Warm Normal Saline Research Articles

Composite mesh a novel innovative bridge approach for refractory pancreatic effusion - sequelae of porous diaphragm syndrome: Case series

Introduction and importanceManaging refractory pancreatic effusion due to porous diaphragm syndrome (PDS) is a challenge. Various surgical interventions such as repairing the defect, sealing with fibrin glue, performing parietal pleurectomy, and talc pleurodesis have been reported however, the use of composite mesh placement in treating PDS has not been described in the literature. Case presentationAll three male patients with a low body mass index were diagnosed with pancreatic disease as described in cases 1–3 and associated pancreatic effusion. These patients required medical treatment as an initial approach and surgical intervention in the form of decortication, sterilization of the thoracic cavity with 20 % betadine and normal saline in the ratio 1:4, followed by warm normal saline washes and composite mesh placement for PDS followed by endoscopic retrograde cholangiopancreatography (ERCP) as a pancreatic intervention after 3 weeks. Only one patient underwent sphincterotomy, while the other two patients had no abnormality on ERCP. Post-operative follow-ups at 3, 6, and 12 months were uneventful with no recurrence. Clinical discussionThe mechanism for pancreatic effusion is explained by pancreatic duct disruption followed by enzyme leak leading to pancreatic-pleural communication mediated by PDS. Various studies have described their role in treating PDS, even thoracoscopic pleurodesis requiring prolong chest tube and repeated talc slurry for better outcome. However, to address this, we performed the above procedure as a bridge approach followed by a pancreatic intervention. ConclusionThoracic intervention with composite mesh can serve as a bridge procedure before future pancreatic intervention or surgery.

Outpatient selected lobar lavage: A novel approach to managing pulmonary alveolar proteinosis

BACKGROUND Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of surfactant components in alveoli, impairing gas exchange. The mainstay of treatment remains whole lung lavage (WLL); however, selected lobar lavage (SLL) using smaller volumes of normal saline has also been described. Due to the marked variability in the severity and natural history of PAP, there is a need for more tailored treatment approaches. METHODS Repeated outpatient SLL were performed using conscious sedation and fiberoptic bronchoscopy at intervals between 1 and 6 weeks. Each procedure targeted a single lobe, with the order of lavages based on degree of radiographic involvement. The bronchoscope was modified with a flushing pump to deliver warm normal saline in 100 mL aliquots up to a maximum of 3000 mL. Computed tomography scans and pulmonary function testing were performed at baseline and repeated after completion of all lavages. RESULTS Radiographic and symptomatic improvement was noted in all cases and physiologic improvement was noted in three of four cases. The only complication was transient procedural hypoxemia. All patients were able to be discharged home on the same day of their procedure. INTERPRETATION Our experience suggests outpatient SLL is a safe and effective alternative to WLL in mild-moderate cases of PAP with the benefits of avoiding admission to hospital, general anesthesia, and endotracheal intubation with single-lung ventilation. All patients remained relapse free for a minimum follow-up duration of 11 months.

Obstetrical Management of Partial Uterine Prolapse in a Mare

Uterine Prolapse is termed as the eversion of the uterus or casting of ‘’wethers’’ or casting of calf bed. It is a common complication of the third stage of labor and more common in pleuripara than primipara. Uterine prolapse is common in cows and ewes, but rarely seen in mares, dogs, and cats. A six-year-old female pony was brought to the emergency unit at the Obstetrics Unit of Veterinary Clinical Complex, Veterinary College and Research Institute Orathanadu, with a history of aborted pre-term (eight months) a day before and the mass hanging through the vulva. On clinical examination, the animal was dull and in a standing posture, the congested mucous membrane with tachycardia was noticed. Further examination of the mass revealed severe congestion and edema of the prolapsed uterus with no evidence of fetal membrane remnants. A vaginal examination explored constricted cervix. Blood samples were collected for hematology and serum biochemistry. Upon epidural anesthesia, the prolapsed mass was washed with potassium permanganate solution and then a hypertonic solution. After 10 minutes, the mass was washed with warm normal saline. Using Cetrimide cream as a lubricant and an antiseptic, the mass was reduced and repositioned. No Buhner’s suture was applied. Mare has received 40 IU of oxytocin for the involution process to begin. Systemic antibiotics and anti-inflammatory drugs were administered for five days. Uterine lavage was done for three days with normal saline and povidone-iodine to aid in uterine clearance. On consequent days, the mare had improved and the cervix was closed with no discharge. The mare had an uneventful recovery.

