Intrauterine synechiae after myomectomy; Laparotomy versus laparoscopy: non-randomized interventional trial

Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion [synechiae]. To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy. In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy [type 3-6 interamural and subserosal fibroids] via laparotomy and laparoscopy in Tehran's Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups. Forty patients [19 laparoscopy and 21 laparotomy cases] were studied. Both groups were similar regarding the size, type [subserosal or intramural], number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference [p=0.99]. Among all patients, no significant relationship was found between the endometrial opening [p=0.92], location [p=0.14] and type of myoma [p=0.08] with the occurrence rate of synechiae. However, a significant relationship was observed between myoma's size [p=0.01] and the location of the largest myoma with the occurrence of synechiae [p=0.02]. With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae

Comparing the operational related outcomes of a robotic camera holder and its human counterpart in laparoscopic ovarian cystectomy: a randomized control trial

Purpose: Glioblastoma Multiforme [GBM] brain tumor is heterogeneous in nature; so, its quantification depends on how to accurately segment different parts of the tumor, i.e. active tumor, edema and necrosis. This procedure becomes more effective when physiological information like diffusion-weighted-imaging [DWI] and perfusion-weighted-imaging [PWI] are incorporated with the anatomical MRI. In this preliminary tumor quantification work, the idea is to characterize different regions of the GBM tumors in an MRI-based multi-parametric approach to achieve more accurate characterization of pathological regions, which cannot be obtained by using individual modalities. Methods: For this purpose, three MR sequences, namely T2-weighted imaging [anatomical MR imaging], PWI and DWI of five GBM patients were acquired. To enhance the delineation of the boundaries of each pathological region [peri-tumoral edema, tumor and necrosis], the spatial fuzzy C-means [FCM] algorithm is combined with the region growing [RG] method. Results: The results show that exploiting the multi-parametric approach along with the proposed segmentation method can improve characterization of tumor cells, edema and necrosis in comparison to mono-parametric imaging approach. Conclusion: The proposed MRI-based multi-parametric segmentation approach has the potential to accurately segment tumorous regions, leading to an efficient design of the treatment planning, e.g. in radiotherapy

Unexpected outcome after expectant management of ectopic pregnancy in two persons

Ectopic pregnancy is one of the main problems in women in reproductive age that needs special attention and appropriate strategy should be managed. In some cases expectant management seems good strategy without any medicine or surgery and their possible side effects. But are the outcomes always the same? Which outcomes should we expect? We have reported 2 patients whose ectopic pregnancy had been managed conservatively and they had sustained pain for several months which needed surgery to resolve In the case of ectopic pregnancy, it is important for the clinician to select the patient meticulously and be aware of common and rare consequences of her treatment

Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy

In this study, we tried to show the efficacy of Intraperitoneal dexametha-sone on relieving shoulder pain after gynecologic laparoscopy. In this double-blind randomized clinical trial, 63 patients who were candidates for gynecologic laparoscopy were included. At the end of the procedure patients randomly received 16 mg dexamethasone [n=31] or placebo [n=32] intraperitoneally. Visual analogue scale [VAS] was used for clinical evaluation of pain severity during 24 hours after laparoscopy. A physician, who was not aware whether patients were treated with drug or placebo, evaluated the patients. The severity of pain in the dexamethasone group within 0, 2, 4, 8, 12, 24 hours after procedure was significantly less than in the placebo group [p<0.001]. The average consumption of opioids as analgesic/ sedative in the placebo group was more than the dexamethasone group [p=0.025]. Findings of this study show that the prescription of 16 mg of dexamethasone [single dose] in the peritoneal cavity may significantly reduce the severity of pain after Laparoscopy in comparison with placebo and may decrease the need for narcotics as pain relief

Isolated fallopian tube torsion: a case report and review of literature

Isolated fallopian tube torsion is rare and often difficult to diagnose. Definitive diagnosis is always made at laparoscopic or via laparotomy exploration performed for suspected ovarian torsion. Early diagnosis and conservative laparoscopic treatment especially in a reproductive age woman is warranted as a means of preserving fallopian tube integrity and maintaining fertility. Here, we describe a case with isolated right fallopian torsion being managed by conservative laparoscopic surgery

Evaluation of effects of micro-electric current on the healing of open wounds in rabbit skin

Several investigations have shown positive effects of microcurrent electrical current on fracture healing. In this study, the effects of microcurrent [microampere] on the full thickness incisional wound healing of rabbits were evaluated by histological and tensiometrical methods. Thirty male adult rabbits were randomly divided into control and experimental groups. Each group divided into 3 subgroups, based on duration of study [4,7,15 days]. Under general anesthesia and sterile conditions, one full thickness incision on skin of each rabbit was made. From the day of surgery, the experimental group received electrotherapy daily for 2 hours [current intensity: 200 micro A/cm [2], current density: 66 micro A/cm [2] frequency 0.5 Hz]. Polarity was negative at first 3 days and was positive thereafter. At the end, rabbits were killed by choloroform and 2 samples were obtained from the wound tissue and the adjacent normal skin for histologic and tensiometeric studies. Number of neurtophils and fibroblasts and cross sections of vessels were counted. Data were analysed using student t test. The number of fibroblasts on seventh day [862.6 +/- 70.1] was significantly higher [P<0.05] than control group [468 +/- 2+59]. Tensile strength of experimental group at fifteenth day [2138.2 +/- 212] was significantly higher than relevant control group [1443.1 +/- 218.8]. Daily application of microcurrent electrical current significantly accelerated wound healing process of incisional wound of skin of rabbits