Liquid biopsy is a promising non interventional diagnostic approach in advanced lung cancer patients, especially during disease progression. Cell free DNA (cfDNA) and circulating tumor cells are valuable in detection of molecular signatures during screening or first time diagnosis, therapy monitoring, and resistance mechanisms that cause disease progression in non-small cell lung carcinoma (NSCLC). Herein we present the genomic landscape of 246 NSCLC patients who underwent next generation sequencing (NGS) on blood samples.

Within a short span of time, the medical-related devices, implants kind of product, have been done by 3D printing manufacturing process. The objective of this study is to design a 3D printable prosthetic foot with an optimized design. The prosthetic foot is very much useful to people with lower-limb loss. It is manufactured by additive manufacturing using nylon 66 materials. The foot is designed using Mechanical CAD Software and imported into ANSYS workbench. The topology optimization is used for providing the portable prosthetic foot with the weight as light as possible. Without compromising the strength and quality of a product, the weight of the product can be reduced using a topology optimization technique.

The amount of toxic benzene gas is increasing rapidly due to development in plastic industries and also due to more amount of vehicle exhaust & gasoline production all over the world. These results not only develop the wealth of a nation, but it seriously affects the environment, human and other living beings. Through this project. We can detect high toxic benzene gas in the car cabin and industry on working condition. By this detection of benzene gas, exposure of passengers to such toxic gases inside vehicle cabin is considerably decreased. In this work, focus has been on car's interior toxic gas detection due to which deformation taken place on dashboards, seats and other plastics on hot weather condition. By this it is also necessary to indicate the value of gas concentration in car's interior in ppm reading. Thereby, a battery is fixed inside a car, and a GSM module and Arduino is powered. MQ135 gas sensor detects the benzene level inside of the car and it will be projected on an LCD display. When the benzene level is increased above 300 ppm, a message will be sent to the mobile as "GAS LEVEL HIGH" and we command a text through mobile as "*START#", by this the exhaust fans and car blower starts, where the car blower blows air from environment to car interior cabin and the exhaust fans expels out the car's interior benzene gas to the environment. When the ppm level is decreased to normal level which is below 286 +/- 14 ppm, a message would be received through mobile phone as "GAS LEVEL LOW" and we command a text as "*STOP#", thus within 7 min the ppm level decreases from 300 to 286 +/- 14 ppm. By this, the exhaust fans and car blower stops. Hence higher level of safety is ensured from the toxic gas produced inside a car cabin and instead of manually opening the door glass to reduce the benzene level. (c) 2021 Elsevier Ltd. All rights reserved. Selection and peer-review under responsibility of the scientific committee of the 2nd International Conference on Materials, Manufacturing, and Machining for Industry 4.0.

Generally, to perform an operation in our life, we need some external energy. So spending amount on energy is necessary in our day to day life. Producing energy without any supply or external source is the major idea and best innovation in our future. So with help of piezoelectric sensor, we'll be able to generate power with our footsteps. The main idea is with the piezoelectric tiles(which is placed under footsteps),we can produce energy that can be stored in a rechargeable battery, so that we can use it for our later purposes and it can be also placed in public places like street light, mobile charging etc. The amount of energy stored can be displayed in a liquid crystal Display.

