Novasure impedance control system versus microwave endometrial ablation for the treatment of dysfunctional uterine bleeding: a double-blind, randomized controlled trial.

PURPOSE OF INVESTIGATION: To compare the efficacy and safety of two different second-generation ablation devices, Novasure impedance control system and microwave endometrial ablation (MEA), in cases of abnormal uterine bleeding (AUB). MATERIALS AND METHODS: This is a randomized controlled trial that took place in a single Gynecological Department of a University Hospital. Sixty-six women with dysfunctional uterine bleeding (DUB), unresponsive to medical treatment, were included in the trial. The ratio of women allocated to bipolar radio-frequency ablation or MEA was 1:1. Follow-up assessments were carried out at three and 12 months post-ablation. The present main outcome measure was amenorrhea rates 12-months post-treatment. RESULTS: The rate of amenorrhea at 12-months post-ablation was significantly higher in women treated by Novasure (25/33; 75.8%) as compared to those treated by MEA (8/33; 24.2%) (rate difference: +51.5%, 95% CI: +27.8 to +67.7). CONCLUSION: In women with DUB, endometrial ablation with Novasure bipolar radiofrequency impedance-controlled system is associated with increased rates of amenorrhea at 12-months post-treatment as compared to the MEA method.

Complicated abdominal hysterectomy subsequent to uterine embolization for large fibroids.

Uterine artery embolization (UAE) has increasingly been offered as a safe alternative method for treating uterine fibroids with major symptoms. By this technique patients could avoid surgical cure or definite treatment such as hysterectomy. UAE decreases the uterine blood supply to the tissues and this might predispose to intraabdominal adhesion formation as a result of tissue necrosis. A case of a complicated routine hysterectomy due to strong adhesions found intraabdominally during surgery is reported. Our patient had no predisposing factors for adhesions, but she had undergone UAE one year earlier for large fibroids and decided to proceed to surgical therapy when symptoms returned.

Microsurgical repair after crush-avulsion injury of the femoral vein in rats: prevention of microvascular thrombosis with recombinant human tissue-type plasminogen activator (rt-PA).

Vein thrombosis is often encountered in microsurgery, especially in the case of crush-avulsion injuries. The aim of this study was to investigate the effect of systemic administration of recombinant tissue-type plasminogen activator (rt-PA) on the patency of the femoral vein of the rat, which had previously sustained a crush-avulsion injury. The study consisted of 3 groups of male Wistar rats, 20 animals each. A standardized crush-avulsion injury model was used. After microvascular repair of the femoral vein, the animals received either normal saline (group A), heparin 100 U/kg body weight (group B), or rt-PA 3.5 mg/kg body weight (group C) systemically. Patency tests were performed at 20 minutes, 48 hours, and 1 week after blood flow reestablishment. According to our results, the patency rate of the rt-PA group was significantly higher than in both the control and heparin groups.

Microvascular repair with 1-mm polytetrafluoroethylene (PTFE) grafts: effect of recombinant tissue-type plasminogen activator (rt-PA) on the patency rate and healing process.

The present study assesses the effect of recombinant tissue-type plasminogen activator (rt-PA) on the patency rate and healing process of microvascular polytetrafluoroethylene (PTFE) grafts. Wistar rats were used, divided into four groups of 25 animals each. After dissection of the carotid artery a segment of the vessel, 1 cm long, was resected and replaced by equal length graft. Two different type fibril length (30- or 60-microm) grafts of the same wall thickness (0.18 mm) were used. Normal saline or 3 mg/kg of body weight of rt-PA was applied locally in each group of different fibril length grafts. Patency tests were performed at 15 min and 4 weeks after blood flow was reestablished. All grafts were harvested and examined histologically. The results showed that local application of rt-PA improves patency statistically significantly in both types of fibril length grafts. Patency in 60-microm fibril length grafts was statistically significantly higher than that of 30-microm fibril length grafts, whether rt-PA was used or not. The use of rt-PA had no influence on the healing process of either type of graft.

Prefabrication of an axial bio-synthetic flap for circumferential tracheal defect reconstruction.

