[VACUUM-THERAPY OF DIFFUSE PERITONITIS]

The experience of treatment of 37 patients, suffering diffuse peritonitis, in 18 of them in complex with vacuum-therapy, is adduced. In a comparison group a sanation relaparotomy was applied only. International classifications SOFA, APACHE II, Manheim’s Index of the Peritonitis Severity were used for estimation of the patients’ state severity. The vacuum-therapy application have promoted significant reduction of the abdominal cavity microbial soiling, permitted to escape the compartment syndrome occurrence, and to reduce the sanation relaparotomy performance rate.

[APPLICATION OF VACUUM-THERAPY ON STAGES OF SURGICAL TREATMENT OF THE DIABETIC FOOT SYNDROME]

Vacuum therapy of an acute and chronic wounds was used in a complex of surgical treatment of 228 patients, suffering diabetic foot syndrome. There was established a positive local and systemic action of this method for the treatment of the wound defect. Vacuum therapy of the wounds guarantees the wound process clinical course stabilization, improvement of microcirculation, reduction of their microbial soiling, stimulation of regenerative processes, elimination of endogenous intoxication.

[Different methods for the diagnosis of endometrial histological comparative study]

OBJECTIVE

To evaluate the feasibility of endometrial sampler Pipelle for endometrial histologic diagnosis.

METHODS

Using prospective and self-control methods, 200 patients with endometrial biopsy firstly used Pipelle endometrial sampler for endometrial tissue, then followed by diagnostic curettage, the same pathologist evaluated the specimen quality and made the histologic diagnosis.

RESULTS

Totally 200 patients completed the observation, the specimen satisfaction of Pipelle was 93.0% (in this 200 cases, 186 cases were satisfactory), its pathological accuracy was 85.0% (in this 200 cases, 170 cases' pathological results are highly consistent with diagnostic curettage). There was no significant difference between two kinds of endometrial sampling (P > 0.05). There was no pain for patients during the Pipelle using process.

CONCLUSION

Pipelle could obtain satisfactory samples used for histological diagnosis in normal endometrium, simple hyperplasia, complex hyperplasia, atypical hyperplasia and endometrial cancer disease, because its pathological accuracy is so close to the diagnostic curettage, which may be used as a routine screening tool of endometrial diseases.

Comparison of level of pain between using manual vacuum aspiration and sharp curettage in management of abnormal uterine bleeding

OBJECTIVE

To compare the level of pain between using manual vacuum aspiration and sharp curettage in the patients who had abnormal uterine bleeding that underwent uterine curettage under paracervical block with analgesics.

DESIGN

Randomized controlled trial study.

MATERIAL AND METHOD

Between September 2009 to June 2010, 48 women with abnormal uterine bleeding who need to undergone uterine curettage were asked to join the present study and informed consents were signed. Twenty four women were randomly assigned into manual vacuum aspiration (MVA) group and other 24 women into sharp curettage group. The main outcome was the difference of the level of pain before, during and after procedure measured by using the visual analog scale and categorical pain scores. Fisher exact, Student t test and Mann-Whitney U test were used for statistical analysis.

RESULTS

The median visual analog score during MVA-procedure was significantly lower than the median visual analog score during in sharp curettage (median visual analog pain scores (interquartile range) 80 (30-100) vs. 45 (0-80); p < 0.01)). And the median score immediately after procedure in the MVA group was also significantly lower than in the sharp curettage group (median visual analog pain scores (interquartile range) 45 (0-80 vs. 25 (0-70); p = 0.02). The categorical pain score in the MVA group during procedure and immediately after procedure were also significantly lower than in the sharp curettage group. (No pain to mild pain vs. moderated to severe pain; p = 0.03, immediately after procedure: no pain to mild pain vs. moderated to severe pain; p = 0.01).

CONCLUSION

The level of pain in the patients who underwent uterine curettage by using MVA was lower than using sharp curettage. The using MVA may reduce pain compared to sharp curettage. However, more sample size research should be conducted to determine this significant.

VFDs can cut costs and improve control

Phil Giles of Becker Pumps Australia examines the use of variable frequency drives for medical suction plant, and explains the many potential benefits--both practical and economic. The paper on which this article is based was presented at the Institute of Hospital Engineering Australia's (IHEA) 60th National Conference in 2009.

New mechanical recanalization devices - the future in pediatric stroke treatment?

OBJECTIVE

To evaluate the recanalization rate and clinical outcome in children with acute ischemic stroke following treatment with innovative mechanical thrombectomy devices.

PATIENTS AND METHODS

Three subjects aged 7-16 years presenting with acute cerebral vascular occlusions (thrombolysis in myocardial infarction [TIMI] 0) were treated with either the Penumbra System, operating on an aspiration platform, or the Phenox clot retriever device, a flexible wire compound with perpendicularly-oriented polyamid microfilaments. Target vessels were the internal carotid artery, the middle cerebral artery and the basilar artery.

RESULTS

Successful recanalization (TIMI 3) was attained in all cases. No device-related complications or intracranial hemorrhage occurred. Follow up was conducted for up to 30 days. A 10- to 26-point improvement in the National Institutes of Health Stroke Scale (NIHSS) score was achieved.