Comparison between Olive Oil and Nano-Bio Fusion Gel and their Role in the Treatment of Alveolar Osteitis: A Double-Blind Randomized Trial

Abstract: Background: Alveolar osteitis is a painful condition that occurs after tooth extraction. This condition has been treated with various chemical and herbal formulations that are found to be efficacious with different success rates. Objectives: The present study is aimed to evaluate and compare the efficacy of organic olive oil and Nano-Bio Fusion (NBF) gel in the management of alveolar osteitis. Materials and Methods: 90 patients who were diagnosed with alveolar osteitis following non-surgical dental extractions were selected and randomly divided into two groups. The extraction socket was irrigated with warm normal saline followed by insertion of sterile gauze soaked in organic olive oil in Group I patients (n=45) and with NBF gel in Group II patients (n=45). The patients were recalled for the change in dressings on day 3, day 5 and day 7. The subjects were evaluated for the following parameters on 7th day; pain, gingival erythema, granulation tissue and the extraction socket margin. Data were analyzed using Friedman test and Mann-Whitney U test. P≤0.05 was considered statistically significant. Results: The mean VAS score on day 1 for group I was 8.9 and group II was 8.6. The mean VAS score for both the groups was zero on day 7 though the participants of group II reported better pain relief from day 3 to day 7 when compared with group I patients. Subjects treated with olive oil showed a mildly inflamed gingival to a normal pink variant on day 7. However, all the subjects treated with NBF gel presented with healthy pink gingival on day 7. There was significant improvement in the healing of the margin in both cases. Conclusion: Compared to the olive oil, NBF gel helps in enhanced healing in cases of alveolar osteitis. Keywords Alveolar osteitis, Pain, Extraction, Mandibular third molars, Olive oil, Nano-Bio Fusion.

Efficiency Evaluation of Two Media for In Vitro Maturation of Buffalo Oocytes

This study was conducted to evaluate morphometry of ovarian functional structures and effect of two different commercially available in vitro maturation (IVM) media on cytoplasmic and nuclear maturation of slaughter origin buffalo oocytes. The buffalo ovaries were collected from Ahmedabad Municipal slaughter-house, Ahmedabad and were transported at the laboratory within 2-3 h of slaughter at 33 to 35°C warm normal saline. The ovaries were washed and processed under laminar floor and evaluated for functional structures like mature corpus luteum (CL) and follicles i) <3 mm (small), ii) 3 to 6 mm (medium) and iii) 6 mm (large). The cumulus oocytes complexes (COCs) were aspirated with 18 G needle in 5 mL sterile disposable needle. The COCs were graded in to four categories (I to IV) and first three categories of COCs were used for IVM. For IVM 90 µL drops of BO IVM (IB; Bioscience) and IVM (VB; Vitrogen, Brazil) media were prepared and kept in benchtop incubator at 5 % O2, 5% CO2 and rest N2 at 38.5 °C. The selected COCs were randomly allocated to two media treatments and incubated for 22 h. The cytoplasmic and nuclear maturation were observed using morphology and nuclear staining method (Hoechst 334452). The weight of ovaries with CL (6.63 ± 0.18 g) was significantly higher as compared to without CL (4.33 ± 0.14 g). Total 546 visible follicles with average 2.15 per ovary observed were aspirated from 254 buffalo ovaries and 440 COCs were collected. Overall oocyte recovery per ovary (OR/O), follicle recovery per ovary (FR/O) and oocyte retrieval per follicle (OR/F) were 1.73, 2.15 and 0.81, respectively. The small, medium and large follicles were 43.04, 41.94 and 15.01 %, respectively. The mean ± SE (n) count of oocytes with Grade I, Grade II, Grade III and Grade IV were 6.90 ± 0.61 (138), 6.50 ± 0.48 (130), 4.35 ± 0.40 (87) and 4.25 ± 0.54 (85) with recovery rate of 31.36, 29.54, 19.77 and 19.31 %, respectively. Total 133 and 137 COCs were randomly allocated to IB and VB media treatment. Total cytoplasmic maturation in IB and VB was 79.69 and 73.71 %. Similarly, the nuclear maturation was 78.19 and 71.53 % in IB and VB media. No significant differences in cytoplasmic or nuclear maturation between two media were observed. The study concludes that CL influences ovarian weight and both commercial medias can be used for successful in vitro maturation of COCs of buffaloes.

