SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Laparoscopic evaluation of female genital tuberculosis in infertility: An observational study

Background & objectives: Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB. Methods: This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB. Results: Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases. Interpretation & conclusions: The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.

Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats / Gastrotomia seguida de gastrorrafia, uma técnica mais confiável e fisiológica para a indução de aderências peritoneais em ratos

ABSTRACT Objective: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. Methods: eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. Results: the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. Conclusion: the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.

RESUMO Objetivo: o objetivo deste estudo foi criar um novo modelo animal de indução de aderências peritoneais capaz de levar à formação de aderências em todos os animais operados, simples e reprodutível, associado a manutenção da saúde dos animais. Métodos: Dezoito ratos machos, adultos, da linhagem Wistar (Rattus norvegicus) foram distribuídos aleatoriamente em três grupos: Grupo Controle (parâmetro anatômico e clínico), Grupo Sham (manipulação delicada do estômago e exposição de cavidade peritoneal ao ar ambiente) e Grupo Cirurgia (gastrotomia seguida de gastrorrafia). Os animais foram submetidos à análise e classificação macroscópicas, seguindo dois modelos de classificação de aderências. As diferenças entre os grupos foram consideradas estatisticamente significantes se p<0,05. Resultados: os seis animais do grupo controle não apresentavam aderências peritoneais, três dos seis animais do grupo sham apresentavam aderências peritoneais focais e todos os seis animais do grupo cirurgia (gastrotomia seguida de gastrorrafia) apresentavam aderências peritoneais firmes. Todas as aderências encontradas foram quantificadas macroscopicamente e confirmadas microscopicamente, sem a realização de classificação microscópica das aderências. Conclusão: o novo modelo desenvolvido, de gastrotomia seguida de gastrorrafia, mostrou-se seguro e eficiente para induzir e estudar aderências peritoneais.

Vólvulo ileal secundario a síndrome adherencial posquirúrgico. Presentación de un caso

Se presentó el caso de una paciente de 71 años que tuvo durante tres meses previo a su ingreso dolor abdominal tipo cólico difuso a predominio de hemiabdomen inferior, acompañado de distensión abdominal intermitente, vómitos en cantidad y frecuencia no precisada de contenido alimentario. Al examen físico se apreció paciente en regulares condiciones, facies álgica, afebril, deshidratada. En la evaluación abdominal se evidenció abdomen distendido, con ruidos hidroaéreos disminuidos en intensidad, tono y frecuencia. Se decidió ingresar para manejo clínico y realización de estudios de apoyo diagnóstico. Se diagnosticó un síndrome adherencial, conjunto de signos y síntomas provocados por la formación de adherencias intraabdominales. Frente a un paciente con abdomen agudo obstructivo con antecedente de intervención quirúrgica previa, debe sospecharse en una complicación secundaria a síndrome adherencial, teniendo al vólvulo de íleon como una de sus expresiones clínicas.

The case of a 71-year-old patient was presented who had diffuse colicky abdominal pain predominantly in the lower abdomen for three months prior to admission, accompanied by intermittent abdominal distention, vomiting in an unspecified amount and frequency of food content. During the physical examination, the patient was found to be in fair condition, with pain, fever, and dehydration. The abdominal evaluation revealed a distended abdomen, with fluid sounds decreased in intensity, tone and frequency. It was decided to enter for clinical management and diagnostic support studies. An adhesion syndrome was diagnosed, a set of signs and symptoms caused by the formation of intra-abdominal adhesions. In a patient with acute obstructive abdomen with a history of previous surgical intervention, a complication secondary to adhesion syndrome should be suspected, with ileal volvulus as one of its clinical expressions.

