining numbers of coliform bacteria and E. coli in food.

Comparison of SimPlate Total Plate Count test with plate count agar method for detection and quantitation of bacteria in food.

The SimPlate Total Plate Count (TPC) test, developed by IDEXX Laboratories, Inc., detects and quantitates total bacterial concentration in food after 24 h of incubation. The performance of SimPlate TPC was compared with that of the plate count agar (PCA) method for enumerating total bacterial concentration of 255 food samples representing 15 different food matrixes. Total bacterial counts on SimPlate TPC were measured after 24 h of incubation and plotted against values obtained from PCA after 48 h. Simple regression analysis of the data showed strong correlation between the methods (r = 0.95); the sensitivity of SimPlate TPC for foodborne bacteria was 96% relative to PCA (slope = 0.96). It was concluded that SimPlate TPC is a suitable alternative for the detection and quantitation of foodborne bacteria. The method has been granted Performance Tested Certification by the AOAC Research Institute.

Safe and cost-effective laparoscopic removal of adnexal masses.

STUDY OBJECTIVE: To evaluate laparoscopic removal of adnexal masses using a plastic bag to avoid peritoneal spillage. DESIGN: An observational study. SETTING: A university-affiliated private hospital. PATIENTS: Thirty-one women (mean age 48.7 yrs) with adnexal masses. INTERVENTIONS: Laparoscopic removal of adnexal masses ranging from 3 to 12 cm (18 complex, 5 septated cystic masses, 8 persistent simple cysts). The masses were placed in plastic sandwich bag and removed through the umbilical incision. Hospital costs, length of stay and operating times were compared with those of 24 patients undergoing the removal of similar masses by laparotomy. MEASUREMENTS AND MAIN RESULTS: Three masses were functional cysts, 4 were tubal cysts, 4 were endometriomas, and 20 were benign ovarian neoplasms. There were no malignancies. Peritoneal spillage occurred during one ovarian cystectomy. The only complication was bleeding from the cannula site. Comparing laparoscopy and laparotomy, average operating time was 73.45 minutes (range 34-148 min) and 81 minutes, average length of hospital stay was 17.4 hours (range 6-73 hrs) and 2.92 days, and average hospital cost was $2401 and $3539, respectively. CONCLUSION: Laparoscopic access provides a cost-effective method of removing adnexal masses with a very small risk of peritoneal spillage. When managed in this manner, rather than laparotomy, the cost reduction was significant.

Are ureteral catheters in gynecologic surgery beneficial or hazardous?

STUDY OBJECTIVE: To evaluate the use of ureteral catheters in gynecologic surgery. DESIGN: A prospective study. SETTING: A university-affiliated private hospital. PATIENTS: A series of 317 women undergoing a variety of gynecologic surgeries who were at high risk for ureteral injury. INTERVENTIONS: The procedures ranged from radical oncologic surgery to difficult operations for benign disease. In 273 patients the ureteral catheters were inserted prophylactically, and in 44 they were inserted postoperatively to confirm ureteral patency. Nineteen were lighted catheters used during laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Only 3 of 546 ureters could not be catheterized preoperatively. The average time to insert the catheters was 6 minutes (range 2-21 min). All ureters were easily identified, and their dissection was facilitated by the catheters. Two asymptomatic cases of transitional cell cancer of the bladder were diagnosed. One case of ureteral obstruction was identified at postoperative ureteral catheter insertion. No immediate or delayed problems were identified. The frequency of urinary tract infection was 3.2%. CONCLUSION: Ureteral catheters are safe and are simple to insert. They enhance identification of ureters and facilitate ureteral dissection.

Transvaginal repair of bladder lacerations during LAVH.

Eight bladder lacerations occurred during laparoscopic-assisted vaginal hysterectomy (LAVH) at a university-affiliated private hospital. All were exposed vaginally. Six were repaired with a standard two-layer closure by the vaginal route. One patient had a combined vaginal and laparoscopic repair. Another had a partial ureteric avulsion that was repaired vaginally, and a double-J ureteric catheter was left in situ for 6 weeks. All patients underwent cystoscopy to confirm adequate closure and confirmation of ureteric patency. All repairs were successful. The planned procedure (LAVH) was completed without further complications and the hospital stay was not prolonged as a result of the injury. The patient with partial ureteric avulsion had a normal intravenous pyelogram, and the ureteric catheter was removed in the office by transurethral cystoscopy. We conclude that bladder injuries during LAVH can be readily identified intraoperatively. Excellent results can be achieved with transvaginal repair, and the planned procedure can be completed by the intended route. Cystoscopy to confirm ureteric patency is essential after all repairs.