Discovery of escapee tumour cells—a milestone in cancer surgery

AbstractBackgroundComplete excision of tumour is the basic principle of curative surgery and traditionally oncological en‐bloc tumour resection is a common practice. However, ironically, it is questionable whether surgery itself will cause tumour spillage.MethodFrom January 2019 to March 2022, 133 tumour‐related operations were performed. Routine operating field toileting was performed using warm normal saline before the end of operations. A filter was connected to the suction device throughout the whole operation processes. Sediments being trapped by the filter were sent for histopathology to look for the presence of spillage tumour cells—escapee tumour (ET) cells.ResultsA total of 26 (19.5%) of the collected residue showed the presence of ET cells while 16 residue samples (12%) revealed the presence of atypical cells. Incomplete resection (R1, R2 resection; P = .005, B = 1.519), advanced N‐stage (N2 or N3 disease; P = .031, B = 1.510) and certain cancer type (oesophageal cancer in this study; P = .027, B = −1.567) are the statistically significant factors related to the presence of ET cells.ConclusionTumour spillage occurs during operations. Long‐term follow‐up and larger‐scale studies are required to determine the clinical significance of the positive ET cell cases and how to prevent tumour spillage during operations in the future.

PS-C20-5: WARM IV INFUSION IN HYPERTENSIVE URGENCY

Background: Hypertensive Urgency is defined as marked elevation in systemic blood pressure without any evidence of end organ damage. At present, the condition is managed with intravenous (IV) antihypertensives, of which most common is Sodium Nitroprusside. Aim: In this abstract we explore the possibility of slow IV infusion of warm (37–38oC) Normal Saline along with IV antihypertensives for a better and faster management of Hypertensive Urgency. Content: The slow IV will gradually increase the core body temperature of the patient while preventing fluid overload. Homeostatic regulation of Systemic Blood Pressure is maintained by an intricate network of correlated mechanisms, most of which are temperature dependent. The raised body temperature will be useful to control the Blood Pressure through the following mechanisms - Cardiac Output: reduces as core body temperature increases. Baroreflex: decreased post-synaptic adrenergic vasoconstrictor responses. Chemoreceptors: vascular responsiveness to adrenergic receptor stimulation reduces at higher temperatures. RAAS: Kosunen et al recorded reduced Systolic and Diastolic Blood Pressures at raised body temperatures despite increased levels of Angiotensin II & Aldosterone. Endothelin: Serum concentration of Endothelin-I reduces at higher temperatures. Sweat: Thermal stimulation of sweat gland will help excretion of both salt and water, thus maintaining the sodium balance. VEGF: VEGF-A, a potent vasodilator, is increased during elevated body temperature. However, apart from Blood Pressure, a change in core body temperature causes change in many other parameters as well, which must be considered during this discussion. Coagulation profile - Valeri et al noted no change in in-vivo coagulation states till 100oF Effect on other visceral organs - Internal visceral organs like Liver, Kidneys and Brain were not affected till 100oF Infection Control - Core body temperature close to 100oF has also been found to have a protective role against invasive fungal infections in the ICU Discussion: Though the effects of various antihypertensive drugs to raised body temperatures need to be tested, the above points prove that introducing a protocol of warm IV saline Infusion in patients of Hypertensive Urgency may be extremely beneficial, and also prevent clinical inertia.

A randomized controlled study to compare the efficacy of amyl meta cresol-2, 4-dichlorobenzyl alcohol lozenges Vs warm saline gargles Vs control in the prevention and treatment of post-operative sore throat after endotracheal intubation

The incidence of a post-operative sore throat (POST) varied from 21%–100% in intubated patients. Numerous non-pharmacological and pharmacological measures have been used for attenuating POST with variable success. The aim of the present study was to compare the efficacy of amyl meta cresol-2,4-dichlorobenzyl alcohol (AMC-2,4-DCBA) lozenges against warm normal saline (0.9%) gargles versus control in preventing and treating POST after extubation of the patients who have undergone surgical procedures under general anaesthesia.This single-blind randomised controlled study was conducted in 120 patients. Group S patients received one honey and lemon-flavoured AMC-2,4-DCBA lozenge. Group G and Group C patients received warm normal saline and distilled water for gargling respectively. Assessment of POST was carried out at 1 h, 12 h and 24 h. The primary outcome measure was to compare the degree of sore throat whereas secondary outcome measure was to compare patient comfort in terms of relief of symptoms. Comparison of quantitative and qualitative variables was done using analysis of variance test and chi-square test/Fisher’s exact test respectively.There was no statistically significant difference between Group S, Group G and Group C in relation to Ramsay sedation score, supplemental analgesics given, three-point assessment score at 1 h, 12 h, and 24 h. AMC-2,4-DCBA lozenges offered the maximum benefit in terms of patient comfort of POST symptoms at the end of 24 h post-surgically. Amyl meta cresol-2,4-dichlorobenzyl alcohol lozenges and warm normal saline gargles did not show a significant benefit in relieving post-operative sore throat in the post-surgical period as compared to the placebo.

