Fallopian Tube Prolapse after Hysterectomy: A Systematic Review

Background

Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding.

Objectives

We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy.

Search Strategy

A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers.

Results

Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success.

Conclusions

This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment.     

Differentiation of Fanconi anemia and aplastic anemia using mitomycin C test in Tunisia

Fanconi anemia (FA) is a recessive chromosomal instability syndrome that is clinically characterized by multiple symptoms. Chromosome breakage hypersensitivity to alkylating agents is the gold standard test for FA diagnosis. In this study, we provide a detailed laboratory protocol for accurate assessment of FA diagnosis based on mitomycin C (MMC) test. Induced chromosomal breakage study was successful in 171 out of 205 aplastic anemia (AA) patients. According to the sensitivity of MMC at 50 ng/ml, 38 patients (22.22%) were diagnosed as affected and 132 patients (77.17%) as unaffected. Somatic mosaicism was suspected in an 11-year-old patient with a FA phenotype. Twenty-six siblings of FA patients were also evaluated and five of them (19.23%) were diagnosed as FA. From this study, a standard protocol for diagnosis of FA was developed. It is routinely used as a diagnostic test of FA in Tunisia.     

Changes in Membrane Fatty Acid Composition of Pseudomonas aeruginosa in Response to UV-C Radiations

The changes in lipid composition enable the micro-organisms to maintain membrane functions in the face of environmental fluctuations. The relationship between membrane fatty acid composition and UV-C stress was determined for mid-exponential phase and stationary phase Pseudomonas aeruginosa. The total lipids were obtained by dichloromethane/methanol (3:1) and were quantified by GC. The TLC analysis of phospholipids showed the presence of three major fractions phosphatidylethanolamine, phosphatidylglycerol, and cardiolipin. Significant modifications, as manifested by an increase of UFA, were obtained. Interestingly, this microorganism showed a remarkable capacity for recovery from the stressful effects of UV-C.     

Chemically-induced resistance on soybean inhibits nodulation and mycorrhization

Induced plant resistance (IR) against pathogen infection can be triggered by various chemical and biological elicitors. The effectiveness of elicitors to induce resistance as a practical means to control plant disease makes use of the plant’s own defence mechanisms triggered by resistance inducing agents. The aim of the present study was to examine the possible side effects of IR on the establishment and the efficiency of a rhizobial symbioses (Bradyrhizobium japonicum-soybean) and an arbuscular mycorrhizal symbioses (Glomus mosseae —soybean). IR was triggered by applying, acibenzolar S-methyl (ASM) at 80 mg a.i. L^?1 by two ways: seed soaking or foliar spray. Chitinase activity, used as a biochemical marker of IR, increased when ASM was applied both as seed soaking or as foliar spray. In vitro ASM showed no direct effect on the growth of B. japonicum and induced, only at a high concentration, a slight inhibition effect on spore germination of G. mosseae. ASM caused after both treatments a significant decrease in the number of nodules. Nitrogen content in aerial parts and roots decreased. On the other hand, ASM showed no significant effect on the frequency of colonization by G.mosseae but reduced the intensity of colonization and the proportion of arbuscules. The possible interaction between IR and the induction and suppression of defence-like mechanisms during symbiotic processes is discussed.     

Comparative phenology and growth of four Cenchrus ciliaris L. accessions established under arid bioclimate in Tunisia

A phenological study is one of the first steps in understanding the function of ecosystems. This is because phenological events reflect the way in which the species exploit the so‐called favourable periods in order to gain carbon and to allocate photosynthetic products for growth and reproduction. The objective of the present work was to examine the phenology of reproduction and the above‐ground growth of several Cenchrus ciliaris accessions, growing under the arid bioclimate in Tunisia. These accessions collected in the south of Tunisia are: Bou Hedma (P1), Tozeur (P2), Raas Jedir (P3) and Sidi Toui (P4). It was demonstrated that an important phenological variability exists within the different accessions studied. The statistical analysis (correlation and principal component analysis) showed that the accession from Bou Hedma (P1) was the most precocious and vigorous one.     

The impact of the Bacillus subtilis SPB1 biosurfactant on the midgut histology of Spodoptera littoralis (Lepidoptera: Noctuidae) and determination of its putative receptor

SPB1 is a Bacillus subtilis strain producing a lipopeptide biosurfactant. The insecticidal activity of this biosurfactant was evaluated against the Egyptian cotton leaf worm (Spodoptera littoralis). It displayed toxicity with an LC(50) of 251 ng/cm(2). The histopathological changes occurred in the larval midgut of S. littoralis treated with B. subtilis SPB1 biosurfactant were vesicle formation in the apical region, cellular vacuolization and destruction of epithelial cells and their boundaries. Ligand-blotting experiments with S. littoralis brush border membrane vesicles showed binding of SPB1 biosurfactant to a protein of 45 kDa corresponding to its putative receptor. The latter differs in molecular size from those recognized by Bacillus thuringiensis Vip3A and Cry1C toxins, commonly known by their activity against S. littoralis. This result wires the application of B. subtilis biosurfactant for effective control of S. littoralis larvae, particularly in the cases where S. littoralis will develop resistance against B. thuringiensis toxins.     

Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

IntroductionAn increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff.ResultsSignificant differences were observed in the measured humeral head BMD of the Control and OVX-PTH groups compared to the OVX-Saline group (P = 0.0004 and P = 0.0024, respectively). No significant difference was found in failure stress among the three groups, but an expected trend with the control group and OVX-PTH group presenting higher failure strength compared to the OVX-Saline group. BMD at the humeral head showed a positive linear correlation with stress (r² = 0.54). Histology results showed the superiority in OVX-PTH group ISP enthesis compared to the OVX-Saline group.ConclusionBone loss of the humeral head leads to decreased tendon/bone insertion strength of the infraspinatus tendon enthesis. Teriparatide administration can increase bone density of the humeral head and may improve the mechanical properties of the infraspinatus tendon enthesis.