Intraoperative and early postoperative complications of operative hysteroscopy.

With preoperative evaluation, meticulous technique, and vigilance for impending problems, intraoperative and early postoperative complications of operative hysteroscopy are largely preventable. Fluid overload is the most common serious complication. The hysteroscopist must understand the significant differences between hypotonic, electrolyte-free distention media and isotonic, electrolyte-containing media and their respective sequelae. As new operative tools become available, hypotonic and electrolyte-free distention media may become obsolete. The physiology and management of air embolism, the most grave intraoperative complication, are essential to the knowledge base of any active hysteroscopist. Mechanical accidents, anesthetic complications, laser and electrical injury, and infections can be reduced by knowledge and preparation. Technologic advances, ongoing research, and postgraduate training in hysteroscopic technique continue to expand the safe and beneficial applications of hysteroscopy into the next century.

Late complications of operative hysteroscopy.

The late complications of operative hysteroscopy result from either persistent endometrium after ablation or myometrial damage during surgery. Residual endometrium can become neoplastic, cause pain, or support a pregnancy. Myometrial damage can produce catastrophic consequences during a later pregnancy. These long-term problems place the impetus on the operating physician to select patients carefully, prepare the endometrium, and operate in such a way as to minimize the likelihood of residual endometrium and unnecessary myometrial damage. The value of operative hysteroscopy for infertility secondary to adhesions and uterine septa is unequivocal. Hysteroscopic surgery offers increased fertility rates while avoiding the risks of open surgery. For the treatment of abnormal uterine bleeding, endometrial ablation can be performed safely, and the long-term benefits are durable. As more operative hysteroscopy is performed, more delayed complications will arise. Easy-to-perform global ablation techniques and multifunctional operative hysteroscopes have enticed more gynecologists to test the waters of endometrial ablation and operative hysteroscopy. Although they empower the hysteroscopist to offer more advanced and more valuable minimally invasive options to patients, these tools simultaneously can tempt the surgeon to forego meticulous preoperative evaluation. Evidence exists that too often women undergo surgery without complete diagnostic assessment. In one study, 50% of women underwent hysterectomy without any diagnostic evaluation of the endometrium. Hysterectomy possesses a saving grace in that it provides cover for many missed diagnoses. Conservative, nonextirpative procedures offer no such life raft. Meticulous diagnostic assessment and preoperative consideration of risk factors for residual endometrium and future pregnancy remain the keys to minimizing late complications.

Hysteroscopy in the management of abnormal uterine bleeding.

The ever-increasing value of diagnostic and operative hysteroscopy for patients with AUB serves as an appropriate, although belated, tribute to Pantaleoni who in 1869 dared to look inside a woman's uterus. Future generations of women and their physicians will be indebted to this physician-pioneer. Contemporary instrumentation permits the gynecologist to acquire quickly the basic skills necessary for routine performance of office-based hysteroscopy. With increasing experience, operative hysteroscopic techniques, including resection of polyps, myomata, and endometrial ablation, can be easily mastered.

Emergency management skills of South Australian paediatric trainees.

OBJECTIVE: This article describes a theoretical and practical assessment of the emergency management skills of South Australian paediatric trainees. The aim was to identify strengths and weaknesses so as to optimally orientate future training in this area, and to provide a baseline that could be used to assess effectiveness of future interventions. METHODOLOGY: Thirty-four paediatric trainee medical officers responsible for after hours emergency care in Adelaide were asked to anonymously complete a 24 question theory assessment based on recognized emergency management training programmes, and to perform a mock clinical resuscitation. Response rate was 90% for the theoretical section and 69% for the practical. RESULTS: The average trainee was found to be deficient in one quarter to one third of the theoretical precepts, and required an average of 2 min to establish effective bag-valve-mask ventilation with an infant manikin. CONCLUSIONS: There is a range of theoretical and practical resuscitation deficits that may currently hinder effective emergency management by paediatric trainees.

Presence of tau in isolated nuclei from human brain.

Previous studies have demonstrated that the microtubule-associated protein (MAP) tau is present in the axonal and somatodendritic compartment of neurons. In cultured primate cell lines, tau has been found localized to the NOR regions of the acrocentric chromosomes in mitotic cells and the dense fibrillar regions of nucleoli in interphase cells. We report here the presence of nuclear tau in nuclei isolated from fresh, frozen human frontal cortex. Using several monoclonal antibodies against tau, Tau-1, Tau 46.1, and 5E2, we have established by both indirect immunofluorescence and Western blotting that tau is an integral component of nuclei isolated from Alzheimer's disease (AD) and pathologically normal control brains. Brain nuclear tau, like nuclear tau in primate cells, is insoluble in SDS and must first be extracted with formic acid prior to analysis by Western blot. Immunoblot analysis of isolated brain nuclei displays the characteristic ladder of tau proteins and demonstrates that all isoforms of tau are present. It is unclear whether levels of nuclear tau can be correlated to pathologic events in AD, but its insoluble nature along with reports of intranuclear PHFs warrant further studies of nuclear tau as a molecular candidate in the genesis of AD.

Dopaminergic cells align along radial glia in the developing mesencephalon of the rat.

Studies were performed to examine the relation of dopaminergic cells and radial glia in the developing mesencephalon of the rat at ages E12-E20. Dopaminergic cells were immunolabelled with an antiserum which recognizes tyrosine hydroxylase, and radial glia were immunolabelled with a monoclonal antibody which recognizes vimentin. The vimentin-immunoreactive fibres of radial glia were noted at E12. At E12, and more clearly at later time points, the radial glia extended from the aqueduct to the pial surface, and this pattern persisted throughout the prenatal period. Tyrosine hydroxylase-immunoreactive cells were located along the ventral surface of the mesencephalon at age E13. At age E15, E16, and E18 the tyrosine hydroxylase-immunoreactive cells were present from the aqueduct to the ventral pial surface of the mesencephalon and were aligned along radial glia. Our study suggests that radial glia provide paths for migration of dopaminergic cells in the mantle layer from E15 to E18 of the developing mesencephalon. It also suggests that some dopaminergic cells between E15 and E18 may express tyrosine hydroxylase during their migration through the mantle layer and prior to reaching the location they occupy in the adult brain.