A novel, cost-effective lens irrigation system for rigid endoscopes in transnasal endoscopic surgery.

In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process. This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port. A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability. This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting.

The Role of Passive legs Raising Position in Hypovolemic Shock: A Case Report and Review of the Literature

Background: Hypovolemic shock can be catastrophic rapidly unless recognized and treated promptly. Although gastrointestinal loses might be the cause of hypovolemic shock in the elderly, it rarely causes a change in the blood gas analysis results.Purpose: This study aimed to report a case of a 75-year-old male with signs of hypovolemic shock caused by gastrointestinal loses and discuss the effect of passive leg raising procedure as an early nursing intervention in patients presenting with shock.Methods: The method used in this paper is a case study. The subject in this study is a 75-year-old male presenting to our Emergency Room with signs of shock which was caused by gastrointestinal problems. Passive leg raising or also known as modified Trendelenburg Position was performed as the patient presenting with low blood pressure. The results of physical dan laboratory investigation, as well as the nursing and medical therapies were presented, analyzed and discussed based on the recent literature.Results: There was an increase in the Mean Arterial Pressure (MAP) after the intervention was given for five minutes followed by fluid resuscitation with 1000 ml of warm Normal Saline. The patient responded well to the intervention given in the ED and was sent to the Intermediate Ward for further treatments.Conclusion: Passive leg raising might be beneficial to be performed in patients with hypovolemic shock as it increases the venous blood return the heart.

S2363 Underwater Full-Thickness Resection of a Colonic Polyp: A Novel Technique

INTRODUCTION: Underwater resection is an emerging technique in which the gastrointestinal lumen is distended with water instead of air, allowing the mucosal layer to float, facilitating lesion demarcation and resection. Underwater endoscopic mucosal resection (EMR) for colon polyps has been well-studied. Full-thickness resection device (FTRD, Ovesco Endoscopy AG, Tuebingen, Germany) is a dedicated system for single step full-thickness resection of colon lesions that are not amenable for resection by conventional methods. In this study, we combined both techniques to resect a recurrent adenomatous colonic polyp. CASE DESCRIPTION/METHODS: A 52-year-old female patient with no significant past medical history underwent screening colonoscopy which revealed a 2 cm polyp (Kudo IV) in the descending colon. The polyp was completely resected using underwater EMR. Histology report showed tubulovillous adenoma with low grade dysplasia. A follow-up colonoscopy was performed 3 months later and revealed a 2 cm sessile polyp at the previous resection site consistent with recurrent adenoma. Underwater full-thickness resection using FTRD was planned. A colonoscope was inserted and advanced to the lesion site. The FTRD grasper was used to grasp the lesion and pull it completely into the PRVE Cap. The lesion was determined to be amenable to full-thickness resection. The area surrounding the lesion was marked with the FTRD marking probe. The colon lumen was then distended with warm normal saline. The colonoscope was removed and the FTRD device was attached to the scope. The colonoscope with FTRD was then reinserted into the colon and advanced to the site of the lesion. The over-the-scope (OTS) clip was then deployed successfully and the FTRD snare was used to resect the lesion. The entire device and scope were withdrawn from the colon. A second colonoscope was then advanced into the colon to the site of resection with excellent visualization of the resected area. The resected lesion measured 2 cm × 2.5 cm. No complications were reported during or after the procedure. The patient was discharged on the same day. DISCUSSION: The use of FTRD in a water filled colon lumen can improve feasibility, efficacy, and safety of lesion resection via FTRD. Further research should be performed to determine whether the underwater technique enhances the FTRD procedure by possibly reducing procedure time and improving patient outcomes.