Vital staining is a useful and known technique to study normal and abnormal endometria [1Marconi G Vilela M Quintana R Diradourián M Young E Sueldo C. New observations on endometrial physiology after transcervical injection of methylene blue dye.Fertil Steril. 2004; 82: 1700-1704Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 2Gupta T Singh S Verma AK. Role of chromohysteroscopy in evaluation of endometrial pathology using methylene blue dye.J Obstet Gynaecol India. 2019; 69: 363-368Crossref PubMed Scopus (1) Google Scholar, 3Küçük T Deveci S. “Chromohysteroscopy” for evaluation of endometrium in recurrent miscarriage.Clin Exp Obstet Gynecol. 2008; 35: 133-136PubMed Google Scholar, 4Küçük T Safali M. “Chromohysteroscopy” for evaluation of endometrium in recurrent in vitro fertilization failure.J Assit Reprod Genet. 2008; 25: 79-82Crossref PubMed Scopus (11) Google Scholar]. A 25-year-old woman with 2-year primary infertility was taken up for hysteroscopic evaluation. The entire uterine cavity was unremarkable for any pathologic condition. The endocervical canal was then stained with Waterman blue ink (Chelpark blue ink; Chelpark Company Private Ltd., Bangalore, India, or Parker blue ink; Luxor Writing Instruments Pvt. Ltd., New Delhi, India) [5Kumar A Kumar A Microcolpohysteroscopy.J Am Assoc Gynecol Laparosc. 2004; 11: 131-132Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] by inserting a cotton pledget into the endocervical canal for a few seconds. The transformation zone when viewed at 80 × magnification in the contact mode using the Hamou Microhysteroscope II (26157 BT; Karl Storz, Tuttlingen, Germany) [5Kumar A Kumar A Microcolpohysteroscopy.J Am Assoc Gynecol Laparosc. 2004; 11: 131-132Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar,6Hamou JE Taylor PJ Sciarra JJ. The optical basis for and principals of endoscopic instruments.Hysteroscopy and Microcolpohysteroscopy: Text and Atlas. Appleton & Lange, Norwalk1991: 18Google Scholar] revealed a papillary structure of the transformation zone lined by initial squamous metaplastic cells; the nuclei of the initial squamous metaplastic cells were well visualized; the afferent, efferent, and interconnecting arterioles containing red blood cells were clearly visible; and the papillary stroma contained cellular infiltrate (Fig. 1). Columnal cells remain unstained with Waterman blue. By dragging the microhysteroscope II over the left lateral wall toward the external os, the transformation zone was seen; the squamous metaplastic cells located superiorly appeared a bit hazy, being a little out of focus, and the inferiorly located squamous cells were seen (Fig. 2). By rotating the microhysteroscope to the posterior wall, the multiple papillae of the transformation zone lined by squamous metaplastic cells were seen; the stroma contained cellular infiltrate (Fig. 3). The squamous cells were not seen, being out of focus. By further dragging the microhysteroscope toward the inferior rim of the transformation zone near the external os, multiple polyhedral squamous cells of the proximal transformation zone with prominent pyknotic nuclei were clearly seen, and the junctions between the squamous cells were starkly visible [5Kumar A Kumar A Microcolpohysteroscopy.J Am Assoc Gynecol Laparosc. 2004; 11: 131-132Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] (Supplemental Fig. 1). The nucleocytoplasmic ratio of the squamous cells seemed normal, and no mitotic spindles were seen inside the cytoplasm of the squamous cells. The biopsy from this region of the transformation zone consisted of tissue lined by columnar epithelium, and the subepithelial tissue showed endocervical glandular tissue. The entire picture was suggestive of a normal study.Fig. 2The transformation zone. Squamous metaplastic cells are toward the right side, and the squamous cells toward the left side are out of focus.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3The transformation zone. Squamous metaplastic cells are toward the left side, and the squamous cells are out of focus.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Download .jpg (1.64 MB) Help with files Supplemental Fig. 1. Squamous cells of the transformation zone.

Mushroom cultivation nowadays mostly done as indoor cultivation. The yield of mushroom is lesser in conventional method. To improve the yield of mushroom, automation in mushroom cultivation is needed and can be achieved using smart electronic components. For cultivating and growing mushrooms, certain parameters like temperature, humidity, light intensity, CO2 level should be maintained at certain level. Depending upon the type of mushroom, these parameters should be changed. Mushroom needs a dark, cool, moist, and humid growing atmosphere. Many of them proposed Automatic mushroom cultivation, but cultivator didn’t achieve the required cooling. In order to solve the proposed problem, Peltier Air Conditioner with honey pad setup methodology is proposed in this paper. The main objective is to monitor and control the physical parameters automatically, those are essentially needed to be in control round the clock for the efficient cultivation of mushroom.

Objective: To develop hysteroscopic markers for early diagnosis of endometrial tuberculosis (TB) from a pregnancy point of view post anti tubercular therapy (ATT).

