"The Green Peace" How ICG can prevent complications in endometriosis surgery?

This literature review summarises the investigation into using Indocyanine Green (ICG) in the surgical management of endometriosis, focusing mainly on its application in Deep Endometriosis (DE). The study reviews the development, fluorescence characteristics, and clinical usage of ICG in enhancing the precision of identifying endometrial lesions during surgery. Emphasizing the technology's contribution to improved lesion visualisation, the paper discusses how ICG facilitates increased diagnostic accuracy, potentially reducing recurrence rates and the necessity for subsequent interventions. Additionally, it explores ICG's role in minimizing the risk of iatrogenic injuries, especially in ureteral endometriosis, and its utility in surgical decision-making for rectosigmoid endometriosis by evaluating bowel perfusion. Conclusively, while acknowledging the clear benefits of ICG integration in endometriosis surgical procedures, the abstract calls for more extensive research to validate its efficacy and cost-efficiency in the broader context of endometriosis treatment.

Innovative Cadaveric Technique: Utilising n-Butyl Cyanoacrylate (n-BCA) for Deep Endometriosis Excision Simulation in Minimal Invasive Surgery Training.

Background: Our study aimed to create a novel technique using n-butyl cyanoacrylate (n-BCA) for minimal access simulation training on cadavers in deep endometriosis excision. Objectives: A step-by-step video demonstration of using n-BCA in cadavers to simulate deep endometriosis. This technique is integrated into training sessions using cadavers aimed at enhancing surgical proficiency for deep endometriosis procedures. Material and Methods: Video article describing using n-BCA in cadavers as a simulation model. Result: This technique has been used in a hands-on cadaveric training course, and positive feedback supports the recommendation to incorporate this technique. Conclusion: Utilizing a human cadaver model proves beneficial for enhancing understanding of deep pelvic innervation. Implementing n-BCA in these cadaver dissections demonstrates both reproducibility and safety. This approach significantly contributes to refining surgical expertise in the excision of deep infiltrating endometriosis.

Nutrition in decompensated liver disease: A regional trainee-led audit investigating patient nutrition and outcomes following admission with decompensated chronic liver disease.

OBJECTIVE: To conduct a regional audit assessing the prevalence and management of malnutrition in decompensated liver disease. METHOD: All adults admitted with decompensated cirrhosis over one-month period to participating trusts were included. Malnutrition was identified using MUST and Royal Free Hospital-Nutritional Prioritisation Tool (RFH-NPT). RESULTS: 47 patients were identified. The prevalence of malnutrition was 76.6%. This was independent of age (<65 versus ≥65; p = 1) or aetiology of liver disease (alcohol-related versus not; p = 0.55). Screening was significantly higher on Gastroenterology wards than other wards (77% versus 23%; p = 0.012). RFH-NPT identified 76.6% of patients as malnourished whereas MUST identified 55.3%. Supplementation was prescribed to 83% of eligible patients. 80% was oral supplementation and 20% received NG feeding. Median length of stay (9 (2-62) days) was higher in those prescribed supplements (11 vs 7 days, p = 0.041). Readmission rates were similar regardless of supplementation. Mortality was higher in malnourished patients (p = 0.03) and in those prescribed nutritional supplements at 1, 3 and 6 months (p = 0.026, p = 0.026 and p = 0.008) respectively, who were more likely to have severe liver disease. CONCLUSION: Prevalence of malnutrition is high in patients with decompensated cirrhosis but independent of age and aetiology and associated with higher Child-Pugh scores. The RFH-NPT was a more sensitive screening tool than MUST. Increased nutritional screening was noted on gastroenterology wards with more intervention in those with severe liver disease. Despite the study's limitations, once malnourished, nutritional intervention did not appear to impact on patient readmission or mortality rates therefore, we propose addressing malnutrition by utilising specialty dietician involvement at an earlier stage.

Growth, carcass characteristics, meat quality, and microbial aspects of growing quail fed diets enriched with two different types of probiotics (Bacillus toyonensis and Bifidobacterium bifidum).