Foi apresentado o caso de um paciente de 71 anos que apresentava cólica abdominal difusa predominantemente no baixo ventre há três meses antes da internação, acompanhada de distensão abdominal intermitente, vômitos em quantidade e frequência de conteúdo alimentar não especificadas. Durante o exame físico, o paciente apresentou-se em bom estado, com dor, febre e desidratação. A avaliação abdominal revelou abdômen distendido, com sons fluidos diminuídos de intensidade, tônus e frequência. Decidiu-se ingressar em estudos de manejo clínico e apoio diagnóstico. Foi diagnosticada uma síndrome de aderências, conjunto de sinais e sintomas causados pela formação de aderências intra-abdominais. Em paciente com abdome obstrutivo agudo e história de intervenção cirúrgica prévia, deve-se suspeitar de complicação secundária à síndrome de aderências, tendo o volvo ileal como uma de suas expressões clínicas.

CT-guided diagnosis of banded vs membranaceous adhesive small bowel obstruction / 中华普通外科杂志

Objectives:To study the computed tomography features of banded adhesions(BA) and matted adhesions(MA) of adhesive small bowel obstruction(ASBO).Methods:We enrolled 150 patients operated on for ASBO. According to intraoperated findings, ASBO were classified into those caused by BA or MA. A multivariable logistic regression was established to analyze independent risk factors on Computed Tomography features.Results:There were significant differences in closed-loop sign (36.8% vs. 14.3%, P=0.002) mesenteric haziness (43.7% vs. 17.5%, P=0.001), beak sign (48.3% vs. 17.5%, P<0.001), fat notch sign (39.1% vs. 9.5%, P<0.001) and peritoneal fluid (54.0% vs. 34.9%, P=0.015) between the two groups. The presence of beak sign [ OR=6.15, 95% CI (2.55-14.84), P<0.001], fat notch sign [ OR=6.19, 95% CI (2.16-17.82), P=0.001] and mesenteric haziness [ OR=3.34, 95% CI (1.34-8.32), P=0.009] were independent risk factors with BA. Conclusion:Beak sign, fat notch sign and mesenteric haziness were independent risk factors for diagnosing BA.

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes

ABSTRACT Purpose: Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. Methods: Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. Results: As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. Conclusions: The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.

Diseño y validación de una herramienta para la predicción de desenlaces adversos en pacientes con obstrucción intestinal por bridas: La escala HALVIC / Design and validation of a predicting adverse outcomes toll for patients with adhesive small bowel obstruction: HALVIC score

Introducción. La obstrucción intestinal por bridas representa una causa común de consulta a los servicios de urgencias, pero hay poca claridad sobre qué pacientes tienen mayor riesgo de desarrollar complicaciones. El objetivo de este estudio fue diseñar y validar una escala de predicción de riesgo de desenlaces adversos en pacientes con obstrucción intestinal por bridas. Métodos. Estudio de cohorte retrospectivo realizado a partir de la base de datos MIMIC-IV. Se incluyeron pacientes adultos admitidos al servicio de urgencias entre 2008 y 2019, con diagnóstico de obstrucción intestinal por bridas. El desenlace principal fue el compuesto de resección intestinal, ingreso a unidad de cuidados intensivos y mortalidad por cualquier causa. Se diseñó una escala de predicción de riesgo asignando un puntaje a cada variable. Resultados. Se incluyeron 513 pacientes, 63,7 % hombres. El desenlace compuesto se presentó en el 25,7 % de los casos. La edad, historia de insuficiencia cardiaca y enfermedad arterial periférica, nivel de hemoglobina, recuento de leucocitos e INR constituyeron el mejor modelo de predicción de estos desenlaces (AUC 0,75). A partir de este modelo, se creó la escala simplificada HALVIC, clasificando el riesgo del desenlace compuesto en bajo (0-2 puntos), medio (3-4 puntos) y alto (5-7 puntos). Conclusión. La escala HALVIC es una herramienta de predicción simple y fácilmente aplicable. Puede identificar de manera precisa los pacientes con obstrucción intestinal por bridas con alto riesgo de complicaciones, permitiendo el ajuste individualizado de las estrategias de manejo para mejorar los desenlaces