CONCLUSIONS

Mechanical thrombectomy devices possess a dual advantage whereby they can achieve instant recanalization as well as minimize the number of bleeds that customarily accompany intravenous and intra-arterial therapy. These new devices could contribute greatly to treatment decisions in a field not yet clearly defined by current guidelines.

Barriers to sustainable MVA supply in Ghana: challenges for the low-volume, low-income providers

Multiple studies have demonstrated that manual vacuum aspiration (MVA) is ideal for surgical uterine evacuation in low-resource settings such as Ghana, but developing a sustainable supply to MVA has been challenging. In 2007 a situational analysis was conducted in Ghana to identify barriers to sustainable MVA supply. Information about MVA availability was gathered in seven regions of Ghana and obtained through background literature, unpublished data and reports, and 70 informational interviews with stakeholders involved with MVA policy, manufactufing, procurement, distribution, supply, training, and provision. The findings revealed that despite consensus about the dire need for MVA in Ghana, developing sustainable access to MVA instruments has proven difficult. In the public and the private health sectors, procuring MVA equipment has been particularly challenging for low-income, low-volume service providers. Research findings yielded ten recommendations for improving sustainable access to MVA, including the implementation of a revolving purchase mechanismn for health provider associations, such as the Ghana Registered Midwives Association.

[Vacuum assisted closure for postoperative mediastinitis using a portable aspirator]

We report a case of successful treatment of a methicillin resistant Staphylococcus aureus (MRSA) mediastinitis by vacuum assisted closure (VAC) using SB VAC system as a portable aspirator. A 67-year-old male with intellectual disability and diabetes mellitus suffered from angina pectoris and underwent on-pump coronary artery bypass grafting. He had a MRSA mediastinitis following the surgery. We started vancomycin administration and VAC. It was expected that using wall suction for VAC would be difficult because of his intellectual disability. So we performed VAC using SB VAC system as a portable aspirator. VAC therapy for mediastinitis after cardiac surgery is effective and SB VAC system can be used as a portable aspirator.

Development of a palm portable mass spectrometer

A palm portable mass spectrometer (PPMS) has been developed with a weight of 1.48 kg (3 lb) and a size of 1.54 L (8.2 x 7.7 x 24.5 cm(3)) that can be operated with an average battery power of 5 W. A miniaturized ion trap has been used as a mass analyzer that consists of four parallel disks with coaxial holes. A rf voltage of 1500 V(p-p) at 3.9 MHz has been used for scanning ion mass of up to m/z 300. An ion-getter pump serves for high vacuum of the PPMS. Sample gas was introduced in pulse mode. An embedded microcomputer has been developed for system control. Detection of organic gases diluted in the air has been demonstrated up to 6 ppm for toluene and 22 ppm for dimethyl methylphosphonate (DMMP). Performance results suggest usefulness of the PPMS as a personal mobile device for detection/identification of chemical warfare agents in the field.

Extraction of challenging intracoronary thrombi: multi-device strategies using guide catheters, distal vascular protection devices and aspiration catheters

Patients with large intracoronary thrombi represent a difficult management problem for the interventional cardiologist. We report 10 cases of challenging thrombi treated percutaneously using varying combinations of deep guide catheter engagement, guide aspiration, dedicated catheter aspiration and withdrawal of a distal filter vascular protection device. These cases demonstrate interventional options which may be considered for such patients.

Designs of devices: the vacuum aspirator and American abortion technology

In 1965, 71% of legal abortions in the United States were performed using the surgical procedure of dilation and curettage. By 1972, a mere seven years later, approximately the same percentage (72.6%) of legal abortions in the United States were performed using a completely new abortion technology: the electrical vacuum aspirator. This article examines why, in less than a decade, electric vacuum suction became American physicians' abortion technology of choice. It focuses on factors such as political and professional feasibility (the technology was able to complement the decriminalization of abortion in the US, and the interests, abilities, commitments, and personal beliefs of physicians); clinical compatibility (it met physician/patient criteria such as safety, simplicity and effectiveness); and economic viability (it was able to adapt to market factors such as production, cost, supply/demand, availability, and distribution).

Plastic suction curette as uterine manipulator at combined laparoscopic sterilization: a prospective study of 531 cases

OBJECTIVE

To determine the efficacy and safety of a plastic suction curette (PSC) as uterine manipulator during combined surgical abortion and laparoscopic sterilization.

METHODS

This prospective observational study was conducted between January 1996 and December 2003 in a university teaching hospital and a district hospital. All cases of combined first trimester surgical abortion and laparoscopic sterilization were performed under general anaesthesia in the day surgery unit. A straight or curved PSC with a diameter of 7-12 mm was used for surgical abortion and, afterwards, to manipulate the uterus at laparoscopic sterilization. The negative pressure of 600 mmHg or -80 kPa was maintained during manipulation. Any intra-operative trauma or difficulties in identifying the tubes and blood loss during sterilization were noted.

RESULTS

A total of 531 cases of combined abortion and laparoscopic sterilization were performed. There was no failure to identify the tubes nor any uterine perforation; blood loss was minimal. No patient required hospital admission because of direct surgical complications.