Lung ultrasound to quantitatively evaluate extravascular lung water content and its clinical significance

Background As we all know, pulmonary edema can be diagnosed by lung ultrasound (LUS), but how to accurately and quantitatively evaluate lung water content by ultrasound is a difficult problem that needs to be solved urgently. B-line assessment with LUS has recently been proposed as a reliable, noninvasive semiquantitative tool for evaluating extravascular lung water (EVLW). To date, however, there has been no easy quantitative method to evaluate EVLW by LUS. Objective (1) To explore the feasibility of establishing a rabbit model with increased EVLW by injecting warm normal saline (NS) into the lungs via the endotracheal tube. (2) To establish a simple, accurate and clinically operable method for quantitative assessment of EVLW using LUS. (3) To develop LUS into a resource for guiding the clinical treatment of patients with increased EVLW. Methods Forty-five New Zealand rabbits were randomized into nine groups (n = 5). After anesthesia, each group of rabbits was injected with different amounts of warm sterile NS (0 ml/kg, 2 ml/kg, 4 ml/kg, 6 ml/kg, 8 ml/kg, 10 ml/kg, 15 ml/kg, 20 ml/kg, 30 ml/kg) via the endotracheal tube. Each rabbit was examined by LUS before and after NS injection. At the same time, the spontaneous respiratory rate (RR, breaths per minute), heart rate (HR, bpm) and arterial blood gas (ABG) of the rabbits were recorded. Then, both lungs were dissected to obtain the wet and dry weight and conduct a complete histological examination. Results Injecting NS into the lungs through a tracheal tube can successfully establish a rabbit model with increased EVLW. The extent of EVLW increase is related to the volume of NS injected into the lungs. As the EVLW increases, three different types of B-lines can be seen in the LUS. When the NS injection volume is 2–6 ml/kg, comet-tail artifacts and B-lines are the main patterns found on LUS; as additional NS is injected into the lungs, the rabbits' RR gradually increases, while their HR gradually decreases, ABG remains normal or shows mild metabolic acidosis (MA). Confluent B-lines grow gradually but significantly, reaching a dominant position when the NS injection volume reaches 6–8 ml/kg and predominating almost entirely when the NS injection volume is 8–15 ml/kg; at that time, rabbits' RRs and HRs decrease sharply, and the ABG indicated type I respiratory failure (RF).Compact B-lines occur and predominate almost entirely when the NS injection volume reaches 10 ml/kg and 15–20 ml/kg, respectively. At that time, rabbits begin to enter cardiac and respiratory arrest, and ABG shows type II RF and MA. Conclusion In this study, the establishment of an animal model with increased EVLW confirmed that different lung water content had corresponding manifestations in ultrasound and was associated with different degrees of clinical symptoms, and the study results can be used to guide clinical practice.

Using lung ultrasound to quantitatively evaluate pulmonary water content.

Increases in extravascular lung water (EVLW) can lead to respiratory failure. This study aimed to investigate whether the B-line score (BLS) was correlated with the EVLW content determined by the lung wet/dry ratio in a rabbit model. A total of 45 New Zealand rabbits were randomly assigned to nine groups. Among the animals, models of various lung water content levels were induced by the infusion of different volumes of warm sterile normal saline (NS) via the endotracheal tube. The arterial blood gas, spontaneous respiratory rate, and PaO2 /FiO2 ratio were detected before and after infusion. In addition, the B-lines were determined before and immediately after infusion in each group. Finally, both lungs were resected to determine the wet/dry ratio. In addition, all lung specimens were analyzed histologically, and EVLW was quantified using the BLS based on the number and confluence of B-lines in the intercostal space. The BLS increased with increasing infusion volume. The BLS was statistically correlated with the wet/dry ratio (r2 = .946) and with the PaO2 /FiO2 ratio (r2 = .916). Furthermore, a repeatability study was performed for the lung ultrasound (LUS) technology (Bland-Altman plots), and the results suggest that LUS had favorable intraobserver and interobserver reproducibility. This study is the first to suggest that the BLS can serve as a sensitive, quantitative, noninvasive, and real-time indicator of EVLW in a rabbit model of lung water accumulation. Notably, the BLS displayed an obvious correlation with the experimental gravimetry results and could also be used to predict the pulmonary oxygenation status.

Abortion and uterine prolapse in a Thoroughbred mare with twin pregnancy: Clinical and laboratory findings and treatment approach.