Introduction. Adhesive Small Bowel Obstruction (ASBO) represents a common cause of consultation to the emergency department. Currently there is little clarity about which patients with ASBO are at increased risk of developing complications, potentially benefiting from early surgical management. The present study aims to design and validate a risk prediction scale for adverse outcomes in patients with ASBO. Methods. Retrospective cohort study performed from the MIMIC-IV database between 2008 and 2019. Adult patients admitted to the emergency department with a diagnosis of ASBO were included. The primary outcome was the composite of bowel resection, intensive care unit admission, and all-cause mortality. A risk prediction scale was designed by assigning a score to each variable according to the measure of association obtained in the logistic regression model. All analyses were performed in R statistical software (version 3.5.3). Results. Five-hundred-thirteen patients were included (men 63.7%, median age: 61 years). Composite outcome was present in 25.7% of cases. Age, history of heart failure and peripheral arterial disease, hemoglobin level, leukocyte count, and INR were the best predictors of these outcomes (AUC 0.75). Based on this model, the simplified HALVIC scale was created, classifying the risk of the composite outcome as low (0-2 points), medium (3-4 points) and high (5-7 points). Conclussion. The HALVIC scale is presented as a simple and easily applicable predictive tool in the clinical setting, which can accurately identify patients with ASBO at high risk of complications, allowing the surgeon to adjust management strategies individually and potentially improving the outcomes of these patients

Obstrucción intestinal por adherencias: un lienzo en blanco en el que el cirujano elige los colores / Intestinal obstruction due to adherences: a blank canvas on which the surgeon chooses the colors

Introducción. La obstrucción intestinal es una patología de alta prevalencia. Su abordaje diagnóstico y terapéutico ha evolucionado acorde con el avance del conocimiento e implementación de la tecnología. El impacto de sus complicaciones obliga a redoblar esfuerzos en pro de lograr una mayor efectividad. Se hizo una aproximación reflexiva al problema, mediante una identificación de los puntos controversiales de interés para el cirujano general. Métodos. Se realizó una búsqueda sistemática de la literatura en varias bases de datos, utilizando dos ecuaciones de búsqueda que emplearon términos seleccionados a partir de los tesauros "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Resultados. Se recolectaron 43 artículos y a partir de ellos se construyó el texto de revisión. La identificación pronta de los posibles candidatos a cirugía, mediante un esquema diagnóstico y terapéutico, se constituye en una prioridad en el manejo de estos pacientes. De igual manera, se efectúan consideraciones en la toma de decisiones con respecto a la vía quirúrgica, así como recomendaciones técnicas operatorias producto de la experiencia y lo reportado en la literatura. Existen factores propios del cirujano, del contexto y del paciente, que inciden en la resolución del problema. Conclusión. La obstrucción intestinal y sus implicaciones clínicas obligan a una reevaluación constante de su estado del arte y avances en el manejo, tendiente a una búsqueda de oportunidades para impactar favorablemente en su curso clínico. Hay estrategias por implementar, inclusive el manejo laparoscópico en casos seleccionados

Introduction. Intestinal obstruction is a pathology of high prevalence. Its diagnostic and therapeutic approach has evolved according to the progress in knowledge and implementation of technology. The impact of its complications makes it necessary to make the efforts to achieve higher effectiveness. A reflexive approach to the problem is made by identifying the controversial points of interest for the general surgeon. Methods. A systematic literature search was carried out in several databases, using two search equations from the review performed in the thesaurus "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). Results. A total of 43 articles were collected using the selected methods and the review text was constructed from them. The early identification of possible candidates for surgery, by means of a diagnostic and therapeutic algorithm, is a priority in the management of these patients. Likewise, considerations are made in decision-making regarding the laparoscopic vs. traditional approach, as well as operative technical recommendations based on experience and what has been reported in the literature. There are factors specific to the surgeon, the context and the patient that influence the resolution of the problem. Conclusion. Intestinal obstruction and its clinical implications require a constant reevaluation of the state of the art and advances in management, tending to search for opportunities to favorably impact its clinical course. There are strategies to be implemented, including laparoscopic management in selected cases

