Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre.

INTRODUCTION: The aetiology and management of ovarian pathology in children differs between antenatal and postnatal lesions. However, all lesions may present acutely due to adnexal torsion. In this setting, opportunities to preserve fertility with ovary-sparing surgery (OSS) may be missed. Some studies suggest that pediatric and adolescent gynaecology (PAG) input in care is associated with OSS. METHODS: A retrospective cohort study of children undergoing surgery for ovarian pathology at a tertiary pediatric surgery centre over an 8-year period (2011-2018). Patient factors, lesion characteristics and PAG involvement were examined for association with OSS using multivariate logistic regression. RESULTS: Thirty-five patients with ovarian pathology managed surgically were included. Ten were infants with lesions detected antenatally; all were managed by pediatric surgeons (PS) alone at median age 2 weeks (1 day-25 weeks). Twenty-five patients presented postnatally at median age 11 (0.75-15) years. In total, there were 16 cases of adnexal torsion, each managed primarily by PS. Twelve underwent oophorectomy and six (50%) of these cases had viable ovarian tissue on histology. Furthermore, two infants with large simple cysts were similarly managed by unnecessary oophorectomy based on histology. Overall rate of OSS was 46% and PAG involvement was the only factor associated with ovarian salvage. CONCLUSION: Differences in surgical management between PAGs and PS may be attributable to the different patient populations they serve. We recommend improving the knowledge of PS trainees in OSS approaches for adnexal torsion and large benign lesions.

Contralateral Hypoplastic Venous Draining Sinuses Are Associated with Elevated Intracranial Pressure in Unilateral Cerebral Sinovenous Thrombosis.

Variations in cerebral venous development can influence the ability to regulate drainage. In cerebral sinovenous thrombosis, these variations can be associated with elevated intracranial pressure. We present a series of pediatric patients with unilateral cerebral sinovenous thrombosis and investigate whether the contralateral venous sinus size increases the risk of developing elevated intracranial pressure. Patients diagnosed with a unilateral cerebral sinovenous thrombosis were identified by querying our institutional radiology data base. The difference in the occurrence of elevated intracranial pressure in patients with cerebral sinovenous thrombosis with and without hypoplastic venous sinuses was studied. Twelve cases of unilateral cerebral sinovenous thrombosis met the inclusion criteria and had sufficient images. Six patients had hypoplastic contralateral venous sinuses. The presence of hypoplastic contralateral venous sinus in the setting of thrombosis of a dominant sinus was associated with elevation of intracranial pressure (83% versus 0%, P = .015). Patients with cerebral sinovenous thrombosis and contralateral hypoplastic venous sinuses are at higher risk of developing elevated ICP and may benefit from screening with an ophthalmologic examination.

Analysing urban resilience through alternative stormwater management options: application of the conceptual Spatial Decision Support System model at the neighbourhood scale.

Recent changes in cities and their environments, caused by rapid urbanisation and climate change, have increased both flood probability and the severity of flooding. Consequently, there is a need for all cities to adapt to climate and socio-economic changes by developing new strategies for flood risk management. Following a risk paradigm shift from traditional to more integrated approaches, and considering the uncertainties of future urban development, one of the main emerging tasks for city managers becomes the development of resilient cities. However, the meaning of the resilience concept and its operability is still not clear. The goal of this research is to study how urban engineering and design disciplines can improve resilience to floods in urban neighbourhoods. This paper presents the conceptual Spatial Decision Support System (DS3) model which we consider a relevant tool to analyse and then implement resilience into neighbourhood design. Using this model, we analyse and discuss alternative stormwater management options at the neighbourhood scale in two specific areas: Rotterdam and New Orleans. The results obtained demonstrate that the DS3 model confirmed in its framework analysis that stormwater management systems can positively contribute to the improved flood resilience of a neighbourhood.

Antimicrobial screening of some Egyptian plants and active flavones from Lagerstroemia indica leaves.

One hundred and twenty four plant extracts were evaluated for their antimicrobial activity against four pathogenic bacteria (Staphylococcus aureus (ATCC 8095), Salmonella enteritides (ATCC 13076), Escherichia coli (ATCC 25922), and Listeria monocytogenes (ATCC 15313)) and Candida albicans yeast (ATCC 10231) using the disk diffusion and broth microdilution methods. Of the plant extracts, fourteen exhibited antimicrobial activity against two or more of the five microorganisms tested. Only the methanol extract of Lagerstroemia indica leaves exhibited antimicrobial activity against all pathogenic bacteria and C. albicans yeast that were tested. Purification of the methanol extract of L. indica leaves using antimicrobial assay-guided isolation yielded one pure active compound. The chemical structure of the isolated active compound was found to be '4-methoxy apigenin-8-C-ß-D-glucopyranoside; cytisoside according to detailed spectroscopic analysis of its nuclear magnetic resonance and mass spectrometry data. The compound exhibited antimicrobial activity against C. albicans (minimum lethal concentration (MLC): 32 µg/mL), S. aureus (MLC: 16 µg/mL), S. enteritides (MLC: 16 µg/mL), E. coli (MLC: 16 µg/mL), and L. monocytogenes (MLC: 16 µg/mL). The present study found that the methanol extract of L. indica leaves holds great promise as a potential source of beneficial antimicrobial components for different applications.