The present investigation aimed to explore the impact of dietary graded levels of 2 types of probiotic bacteria (Bacillus toyonensis [BT] and Bifidobacterium bifidum [BB]) on growth, carcass traits, meat quality, and bacteriology of growing Japanese quail reared under the cage system. One thousand three hundred sixty Japanese quail day-old chicks were randomly divided into 10 groups (8 replicates each). Birds were fed a basal diet (control, T1) and the basal diet plus 0.05, 0.075, 0.10, and 0.125% BT (T2, T3, T4, and T5, respectively), 0.10% BB (T6), and the same previous doses of BT plus 0.05% BB (T7, T8, T9, and T10, respectively). Results showed a significant (P < 0.001) increase in final BW and weight gain because of probiotic supplementation (except T2 for weight gain). Both feed intake and feed conversion ratio did not differ during the overall experimental period (1-42 D of age) except feed intake that was reduced in T2 and increased in T5 and T9 groups. All carcass traits studied were significantly (P < 0.01) affected by probiotics, and the combination between BT and BB in group T8 increased all studied parameters as compared with the other treatment groups. The quail meat color of redness a∗ and L∗ values, thiobarbituric content, cooking loss, proteolysis, and total coliform were decreased (P < 0.001) by probiotic treatment. In general, supplementing BT, BB, or their combination to the basal diet delayed the proliferation of pathogenic bacteria in the diet and intestine. Using BT and BB as feed supplements enhanced growth performance and meat quality of quails as well as diminished pathogenic bacteria proliferation in their diet and intestine. As per our results, we can recommend the application of T5 and T8 to T10 levels for the best performance, carcass traits, and meat quality of growing quails.

Use of red pepper oil in quail diets and its effect on performance, carcass measurements, intestinal microbiota, antioxidant indices, immunity and blood constituents.

Plant-derived additives are used to maintain the health and growth performance of livestock. The use of red pepper oil (RPO) has recently attracted considerable scientific interest mainly due to its potential benefits for animals and humans. The present study was conducted to evaluate the effect of dietary supplementation with RPO on growth performance, carcass measurements, antioxidant status and immunity of growing quails between 1 and 5 weeks of age. A total of 240 growing quails (1-week old) were distributed into 5 equal groups consisting of 48 birds (4 replicates of 12 birds each). The first group was fed a basal diet without RPO (0 g/kg diet), and the second, third, fourth and fifth groups received diets containing RPO (0.4, 0.8, 1.2, 1.6 g/kg diet, respectively). The experiment lasted for 5 weeks. At age of 5 weeks, quails were slaughtered for carcass examinations, microbiological analysis of intestine and to determine blood constituents. Data were statistically analyzed by one-way ANOVA. Quails fed with 0.8 g RPO/kg diet showed 12.14%, 14.4% and 15% improvement in live BW, body weight gain and feed conversion ratio, respectively, compared with the control group. Quails that received diets with 1.2 g RPO consumed more feed than the others during the total period (1 to 5 weeks). Plasma globulin levels were significantly decreased (P = 0.0102), but albumin/globulin ratio was significantly increased (P = 0.0009) in birds fed diets containing RPO (0.4 and 1.2 g/kg) compared with those in the control group. Activity of liver enzymes in the plasma was nonsignificantly decreased in quails supplemented with 0.8 g RPO/kg diet compared with those in the control group. Activities of antioxidant enzymes (glutathione and catalase) in the group fed on diets supplemented with RPO (0.8 g/kg) were significantly higher than those in the control group. The inclusion of RPO (0.8 g/kg diet) in quail diets improved (P < 0.05) plasma lipid profile and also decreased pH of the caecal content (P = 0.0280) compared with those in the control group. The caecal bacterial population, Salmonella spp., coliform and Escherichia coli, were lowered (P < 0.05) in the groups treated with RPO (0.8, 1.2 and 1.6 g/kg) compared with those in the control group. In conclusion, dietary supplementation of RPO (0.8 g/kg) can enhance the performance and antioxidant indices and decrease intestinal pathogens and thus improve the health status of Japanese quail.

Improving productive performance and mitigating harmful emissions from laying hen excreta via feeding on graded levels of corn DDGS with or without Bacillus subtilis probiotic.