Development and Evaluation of Vaginal Suppository Containing Althaea officinalis L. Polysaccharide Extract

Abstract Intrauterine adhesions cause several gynecological problems. Althaea officinalis L. roots known as marshmallows contain polysaccharides (M.P.) which possess anti-inflammatory and anti-ulcerogenic activities also can form a bio-adhesive layer on damaged epithelial membranes prompting healing processes. Vaginal formulations of herbal origin are commonly applied to relieve cervico-uterine inflammation. Herein, we aim to develop and evaluate vaginal suppositories containing polysaccharides isolated from the A. officinalis root. Six formulations (four P.E.G.-based and two lipid-based suppositories containing 25% and 50% M.P.) met standard requirements, which were then subjected to qualitative and quantitative evaluation. All suppositories exhibited acceptable weights, hardness, content uniformity, melting point, and disintegration time, which fall within the acceptable recommended limits. Higher concentrations of M.P. in PEG-bases moderately increased the hardness (p<0.05). PEG-formulations showed content uniformity>90% of the average content while it was 75-83% for suppocire formulations. All formulations disintegrated in<30minutes. In-vitro release test revealed that M.P. release from 25%-MP formulations was higher than that of 50%-M.P. suppositories. Overall, results revealed the feasibility of preparing P.E.G.-or lipid-based suppositories containing M.P., which met the B.P. quality requirement

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Application of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries / 中国基层医药

Objective:To investigate the efficacy of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries.Methods:The clinical data of 103 patients with rotator cuff injuries treated in The 72 nd Military Hospital of PLA from December 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the treatment methods. The control group ( n = 48) was treated with ultrasound-guided adhesiolysis. The study group ( n = 55) was treated with ultrasound-guided adhesiolysis and intra-articular injection of platelet rich plasma. Therapeutic effects, pain score, shoulder function score, shoulder range of motion, healing rate, and re-tear rate were compared between the control and study groups. Results:Total effective rate was significantly higher in the study group than in the control group (96.36% vs. 81.25%, χ2 = 6.14, P < 0.05). Pain score in each group was significantly decreased after treatment compared with before treatment [study group: (1.69 ± 0.81) points vs. (6.13 ± 1.28) points; control group: (3.22 ± 1.05) points vs. (6.13 ± 1.28) points, t = 31.510, 8.33, both P < 0.001]. The University of California at Los Angeles (UCLA) shoulder score in each group was significantly increased after treatment compared with before treatment [study group: (33.26 ± 3.81) points vs. (14.03 ± 2.96) points; control group: (28.81 ± 3.20) points vs. (13.92 ± 3.03) points, t = 42.13, 33.12, both P < 0.001]. Constant-Murley Score in each group was significantly increased after treatment compared with before treatment [study group: (94.22 ± 4.15) points vs. (55.29 ± 8.18) points; control group: (82.11 ± 8.13) points vs. (56.33 ± 7.83) points; t = 46.83, 22.38, both P < 0.001]. After treatment, pain score was significantly lower in the study group than in the control group [(1.69 ± 0.81) points vs. (3.22 ± 1.05) points, t = 8.33, P < 0.001]. UCLA score and CMS were significantly higher in the study group than in the control group [(33.26 ± 3.81) points vs. (28.81 ± 3.20) points, (94.22 ± 4.15) points vs. (82.11 ± 8.13) points, t = 6.37, 9.70, both P < 0.001]. After treatment, there were improvements in flexion [study group: (159.26 ± 13.51)° vs. (85.26 ± 11.35)°; control group: (150.22 ± 14.35)° vs. (86.33 ± 11.51)°; t = 45.15, 34.23, both P < 0.001], internal rotation at 90° abduction [study group: (83.64 ± 5.29)° vs. (60.33 ± 4.12)°; control group: (76.81 ± 4.82)° vs. (60.61 ± 4.51)°; t = 36.74, 24.06, both P < 0.001], abduction [study group: (161.29 ± 10.76)° vs. (72.91 ± 5.16)°; control group: (152.81 ± 11.84) ° vs. (73.26 ± 5.22)°; t = 82.34, 64.61, both P < 0.001], external rotation at 90° abduction [study group: (87.82 ± 3.04)° vs. (4.29 ± 5.18)°; control group: (80.22 ± 4.13)° vs. (80.22 ± 4.13)°; t = 42.46, 21.55, both P < 0.001] , and external rotation in neutral position [study group: (43.18 ± 3.20)° vs. (22.85 ± 4.12)°; control group: (37.26 ± 4.12)° vs. (22.64 ± 3.95)°; t = 41.19, 25.10, both P < 0.001] in each group compared with before treatment. After treatment, range of motion of the shoulder in the above positions was significantly higher in the study group than in the control group [flexion: (159.26 ± 13.51)° vs. (150.22 ± 14.35)°; internal rotation at 90° abduction: (83.64 ± 5.29)° vs. (76.81 ± 4.82)°; abduction: (161.29 ± 10.76)° vs. (152.81 ± 11.84)°; external rotation at 90° abduction: (87.82 ± 3.04)° vs. (80.22 ± 4.13)°; external rotation in neutral position: (43.18 ± 3.20)° vs. (37.26 ± 4.12)°, t = 3.29, 6.81, 3.81, 10.72, 8.20, all P < 0.001]. There was no significant difference in healing rate between the study and control groups (1.82% vs. 16.67%, χ2 = 5.35, P < 0.05). Conclusion:Ultrasound-guided adhesiolysis combined with platelet-rich plasma is highly effective in the treatment of rotator cuff injuries because it can greatly improve shoulder function, reduce pain degree, and increase the range of motion of the shoulder.

