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Biomedical subjects

I Hassan

Publications and source records attributed to I Hassan.

At least 19 recordsLinked to original sources
PubMed2006

Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance.

BACKGROUND: This study explored the impact of habitual stress-coping strategies on the laparoscopic performance of novices in surgery using a virtual reality simulator. METHODS: The SVF78 stress-coping questionnaire was administered to 12 medical students in their final year of medical school (camera holders) and to 12 inexperienced surgical residents (postgraduate years 1-3). The questionnaire included devaluation during stressful situations, distractions from stressful situations, control over stressful reactions and negative coping strategies such as stress avoidance and need for social support. Assessment of laparoscopic dexterity was based on the results of performance on a virtual reality simulator. The variables of time taken to complete the task, errors and economy of motion were analysed, with a higher score indicating poor performance. Pearson and non-parametric Spearman correlations were used to compare the subjects' results on the SVF78 with those on the LapSim. RESULTS: Time taken to complete the task correlated with high values in distractive stress-coping strategies (P = 0.002) and high values in negative stress-coping strategies (P = 0.042). CONCLUSION: Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. The need for effective intraoperative stress-coping strategies is evident.

Adaptation, Psychological↗
PubMed2006

[Instituting a surgical skills lab at a training hospital].

The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. Selected training courses are still offered in a few clinics. Presently, laboratories which train the surgical skills of novices in an individually adapted form are lacking. A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room.

Clinical Competence↗
PubMed2006

Adverse obstetric outcome in women with a history of infertility: a retrospective study.

Women with a history of infertility are associated with a higher incidence of adverse pregnancy outcome. This retrospective study reviewed 105 women with a known history of infertility; of these 105 women, 77 (73%) conceived spontaneously and 28 (27%) had assisted conception. Our finding confirms higher perinatal complications; relative ratios (RR) for pre-eclampsia was 4.6 (95% CI=2.1-9.9), intrauterine growth restriction 4.8 (95% CI=1.9-12.0), gestational diabetes 1.8 (95% CI=0.5-5.8), pre-term premature rupture of membrane 2.3 (95% CI=0.6-8.8) and pre-term labour 2.6 (95% CI=1.1-5.9). We postulate that women with a history of infertility are at high risk of such obstetric complications and may benefit from intensified antenatal care.

Adult↗
PubMed2006

A way to lend objectivity to Bishop score.

The aim of this study was to explore the possibility of utilising pre-induction cervical length assessment by trans-vaginal ultrasound to improve the predictive value of the Bishop score. The idea of this paper has evolved following our prospective study, which was designed to compare the pre-induction objective assessment of the cervix by ultrasound with the subjective one by Bishop Score. The Bishop scores of the 104 women included in the study were modified by replacing the digital assessment of the cervical length by ultrasound cervical length measurements. There was a significant statistical difference (p < 0.0001) between the median of the original and the modified Bishop scores. The original Bishop score showed insignificant association (p > 0.05) with the induction-delivery interval (IDI) and the mode of delivery while the modified score showed a significant association (r = 0.31, p < 0.05) with mode of delivery and a highly significant one (r = 0.55, p < 0.0001) with the IDI. The receiver operating characteristic curve showed that the optimised cut-off value for prediction of vaginal delivery was >5 for the original Bishop Score and >3 for the modified one. At those optimised cut-off values, the original Bishop Score predicted vaginal delivery with a sensitivity of 23% (95% CI; 14.6%, 33.2%) and specificity of 88.2% (95% CI; 63.5%, 98.5% while the modified Bishop score predicted vaginal delivery with a sensitivity of 62% [95%; CI 51 - 72.3] and specificity of 82% [95%; CI 56.6 - 96]). In conclusion, the modified Bishop score is better than the original one in predicting the IDI and the success of induction of labour. The sensitivity of the Bishop score in predicting the rate of vaginal delivery has been improved significantly following the modification.

Adolescent↗
PubMed2006

Comparison between subjective and objective assessments of the cervix before induction of labour.