CONCLUSION

The plastic suction curette is a safe and efficient uterine manipulator at combined laparoscopic sterilization procedure.

Removal of a large spherical foreign object from the rectum using an obstetric vacuum device: a case report

Reports of retained rectal foreign bodies are increasingly common worldwide. It is likely that any surgeon practicing at a major medical center will encounter this type of case, and thus, should be familiar with both surgical and nonsurgical management options. The diagnosis is usually easy to confirm with a thorough history and physical exam and plain abdominal films. Low-lying objects can usually be extracted in the emergency room transanally, whereas high-lying foreign bodies may require anesthesia and laparotomy. We report an experience using an obstetric vacuum device to extract a high-lying foreign body from the rectum.

Excimer Laser Assisted Non-occlusive Anastomosis (ELANA). Our experience with a training model in vivo

AIM

In this study the ELANA Technique has been reproduced in our experimental laboratory in order to verify its feasibility and reproducibility, the percentage of patent anastomosis in acute at different steps along the learning curve of the surgical team, specific problems related to the surgical technique.

METHODS

In 20 rabbits New Zealand 4kg body weight the training model in vivo proposed by Tulleken and coworkers has been reproduced, realizing 40 ELANA anastomosis. The model consists in the realization of two different end-to-side anastomosis on the abdominal aorta of each experimental animal, assisted by a special designed suction/excimer laser catheter, then connected by an end-to-end suture. After a few hours the animals are sacrificed and the by-pass site withdrawn and examined in order to verify the percentage of patency in acute.

RESULTS

In the first 5 animals (group A), the anastomosis were realized using a jugular vein graft and the procedure results successful in only 3 cases out of ten (30%). For the following experiments - groups B, C and D where an aorta artery graft was used, the percentage of arterial flap retrieval was respectively 50%, 60% and 80%.

CONCLUSIONS

ELANA is a feasible fascinating microsurgical technique for the realization of high flow, non-occlusive anastomosis. The rate of success results progressively higher along the learning curve of the surgical team. In our opinion, before the application of the ELANA technique on humans, a period of propaedeutic training in vivo on laboratory animals is essential for the dedicated team.

Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery

The diffusion of minimally invasive cardiac surgery (MICS) during open-heart surgery has increased the use of assisted venous drainage support for cardiopulmonary bypass (CPB). Peripheral cannulation with small cannulae and vacuum-assisted venous drainage (VAVD) during MICS has been adopted in our institution since 1998.

After the Heartport technique (HP) experience, the trans-thoracic clamp technique is now currently used. The aim of this study is to report our experience with extrathoracic CPB with VAVD application (on CPB) during open-heart MICS.

From October 1999 to June 2006, 193 patients underwent MICS. Thirty-seven (19.2%) patients were treated with the HP - 13 (35%) with robotic technology and 156 (80.8%) with trans-thoracic aortic clamping (TTAC). Mean age was 39 years (range: 12-77), and 114 patients (59.1%) were female. A total of 128 patients (66.3%) underwent mitral valve surgery, 57 (29.6%) atrial septal defect closure, five (2.6%) cardiac mass removal, and three (1.5%) tricuspid valve repair. Four patients (2.0%) had a previous cardiac procedure.

Peripheral CPB was established with a standard coated circuit. A 14 Fr arterial cannula was inserted into the right jugular vein and positioned at the atrial/superior vena cava junction. A 21 or 28 percutaneous femoral cannula, depending on body surface area, was inserted in the femoral vein and an arterial cannula in the right femoral artery. Gravitational drainage was combined with VAVD. To improve the safety and effectiveness of this technique, we monitored the pressure on each venous cannula and in the reservoir. The mean CPB time was 74.8∓30 min (TTAC) and 119∓48 min (HP); mean aortic clamping time was 51∓19 min (TTAC) and 73∓29 min (HP).

We did not record any neurological complication. Two patients (1.0%), one from each group, were converted to sternotomy. Three patients (1.5%) underwent re-exploration for bleeding. In-hospital mortality was 0.5% (N = 1) (HP). Mechanical ventilation time and intensive care unit stay were comparable to those recorded with conventional sternotomy.

In conclusion, we found that extrathoracic CPB and VAVD during trans-thoracic clamping is a safe, simple, and effective technique for MICS. However, there is a potential risk of haemolysis and air embolism, which can be prevented with vacuum monitoring, and with the addition of gravitational drainage to reduce vacuum pressure.

Aspiration curette for anterior capsule polishing: Laboratory and clinical evaluation

Capsular fibrosis or fibrotic after-cataract results from transdifferation of anterior lens epithelial cells into myofibroblasts with consequent contraction and collagen deposition. To avoid possible complications, an instrument was designed for efficient and safe polishing of the anterior capsule leaf. The curette features an upward-facing slit with sharp-edged flanks and rounded turning points and an optional bypass hole. It is introduced through 3 equidistant 20-gauge paracentesis openings. In a laboratory test, vacuum rise time and vacuum levels under occlusion and the effect of adding a bypass hole were investigated for various pump settings. In a clinical pilot series, efficiency and safety of various designs were tested and vacuum and flow settings titrated for optimum performance; the clinical effect was determined in prospectively randomized bilateral studies. Optimum pump settings were 5 mL/min and 10 mm Hg with the nonventing curette and 7 to 10 mL/min and 50 mm Hg with the venting curette. A bypass hole delayed the vacuum rise and reduced the mean vacuum level on full occlusion. It also allowed fine-tuning the vacuum at the slit by varying the flow rate with the foot pedal. Anterior capsule polishing significantly decreased capsule fibrosis and is recommended when posterior capsulorhexis and optic buttonholing are combined.