The aim of the present work is to improve the corrosion behaviour of aluminum matrix composite with reinforcement of boron carbide and Rice Husk Ash (RHA). The different weight percentage like 4.25,4.5,8and 9%wt of boron carbide and 2,2.5,3.75,5 and 7.5%wt of rice husk ash were added for reinforcement. The casting process of aluminium metal matrix was made by stir casting process. Aluminium chloride is the solution to examine the corrosion behaviour of aluminium metal matrix by using immersion test. It is used in automobile and aircraft industries with reduced weight and increased corrosion resistance. The overview indicates that the developed method is quite successful and there is a decrease in the value of corrosion rate with increase in weight percentage of reinforcement.

The emergence of the coronavirus disease (COVID-19) pandemic has resulted in a global public health emergency [1Al-Shamsi HO Alhazzani W Alhuraiji A et al.A practical approach to the management of cancer patients during the novel coronavirus Disease 2019 (COVID-19) pandemic: an International Collaborative Group.Oncologist. 2020; 25: e936-e945Crossref Scopus (465) Google Scholar]. It rapidly spread globally infecting many individuals in many countries. In early March 2020, the World Health Organization designated the disease COVID-19 as a pandemic. Common symptoms include fever, severe headache, loss of smell and taste, dry cough with shortness of breath, general malaise, muscle ache, diarrhea, and abdominal pain [2Yang X Yu Y Xu J et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; 8: 475-481Abstract Full Text Full Text PDF PubMed Scopus (6897) Google Scholar]. Whereas most cases are mild, some become severe progressing to pneumonia with multiorgan failure and death [3Wu Z McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.JAMA. 2020 Feb 24; ([E-pub ahead of print])Crossref Scopus (12457) Google Scholar]. Evidence shows that the virus spreads mainly during close contact and via respiratory droplets [4Wang W Xu Y Gao R et al.Detection of SARS-CoV-2 in different types of clinical specimens.JAMA. 2020 Mar 11; ([E-pub ahead of print])Crossref Scopus (3745) Google Scholar]. It may also be contracted by touching contaminated surfaces on which the virus can live for up to 72 hours [5van Doremalen N Bushmaker T Morris DH et al.Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.N Engl J Med. 2020; 382: 1564-1567Crossref PubMed Scopus (6643) Google Scholar]. The average time from exposure to onset of symptoms varies between 2 and 14 days, with an average of 5 days [6Yu F Yan L Wang N et al.Quantitative detection and viral load analysis of SARS-CoV-2 in infected patients.Clin Infect Dis. 2020 Mar 28; ([E-pub ahead of print])Crossref Scopus (500) Google Scholar]. The standard method of diagnosis is by reverse transcription polymerase chain reaction (PCR) from a nasopharyngeal swab [7Chan JF Yuan S Kok KH et al.A familial cluster of pneumonia associated with the 2019 Novel Coronavirus indicating person-to-person transmission: a study of a family cluster.Lancet. 2020; 395: 514-523Abstract Full Text Full Text PDF PubMed Scopus (6149) Google Scholar, 8Guan WJ Ni ZY Hu Y et al.Clinical characteristics of coronavirus disease 2019 in China.N Engl J Med. 2020 Feb 28; ([E-pub ahead of print])Crossref Google Scholar, 9Li Q Guan X Wu P et al.Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.N Engl J Med. 2020; 382: 1199-1207Crossref PubMed Scopus (10590) Google Scholar], although rapid IgM-IgG combined antibody tests are being developed [10Li Z Yi Y Luo X et al.Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis.J Med Virol. 2020 Feb 27; ([E-pub ahead of print])Google Scholar]. The recommended measures to prevent infection include frequent hand washing, social distancing (maintaining a physical distance of at least 6 ft from others), and covering the mouth and nose when coughing or sneezing to avoid dispersing droplets of body fluids [11Prem K Liu Y Russell TW et al.The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study.Lancet Public Health. 2020; 5: e261-e270Abstract Full Text Full Text PDF PubMed Scopus (1354) Google Scholar]. Aiming to enforce social distancing and to preserve hospital resources, joint statements have been produced by many professional societies, encouraging the suspension of nonessential medical visits. However, emergencies and procedures in which delay could potentially worsen the patient's outcome must be performed. There is emerging evidence regarding potential viral dissemination during gynecologic minimally invasive procedures owing to the presence of the virus in blood and stool and the aerosolization of the virus, especially when using smoke-generating devices [12Zhang W Du RH Li B et al.Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes.Emerg Microbes Infect. 2020; 9: 386-389Crossref PubMed Scopus (1312) Google Scholar]. This risk is greater during aerosol-generating procedures (AGPs) such as laparoscopy or robotic surgery, especially during bowel surgery interventions, and is minimal during hysteroscopy. Because hysteroscopy is not an AGP, the actual risk is unknown, but the theoretic risk is low. Hysteroscopy is considered the gold standard procedure for the diagnosis and management of intrauterine pathologies [13Salazar CA Isaacson KB Office operative hysteroscopy: an update.J Minim Invasive Gynecol. 2018; 25: 199-208Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar]. It is frequently performed in an office setting without the use of anesthesia [13Salazar CA Isaacson KB Office operative hysteroscopy: an update.J Minim Invasive Gynecol. 2018; 25: 199-208Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar,14Cicinelli E Hysteroscopy without anesthesia: review of recent literature.J Minim Invasive Gynecol. 2010; 17: 703-708Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar]. It is usually well tolerated with only a few patients reporting discomfort [14Cicinelli E Hysteroscopy without anesthesia: review of recent literature.J Minim Invasive Gynecol. 2010; 17: 703-708Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar]. It allows for the diagnosis and the immediate treatment, using the "see and treat" approach, of patients with intrauterine pathologies avoiding the risk of anesthesia, in particular, the need for intubation, which is a procedure with a high risk of droplet contamination in individuals with COVID-19 [15Wax RS Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients.Can J Anaesth. 2020; 67: 568-576Crossref PubMed Scopus (674) Google Scholar]. There are several considerations that should guide the clinician who participates in hysteroscopic procedures at this time. Aiming to protect the patients and the healthcare providers by minimizing the risk of viral exposure, the following review will provide recommendations for clinicians performing hysteroscopic procedures during the COVID-19 pandemic. (Fig. 1). (1)Hysteroscopic procedures should be limited to those patients in whom delaying the procedure could result in adverse clinical outcomes [16American Association of Gynecologic Laparoscopists. COVID-19: joint society statement on elective surgery. Available at:http://www.aagl.org/news/covid-19-joint-statement-on-elective-surgeries/. Accessed April 5, 2020.Google Scholar].