ABSTRACTThis report presents a case of uterine prolapse in a Thoroughbred mare. The uterine prolapse occurred after abortion of twins in the eighth month of gestation. The prolapsed uterus was bleeding and congested but not damaged. The placenta was still attached to the endometrium. Blood samples were collected for hematology and for estimation of calcium, progesterone and estrogen. The cervix and clitoris were swabbed for bacteriology. The mare showed a decrease in the number of lymphocytes. The concentrations of estrogen and progesterone seemed normal compared with mares that foaled. Pseudomonas aeruginosa was isolated. The prolapsed uterus was washed with warm normal saline, and the retained placenta was carefully removed. An antibiotic cream was spread on the prolapsed uterus before replacing it. Two-thirds of the upper vulva was transiently sutured. Systemic antibiotics and an anti-inflammatory were administrated for 5 days. After 24 hr, the sutures were removed, and uterine lavage was performed using warmed normal saline for three days. The mare received 20 IU of oxytocin twice a day for three days to aid uterine clearance. A local antibiotic was inserted into the uterus. After treatment, the mare did not show any health disorders. She entered estrus 9 days after abortion and again 10 days later. In conclusion, twin pregnancy in a mare is considered a critical condition that necessitates specific management during early and late pregnancy. Uterine prolapse is an emergency that should be treated in a skilled manner to protect the mare and her future fertility. Calcium deficiency might predispose mares to uterine prolapse.

Simple laparoscopic repair of perforated peptic ulcer without omental patch

We evaluated the outcomes of laparoscopic repair of perforated peptic ulcers using simple closure only. This retrospective study included 79 patients who underwent laparoscopic repair of perforated peptic ulcers from January 2011 to February 2016. They were divided into two groups: repair with an omental patch and repair with simple closure only. All of them underwent peritoneal cavity lavage with several litres of warm normal saline. A closed suction drain system was placed for drainage of intra-abdominal abscess. Patients' age, sex, Boey score, perforation size, operation time, overall complications, and length of hospital stay were evaluated. A total of 79 patients diagnosed with perforated peptic ulcers who underwent emergency laparoscopic operations were enrolled in this study. Thirty patients underwent simple closure without an omental patch (group A), and 49 patients underwent simple closure with an omental patch (group B). Between the two groups, there were no statistically significant differences in the patients' age, size of perforation, and Boey score. However, the operation time was significantly different (p<0.05) between the groups, with the average time being 84.4min in group A and 106.65min in group B. There was no statistically significant difference in the complication rate or the average length of hospital stay. No patient underwent reoperation for complications. Laparoscopic repair of a perforated peptic ulcer without an omental patch is a safe option and does not increase the morbidity and mortality rate.

Effectiveness of Warm Saline Distension Media on Relieving Pain in Outpatient Office Hysteroscopy: A Randomized Controlled Clinical Trial

Background: Outpatient hysteroscopy is the preferred examination procedure for diagnosis of intrauterine pathology and abnormal uterine bleeding causes, in addition for therapeutic operative management. It is desirable to apply as many procedures as possible with an office hysteroscopy, if they are implemented in a safe and effective fashion. Aim: Evaluation and investigation of the effectiveness of warm saline distensibility media in reducing the pain perceived in women undergoing diagnostic hysteroscopy procedure. Methodology: A randomized controlled clinical research trial that recruited 82 women scheduled for outpatient office hysteroscopy in Early cancer detection unit in Ain Shams Maternity Hospital from April 2017 till May 2018. Two research groups were categorized into warm saline and normal room temperature saline research groups each contained 41 cases. Comparative analysis of pain perceived in both groups was conducted to assess efficiency of warm saline to reduce pain perception. Results: Hysteroscopic findings didn’t differ significantly between the two groups, namely ease of introduction of hysteroscope, position of uterus and morphological appearance of the ectocervix, endocervical canal, endometrium, endometrial cavity, and tubal ostia. Also, no statistically significant differences were observed between the two groups in the duration of procedure. Parameters of pain assessment differed statistically significantly between the two research groups. p value &lt;0.001 .Simple analysis of VAS scores revealed a statistically significantly lower VAS score at the end of the procedure in the warm distention medium group in comparison to the room-temperature distention medium group. The same finding remained constant after 15 minutes from the end of the procedure. Assessment of variation of VAS score with combined variation of temperature of distention medium over time was assessed using repeated measure ANOVA analysis. Patient satisfaction, indicated by the proportion of the patients who would undergo the hysteroscopic examination again by usage of same method, was statistically significantly higher in the warm distention medium research group in comparison to the room-temperature medium research group (89.74% vs 71.05% consecutively).(p value &lt;0.04) Conclusions: Pain is measured by VAS score is statistical significantly lower at the end of the procedure in warm saline distension medium research group in comparison to room temperature distension medium research group (1.64+0.82vs 3.05+1.17) consecutively. Denoting possible effectiveness of warm saline in reducing pain perceived in office hysteroscopy