Laparoscopic hepatectomy by curettage and aspiration. Experiences of 62 cases

BACKGROUND

This article introduces a new technique for hepatectomy. Its purpose is to describe the details of laparoscopic hepatectomy by curettage and aspiration (LHCA) and develop a new instrument for this technique.

METHODS

We have performed laparoscopic hepatectomy by curettage and aspiration (LHCA) in 62 patients in our institute between 1998 and 2005: 34 men and 28 women, mean age 47.8 years (range: 26-71 years). Their diagnoses included 18 primary hepatic carcinoma, 2 metastatic carcinoma, 19 intrahepatic duct calculus, and 23 benign entities.

RESULTS

The LHCA operation was completed in 60 patients. In two, the procedure had to be converted to open operation. The mean operative time was 146 min and the mean operative blood loss was 458 ml. Complications occurred in two patients, one with bile leakage and the other with pneumothorax. All the patients were ambulatory within 24 hours of operation. The average length of hospital stay was 1 week.

CONCLUSIONS

Our experience leads us to believe that laparoscopic hepatectomy by curettage and aspiration (LHCA) is a safe and effective technique for resection of liver lesions.

The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum

PURPOSE

This report describes the authors' experience using a vacuum to pull the abnormal chest wall outward in patients with pectus excavatum.

METHODS

A suction cup was used to create a vacuum at the chest wall. A patient-activated hand pump was used to reduce pressure up to 15% below atmospheric pressure. The device was used by 60 patients (56 males, 4 females), aged 6.1 to 34.9 years (median, 14.8 years), for a minimum of 30 minutes, twice a day, up to 5 hours per day (median, 90 minutes). Patient progress was documented using photography, radiography, and plaster casts of the defect. In 14 children this method was used during the Nuss procedure to enlarge the retrosternal space for safer passage of the introducer.

RESULTS

Follow-up occurred between 2 and 18 months (median, 10 months). Computed tomographic scans showed that the device lifted the sternum and ribs within 1 to 2 minutes; this was confirmed thoracoscopically during the Nuss procedure. The suction cup enlarged the retrosternal space for safer passage of the introducer. Initially, the sternum sank back after few minutes. After 1 month, an elevation of 1 cm was noted in 85% of the patients. After 5 months, the sternum was lifted to a normal level in 12 patients (20%) when evaluated immediately after using the suction cup. All patients exhibited moderate subcutaneous hematoma, although the skin was not injured. One patient suffered from transient paresthesis in the right arm and leg. Two patients experienced orthostatic disturbances during the first application of the suction cup. There were no other complications.

DISCUSSION

In patients with pectus excavatum, application of a vacuum effectively pulled the depressed anterior chest wall forward. The initial results proved dramatic, although it is not yet known how much time is required for long-term correction.

CONCLUSIONS

This vacuum method holds promise as a valuable adjunct treatment in both surgical and nonsurgical correction of pectus excavatum.

Physician assistants as providers of surgically induced abortion services

OBJECTIVES

We compared complication rates after surgical abortions performed by physician assistants with rates after abortions performed by physicians.

METHODS

A 2-year prospective cohort study of women undergoing surgically induced abortion was conducted. Ninety-one percent of eligible women (1363) were enrolled.

RESULTS

Total complication rates were 22.0 per 1000 procedures (95% confidence interval [CI] = 11.9, 39.2) performed by physician assistants and 23.3 per 1000 procedures (95% CI = 14.5, 36.8) performed by physicians (P =.88). The most common complication that occurred during physician assistant-performed procedures was incomplete abortion; during physician-performed procedures the most common complication was infection not requiring hospitalization. A history of pelvic inflammatory disease was associated with an increased risk of total complications (odds ratio = 2.1; 95% CI = 1.1, 4.1).

CONCLUSIONS

Surgical abortion services provided by experienced physician assistants were comparable in safety and efficacy to those provided by physicians.

Which cannulae fit the Ipas manual vacuum aspiration syringe?

BACKGROUND

The Ipas double-valve manual vacuum aspiration (MVA) syringe is an alternative to electrical vacuum aspiration.

METHODS

This study determines which US cannulae (flexible, rigid-straight and rigid-curved) work with the Ipas MVA syringe. Cannulae from Ipas, MedGyn, Berkeley and Milex, in sizes 6-12 mm, were randomized and affixed to the MVA syringe. A pressure gauge was attached to the cannula with rubber tubing. Pressure readings were recorded initially and over 30 s.