(2)Adequate screening for potential COVID-19 infection, independent of symptoms, and not limited to those patients with clinical symptoms. When possible, a phone interview to triage patients on the basis of their symptoms and infection exposure status should take place before the patient arrives to the hysteroscopic center. Any woman with suspected or confirmed COVID-19 infection should be asked not to come to the hysteroscopic center. Patients with suspected or confirmed COVID-19 infection who require immediate evaluation should be directed to COVID-19 designated emergency areas. Once the patient arrives, a thorough history taking regarding potential viral exposure and physical examination must be performed. Consider preoperative universal COVID-19 testing. Only patients with a negative COVID-19 test (if performed) and a negative history of symptoms (including body temperature <37.3°C) or exposure to COVID-19 should be allowed to enter the unit.(3)A maximum of 1 adult companion, under the age of 60 years, per patient should be allowed access to the unit when absolutely necessary. It is understood that visitor policy may vary at the discretion of each institution's guidelines. Children and individuals over the age of 60 years should not be granted access to the unit. Companions will be subjected to the same screening criteria as the patients.(4)If more than 1 patient is scheduled to be at the facility at the same time, ensure that the facility provides adequate space to ensure the appropriate social distancing recommendation between patients. Avoid the presence of multiple individuals in the waiting room at any given time. Ensure that the seating in the waiting room is spaced at least 2 meters apart. Hand sanitizers and face masks should be available for patients and companions. We recommend the use of face masks by all individuals present in the hysteroscopic unit (patients, companions, and staff members). The masks should always be worn, not only during the hysteroscopic procedure.(5)It is imperative that all healthcare members in close contact with the patient during the procedure wear personal protective equipment (PPE), which includes an apron and gown, a surgical mask, eye protection, and gloves. Extreme caution should be implemented to avoid contamination. Healthcare providers should always wear PPE that is deemed appropriate by their regulatory institutions following their local and national guidelines during clinical patient interaction.(6)The use of electrosurgery in hysteroscopy is performed in a liquid environment. Bubbles that are generated with the use of thermal energy devices (monopolar, bipolar, or laser) are cooled down rapidly and partly absorbed by the surrounding liquid [17Farrugia M. Electrosurgery on the uterus: an investigation of the local and systemic effects [dissertation]. University of London, London2009Google Scholar]. Cell fragments generated are contained within the uterine cavity [18Farrugia M Hussain SY Perrett D Particulate matter generated during monopolar and bipolar hysteroscopic human uterine tissue vaporization.J Minim Invasive Gynecol. 2009; 16: 458-464Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. Any gases that are volatile at ≤37°C and cell fragments are actively suctioned through the outflow channel, in a closed circuit, without an aerosol-generating effect, minimizing any risk of viral dissemination. In addition, it is recommended to avoid multiple insertions and removals of the hysteroscope from inside the uterine cavity.(7)The participation of learners and physicians in training should be organized by video transmission and not by physical presence in the office or operating room.(8)In patients with confirmed positive COVID-19 infection and in need of urgent hysteroscopic surgery, the operation should be performed under strict protective conditions ideally in an operating room with negative pressure and independent ventilation. (1)Patients should be advised to come to the office alone. If the examination requires a companion, a maximum of 1 companion at the appointment can be accepted. When coming to the unit alone, it is recommended that patients ensure secure transportation that can pick them up after the visit is over to avoid driving immediately after the procedure.(2)Limit the number of the healthcare team members present in the procedure room.(3)Favor the use of instruments that do not produce surgical smoke such as scissors, graspers, and tissue retrieval systems. (1)Choose a device that will allow an effective and fast procedure.(2)Use the recommended PPE.(3)Limit the movement of staff members in and out of the procedure room. (1)When more than 1 case is scheduled to be performed in the same procedure room, allow enough time in between cases to perform a thorough operating room decontamination.(2)Allow a patient to recover from the procedure in the same procedure room or in a specific stand-alone patient recovery room, which is subject to the same disinfection rules between 2 patients.(3)Expedite patient discharge.(4)Follow-up after the procedure should be by phone or telemedicine.(5)Standard endoscope disinfection is effective and should not be modified. (1)Adequate patient screening for potential COVID 19 infection, independent of symptoms and not limited to those with clinical symptoms.(2)Limit the number of healthcare team members in the operating procedure room.(3)Surgeons and staff who are not needed for intubation should remain outside the operating room but be immediately available in case emergency assistance is required, until intubation is completed and should leave the operating room before extubation to minimize unnecessary staff exposure. (1)Limit the number of personnel in the operating room to a minimum.(2)Staff should not go in and out of the room during the procedure.(3)When possible, use conscious sedation or regional anesthesia to avoid the risk of viral dissemination at the time of intubation/extubation.(4)Choose a device that will allow an effective and fast procedure.(5)Favor nonsmoke generating devices such as hysteroscopic scissors, graspers, and tissue retrieval systems.(6)Active suction should be connected to the outflow, especially when using smoke-generating instruments to facilitate the extraction of surgical smoke. (1)When more than 1 case is scheduled to be performed in the same room, allow enough time in between cases to perform a thorough operating room decontamination.(2)Expedite postprocedure recovery and patient's discharge.(3)After completion of the procedure, remove scrubs and change into clean clothing if available.(4)Standard endoscope disinfection is effective and should not be modified. The COVID 19 pandemic has caused a global health emergency. Enforcing social distancing and preserving hospital resources requires suspension of nonessential medical visits. Procedures in which delay could potentially worsen a patient's outcome must be performed. Adequate triage of patients with potential cancer conditions is critical to ensure patient safety during pandemic infections. The theoretic risk of viral dissemination in the operating theater is higher during AGP than hysteroscopy in which the theoretic risk is extremely low or negligible. Always favor the use of mechanical energy over thermal-generating devices. In addition, when needed, use conscious sedation or regional anesthesia to avoid the risk of viral dissemination at the time of intubation/extubation. Healthcare providers must comply with a step-by-step reimplementation of standard operating procedures, expediting the evaluation and the management of all the deferred cases as soon as the benign pathology consultations can be safely restarted. Patients with negative status for COVID-19 confirmed by PCR, requiring hysteroscopic procedures, should be treated using universal precautions.