The aim of the study was to compare the pre-induction cervical assessment by Bishop's score with the transvaginal ultrasound cervical length as predictors of the induction-delivery interval (IDI) and the success of induction. This prospective study included 104 women with singleton pregnancies who were booked for induction of labour at term over a period of 3 years. Transvaginal ultrasound measurement of the cervical length and Bishop's Score were performed by different operators. Data were collected on parity, gestational age, methods of induction, Bishop's score, ultrasound cervical length measurements, IDI and mode of delivery. A total of 87 women (83.7%) delivered vaginally and 17 (16.3%) delivered by caesarean section. Linear regression models demonstrated that ultrasound cervical length was a better indicator of IDI than Bishop's score. The adjusted R2 for the regression including ultrasound cervical length was 0.87 compared with a value of 0.67 for the model including Bishop's score. Although logistic regression analysis confirmed that cervical effacement was the best component of Bishop's score to predict the mode of delivery, ultrasound cervical length assessment provided better prediction. Receiver operating characteristic curve showed that the optimised cut-off value for prediction of vaginal delivery was < or =3.4 cm for the cervical length and >5 for the Bishop's score. At those optimised cut-off values the cervical length predicted vaginal delivery with sensitivity of 62.1% (95% CI [51%, 72.3%]) and specificity of 100% (95% CI [80.5%, 100%]) while the Bishop's score predicted vaginal delivery with a sensitivity of 23% (95% CI [14.6%, 33.2%]) and specificity of 88.2% (95% CI [63.5%, 98.5%]). Further analysis showed that ultrasound cervical length has a higher sensitivity in prediction of vaginal delivery in multiparous than nulliparous women (85.1% compared with 35%) at a cut-off value of < or =3.4 cm. On the other hand, it has a higher sensitivity in nulliparous comparable with multiparous women (85.3% compared with 30%) in prediction of IDI at a cut-off value of >3.5 cm. In conclusion, transvaginal ultrasound cervical length assessment is better than Bishop's score in predicting the IDI and the success of induction of labour.

Adolescent↗
PubMed2006

Antisense p53 decreases production of VEGF in follicular thyroid cancer cells.

Inactivating mutations of wild-type p53 (WTp53) tumor suppressor gene are common in anaplastic thyroid cancer (ATC) and are associated with poor prognosis. Mutated p53 (MTp53) has been implicated with angiogenesis. Therefore, the potential of MTp53 knockout by oligodeoxyribonucleotide phosphorothioates (ODNs) to affect VEGF production of undifferentiated thyroid cancer cells with a recessive MTp53 mutation was evaluated. Transient transfection with 20 bp ODNs complementary to portions of exon 10 of p53 and a negative control ODN (HIV-RT) were carried out in FTC-133 cells. In vitro secretion of VEGF protein was quantified by EIA and correlated to cell numbers, which was evaluated by in vitro MTT assay. Transfection of undifferentiated thyroid cancer cells with ODN reduced VEGF secretion of FTC-133 cells following transfection by 34% as compared to the negative control (cells transfected with ODN-HIV; p = 0.03). These results suggest that transient MTp53 knockout with ODNs complementary to p53 nucleotide sequences impair secretion of VEGF in the undifferentiated thyroid cancer cell line FTC-133.

Adenocarcinoma, Follicular↗
PubMed2006

Functional thyrotropin receptor attenuates malignant phenotype of follicular thyroid cancer cells.

Thyrotropin (TSH) is a thyroid-specific growth factor inducing differentiated function and growth of thyrocytes in vitro. In thyroid cancer, loss of TSH-receptor (TSHR) expression is a sign of de-differentiation and is believed to contribute to the malignant phenotype. The present studies aimed to determine the in vitro and in vivo effects of functioning TSHR in the follicular thyroid cancer cell line HTC, a subclone of FTC133 cells, lacking endogenous expression of TSHR, and HTCtshr+ cells transfected with human TSHR-cDNA. HTCtshr+ cells grew faster in vitro (doubling time 1.15 vs 1.56 d, p < 0.05) and TSH caused a dose-dependent growth response. Adhesion to and invasion through reconstituted basement membrane were reduced in HTCtshr+ cells, but when stimulated with TSH increased to levels comparable to naïve HTC cells. In vivo, tumor latency was 11 d for naïve HTC as compared to 21 d for HTCtshr+ xenografts. Smaller tumor volumes were registered for HTCtshr+ cells (250 +/- 217 vs 869 +/- 427 mm3, p < 0.05). Angiogenesis, as determined by vascular surface density (VSD) of experimental tumors, was enhanced in naïve HTC tumors (VSD 0.87 +/- 0.1 microm-1 vs 0.55 +/- 0.2 microm-1 in HTCtshr+, p < 0.05). VEGF secretion was more pronounced in naïve HTC cells stimulated with EGF, than in HTCtshr+ cells stimulated with either TSH or EGF. In conclusion, regained expression of functional TSHR in the follicular thyroid cancer cell line HTC alters in vitro features commonly associated with the malignant phenotype. Smaller tumors and reduced angiogenesis of xenotransplanted HTC cells with functioning TSHR suggest a less aggressive in vivo phenotype. The present data highlight the pivotal role of TSHR to affect transformed thyrocytes in vitro and in vivo. They also suggest a role for EGF as a modulator of angiogenesis in thyrocytes devoid of TSHR.