Cloning of the mgtE Mg2+ transporter from Providencia stuartii and the distribution of mgtE in gram-negative and gram-positive bacteria.

The MM281 strain of Salmonella typhimurium possesses mutations in each of its three Mg2+ transport systems, requires 100 mM Mg2+ for growth, and was used to screen a genomic library from the gram-negative bacterium Providencia stuartii for clones that could restore the ability to grow without Mg2+ supplementation. The clones obtained also conferred sensitivity to Co2+, a phenotype similar to that seen with the S. typhimurium corA Mg2+ transport gene. The sequence of the cloned P. stuartii DNA revealed the presence of a single open reading frame, which was shown to express a protein with a gel molecular mass of 37 kDa in agreement with the deduced size of 34 kDa. Despite a phenotype similar to that of corA and the close phylogenetic relationship between P. stuartii and S. typhimurium, this new putative Mg2+ transporter lacks similarity to the CorA Mg2+ transporter and is instead homologous to MgtE, a newly discovered Mg2+ transport protein from the gram-positive bacterium Bacillus firmus OF4. The distribution of mgtE in bacteria was studied by Southern blot hybridization to PCR amplification products. In contrast to the ubiquity of the corA gene, which encodes the dominant constitutive Mg2+ influx system of bacteria, mgtE has a much more limited phylogenetic distribution.

Diagnostic and operative hysteroscopy in the management of persistent postmenopausal bleeding.

OBJECTIVE: To determine the cause and possible treatment of postmenopausal bleeding of 6 months' duration or longer. METHODS: One hundred ten women between the ages of 40-90 years with persistent postmenopausal bleeding were evaluated by diagnostic hysteroscopy and managed by operative hysteroscopy. All had endometrial sampling and/or office hysteroscopy before operative hysteroscopy. RESULTS: A benign organic cause was noted in 95 cases (polyps in 42 and submucous fibroids in 53). Thirteen women had no significant disease and two had an early adenocarcinoma. Resection of the polyps or myomas without ablation was performed in 45 women, and all but one were satisfied with the results of treatment. Resection and ablation with performed in the remaining 50 patients with organic causes, and all but one were satisfied with the results. Twelve of 13 women without organic causes were satisfied with their treatment. The two adenocarcinomas were early lesions, grade 1 without invasion, and were managed by simple hysterectomy. CONCLUSION: Diagnostic and operative hysteroscopy was effective in controlling postmenopausal bleeding of at least 6 months' duration. Almost 90% of the patients had either polyps or submucous fibroids as the primary cause of the bleeding. Resection alone and resection with ablation were equally effective in controlling the bleeding.

Post-ablation-tubal sterilization syndrome.

OBJECTIVE: To determine the cause of unilateral or bilateral pelvic pain associated with vaginal spotting in women who had previously undergone tubal ligation followed by roller-ball endometrial ablation. METHODS: Women who had undergone previous tubal sterilization followed by rollerball endometrial ablation were evaluated laparoscopically and hysteroscopically when they presented with a symptom complex of intermittent vaginal bleeding associated with severe cramping pain in the lower abdomen. RESULTS: During a 1.5-year observation period, six women with the symptom complex had laparoscopy and hysteroscopy. In all cases, marked endometrial scarring was noted. In every case, the proximal portions of either one or both fallopian tubes were swollen, and two cases had the appearance of an early ectopic pregnancy. In the remaining cases, the fallopian tubes were rubbery and swollen to as much as twice normal size. Symptoms in five of six patients subsided after laparoscopic removal of the oviduct. CONCLUSION: It appears that women who have had a tubal sterilization followed by endometrial ablation are at risk of developing an ectopic-like symptom complex. Salpingectomy appears to be effective in relieving symptoms. Whether this represents a new syndrome or just an unusual association between tubal sterilization and endometrial ablation remains to be seen.