RESULTS

Milex cannulae were not compatible. For the remaining brands, initial vacuum pressures ranged from 55 to 65 mmHg. Flexible cannulae from Ipas, Berkeley and MedGyn maintained initial pressures without leaks, as did the 6-12-mm straight- and curved-rigid cannulae by Berkeley. Eight of the 13 tested MedGyn rigid cannulae lost >10% pressure over 30 s.

CONCLUSION

Several US manufacturers produce cannulae that fit on the Ipas MVA syringe without a leak, including Ipas flexible cannula; Berkeley flexible, rigid-straight and rigid-curve cannulae and MedGyn flexible cannula, but not their rigid cannulae.

Der Stand der Vakuumversiegelung

In cases of extended post-traumatic soft-tissue and bone loss as well as with mutilating infection or radical tumor resection, multidisciplinary options are required to salvage extremities and functional rehabilitation. A surgical team approach allows for reduction of amputation rates, wound healing complications, and secondary procedures in limb oncology and trauma. The goals and limitations of cooperative surgical concepts are described. In the future, continuing medical education will focus not only on indications and techniques but also on complication management, medicolegal problems, and economic deficits due to maladapted legal structures. Provided clear clinical pathways are introduced to guide indications, surgical procedures, and postoperative treatment, marked financial deficits may be avoided. While, in the past, responsibility for the patient and ethical considerations resulted in the development of voluntary interdisciplinary treatment programs, economic strategies and an increasing number of malpractice suits in the future will inevitably produce new imperatives for interdisciplinary cooperation.

Manual Versus Electric Vacuum Aspiration for Early First-Trimester Abortion: A Controlled Study of Complication Rates

OBJECTIVE

Manual vacuum aspiration is an alternative to electric suction curettage for first-trimester elective abortion. Although many studies have demonstrated that manual vacuum aspiration is safer than sharp curettage for abortion, only a few studies have directly compared it with electric suction curettage. These studies proved the methods to be equally effective and acceptable but were too small to adequately compare safety. We compared immediate complication rates for abortions performed by manual and electric vacuum aspiration.

METHODS

We conducted a retrospective cohort analysis of all women undergoing elective abortion at up to 10 weeks' gestation at San Francisco General Hospital over a 3.5-year period. A total of 1726 procedures were included: 1002 manual and 724 electric vacuum aspirations. Clinical data were collected from medical records. Rates of uterine reaspiration and other immediate complications occurring at our institution were compared.

RESULTS

We found no difference in the rate of uterine reaspiration after abortions performed with the manual or electric suction device (2.2% versus 1.7%, respectively, P =.43). We had 80% statistical power to detect a 2% difference in uterine reaspiration rates with an microa error of.05. Overall major complication rates were 2.5% with manual and 2.1% with electric suction curettage, P =.56. Multivariable regression analyses controlling for potential confounders showed no difference in uterine reaspiration rates (electric odds ratio [OR] = 0.71, 95% confidence interval [CI] 0.32, 1.6) or overall complications (electric OR = 0.81, 95% CI 0.40, 1.7).

CONCLUSION

Manual vacuum aspiration is as safe as electric suction curettage for abortions at up to 10 weeks' gestation. Expanded use in an office setting might increase abortion access.

Neonatal Subgaleal Hemorrhage and Its Relationship to Delivery by Vacuum Extraction

Subgaleal hemorrhage is a rare condition of the neonate often associated with instrumental delivery. It is a potentially fatal condition that is often underreported and underdiagnosed. The vacuum extractor is being advocated as the instrument of first choice for assisted vaginal delivery, but appears to be associated with an increased incidence of subgaleal hemorrhage. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. Because of the ease of application, vacuum extractors could be used potentially in circumstances in which forceps would not be attempted, allowing an operator of average experience to perform rotational deliveries. The worrisome increase in the incidence of subgaleal hemorrhage associated with vacuum extraction leads to the issuance of warnings from governmental authorities in Canada and the United States. This review discusses the anatomy of this lesion, etiology, clinical presentation, management, and possible prevention.

An evaluation of manual vacuum aspiration instruments

OBJECTIVES

Manual vacuum aspiration (MVA) instruments vary in quality, cost, and availability. This evaluation of MVA instruments was conducted to provide decision-makers with information to assist them in determining which instruments to purchase for their specific health care settings.

METHODS

Nine MVA devices were evaluated for durability, quality, safety, and usability. Study data came from device specifications, laboratory-based technical studies, and field evaluations.

RESULTS

Equipment durability is compromised by high temperatures, quality is compromised by manufacturing defects, and design is key to safe reuse. All MVA instructions are written at advanced reading levels, and device assembly was difficult for most study participants.

CONCLUSIONS

No single brand of MVA instrument is perfectly suited for every setting. Users can evaluate the appropriateness of MVA instrument characteristics by reviewing the elements assessed in this evaluation, which, by complementing the experience of administrators and clinicians, should enable them to determine which MVA is best for their environment.

Similarities in women's perceptions and acceptability of manual vacuum aspiration and electric vacuum aspiration for first trimester abortion

This paper examines women's acceptability of and experiences with manual vacuum aspiration (MVA) as compared with electric vacuum aspiration (EVA) for first trimester abortion. Women requesting pregnancy terminations were randomly assigned to either MVA (n = 64) or EVA (n = 63). Participants completed questionnaires before and after their abortions and approximately 2-4 weeks later. We observed some differences by group in participants' ratings of the importance of method characteristics and in their perceptions of their abortion methods after their abortions. The two groups did not, however, differ in their reports of pain, anxiety or bleeding or in the acceptability of their method.

Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing

OBJECTIVE

To analyze the factors that influence the detection of uterine cancers by Pipelle and Tao Brush endometrial sampling devices.

STUDY DESIGN

Seventy-nine Pipelle currettages were followed by Tao Brush sampling. The curettage specimens were fixed in formalin for histology and reported by surgical pathology, whereas the Tao Brush specimens were fixed in CytoRich Red for histology and cytology and reported by cytopathology. Uterine size and features of residual tumors were obtained from hysterectomy reports. Follow-up for clinically benign cases ranged from 16 to 52 months (mean, 33.7; median, 34).

RESULTS

There were 10 uterine cancers and 9 hysterectomies. Five cases of centrally located adenocarcinoma, ranging from 0.4 to 3 cm, were detected by both samplers. Additionally, a Tao Brush sampled an adenocarcinoma located near the cornu. An endometrial stromal sarcoma found with a Tao Brush was reported as necrotic tissue by Pipelle. Both samplers missed a microscopic focus of adenocarcinoma, an in situ adenocarcinoma in a polyp and a large leiomyosarcoma.

CONCLUSION

The size and type of tumor and its location within the uterine cavity, the mechanism of sampling and preparation method influence the detection of uterine cancer by the Pipelle and Tao Brush.

Exogen, shedding phase of the hair growth cycle: characterization of a mouse model

The hair growth cycle is generally recognized to comprise phases of growth (anagen), regression (catagen), and rest (telogen). Whereas, heretofore, the hair shedding function has been assumed to be part of the telogen phase, using a laboratory mouse model and newly developed techniques for quantitative collection and spectroscopic determination of shed hair, we found that shedding actually occurs as a distinct phase. Although some shedding occurs throughout the growth cycle, the largest peak is coupled to anagen. Using hair dye and rhodamine labeling we established that the shafts that shed arise during the previous hair cycle. We found that over the cycle the ratio of shed overfur to shed underfur hair shafts varies with the cycle phase and that the shed shaft base is unique morphologically, having a cylindrical shape with scalloped or "nibbled" edges. By electron microscopy the mooring cells of the exogen root show intercellular separation suggesting a proteolytic process in the final shedding step. This is the first report describing a distinct shedding, or exogen, phase of the hair cycle. This study supports the notion that this phase is uniquely controlled and that the final step in the shedding process involves a specific proteolytic step.

Comparison of the footpump suction evacuator with the manual vacuum aspirator for uterine evacuation

OBJECTIVE

To compare the efficacy of a novel footpump suction evacuator with the manual vacuum aspirator in the management of women with incomplete abortions requiring uterine evacuation.

DESIGN

A prospective comparative analysis of women allocated to either manual vacuum aspiration of the uterus or footpump suction evacuation, following first- or second-trimester incomplete abortion.

SETTING

The gynaecology casualty theatre, Groote Schuur Hospital, Cape Town.

PATIENTS

121 women with first- or second-trimester abortions. Patients with signs of septic abortion were excluded from the study.

INTERVENTIONS

Uterine evacuation under general anaesthesia by means of a manual vacuum aspirator or a novel footpump suction evacuator.

OUTCOME MEASURES

Endpoints assessed included duration of the procedures, ease of evacuation, estimated blood loss, volume of products of conception obtained, postoperative complications of the procedures and amount of analgesia required postoperatively.

RESULTS

The manual vacuum aspirator and footpump suction evacuator appeared equally effective for uterine evacuation. There were no significant differences in the endpoints assessed.

CONCLUSIONS

Both methods appear equally effective for uterine evacuation.

[Treatment of infection by vacuum sealing]

Between 1 January 1992 and 31 July 1995, 313 patients with acute and chronic infections were treated by vacuum sealing (VS). The average duration of VS treatment was 16.7 days, and there was an average of 3.1 changes in the VS system. In acute infections (n = 203) the wounds were closed by secondary suturing (65.5%), spontaneous epithelialization (17.2%), skin grafting (12.3%) and flap transfer (2%). Six patients died (3%). Infection recurred in 3.9% and was cured by another VS treatment. Unstable scar formations (1%) were treated by free flap transfers. When compared with standard open-wound treatment, the low-cost VS technique offers great advantages with regard to hospital hygiene, patient comfort and therapeutic results.

[Closure of defect wounds by combined vacuum sealing with instrumental skin expansion]

Between 1.6.1995 and 31.12.1995, 17 trauma defect wounds were closed by suturing in 12 patients with a median of age of 35 (11-65) years, a new type of instrument for skin stretching being used in combination with a vacuum sealing procedure. According to clinical experience, closure of the skin defect would have required skin grafting in all patients. After secondary suturing 15 wounds healed without problems, while in the case of 1 wound there was a small skin defect, which healed spontaneously. In another sutured wound a partial dehiscence occurred over the medial malleolus on the 10th postoperative day; this also healed spontaneously without further surgical measures. There were no wound infections or necroses of the wound edges. This procedure is recommended for the closure of defect wounds, as it reduces the risk of wound infections, shortens the period of treatment and avoids cosmetically and functionally inadequate skin grafts.