Isolation and structure elucidation of antioxidant compounds from leaves of Laurus nobilis and Emex spinosus.

In recent years, there has been increasing interest in finding naturally occurring antioxidants from plants for use in food and medicinal materials to replace synthetic antioxidants since such antioxidants are being restricted due to their side effects like carcinogenicity. The aim of this work was to examine the in vitro antioxidant activity of Laurus nobilis and Emex spinosus leaves and to isolate and structurally elucidate the active compounds in those leaves. The aqueous ethanolic extracts (70%) of Laurus nobilis and Emex spinosus leaves exhibited free radical scavenging action against 1,1-diphenyl-2-picrylhydrazyl (DPPH). Their concentrations of 50% inhibition (IC(50)) were 25.3 and 20.73 µg/mL, respectively. Activity-guided separation of these extracts using a combination of different chromatographic methods (TLC and column chromatography) resulted in the isolation of five chromatographically pure compounds (three from Laurus nobilis and two from Emex spinosus leaves). Spectroscopic methods ((1)H, (13)C-NMR, UV and MS) and chemical methods (detection tests and acidic hydrolysis) revealed the isolated antioxidant compounds to be flavonoid substances that were identified as kaempferol, kaempferol-3-rhamnopyranoside, and kaempferol-3,7-dirhamnopyranoside from Laurus nobilis extract and luteolin and rutin from Emex spinosus extract. The five flavonoids had varying ability to inhibit DPPH radicals (IC(50) from 4 to 35.8 µg/mL). Luteolin and rutin had strong scavenging action with an IC(50) of 4 and 4.6 µg/mL, respectively, and this action was stronger than that of synthetic antioxidant BHA, i.e., butylated hydroxyanisole (IC50 = 5.6 µg/mL).

Ferutinin stability in human plasma and interaction with human serum albumin.

Ferutinin is a potent phytoestrogen extracted from plants of the genus Ferula. The biological activity of this sesquiterpene is associated with the esterification of p-hydroxybenzoic acid with the daucane alcohol, jaeschkeanadiol. A HPLC method was developed to investigate the stability of ferutinin in acidic and basic solutions (pH 1.5 and 9.0, respectively), in buffer (pH 7.4) as well as in serial dilutions of albumin and in human plasma. The degradation of ferutinin was relatively slow at physiological pH 7.4 compared with low or high pH. Ferutinin was fully stable in human plasma as well as in albumin solution and the stability increased with albumin concentration. The binding of ferutinin to albumin was investigated by fluorescence spectroscopy. Ferutinin decreased the fluorescence of HSA and that of the only tryptophan residue located in domain IIA. As a result of the interaction between ferutinin and albumin, the binding of bilirubin decreased. The stability of ferutinin in plasma is attributable to ferutinin-albumin binding.

Telephone gynaecological follow-up.

This study was carried out to evaluate the outcome of telephone follow-up in gynaecological patients. The patients were selected using certain criteria. Telephone appointments were arranged with the patient's consent using the computer appointments system, so that data were available for further evaluation. This paper presents the outcome and results of a satisfaction questionnaire sent to the first 100 patients. Seventy-two per cent of the patients replied, of whom 97% were satisfied. This system had an impact on non-attenders. The patients appreciated being able to talk to their consultant directly. Running a telephone follow-up clinic also meant that the consultant was able to see more new patients in the outpatient clinic.

Endometrial ablation with the Cavaterm thermal balloon.

This prospective observational study evaluates the efficacy and safety of thermal Balloon endometrial ablation using the Cavaterm system for the treatment of dysfunctional uterine bleeding. Seventy-seven women with a mean age of 43 years who met the inclusion and exclusion criteria were treated under general anaesthesia. A 9-mm diameter catheter with a silicone balloon at its tip was inserted transcervically into the uterus and was inflated with sterile 1.5% glycine and connected to a control unit that maintained the temperature of the circulating heated fluid at 75 degrees C, monitored the pressure and terminated the treatment after 15 minutes. There were no intra-operative complications and patients tolerated the treatment well. Satisfaction rates were 90% at both 12 and 24 months. At 24 months 10% of patients had heavy periods, 5% normal periods, 39% light periods and 46% amenorrhoea. Cavaterm balloon ablation seems a safe and effective option for women with menorrhagia. The procedure does not require additional training and expertise in operative hysteroscopy and compares favourably with established techniques.