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...
We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION: PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries. PMID: 33034214 [PubMed - as supplied by publisher]
Currently in fellowship doing bread/butter procedures (MBB, epidurals, PNB, few SCS/PNS trials, etc.) and just interviewed at a private practice spot where they do a lot of procedures that I will have not done any training in prior to graduating (e.g. IT pump, SI fusion, Vertiflex, Kypho, MILD, Discectomy, lots of SCS/PNS trials etc) and significant amount of "OR pain procedures" at a very busy practice seeing 30-40 pts/day - how many of you are commonly performing these procedures and are... private practice concern
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Fernando Lopes, Fernando A. Vicentini, Nina L. Cluny, Alexander J. Mathews, Benjamin H. Lee, Wagdi A. Almishri, Lateece Griffin, William Gonçalves, Vanessa Pinho, Derek M. McKay, Simon A. Hirota, Mark G. Swain, Quentin J. Pittman, Keith A. Sharkey
BEST supplements to relieve joint pain: Is your arthritis playing up? The wetter and colder months could partially be to blame. These two pills may help.
Authors: Kim H, Lim YM, Lee EJ, Kim HW, Ahn HS, Kim KK PMID: 33029979 [PubMed]
CONCLUSIONS: More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level. PMID: 33029972 [PubMed]
Authors: Kim EH, Shim WH, Lee JS, Yoon HM, Ko TS, Yum MS Abstract BACKGROUND AND PURPOSE: Recent quantitative neuroimaging studies of childhood absence epilepsy (CAE) have identified various structural abnormalities that might be involved in the onset of absence seizure and associated cognitive and behavioral functions. However, the neuroanatomical alterations specific to CAE remain unclear, and so this study investigated the regional alterations of brain structures associated with newly diagnosed CAE. METHODS: Surface and volumetric magnetic resonance imaging data of patients with newly diagnosed CAE (n=18) an...
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.