Role of Chromo-hysteroscopy with Toluidine Blue in Diagnosing Endometrial Pathology after 40 years of Age

Endometrial Cancer is the sixth most common cancer in females worldwide. The lifetime risk of developing the disease is approximately 2.7%. Endometrial cancer often develops in the setting of endometrial hyperplasia that is now being established as a premalignant state. Clinical presentation of both endometrial hyperplasia and endometrial carcinoma is similar. They present as menorrhagia, poly-menorrhoea, inter-menstrual bleeding or postmenopausal bleeding. Almost 15% of outpatient cases and 25% of gynecologic surgery cases present with abnormal uterine bleeding (AUB).

Such abnormal uterine bleeding (AUB) in perimenopausal & menopausal women is routinely investigated with ultrasonography, hysteroscopy and endometrial biopsy. Hysteroscopy guided endometrial biopsy is considered gold standard since it allows direct visualization of the endometrial lesions and directed biopsy thereafter. Sometimes focal endometrial hyperplasia or early endometrial cancer may also be missed on hysteroscopy. Chromo-hysteroscopy is a new technique in which some staining agent is used during hysteroscopy to identify focal endometrial lesions. Chromo hysteroscopy identifies endometrium to be targeted for biopsy with the help of staining dyes like methylene blue, Lugols’s solution, Congo red and Indigo Caramine . The earliest use of Methylene blue or other vital stains or dyes in the endometrium dates back to 1980s when it was used to distinguish normal endometrial tissue from fibrotic one in Asherman’s syndrome . Ozturk et al., conducted a cross-sectional study in 50 patients to evaluate the usefulness of endometrial staining for locating the sampling areas during frozen section procedures of hysterectomy specimens . They suggested that chromo-hysteroscopy with toluidine blue could help in pre-operative evaluation for endometrial hyperplasia & endometrial carcinoma during hysteroscopy.

Toluidine blue is an acidophilic, vital dye of the thiazine group that stains cellular nuclei containing DNA and RNA. These characteristics make toluidine blue useful for identifying premalignant and malignant tissues that have increased DNA synthesis. Toluidine blue is also used to screen for early squamous esophageal cancers.

Preliminary Evaluation of Silica Sand in Sudan with Respect to Fracture Sand

Since its introduction in 1948, hydraulic-fracturing has been one of the primary engineering tools for improving well productivity in tight or low permeability reservoirs; it is used to increase or restore the rate at which fluids, such as petroleum, water, or natural gas can be produced from reservoirs. Due to its effective performance, the technique has progressively expanded so that by the end of 1955 more than 100,000 individual jobs had been performed (Economides 1989); the process has been employed to enhance the production of oil and gas from underground reservoirs for more than sixty years. Recently, the exploration of the unconventional resources was widely increased; then, the need for massive hydraulic fracture job was also increased. The technique in generally use to by-pass formation Damage and increase drainage Area; also, it can be used to connect the wellbore with disconnected zone, and was widely used to control sand production from friable formations.

The process requires an array of specialized equipment and materials; it is involves injection of frac-fluid at a high pressure into a selected section of wellbore; this fluid pressure creates a fracture extending into the rock medium which contains oil or gas. When the fluid pumped into a well, necessarily the pressure rises, and at some point something breaks (either the rock or the equipments); as the rock is generally weaker than steel, the formation will breaks, resulting in wellbore fracturing along its axis. To maintain fracture opening during the production life of the well, solid substance with specific characteristics (known as proppant) injected to the fracture to suspend the fracture.