Construction and evaluation of a nomogram prediction model for the intrauterine adhesions risk factor after hysteroscopic surgery for subumcosal myoma of uterus / 中国医师进修杂志

Objective:To analyze the risk factors of intrauterine adhesions in patients after hysteroscopic surgery for subumcosal myoma of uterus, and to construct and evaluate a nomogram prediction model.Methods:The clinical data of 322 patients underwent hysteroscopic surgery for subumcosal myoma of uterus in Dongguan Maternal and Child Health Hospital from January 2017 to December 2020 were collected. The univariate analysis and multivariate Logistic regression were used to analyze the factors affecting the occurrence of intrauterine adhesions, according to the analysis results, R software was used to construct a nomogram prediction model that affected the occurrence of intrauterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus, and the H-L fit curve and the area under the curve were used to evaluate the effectiveness and discrimination of the model.Results:Through a 1-year follow-up, it was found that 47 patients had intrauterine adhesions (adhesions group), accounting for 14.60%; another 275 patients was enrolled in non-adhesions group. The results of univariate analysis showed that combined pelvic inflammatory disease, pregnancy times, history of curettage, combined uterine fibroids, and serumtransforming growth factor (TGF)-β1 level were risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The results of multivariate Logistic regression analysis showed that serum TGF-β1 level, pelvic inflammatory disease, history of curettage and uterine fibroids were independent risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The nomogram prediction model was established with the results of multivariate Logistic regression analysis, and the discrimination of the nomogram model was evaluated, the results showed that the area under the curve was 0.854, and the sensitivity and specificity were 91.50% and 70.50%, respectively. The validity of the model (H-L fit curve) was evaluated and the results showed that χ2 = 7.12, P = 0.413. Conclusions:Serum TGF-β1 level, combined with pelvic inflammatory disease, history of curettage, combined with uterine fibroids are independent risk factors that affect the occurrence of uterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus. The constructed nomogram prediction model has relatively good effectiveness and discrimination. It can be used as an effective predictive tool for early clinical intervention.

Effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion / 中国基层医药

Objective:To investigate the effects of different induced abortions on women's menstrual re-fluid time, vaginal bleeding time and the incidence of postoperative intrauterine adhesion.Methods:A total of 260 women who underwent painless abortion under ultrasound surveillance in The Second Hospital of Jiaxing from January 2019 to January 2021 were included in the ultrasound group. An additional 260 women who underwent minimally invasive endoscopic visual abortion were included in the endoscopy group. Operation-related indexes were compared between the two groups. Menstrual re-fluid time, vaginal bleeding time, postoperative abdominal pain and the incidence of postoperative intrauterine adhesion were compared between the two groups.Results:Operative time in the endoscopy group was significantly shorter than that in the ultrasound group [(3.37 ± 0.84) minutes vs. (6.59 ± 2.03) minutes, t = 23.68, P < 0.001]. The amount of intraoperative blood loss in the endoscopy group was significantly less than that in the ultrasound group [(15.87 ± 5.65) mL vs. (33.04 ± 10.44) mL, t = 23.33, P < 0.001]. Postoperative vaginal bleeding time and menstrual re-fluid time in the endoscopy group were (3.16 ± 1.58) days and (30.37 ± 6.13) days, respectively, which were significantly shorter than those in the ultrasound group [(4.23 ± 1.83) days, (32.07 ± 4.25) days, t = 7.10, 3.69, P < 0.001]. There were no significant differences in the severity and duration of postoperative abdominal pain between the two groups (both P > 0.05). Complete abortion rate in the endoscopy group was significantly higher than that in the ultrasound group [98.85% vs. 96.15%, χ2 = 3.86, P < 0.05]. The incidence of complications in the endoscopy group was significantly lower than that in the ultrasound group (2.31% vs. 5.77%, χ2 = 4.01, P < 0.05). There was no significant difference in the incidence of postoperative intrauterine adhesion between the endoscopy and ultrasound groups (1.15% vs. 3.46%, P > 0.05). Conclusion:Both minimally invasive endoscopic visual abortion and B-ultrasound-guided painless abortion have painless effects. Minimally invasive endoscopic visual abortion produces less postoperative impact, leads to better postoperative recovery, and is safer than B-ultrasound-guided painless abortion.

Análisis clínico-tomográfico en obstrucción de intestino delgado por adherencias según el sitio de obstrucción en la tomografía / Clinical-tomographic analysis in adhesive small bowel obstruction according to obstruction site in the tomography

Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias. Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel. Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal. Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.

Introduction. Postoperative adhesions are the most common cause of small bowel obstruction. The clinical presentation suggests the diagnosis, but imprecisely the cause and the site of the obstruction. Contrast computed tomography is the optimal study and allows the timely identification of patients requiring surgical intervention. The objective of this study was to analyze the correlation between the symptoms and the obstruction site detected in the abdominal contrasted computed tomography in patients with suspected diagnosis of small bowel obstruction due to adhesions. Methods. Prospective, cross-sectional and analytical study of patients with clinical suspicion of small bowel obstruction due to adhesions and surgical history, and its correlation with the obstruction site detected in the abdominal contrasted computed tomography, during March 2016 to February 2019 in a secondary level hospital. Results. Forty-one patients were included, the mean age was 59 years and the male gender was the most frequent (68.3%, n=28); the absence of evacuations was present in 97.5% (p=0.026). Contrast computed tomography showed the obstruction site in 73% of the patients. The most prevalent location of the obstruction was in the distal ileum (31.7%, n=13). It was associated with leukocytosis (p=0.041) and more intense pain (p=0.049), without presenting peritoneal irritation. Conclusion. The obstruction located in the distal ileum was characterized by more pain and a higher white blood cell count, without correlation as a risk factor for requiring surgical treatment