OBJECTIVE:To develop a consensus on the diagnostic criteria for chronic endometritis (CE) at hysteroscopy (HSC), and to evaluate these proposed criteria in a randomized-controlled observer study. DESIGN:Systematic review of studies evaluating the diagnostic accuracy of HSC in CE diagnosis; Delphi consensus on hysteroscopic diagnostic criteria for CE; randomized-controlled observer study to evaluate the reproducibility of the proposed diagnostic criteria. SETTING:Not applicable. PARTICIPANT(S):Experts from different countries were involved in the systematic review and contributed to the Delphi consensus. Physicians from different countries were involved in the observer study. INTERVENTION(S):After reaching consensus on the diagnostic criteria, the Delphi poll created a questionnaire including 100 hysteroscopic pictures (50 from women with CE [domain 1] and 50 from women without CE [domain 2]), with a single question per picture (Answer_A: suggestive of CE; answer B: not suggestive of CE). A total of 200 physicians were invited to take part in the observer study. Before completing the questionnaire, physicians were randomized to receive a description of the diagnostic criteria (group A) or no such information (group B). MAIN OUTCOME MEASURE(S):The primary outcome was to compare the questionnaire scores for the two groups of observers. The secondary outcome was to assess the interobserver agreement in the diagnosis of CE in each group. RESULT(S):A total of 126 physicians completed the questionnaire (62 in group A and 64 in group B). Observers in group A obtained higher total scores compared with those in group B (P<.001). Specifically, group A showed higher mean score in domain 1 (P<.001), but not in domain 2 (P=.975). A substantial agreement was found among observers in group A (intraclass correlation coefficient [ICC] 0.78), whereas a fair agreement was found among observers in group B (ICC 0.40). CONCLUSION(S):This randomized-controlled observer study found a positive impact of our criteria on physicians' ability to recognize CE.