[Manual intrauterine aspiration using a Karmann syringe. Multicenter study in Sonora and Sinaloa, Mexico]

These are the results of a prospective, multicentric study carried out in five institutional hospitals in Sonora and Sinaloa, using Karmann syringe and cannulae for manual intrauterine aspiration in cases of incomplete abortion, dead and retained ovum, hidatiform mola and endometrial biopsy. Management data in 1046 patients, are described; methodology is shown, and demonstrating that it converts uterine emptying is a simple, efficacious and economical procedure, with a very low risk and it allows these patients management in an ambulatory way. From these results, and as it is demonstrated in the study, institutions may increase their programable resources as to amount of disposable beds, for other type of patients, and the offering of attention by surgeon, anesthetist, nurse and medication, as their hospital stay is minimal, and in most of the cases active anesthetist participation is not required. In the same way, it permits the patient a better relationship with the personal of the institution, and so, a more human care and the possibility of reintegrating the patient to a familiar environment, rapidly, and in good psychical and physical conditions.

Karman's cannula and vacuum aspirator in gynecological practice

The charts of 340 patients who underwent an endometrial suction procedure using Karman's cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted.

Histopathologic adequacy of office endometrial biopsies taken with the Z-sampler and Novak curette in premenopausal and postmenopausal women

This study compared the adequacy of office endometrial biopsies taken with the Novak curette and a disposable, flexible polypropylene biopsy device, the Z-sampler, in premenopausal and postmenopausal women. Between September 1988 and November 1991, 407 women had paired office endometrial biopsies with the Z-sampler followed by the Novak curette. Overall, 83.0% of endometrial biopsies obtained with the Z-sampler were adequate for histopathologic diagnosis as compared to 84.5% obtained with the Novak curette (P = .53). In 181 (44.5%) premenopausal women, 94.5% of Z-sampler biopsies were adequate as compared to 95.6% of Novak curette biopsies (P = .80). In 226 (55.6%) post-menopausal women, 73.9% of Z-sampler biopsies were adequate as compared to 75.7% of Novak curette biopsies (P = .66). The Z-sampler biopsies were adequate in 94.5% of premenopausal women as compared to 73.9% of postmenopausal women (P < .0001). The Novak curette biopsies were adequate in 95.6% of premenopausal women as compared to 75.7% of post-menopausal women (P < .001). While we did not demonstrate a significant difference in the adequacy of endometrial samples taken with the Z-sampler and Novak curette in premenopausal and postmenopausal women, postmenopausal women had a significantly lower rate of adequate samples obtained with either device as compared to premenopausal women.

[Technique of induced abortion, abrasion and vacuum extraction. Clinical trial of Ambu Twin Pump 1000]

Ambu Twin Pump 1000 is a suction pump designed for pharyngeal and tracheal suction in emergency situations. The pump can be operated by foot or by hand. The object of this test was to evaluate the applicability of the pump in performing legal abortion (before 13th. week), suction curettage and vacuum extraction, in places where electricity is not available; thus especially for use in Third World countries. The evaluation of the pump concerned the suction capacity, the stability on the support and finally ease of dismantling and cleaning. It is concluded that Ambu Twin Pump 1000 are easy to use and has sufficient suction capacity for the mentioned purposes. For induced abortion the pump was provided with a 200 ml reservoir for cleaning purposes.

Endometrial suction in luteal phase as a method of late postcoital contraception

In a pilot study group of 25 women presenting in our clinic after exposure at ovulation to undesired pregnancy, endometrial suction by means of a Pipelle catheter was performed. Sixteen of the 25 women had proven fertility and 9 had never tried to conceive. The women were aged 18 to 38 years. Pathological dating of endometrial sampling verified that the patients were actually post-ovulation in all cases studied. hCG tests were performed 10 to 14 days after endometrial suction and all were negative. We conclude that endometrial suction in the luteal phase is a possible means of postcoital non-hormonal contraception, and we are currently expanding our study.

Early pregnancy termination: an improved technique for 'menstrual regulation' with ultrasound assistance

We performed aspiration of early pregnancy on 100 women requesting termination, using a low caliber angled catheter under sonographic guidance, without analgesia or anesthesia. The sonographic inclusion criteria for the study were: (1) mean gestational sac diameter less than 30 mm, or (2) crown rump length less than 10 mm when an embryo was visualized. The uterine content was successfully evacuated in all cases and none needed an additional curettage. Two women developed mild endometritis which responded to antibiotic therapy. This refinement of this 'menstrual regulation' technique seems to be safer when compared with the reported results of the original technique.

[A method of vacuum aspiration in early pregnancy in women with a history of severe gynecologic diseases]

Early (with the regular menstrual period absent for 6 to 20 days) artificial abortions were carried out in 61 women with a history of uterine myomas, cicatrix on the uterus, and developmental defects of the genitals. Analysis of early complications has shown that their incidence is virtually the same as in healthy women: 3.3%. Vacuum aspiration is an effective and safe method for early artificial abortions. A course of rehabilitation measures in the postoperative period reduces the incidence of early complications and is conducive to timely recovery of the normal cycle.