The aim of this study was to prefabricate an axial bio-synthetic flap for reconstruction of circumferential tracheal defects in a rabbit model. Two series of experiments were performed. In the first set of experiments axial island bio-synthetic flaps were prefabricated. These consisted of an inner island de-epithelialised fasciocutaneous flap from a rabbit's ear and an outer polytetrafluoroethylene vascular graft. The flaps were buried at the base of the rabbit's ear for periods of 1, 2 and 3 weeks (groups A, B and C, respectively), 10 flaps per group. Only one flap in group C failed to survive. Clinical and histological assessment, at the completion of each time period, showed that only the viable flaps of group C developed all the characteristics needed for a tracheal substitute. In the second set of experiments the prefabricated bio-synthetic flaps were transferred to the rabbit's neck by means of microvascular anastomoses. Ten such free flaps were buried at the rabbit's neck for 3 weeks (group D). Eight of the flaps remained viable and all the viable flaps had characteristics similar to those of group C. These results demonstrate the feasibility of creating a prefabricated axial bio-synthetic flap (island or free), over a 3-week period, possessing the characteristics needed for a tracheal substitute in a rabbit model.

Microvascular repair following a modified crush-avulsion injury in a rat model: effect of recombinant human tissue-type plasminogen activator on the patency rate.

The failure rate of replantations following a crush-avulsion type injury is high. This study has been designed to reproduce an effective standardized crush-avulsion injury model to the femoral artery of the rat and evaluate the antithrombotic efficacy of systemic intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA). The crush-avulsion injury was reproduced by using a bulldog clamp and two hemostats and followed by microvascular repair. The animals were divided into three groups of 20 rats each and received either normal saline, heparin 100 U/kg body weight, or rt-PA 3.5 mg/kg body weight intravenously. Patency tests were performed 20 min and 48 h after blood flow reestablishment. Results showed that this experimental crush-avulsion injury model ensures low patency in the control group, whereas systemic rt-PA administration improves the patency rate statistically significantly compared to control and heparin groups at both 20 min and 48 h postrevascularization.

Transmission of electrocardiograms from a moving ambulance.

Delay is the enemy for patients with acute myocardial infarction. It would be helpful for the hospital cardiologist to interpret the patient's electrocardiogram (ECG) before the arrival of the ambulance. The aim of our study was to determine whether ECG transmission from an ambulance is feasible and to assess the time savings. An ambulance was equipped with an ECG recorder, which was connected to a notebook computer and coupled to a cellular telephone for transmission to a hospital-based station. Paramedics needed 2 min (SD 0.5) to record the ECG on the move and 34 s (SD 14) to transmit it. The ambulance arrived 15.5 min (SD 6.5) after reception. The time between arrival and ECG diagnosis, for a control group patient, was approximately 9.5 min (SD 3.5). Therefore, pre-hospital ECG diagnosis took place 25 min (SD 7.5) before in-hospital diagnosis. We conclude that ECG transmission from a moving ambulance is feasible, reduces in-hospital delays and allows faster triage in critical cardiac cases.

Females of four mole species of genus Talpa (insectivora, mammalia) are true hermaphrodites with ovotestes.

We studied the anatomical, histological, and genetic features of the sexual tract in four European mole species of the genus Talpa (Insectivora, mammalia): T. occidentalis, T. europaea, T. romana, and T. stankovici. All XY individuals had a normal male phenotype, whereas all XX individuals in all four species had features that identified them as intersexes. These individuals were nonetheless presumed to be functionally fertile females. Intersexuality was manifested mainly as gonadal hermaphroditism, with all females possessing bilateral ovotestes. The gonads were composed of a small portion of histologically normal ovarian tissue and a variably sized, generally large mass of disgenetic testicular tissue, accompanied by a small, rudimentary epididymis. The rest of the sexual tract was typically female, including oviducts, uterus, and vagina of normal appearance. Polymerase chain reaction (PCR) and Southern blotting analyses showed that the mammalian testis-determining gene SRY is present in males but not in females. Part of the conserved sequence of the mole SRY gene was cloned and sequenced after PCR amplification in two of the four mole species (T. occidentalis from Spain and T. romana from Italy). Sequences were identical in these two species and were very similar to those of the human and mouse SRY gene. Our findings constitute the first evidence of the existence of a genus-specific case of true hermaphroditism, probably due to a very ancient mutation that fixed in populations of the ancestral species from which contemporary moles evolved. The possible nature of this mutation is discussed with regard to the cytologic, histologic, and genetic features of the gonads in Talpa females.