An experiment that included some inclusions of corn distillers dried grains with solubles (DDGS) with or without supplementation of probiotic bacteria to Hi-sex Brown laying hen diets was conducted to evaluate the impacts on performance, egg quality, blood metabolites and nitrogen and phosphorus excretion in the manure. A total of 216 twenty-two-week-old Hi-sex Brown laying hens were randomly divided into eight treatment groups in a factorial design (4 × 2) experiment, which included four levels of DDGS (0, 50, 100 and 150 g/kg diet) plus two levels of Bacillus subtilis probiotic (0 or 1000 mg/kg diet, with a concentration of 1.5 × 108 CFU/g of dried product). The experimental period extended from 22 to 34 weeks of age. The results showed that linear increase in DDGS level up to 150 g/kg improved (p ≤ 0.01) the values of feed consumption, egg shape index and yolk colour compared to the control and other treatment groups. Inclusion of dietary DDGS up to 150 g/kg in layer diets led to a significant decrease in egg mass and a significant increase in Haugh unit score compared to other groups. In the bacillus group, the values of feed conversion, egg weight and egg mass enhanced by 6.45, 3.27 and 7.60% respectively compared with the control diet. Total protein, albumin, triglycerides, cholesterol, calcium and ammonia in serum were significantly (p ≤ 0.01) influenced by DDGS inclusion. The excreted nitrogen decreased by 8.62 and 4.31% in hens fed 50 or 100 g/kg of DDGS respectively, while excreted phosphorous decreased by 3.33, 7.22 and 10.56% in hens fed 50, 100 or 150 g/kg of DDGS respectively as compared to the control group. It could be concluded that increasing DDGS inclusion level in the diet up to 10% and the supplementation of probiotic bacteria improved the productive performance of laying hens and mitigated the harmful emissions from chicken manure; this means better production within environmentally friendly conditions.

Production and evaluation of weaning foods based on sorghum and legumes.

Five weaning formulations (F1-F5) based on sorghum, groundnuts, sesame seeds, chickpeas, and skim milk powder were processed by a twin-roller drum dryer and evaluated for composition, functional properties (bulk density, water absorption capacity, and apparent viscosity), in vitro indices (protein digestibility and available lysine), protein quality (PER, NPR, and NPU) and effects of feeding on rat livers. Composition and properties of the five formulations were compared to those of Cerelac. The results indicated that F3 (60% sorghum, 20% chickpeas, 5% sesame, 8.5% skim milk powder, 5% sugar, and 1.5% vitamins and minerals) and F2 (55% sorghum, 15% chickpeas, 5% groundnuts, 10% sesame, 8.5% skim milk powder, 5% sugar, and 1.5% vitamins and minerals) formulations had compositions and properties comparable to those of Cerelac and hence have a good potential for use as weaning foods.

Dual infection with mycetoma and tuberculosis: report of two cases.

Dual infection with tuberculosis and mycetoma has not been reported in literature to date. This communication is a report on two patients with such infection. It indicates the serious impact of the dual infection as each of them augments the pathological effects of the other.

Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS.

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing IUDs. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 IUDs represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.

An intrauterine device, releasing approximately 20 micrograms/day of levonorgestrel (LNg 20), used by 1124 women, was studied in a randomized trial of five years duration in comparison with the Copper T, model TCu 380Agm in 1121 women. At five years, the gross cumulative pregnancy rate of 1.1 +/- 0.5 per 100 among users of the LNg 20 devices was not significantly different from the rate of 1.4 +/- 0.4 per 100 experienced by users of the Copper T 380Ag. The steroid-releasing IUD had significantly higher termination rates for expulsion and amenorrhea, a significantly lower termination rate for other menstrual problems and pain, and a lower continuation rate. The five-year continuation rate among women using the TCu 380Ag was 40.6 per 100 as compared with that of 33.0 per 100 among women randomized to the LNg 20 device (P less than .001). Terminations attributed to amenorrhea with the LNg device primarily account for differences in continuation. These two intrauterine devices are the most effective long-term, reversible IUDs yet reported in the literature. No other contraceptive methods have exhibited such low long-term pregnancy rates in randomized comparative trials.

PIP: An IUD. releasing approximately 20 mcg/day of levonorgestrel (LNg 20) was studied in a randomized trial of 5 years duration. 1124 women comprised this group and were compared to another group of 1121 women who used the TCu 380 Ag. At the end of 5 years, the gross cumulative pregnancy rate was 1.1 +or- 0.5/100 among LNg 20 devise users; this was not significantly different from the rate of 1.4 +or- 0.4/100 experienced by those using the TCu 380 Ag. The steroid-releasing IUD had significantly higher rates for expulsion and amenorrhea, a significantly lower termination rate for other menstrual problems and pain, and a lower continuation rate. The 5-year continuation rate among women using the TCu 380 Ag was 40.6/100 as compared to 33.0/100 among women randomized to the LNg 20 device (p0.001). Terminations attributed to amenorrhea with the LNg device are largely responsible for the differences in continuation.

Two years of intrauterine contraception with levonorgestrel and with copper: a randomized comparison of the TCu 380Ag and levonorgestrel 20 mcg/day devices.

