Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis
AbstractDeeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residua...
Just went to a skills lab and they divided us into small groups. Before beginning each skills session, when asked what your primary specialty was, if the person teaching the skill was from an anesthesiology background, more times than not if you answered something other than anesthesia, the proctor would say something similar to "Well I guess you didn't get any training in this in residency". This included a session on suturing after procedures such as SCS or pumps. Not saying all those... Read more
Conclusions Higher cardiovascular endurance may mitigate the relationship between poorer subjective sleep quality and lower EC thickness. Future longitudinal studies should examine the interactive effects of sleep and fitness on brain health among older and more vulnerable populations.
Conclusions In conclusion, using contemporary methods to assess muscle architecture and calculate EFFPCSA did not enhance the muscle strength–size association. For understanding/monitoring muscle size, the major determinant of strength, these findings support the assessment of muscle volume, which is independent of architecture measurements and was most highly correlated with strength.
We present a relatively large retrospective cohort of urinary LCNEC, 20 from the urinary bladder, and 2 from the ureter, from a single institution. The patients included 16 men and 6 women with a median age of 74.5 years. Most LCNEC presented at an advanced stage with tumors invading the muscularis propria and beyond (21/22). Eight cases were pure LCNEC, while 14 cases were mixed with other histologic types, including conventional urothelial carcinoma (n=9), carcinoma in situ (n=7), small cell carcinoma (n=6), and urothelial carcinoma with glandular (n=3) features. Most LCNEC expressed neuroendocrine markers synaptophysin ...
Inflammatory pseudotumor is a term used to designate inflammation-rich tumefactive lesions. Following the exclusion of specific entities such as IgG4-related disease and other neoplastic entities previously included in this entity, the majority of hepatic pseudotumors show a prominent fibrohistiocytic inflammatory reaction and have been previously categorized as fibrohistiocytic variant of hepatic pseudotumor (FHVHPT). The goal of this study was to examine the clinical, radiologic, histologic, and etiologic aspects of this entity. After excluding neoplastic diseases, we identified 30 patients with FHVHPT from 3 institution...
We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction.
WHETHER it's general aches and pains, stomach problems or just feeling under the weather, ibuprofen is taken daily by millions of people worldwide. Ibuprofen also treats inflammation such as strains and sprains, and pain from arthritis. Most side effects are minimal or non-existent. However, research has found that spotting a serious sign when you go to the toilet should mean that you stop taking the painkiller.
Endometriosis is a common disease associated with chronic pelvic pain and infertility. For ureteral endometriosis, which is rare, conventional therapy previously consisted of laparotomy. However, laparoscopic ureteroneocystostomy has been reported recently. Laparoscopic surgery for ureteral endometriosis requires greater surgical expertise and takes a longer time to master. The minimally invasive approach is well known to give patients benefits because of its small incision, less pain and shorter hospital stay.
This video presents a laparoscopic deep infiltrating endometriosis which is include bowel and bladder endometriosis. Our case of 39-year-old nulliparous woman. She has suffered of dysmenorrhea, chronic pelvic pain and rectal tenesmus. She had infertility over the 3 years. Laparoscopic exploration showed a obliteration of douglas, right ovarian endometrioma, sigmoid colon nodularity which is causing partial occlusion of passage. Anatomical landmarks must be identified before such operations. Bilateraly ureter must be seen and protected due to complex anatomic structure, sacrouterin ligaments and rectovaginal fascia have to identified.
This video presents a laparoscopic deep infiltrating endometriosis which is include bowel and bladder endometriosis. Our case of 39-year-old nulliparous woman. She has suffered of dysmenorrhea, chronic pelvic pain and rectal tenesmus. She had infertility over the 3 years. Laparoscopic exploration showed a obliteration of douglas, right ovarian endometrioma, sigmoid colon nodularity which is causing partial occlusion of passage. Anatomical landmarks must be identified before suchoperations. Bilateraly ureter must be seen and protected due to complex anatomic structure, sacrouterin ligaments and rectovaginal fascia have to identified.