Is there a need for a histological examination of the adenoid tissue after adenoidectomy?

OBJECTIVES: In Germany there is no uniform practice regarding the histological examination of removed tissue after an adenoidectomy. In addition, the unique benefits of routine histological examination of adenoid tissue cannot be ascertained from current literature due to varying opinion and evidence. METHODS: This study was approved by the Medical Association and Ethics Committee in Cottbus, Brandenburg, Germany. We evaluated the pre- and intra-operative examination findings (direct and indirect epipharyngoscopy, digital palpation, intraoperative macroscopic assessment and examination of removed tissue) and the histopathological findings of excised adenoid tissue. A statistical analysis of obtained results was undertaken thereafter. RESULTS: It was found that in all young patients included in the study, the histological results invariably represented lymphoepithelial hypertrophic mucosa with a varying inflammatory response, matching a clinical picture of adenoid vegetation and in keeping with the pre- and intraoperative investigations and findings. CONCLUSION: The characteristic history of adenoid vegetation in combination with a classic pre- and intraoperative clinical examination and an inconspicuous macroscopic examination of removed tissue, renders routine histopathological workup dispensable. On suspicion of deviant pathology a histopathological examination is recommended and should be undertaken.

Advanced catheter technology: is this the answer to overcoming the long learning curve in complex endovascular procedures.

INTRODUCTION: Advanced endovascular procedures require a high degree of skill with a long learning curve. We aimed to identify differential increases in endovascular skill acquisition in novices using conventional (CC), manually steerable (MSC) and robotic endovascular catheters (RC). MATERIALS/METHODS: 10 novices cannulated all vessels within a CT-reconstructed pulsatile-flow arch phantom in the Simulated Endovascular Suite. Subjects were randomly assigned to conventional/manually-steerable/robotic techniques as the first procedure undertaken. The operators repeated the task weekly for 5 weeks. Quantitative (cannulation times, wire/catheter-tip movements, vessel wall hits) and qualitative metrics (validated rating scale (IC3ST)) were compared. RESULTS: Subjects exhibited statistically significant differences when comparing initial to final performance for total procedure times and catheter-tip movements with all catheter types. Sequential non-parametric comparisons identified learning curve plateau levels at weeks 2 or 3(RCs, MSCs), and at week 4(CCs) for the majority of metrics. There were significantly fewer catheter-tip movements using advanced catheter technology after training (Week 5: CC 74 IQR(59-89) versus MSC 62(44-81); p = 0.028, and RC 33 (28-44); p = 0.012). RCs virtually eliminated wall hits at the arch (CC 29(28-76) versus RC 8(6-9); p = 0.005) and produced significantly higher overall performance scores (p < 0.02). CONCLUSION: Advanced endovascular catheters, although more intricate, do not seem to take longer to master and in some areas offer clear advantages with regards to positional control, at a faster rate. RCs seem to be the most intuitive and advanced skill acquisition occurs with minimal training. Robotic endovascular technology may have a significantly shorter path to proficiency allowing an increased number of trainees to attempt more complex endovascular procedures earlier and with a greater degree of safety.

A comparative evaluation of clinical examination, pelvic ultrasound and laparoscopy in the diagnosis of pelvic masses.

This is a prospective study conducted on one hundred female patients with pelvic masses. The diagnostic accuracy of clinical examination alone and in conjunction with ultrasonic examination was comparable (p > 0.05). However diagnostic accuracy of 92% with laparoscopy was statistically significant as compared to 68% of clinical examination (p < 0.001) and 76% of ultrasonic examination (p < 0.05).

Microbiological study of vaginal discharge associated with the use of CuT 200.

A microbiological study of the vaginal discharge was conducted on 75 women attending family planning outdoors. In 24 out of 25 symptomatic CuT 200 users suffering from non-specific vaginitis, Gardnerella vaginalis was isolated from 19 cases (79%). The difference in the recovery rate of Gardnerella vaginalis was highly significant between symptomatic CuT 200 users and non-users (p less than 0.001) and that between symptomatic and asymptomatic CuT 200 users (p less than 0.05). But the difference between asymptomatic CuT 200 users and non-users was not statistically significant. The presence of clue cells on direct Gram's staining of vaginal discharge is significantly (p less than 0.05) related to the recovery of Gardnerella vaginalis on culture.

Gardnerella vaginalis vaginitis in Cu T 200 users.

Vaginal samples obtained from intrauterine contraceptive device (IUD) users with and without vaginitis and from healthy non-users were studied for presence of G. vaginalis and cytological changes. Vaginitis was present in 29.5 per cent IUD users and most of them (76%) yielded G. vaginalis. G. vaginalis was also recovered from asymptomatic IUD users and from non-users, but heavy colonisation was infrequent. The presence of clue cells and many small Gram negative bacilli and scanty lactobacilli were associated with G. vaginalis recovery. Inflammation was more frequent in IUD users than in non-users (P less than 0.001). A significant correlation was also found between inflammatory changes and G. vaginalis colonisation among all groups of patients.