Retained Pelvic Oxidized Regenerated Cellulose Mistaken for Dilated Fallopian Tubes

Surgicel is oxidized regenerated cellulose used successfully for haemostasis and prevention of adhesions for many years in different surgical disciplines. However, many reports of different related complications appeared in the literature. In this manuscript I am reporting on two patients who had surgicel gauze removed from the pelvis many months after surgery because of intolerable dull pelvic pain and intermittent low-grade fever. Transvaginal ultrasound scan examinations in both cases showed tubular masses with medium echogenicity in the pelvis which were mistaken for dilated fallopian tubes. Both patients responded well after laparoscopic surgicel removal and pelvic lavage with 2 litres of warm normal saline. This was followed by instillation of 500 mg of hydrocortisone diluted in 50 ml of saline. Culture of the peritoneal contents was negative. In both cases the symptoms were mostly related to foreign body reaction as the gauze was isolated and encapsulated within a thin membrane. Furthermore, neither patient needed any antibiotics after it was removed. These are the first two case reports for retained surgicel used during laparoscopic gynaecological surgery to be mistaken for dilated fallopian tubes. I suggest that all patients who had surgicel used during similar operations should have transvaginal ultrasound scan examination one month after the procedure, or even sooner if they remained symptomatic. Any tubular pelvic mass should be explored by diagnostic laparoscopy as it might be a retained surgicel gauze. Better still, a clinical preoperative test needs to be developed to check which patients might be at risk of developing such complications.

RE: The Evaluation of the Result of Warm Normal Saline Irrigation in Ureteral Endoscopic Surgeries: A Randomized Clinical Trial.

RE: The Evaluation of the Result of Warm Normal Saline Irrigation in Ureteral Endoscopic Surgeries: A Randomized Clinical Trial.

Evaluation the result of warm normal saline irrigation in ureteral endoscopic surgeries.

Transurethral lithotripsy (TUL) is a major modality for the endoscopic management of ureteral stones. Ureteral spasm makes access for ureters difficult, which causes impaction of the ureteroscope, ureteral dislodge, and a low success rate of endoscopic surgeries. This study described the outcomes of a new endoscopic surgical experience by use of 40-degree warm saline irrigation during TUL compaired with routine ambient air irrigation in TUL. In this randomized clinical trial from 2014 to 2015, 150 patients with ureteral stone with balanced randomization were divided into two parallel groups. Patients underwent TUL in the first group with 20-25 degree saline irrigation and in the second group with 40-degree saline irrigation. One surgical team with the same semi-rigid instrument performed all TULs and the other steps were similar in both groups. Complete stone fragmentation was measured as the primary outcome and the duration of procedure, retrograde stone migration and all and any intraoperative complications were the secondary measurements. While comparing warm saline irrigation with cold saline irrigation, the rate of access to upper ureter was 95% versus 72%, stone retropulsion frequency was 10.7% versus 30.7% and the stone-free rate was 96% versus 76% respectively (P < .05). There was no ureteroscope impaction and ureteral dislodge in both groups. Using warm saline irrigation in endoscopic surgeries results in better surgical outcomes including a lower ureteral spasm rate, greater ureteral muscle relaxation and better access to the upper ureteral zone, and a lower rate of complications, such as ureteroscope impaction, ureteral dislodge and stone retropulsion.

Treatment of feline pyothorax: A report of two spontaneous cases

Two cases of feline pyothorax, presented in severe respiratory distress, were treated successfully by applying intermittent drainage and daily lavage of the pleural space with warm normal saline. Before that an indwelling thoracostomy tube had been fixed on the thoracic wall and left in place from 5 to 10 days. The only complication noticed was a symptomatic pneumothorax due to either tube malpositioning or damage to the tube wall. In both instances, the inspiratory dyspnea decreased or disappeared as soon as the tube was removed. Systemic and long term (6-9 weeks) treatment with antibiotics, combined with supportive measures and good nursing care, had a positive effect to the successful outcome in both cases.