A 27-year-old woman with 3-year primary infertility and 3 failed cycles of in vitro fertilization was referred for a hysteroscopic evaluation. On hysteroscopy, the endocervical canal and the uterine cavity appeared unremarkable for any pathology; thus, attention was focused on the cervix. The ectocervix was diffusely covered with a subtle hyperemia, which also could be overlooked (Fig. 1). The anterior and the posterior lips of the cervix were visualized with a Hamou II micro-hysteroscope (model 26157 BT; Karl Storz, Tuttlingen, Germany) in the contact mode [ 1 Hamou J.E. Taylor P.J. Sciarra J.J. The optical basis for and principals of endoscopic instruments. in: Hamou J.E. Taylor P.J. Hysteroscopy and Microcolpohysteroscopy: A Text and Atlas. Appleton & Lange, Norwalk, CT1991: 18 Google Scholar , 2 Kumar A. Kumar A. Microcolpohysteroscopy. J Am Assoc Gynecol Laparosc. 2004; 11: 131-132 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar ] by placing the tip of the hysteroscope over the cervix and using 80× at-source magnification. Tortuous, unusually engorged capillaries filled with red blood cells were seen over the posterior lip of the cervix (Fig. 2), as well as over the anterior lip of the cervix (Fig. 3). Contact scanning of the squamocolumnar junction after methylene blue staining revealed multiple papillae lining the columnar epithelium and containing unusually engorged afferent, efferent vessels and interconnecting vessels filled with red blood cells (Fig. 4). Fig. 2Dilated capillaries containing red blood cells over the posterior lip of the cervix. View Large Image Figure Viewer Download Hi-res image Fig. 3Dilated capillaries containing red blood cells over the anterior lip of the cervix. View Large Image Figure Viewer Download Hi-res image Fig. 4Prominent papilla containing afferent, efferent, and interconnecting vessels filled with red blood cells over the squamocolumnar junction. View Large Image Figure Viewer Download Hi-res image