Combined vascular reconstruction and adjunctive tissue transfer in the treatment of infected arterial prostheses and tissue defects.

One of the most serious complications in vascular surgery is infection of the vascular arterial prosthesis (VAP) which might lead to loss of limb or even death. Very often infected prostheses are combined with infectious infiltration of the adjacent tissues or even necrosis and their loss. This paper deals with the experience in the management of 5 patients suffering from infection of vascular arterial prostheses in various locations, for by-passing abdominal aorta and distal arteries with loss or necrosis of the skin and tissues adjacent to the graft. Removal of the infected graft was performed in all of the cases, together with wide debridement of the infested area and placement of a new graft, coursing far from the infected area for revascularization of the affected limb. The cleaned infected area was covered at a first or second stage by applying plastic procedures utilizing musculocutaneous tissue transfer. The results were quite satisfactory. We conclude that the management of infected vascular arterial prostheses, when these are combined with loss of adjacent tissues, is a challenge for the Vascular Surgeon. Their removal, extended cleaning and covering of the area by means of plastic procedures with tissue transfer, proved to be effective in the management of this problem.

Descriptive kinetics of the seminiferous epithelium cycle and genome size in the mole Talpa occidentalis (Insectivora).

The male germ cell cytodifferentiative process of the mole Talpa occidentalis is described. Cytochemical procedures were used 1) to follow acrosome formation and spermatid differentiation, dividing the seminiferous epithelium cycle into ten stages, each characterized by typical germ cell-to-cell associations, and recognizing 13 steps in spermatid differentiation; 2) to monitor, in situ, histones replacement by protamines at step 11 of the spermiogenic process. The seminiferous epithelium cycle of the mole has the basic histological features present in all mammals and appears rather similar to that of the common shrew (Sorex araneus), the only one so far known among Insectivora. The metabolism of the DNA-associated proteins reveals that protamines replace histones during the late steps (11-13) of spermiogenesis, mRNA for protamines having been synthesized at an earlier step (assuming that in the mole this occurs at the first spermiogenic steps, as in the house mouse). In addition the genome size (5.0 pg) and the AT/GC ratio (1.3) were evaluated.

Use of free flaps in the aesthetic reconstruction of face and neck deformities.

Three cases of face and neck deformities, reconstructed with free flaps in order to obtain better aesthetic results, are presented here. Nasal tip, cartilage, and soft tissue defects as well as facial burn contractures were reconstructed with a free radial forearm flap, latissimus dorsi myocutaneous flap, and groin flap, respectively. Case specifics are discussed.

Microvascular anastomosis by invagination: an experimental study.

A technique of end anastomosis of microvessels of equal or unequal diameter, requiring only two sutures is described. In the present investigation we used the common carotid artery and the femoral vein of 37 white rats. The adventitia of the proximal part of the anastomosed artery was subsequently prepared and removed. However, in case of vein anastomosis, the adventitia of the distal part was removed. Following this washing with saline solution was done. 10-0 Nylon monofil sutures, were used which were placed at 180 degrees. The anastomosis was completed by ligation in such a way that one end was invaginated into the other and was fixed firmly. Five months later the anastomoses were examined after careful preparation under the surgical microscope and photographed. A SEM examination was then done in half of them and photos were taken at 24X, 80X, 1,200x magnification. The remaining tissue was examined histologically. The findings after surgical microscope SEM and histological examination are described.

The value of profundoplasty for the revascularization of the lower extremities.

During a nine-year period, 201 profundoplasties were performed on 152 patients; of these, 83 were simple and the remaining 132 combined with other inflow or outflow by-pass procedures. Immediate postoperative results were satisfactory whereas late results of 63 simple profundoplasties carried a patency rate of 78% and a limb salvage of 70% was detected eight years postoperatively. Profundoplasty alone or in combination with proximal or distal angioplastic procedures is a very effective method for the revascularization of ischemic lower extremities.