Suction curettage with a tissue trap compared with sharp curettage for tissue sampling

Recent reports have shown that various endometrial sampling techniques are comparable to each other. This study showed that suction curettage utilizing tissue traps is superior to sharp curettage in terms of adequacy of sampling. The results show that adequate tissue was obtained in all 114 cases, regardless of which type of curettage was utilized first. However, when sharp curettage was the second procedure, only 43 of 57 procedures yielded adequate tissue, whereas when suction curettage was the second procedure, 56 of 57 procedures yielded adequate tissue. Suction curettage utilizing tissue traps was more thorough than sharp curettage.

Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion

In a study to assess the efficacy of and safety of vacuum aspiration syringe in the management of incomplete abortion 300 patients with non septic abortion were evacuated by the method in the ward. A control group 285 patients was evacuated in theatre by sharp currettage. All patients were followed up for 21 days. 54.7% of the study patients were evacuated without any need for analgesia while all the control patients were given intravenous pethidine and valium. 2.3% of vacuum aspiration and 3.5% of control patients needed revacuation (p greater than 0.05). 70.3% of vacuum aspiration cases were dry by day 7 compared to 64.6% of the control group (p greater than 0.05). Immediate complications of nausea and vomiting were seen in 5.3% study patients (p less than 0.001). There was one uterine perforation in the control group. 5.4% of study and 6.0 of control patients developed mild to severe sepsis (p greater than 0.05). Vacuum aspiration is a safe, simple and quick method of treating incomplete abortion. Its wider use in developing countries is highly recommended.

Endocervical curettage by Vabra aspiration as part of colposcopic evaluation

Endocervical curettage as routine part of colposcopic examination in patients with abnormal cervical cytology is recommended by many experts. Endocervical curettage (ECC) by Vabra aspiration has never been reported in literature. The results of Vabra ECC in 103 patients are analyzed and compared to the results of a second endocervical specimen, obtained by conventional curettage, cone biopsy, or hysterectomy. An accordance of over 98% is demonstrated and the difference is discussed. In 88% and 71% adequate Vabra ECC specimens were available for cytological and histological examination, respectively. In any patient at least one result was present. Both cytological and histological specimens are of reliable quality. No cases of invasive (adeno)carcinoma were missed. In addition, the results are compared to literature data concerning Vabra aspiration for endometrial disease and ECC by other techniques. Vabra ECC is considered an efficient, safe, and well-tolerated diagnostic outpatient method and recommended as a standard part of colposcopic evaluation.

Transcervical uterine cultures with a new endometrial suction curette: a comparison of three sampling methods in postpartum endometritis

The potential for cervicovaginal contamination has precluded direct sampling of the endometrial cavity and has led to the development of multi-lumen protected catheter systems, among other techniques. The extent of this presumed contamination was examined using three different techniques in 55 postpartum women with the diagnosis of endometritis. Each woman had the endometrium sampled with an unprotected cotton-tipped swab, a double-lumen catheter with brush, and a flexible endometrial suction curette. A statistically larger number of bacterial species was recovered with the cotton swab (2.4) than with the double-lumen catheter (1.3) or the suction curette (1.7) (P less than .001). A difference was also noted between the double-lumen catheter and the suction curette (P = .006); however, this represented less than one-third of a single bacterial species. The larger number of bacterial species recovered by the unprotected methods was found to result not from cervicovaginal contamination, as suspected, but from a significant increase in the recovery of bacteria commonly regarded as potential pathogens, such as Bacteroides bivius, Streptococcus faecalis, Proteus mirabilis, and Bacteroides melaninogenicus.

Endobrush sampling for endometrial cancer

The two intra-uterine cytological sampling methods Endobrush and Pistolet were compared for clinical applicability in 66 premenopausal and 47 postmenopausal women. The taking of the specimens succeeded in 94% of the cases with the Endobrush method and in 99% with the Pistolet method. The two intra-uterine sampling methods were both almost painless. The Endobrush and the Pistolet specimens were filtered and stained by the Papanicolaou method. The Endobrush specimens were also used to make smears, which were also stained by the Pap method. According to the separate evaluations of two cytologists the Endobrush smear yielded specimens with a large or moderate number of cells in 59.0 to 71.4%, the Endobrush filter method in 73.6 to 76.5% and the Pistolet filter method in 71.4 to 76.8%. Specimens with good or moderate quality were found in 83.3%, 86.8 to 89.6% and 93.7 to 99.1%, respectively. Unsatisfactory specimens accounted for only 2.8-0.9% of the cases. All four endometrial carcinomas were placed in Pap classes 3 to 5 on the basis of the Endobrush and Pistolet filter specimens. The diagnostic quality of the smears was inferior to that of the filter specimens. The results suggest that the Endobrush filter method yields cytological endometrial samples which are similar in cell number, quality and diagnostic value to those obtained by the Pistolet method. Endobrush method is also simple, quick and painless, and therefore well acceptable to patients and suitable for clinical use.