Adenocarcinoma, Follicular↗
PubMed2006

Clinical background is required for optimum performance with a VR laparoscopy simulator.

OBJECTIVE: To determine the role of clinical background when assessing the learning effect using a virtual-reality (VR) laparoscopy simulator (LapSim). MATERIALS AND METHODS: Test subjects were 12 final-year medical students (Group A) and 12 inexperienced residents (Group B) with no previous experience of VR simulators. First, to establish a baseline, both groups performed the "clip application" task twice. They then completed a training program of increasing difficulty (coordination, cutting and clip application), after which both groups were re-tested using a difficult level of the "cutting" task as an endpoint measurement. Time to complete the tasks, as well as trauma and precision parameters, were scored. RESULTS: Before training, times to complete the baseline task, as well as parameters of trauma and precision, were similar for both groups. After training, Group B (residents) completed the cutting task significantly faster than Group A (students). However, the former group also showed significant improvement in trauma and precision parameter scores in the endpoint measurement. CONCLUSION: These results suggest that clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills as performed on the laparoscopy simulator. Thus, medical students or other personnel not involved in practical surgery may be unsuitable as candidates for assessing the value of a VR training program.

Adult↗
PubMed2005

Successful treatment of solid-pseudopapillary tumor of the pancreas with multiple liver metastases.

The solid-pseudopapillary tumor (SPT) is a very rare pancreatic neoplasm that predominantly affects young females. About 450 cases have been described in the world literature and approximately 20% of the reported patients were children. The occurrence of SPT with distant metastases in children is extremely rare with only two previously reported cases. We now report a 16-year-old Asian girl with a large SPT and synchronous multiple liver metastases who was successfully treated in a 2-step strategy, including initial pylorus-preserving partial duodenopancreatectomy, right hemicolectomy, resection and allografting of the portal vein and secondary resection of 12 liver metastases. The patient is disease free after a follow-up of 18 months after resection of the primary tumor, suggesting that an aggressive surgical treatment might also be justified for metastasized SPT.

Adolescent↗
PubMed2005

[Quality of surgical continuing education in Germany].

BACKGROUND: One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. METHODS: A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. RESULTS: The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. CONCLUSIONS: Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.

Congresses as Topic↗
PubMed2005

[A virtual reality simulator for objective assessment of surgeons' laparoscopic skill].

BACKGROUND: The aim of this study was to validate computed virtual reality simulation as a tool to assess laparoscopic skills and to establish whether the simulator allows differentiating between surgeons with different laparoscopic experience. METHODS: 27 physicians at the surgical department of the University of Marburg, Germany, with different experience in laparoscopic surgery were divided into three groups: experienced (group I), intermediate (group II), and novices (group III). Following a brief introduction to the virtual reality simulator (LapSim), each participant performed twice a training program consisting of seven tasks (examinations I and II). RESULTS: Comparison of experienced surgeons with less experienced laparoscopic physicians showed a significant (P<0.05) superiority of group I at examinations I and II in most exercises. The groups' difference was more obvious in examination II, since the technique was new for all participants during examination I. Tasks of low complexity in virtual reality such as camera navigation, which are performed by young, not yet responsible surgeons in real surgery, did not show significantly different results between the three groups. CONCLUSION: Differences in laparoscopic experience can be visualised with a virtual reality simulator, and thus a simulator is helpful for assessing surgeons' laparoscopic skills.

Clinical Competence↗
PubMed2005

Intra-vaginal hydrosonography and cervical length assessment in pregnant women before induction of labour: a modified technique.