IUDs releasing 20 mcg/day of levonorgestrel (LNg20) were in randomized trial together with the Copper T, model TCu 380Ag, in seven centers involving 2244 women. Two-year (25 months) gross cumulative pregnancy rates were 0.2 +/- 0.2 and 0.9 +/- 0.3 for the levonorgestrel and copper releasing devices, respectively (P greater than 0.05). There were no ectopic pregnancies in more than 1600 woman-years of use of each device. Removal rates for bleeding and/or pain or for medical reasons other than menstrual problems did not differ significantly between devices. Oligomenorrhea or amenorrhea prompted 10.7 per hundred (gross rate, 8.4 net rate) women using the LNg 20 IUD to request removal in the two-year period, significantly above the 0.2 per hundred rate among women with the Copper IUD (P less than 0.001). At the end of two years an estimated 59.4 per 100 women were continuing use of the LNg 20 IUD, and 67.5 per 100 (P less than 0.001) with the TCu 380Ag. This difference is almost wholly ascribable to a marked reduction in bleeding episodes and days among women using the LNg 20 device with concomitant removal of device. Hemoglobin rose an average of 0.5 g/dl (P less than 0.001) for this group whereas women using the TCu 380Ag experienced a decline of 0.2 g/dl compared with baseline values (P less than 0.001).

PIP: An IUD releasing 20 mcg/day of levonorgestrel (LNg20) was compared with a Copper T IUD (TCu 380 Ag) in a randomized trail involving 2244 women 7 centers in the US, Brazil, Egypt, Chile, Singapore, and the Dominican Republic. The cumulative gross pregnancy rate at 2 years was 0.2 for the LNg 20 device and 0.9 for the TCu 380 Ag IUD. There were no ectopic pregnancies in more than 1600 woman-years of use of each device. The removal rates due to oligomenorrhea or amenorrhea were 10.7/100 among LNg 20 acceptors compared with only 0.2/100 among TCu 380 Ag acceptors in the 2-year study peroid. Removal rates for pain and/or bleeding did not differ significantly between devices. Hemoglobin rose an average of 0.5 g/dl in the LNg 20 group and declined an average of 0.2 g/dl in the TCu 380 Ag group. At the end of 2 years, the continuation rates were 59.4/100 among LNg 20 acceptors and 67.5/100 among TCu 380 Ag acceptors. This difference is ascribable to the scanty and infrequent bleeding patterns associated with the former device. It is concluded that both these IUDs provide highly effective intrauterine protection.

BCG lymphadenitis: a report of eight cases.

An increase in incidence of regional lymphadenitis following BCG vaccination of newborns at King Abdel Aziz University Hospital, Riyadh has been observed. Eight cases are described. One case also had infraclavicular gland enlargement. The only change in routine was the introduction of a Japanese strain of BCG. It is suggested that this might be a cause for the increase in the condition. All patients were given isoniazid. Discharge and scar formation followed aspiration in five cases, whereas in the two cases subjected to surgical excision there was uncomplicated healing. It is suggested that the latter combined with antituberculous therapy may be a more satisfactory form of treatment.

Intrauterine contraception with copper and with levonorgestrel: a randomized study of the TCu 380Ag and levonorgestrel 20 mcg/day devices.

First year results of a randomized study of 1509 users of the Copper T380Ag with a silver core or of an IUD releasing 20 mcg day of levonorgestrel are reported. The cumulative gross pregnancy rate for each device was 0.3 per 100 at one year, with more than 490 women having one year of use with each device. The levonorgestrel-releasing device was associated with significantly fewer bleeding days and significantly increased hemoglobin levels when compared with pre-admission values or the one year values observed among users of the TCu380Ag. Terminations attributable to amenorrhea were significantly more frequent among users of the levonorgestrel-releasing device. The TCu 380Ag was associated with increased frequency and severity of dysmenorrhea compared with pre-admission levels or with the steroid-releasing device. Hemoglobin levels were somewhat reduced among users of the TCu 380Ag device. Terminations attributable to pain were, however, not significantly different by device. Continuation rates at the end of the first year were not significantly different by device.

Long-term luteal changes after tubal sterilization.

