Evidence-Based Guideline on Laparoscopy in Pregnancy: Commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG)

Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and general surgical conditions. It has only been in recent years that laparoscopy has become an acceptable surgical alternative to open surgery in pregnancy. To date there is little clinical guidance pertaining to laparoscopic surgery in pregnancy. This is why the BSGE commissioned this guideline. MEDLINE, EMBASE, CINAHL and the Cochrane library were searched up to February 2017 and evidence was collated and graded following the NICE-approved process. The conditions included in this guideline are laparoscopic management of acute appendicitis, acute gall bladder disease and symptomatic benign adnexal tumours in pregnancy. The intended audience for this guideline is obstetricians and gynaecologists in secondary and tertiary care, general surgeons and anaesthetists. However, only laparoscopists who have adequate laparoscopic skills and who perform complex laparoscopic surgery regularly should undertake laparoscopy in pregnant women, since much of the evidence stems from specialised centres.

Prevalence factors associated with equine herpesvirus type 1 infection in equids with upper respiratory tract infection and/or acute onset of neurological signs from 2008 to 2014

The objective of the present case-control study was to determine prevalence factors associated with the detection of equine herpesvirus type 1 (EHV-1) by quantitative PCR (qPCR) in horses presented to veterinarians with clinical signs related to an upper respiratory tract infection and/or acute onset of neurological disease from March 2008 to December 2014. Nasal secretions and whole blood from 4228 equids with acute onset of fever, respiratory signs and/or neurological deficits were tested by qPCR for EHV-1. Categorical analyses were performed to determine the association between observations and EHV-1. A total of 117/4228 (2.7 per cent) equids tested qPCR-positive for EHV-1, with most of the isolates belonging to the non-neuropathogenic genotype (N752). EHV-1 PCR-positive equids were over-represented in racing horses. Depression, anorexia, nasal discharge and coughing were significantly less frequently reported in the EHV-1 qPCR-positive equids compared with the EHV-1 qPCR-negative cases. Neurological deficits were more frequently reported in the EHV-1 qPCR-positive cases. This study provides contemporary information on the frequency of EHV-1 detection by qPCR in blood and nasal secretions from horses with fever, respiratory signs and neurological deficits.

An Assessment of Surgical Experience among Obstetric and Gynaecology SpR Trainees

Changes in gynaecological practice have resulted in a significant reduction in surgical exposure for trainees. We have attempted to assess surgical experience among obstetric and gynaecology SpR's in Ireland using an anonymous on-line questionnaire. Trainees were asked to assess their own ability to perform a variety of general gynaecological procedures. There was a 97% response rate (29/33 trainees). There were 11 trainees who were in the final or penultimate year of the scheme. This group were analysed separately to assess competency rates in those approaching the end of the scheme. They were subdivided in to those who have completed one year in a general hospital doing pure gynaecology and those who have not. Approximately half of this group (6/11) had completed a pure gynaecology year. All of these trainees deemed themselves competent to perform all general gynaecological procedures listed, with the exception of trans-urethral tape procedures, for which 3/6 reported the requirement of direct supervision. Only 2/6 deemed themselves competent to perform a total laparoscopic hysterectomy. Year 4/5 trainees who had not completed a pure gynaecology year displayed significantly lower competency rates for most of the procedures. With the current changes in gynaecological practice, these results highlight the importance of dedicated gynaecological surgical training.

Study of ovarian cancer management

Ovarian cancer is the most lethal gynecological malignancy. Many patients present at an advanced stage as the symptoms of early stage disease can be vague. AIM We evaluated the demographics, treatment regimens and survival rates of ovarian cancer patients attending Beaumont Hospital Dublin over a nine year period. A retrospective chart review of ovarian cancer patients attending Beaumont Hospital between 11/10/94 and 30/6/3 was performed. Patients were selected from pathology records. Patients with borderline histology and those who died of unrelated causes were excluded. 31% of individuals presented with distension as their only clinical sign. 20% presented with a mass as their only clinical sign. The most common cell type was papillary serous adenocarcinoma in two thirds of cases. 54% presented with advanced disease [stage IIl-IV]. Treatment involved surgical clearance or debulking +/- chemotherapy. 5 year survival for Stage I was 95% versus 19% for Stage IlI. This highlights the importance of early diagnosis.

Palliation of intractable cancer pain by MRI-guided cingulotomy

CASE REPORT

Three cases of intractable pain arising from widespread metastatic cancer with poor response to opioids were treated with MRI-guided cingulotomy.

RESULTS AND CONCLUSIONS

In most cases, MRI-guided cingulotomy was associated with significant pain relief and reduced opioid use. To provide insight into the role of MRI-guided cingulotomy in oncologic pain refractory to more conservative measures, the relative risks and benefits of cingulotomy are discussed, along with the course of one patient who experienced postoperative cognitive impairment. This report also describes the relevant neurosurgical and pharmacotherapeutic issues associated with management of pain in patients with widespread metastatic disease.

Evaluation of a porous bovine collagen membrane bandage for management of wounds in horses

OBJECTIVE

To evaluate the effect of a porous bovine-derived collagen membrane (PBCM) on the rates of wound healing, cellular events, presence of granulation tissue, and appearance at termination of the study in surgically created full-thickness cutaneous wounds of the distal portion of the extremities of horses.

DESIGN

Treated wounds (n = 12) received a PBCM dressing and control wounds were covered with a nonadherent dressing. Forelimbs and hind limbs were cross paired; the right forelimb and left hind limb always received the same dressing application, as did the left forelimb and right hind limb. Limbs pairs were then randomly assigned to 1 of the 2 dressings.

ANIMALS

Six healthy male horses (3 sexually intact, 3 geldings) ranging from 2 to 10 (mean, 6.5) years and weighing between 278 and 568 (mean, 408.5) kg were studied.

PROCEDURE

Full-thickness skin wounds (6.25 cm2) were created on the dorsal metatarsi and metacarpi of the experimental animals. A preformed PBCM dressing was evaluated in half the wounds (n = 12). Control wounds (n = 12) were dressed with a nonadherent gauze dressing. At each bandage change, wounds were subjectively assessed and were photographed, and measurements of horizontal and vertical wound dimensions were documented. Wound biopsy specimens obtained on days 2, 5, 7, 10, 21, and 31 were evaluated for presence of collagen, fibrin, inflammation, epithelium, and cellular elements of healing. Planar morphometry was used to determine total wound area and granulation area from the wound photographs. Percentage of contraction and epithelialization were calculated from these values. Linear regression analysis of the square root of the total wound area and the granulation area was performed. Wound area measurements were analyzed, using ANOVA for repeated measures. Regressions were compared, using covariance analysis and ANOVA. Significance was considered at P < 0.05.

RESULTS

Fibrin score, neutrophil score, and degree of inflammation were significantly greater in the PBCM-treated wounds. No significant differences in the total wound, epithelialized, or contraction areas were detected between the PBCM-treated and control (nonadherent-treated) wounds. Rates of wound healing were not statistically different between the 2 treatment groups, though they were significantly slower in the hind limbs, compared with the forelimbs. Scabs were formed more frequently in the PBCM-treated wounds.

CONCLUSIONS

Application of a porous collagen bandage was not detrimental to full-thickness cutaneous wound healing in horses.