The objective of this study was to demonstrate a new simple technique in introducing saline into the vagina during trans-vaginal scan. This technique will help to identify the cervical length properly when it is difficult to delineate the cervix. This is a prospective study, which included 104 pregnant women who booked to have induction of labour at term over a period of 3 years. Women who were included in the study underwent a transvaginal scan to measure cervical length. Sterile saline was introduced into the vagina using either an ordinary syringe or an Endosampler and the cervical length re-measured. When the outer border of the cervix was not clearly visualised, there was a highly statistically significant difference (p < 0.001) between the medians of pre-and post-saline cervical length measurements. In contrast, no significant difference between the medians (p > 0.05) was detected when the outer border of the cervix was clearly delineated. In those women, who had previous surgery to the cervix, it was very difficult to identify the cervix at all without the saline injection during transvaginal scanning. We conclude that intra-vaginal saline can be used as a contrast medium to help delineate the cervix if it is difficult to identify during transvaginal scan. The Endosampler makes the introduction of the saline into the vagina easy, controlled and well tolerated.

Adolescent↗
PubMed2005

Differential pattern of integrin receptor expression in differentiated and anaplastic thyroid cancer cell lines.

Adhesion of tumor cells to the extracellular matrix (ECM) is a crucial step for the development of metastatic disease and is mediated by specific integrin receptor molecules (IRM). The pattern of metastatic spread differs substantially among the various histotypes of thyroid cancer (TC). However, IRM have only occasionally been characterized in TC until now. IRM expression was investigated in 10 differentiated (FTC133, 236, 238, HTC, HTC TSHr, XTC, PTC4.0/4.2, TPC1, Kat5) and two anaplastic TC cell lines (ATC, C643, Hth74), primary cultures of normal thyroid tissue (Thy1,3), and thyroid cancer specimens (TCS). Expression of 16 IRM (beta1-4, beta7, alpha1-6, alphaV, alphaIIb, alphaL, alphaM, alphaX) and of four IRM heterodimers (alpha2beta1, alpha5beta1, alphaVbeta3, alphaVbeta5), was analyzed by fluorescent-activated cell sorter (FACS) and immunohistochemical staining. Thyroid tumor cell adhesion to ECM proteins and their IRM expression in response to thyrotropin (TSH) was assessed. Follicular TC cell lines presented high levels of integrins alpha2, alpha3, alpha5, beta1, beta3 and low levels of alpha1, whereas papillary lines expressed a heterogenous pattern of IRM, dominated by alpha5 and beta1. ATC mainly displayed integrins alpha2, alpha3, alpha5, alpha6, beta1 and low levels of alpha1, alpha4 and alphaV. Integrin heterodimers correlated with monomer expression. Evaluation of TCS largely confirmed these results with few exceptions, namely alpha4, alpha6, and beta3. The ability of TC cell lines to adhere to purified ECM proteins correlated with IRM expression. TSH induced TC cell adhesion in a dose-dependent fashion, despite an unchanged array of IRM expression or level of a particular IRM. Thyroid carcinoma cell lines of different histogenetic background display profoundly different patterns of IRM expression that appear to correlate with tumor aggressiveness. In vitro adhesion to ECM proteins and IRM expression concur. Finally, TSH-stimulated adhesion of thyroid tumor cell lines to ECM may not be associated with altered IRM expression.

Carcinoma↗
PubMed2005

An authentic malignant epithelioid hemangioendothelioma of the thyroid: a case report and review of the literature.

Hemangioendotheliomas of the thyroid are neoplasms that are rarely encountered in the Alpine region in Europe. The endemic goiter in this iodine-deficient region can be considered as a predisposing factor. We report the second case of an epithelioid hemangioendothelioma (EHE) of the thyroid gland and the first clinical case with malignant behavior. A 73-year-old woman with a long history of multinodular goiter presented with a rapidly growing thyroid mass, free of distant metastases. A total thyroidectomy was performed. Histologically the lesion had characteristic epithelioid and spindle cell proliferation in a background of chondromyxoid stroma. Cytoplasmic vacuolization in the epithelioid and spindle cells were present. Tumor cells were positive for factor VIII-related antigen, MNF116, PAN-ceratin, CD 34, and CD 31 and negative for cytokeratin allowing the diagnosis of EHE. Nine months after the primary resection the tumor locally recurred. A palliative resection was performed in a second operation followed by interferon-alpha therapy. The patient rapidly developed a second local relapse and died 13 months after the diagnosis of an EHE had been made. An improvement of the very poor prognosis of this rare tumor may depend on early tumor diagnosis and surgery combined with a multimodal treatment.

Aged↗