In this study the luteal function was evaluated in 109 subjects 2 to 108 months following tubal sterilization by Pomeroy's technique or laparoscopic tubal rings. Midluteal endometrial biopsies determined by basal body temperature charts were performed and dated in all subjects. Midluteal serum progesterone was estimated by RIA in 40 women. Our results indicated that the mean time which had elapsed since sterilization was significantly shorter in the subjects who revealed luteal defects than in those with normal luteal function. There were no statistically significant differences between the 2 occlusive techniques in terms of poststerilization incidence of luteal defects.

Pelvic schistosomiasis and infertility.

The use of laparoscopy allowed us to diagnose asymptomatic pelvic schistosomiasis in 13 infertile women. The lesion was associated with dense pelvic adhesions in all cases, a defective luteal phase in 23.1% of the women and anovulation in 15.4%. Atraumatic adnexolysis, antibilharzial treatment and correction of ovulatory defects were followed by intrauterine pregnancy in 46% of the patients.

PIP: Laparoscopic diagnosis of pelvic schistosomiasis and the possible effects of this lesion on fertility were examined at the Ain Shams University Hospital in Cairo, Egypt over the 1977-1980 period. All infertile patients who came from endemic areas were thoroughly investigated for schistosomiasis. During the first 2 years of the study, there were 13 patients aged 23-38 years with pelvic schistosomiasis. Exploration was undertaken in all cases and atraumatic adnexolysis was performed. In 3 patients myomectomy was also performed. Ovulatory defects were treated in 5 patients with 100-200 mg of clomiphene citrate administered daily for 5 days, beginning on the 2nd day of the menstrual cycle. In 2 women who failed to respond to a high dose of clomiphene citrate, Pergonal and human chorionic gonadotropins were used. Ambilhar was given to all patients for 6 days to treat schistosomiasis. The cervix was cauterized in 7 women who revealed bilharzial cervicitis. All patients were followed up for 15 months after treatment. All patients complained of primary infertility, the duration of which ranged from 4-14 years. Cervical erosion was present in 5 women, vaginal granulation in 2, and vaginal sandy patches in another 2 women. Pelvic examinations revealed the presence of coporel myomata in 3 patients. Cervicovaginal smears were positive for schistosomal ova in 3 patients. In all patients, the whole length of both fallopian tubes was visualized. These tubes revealed changes that indicated the presence of both periadnexal adhesion and intramural lesions. In all patients the uterine cavity was either normal sized or enlarged. The tubes were whitish, thickened, elongated and coiled. The ovary and the coiled ampullary portions of the tube were encapsulated in dense whitish adhesions. Methylene blue test confirmed the preservation of tubal patency. Bilharzial sandy spots and nodules were detected in all patients. Cervical biopsies revealed the presence of active or healed bilharzial cervicitis in 7 cases (53%). Repeated premenstrual endometrial biopsies showed normal secretory endometrium in 8 women, defective luteal phase in 3 women, and anovulation in 2 women. Laparoscopic biopsies showed a characteristic active or healed bilharzial lesion. As a result of treatment, there were 6 normal intrauterine pregnancies (46.2%). In 1 woman, pregnancy ended in abortion during the 10th gestational week. Ectopic pregnancy was reported in only 1 woman (7.7%). The study results suggest that pelvic schistosomiasis among infertile women is probably much more frequent than previously thought. In about 50% of patients atraumatic adnexolysis, cauterization of cervical lesions, and correction of luteal defects may be followed by pregnancy.

Long-term intracervical contraception with a levonorgestrel device.

An intracervical levonorgestrel-releasing mini-T device was tried as contraceptive in 100 fertile multiparous women for 3 years. This device release about 10 micrograms/day. The results were compared with those of an intrauterine levonorgestrel device and copper-T-200 (Cu-T-200). The continuation rates of the three device did not reveal any significant differences at 1, 2 and 3 years. Incidence of unintended pregnancies and removals due to bleeding and pain was comparable to those of Cu-T-200 but higher than those of intrauterine levonorgestrel device. The number of days of bleeding and spotting for both levonorgestrel devices was significantly lower than those for Cu-T-200.

The norgestrel-T-IUD.

An improved long-acting Norgestrel-T contraceptive device has been developed. The effects of different release levels of levonorgestrel on the endometrium were studied in a selected group of 42 subjects. A randomized comparative study of the clinical performance of Cu-T 200 and Ng-T devices was undertaken in 200 fertile women for 15 months. Quantitation of the menstrual blood loss was performed on a selected group of 20 users. This new Ng-T device proved highly effective in fertility control. It was associated with a significant reduction in the amount of menstrual blood loss and incidence of termination probabilities due to bleeding and pain.