A 57-year-old menopausal woman, gravida 5 para 5, with no history of any hormonal therapy presented with irregular heavy bleeding per vaginum after 5 years of amenorrhea. A vaginal ultrasound scan was unremarkable, showing an endometrial thickness of 2.5 mm. This patient was posted for hysteroscopic evaluation. The anterior uterine cavity wall seen in panoramic view revealed multiple whitish abscess like circumscribed lesions that appeared distinctly pale in comparison with the surrounding endometrium (Fig. 1). A closer visualization (Fig. 2) revealed lesions that were oval in shape and had sharp regular margins, and the endometrium surrounding the lesions appeared dirty, pale, and irregular with no visible endometrial gland openings. The endometrium did not bleed on touch. Targeted biopsies were taken from the rounded lesions. Histopathology revealed endometrium with atrophic changes along with caseating epitheloid granulomata; there was no evidence of malignancy. BACTEC culture (Becton, Dickinson and Company, Sparks, MD) was also suggestive of endometrial tuberculosis. The patient was administered antitubercular therapy, to which she subsequently responded. Fig. 2Closer visualization reveals the regular sharp contours of the endometrial tubercular abscesses. View Large Image Figure Viewer Download Hi-res image

Hysteroscopically, chronic endometritis is characterized by micropolyps <1 mm in size, endometrial edema, irregular endometrium, and hyperemic areas with prominent white glands [ 1 Cicinelli E. Resta L. Nicoletti R. et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol. 2005; 12: 514-518 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar , 2 Cicinelli E. Resta L. Nicoletti R. et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod. 2005; 20: 1386-1389 Crossref PubMed Scopus (108) Google Scholar ]. A 30-year-old woman suffering with secondary infertility and menorrhagia was referred for hysteroscopic evaluation. A vaginal ultrasound was unremarkable, and the endometrial thickness was 5 mm.

Adenomyotic cysts are frequently implicated with dysmenorrhea and menometrorrhagia [ 1 Preutthipan S. Herabutya Y. Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and/or dysmenorrhea. J Obstet Gynaecol Res. 2010; 36: 1031-1036 Crossref PubMed Scopus (16) Google Scholar , 2 Dakhly D.M. Abdel Moety G.A. Saber W. Gad Allah S.H. Hashem A.T. Abdel Salam L.O. Accuracy of hysteroscopic endomyometrial biopsy in diagnosis of adenomyosis. J Minim Invasive Gynecol. 2016; 23: 364-371 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 3 Gordts S. Campo R. Brosens I. Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis. Gynecol Surg. 2014; 11: 273-278 Crossref PubMed Scopus (42) Google Scholar , 4 Basak S. Saha A. Adenomyosis: still largely under-diagnosed. J Obstet Gynaecol. 2009; 29: 533-535 Crossref PubMed Scopus (17) Google Scholar ]. Endometrial resection was performed in a 29-year-old woman suffering with menorrhagia and dysmenorrhea. Suddenly, a large crater-like tear appeared over the left posterolateral uterine cavity wall and brownish turbid fluid began gushing out; this was momentarily confused with a perforation (Fig. 1). Within about 15 seconds the initially gushing brownish fluid was reduced to a mere trickle, which finally stopped. A closer inspection of the ruptured cavity revealed the dark red mucosal lining of an approximately 10-mm cyst (Fig. 2), the wall of which was accidentally cut during endometrial resection. The myometrium adjacent to the cystic crater was resected only to find that the crater was extending deep into the myometrium (Fig. 3). The entire cyst was carefully resected along with its mucosal lining. The surgery was completed satisfactorily, and the postoperative period was uneventful. The histopathology of the endomyometrial tissue pieces revealed myometrium with adenomyosis and endometrium in the proliferative phase. Three years after the surgery the patient is symptom free with respect to menorrhagia and dysmenorrhea. Rupture of an adenomyotic cyst is a rare complication associated with endometrial resection, but it can unnecessarily alarm a surgeon who encounters it for the first time. Fig. 2The myometrial cyst cavity is seen lined by reddish mucosa. View Large Image Figure Viewer Download Hi-res image Fig. 3A crater-like ruptured cyst extending deep into the myometrium. View Large Image Figure Viewer Download Hi-res image