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair / Manguito capturado: Um fator de mau prognóstico no reparo do manguito rotador

Abstract Objective To describe a new presentation of tears and retears of the rotator cuff, which we denominate captured rotator cuff (CRC). We also aim to evaluate it clinically and through images. Methods We assessed retrospectively 16 patients with intraoperative diagnosis of CRC between March 2005 and September 2017; by means of imaging (radiography and magnetic resonance imaging [MRI]) and functional scores (UCLA and Constant & Murley). In images we analyzed the evolution for rotator cuff arthropathy and presence of retears. Functionally, we compared the affected side with the contralateral side and extensive lesions with nonextensive. Results Five (31.25%) patients presented with rotator cuff arthropathy, and 10 (62.5%) with retears. Three (75%) patients with nonextensive lesions had good/excellent UCLA and Constant & Murley scores. In patients with extensive lesions, when the Constant & Murley score was evaluated, 6 (50%) presented good/excellent results, and in the UCLA score, 7 (58.3%). Comparing the affected side (Constant 74.72 points; UCLA 20 points) with the contralateral side (Constant 96.96 points; UCLA 25.63 points), there were worse functional results with statistical significance. Conclusion The diagnosis of CRC is suspected by characteristic findings on MRI and confirmed in arthroscopy. The affected shoulders present worse functional postoperative scores.

Resumo Objetivo Descrever uma nova apresentação de ruptura e rerruptura do manguito rotador (MR), a qual denominamos manguito capturado (MC). Objetivamos também avaliá-la clinicamente e por meio de imagens. Métodos Foram avaliados retrospectivamente 16 pacientes com diagnóstico intraoperatório de MC no período de março de 2005 a setembro de 2017; por meio de exames de imagem (radiografia e ressonância magnética [RM]) e escores funcionais (UCLA e Constant & Murley). Nas imagens, analisamos a evolução para artropatia do manguito rotador e presença de rerrupturas. Funcionalmente, comparamos o lado afetado com o contralateral e as lesões extensas com nãoextensas. Resultados Cinco (31,25%) pacientes evoluíram com artropatia do manguito rotador e 10 (62,5%) tiveram rerrupturas. Três (75%) pacientes com lesões não extensas tiveram UCLA e Constant & Murley bons/excelentes. Nos pacientes com lesões extensas, quando avaliado Constant & Murley, 6 (50%) apresentaram resultados bons/excelentes, e no escore UCLA, 7 (58,3%). Comparando o lado acometido (Constant 74,72 pontos; UCLA 20 pontos) com o contralateral (Constant 96,96 pontos; UCLA 25,63 pontos), houve pior resultado funcional com significância estatística. Conclusão O diagnóstico de MC é suspeitado por achados característicos na RM e confirmado na artroscopia. Os ombros acometidos apresentam piores escores funcionais pós-operatórios.

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

OBJECTIVES: This study aims to compare the clinical efficacy of an integrated approach to prevent and treat the recurrence of moderate-to-severe intrauterine adhesions (IUA) after hysteroscopic transcervical resection of adhesion (TCRA). METHODS: The study included a total of 70 patients with moderate-to-severe IUAs who underwent TCRA. Patients were randomly divided into two groups: treatment group (n=35) and control group n=35). In the treatment group, patients underwent balloon uterine stent placement and artificial cycle as well as received intrauterine perfusion of Danshen injection and oral Chinese medicine. In the control group, patients underwent balloon uterine stent placement and artificial cycle as well as received hyaluronic acid sodium and intrauterine device (IUD). Follow-up was performed after treatment of uterine cavity, menstruation and pregnancy. RESULTS: After 3 months of treatment, we observed a significantly lower rate of intrauterine re-adhesion (45.71% versus 77.14%, p=0.044) and significantly higher clinical efficiency (82.86% versus 77.14%, p=0.025) in the treatment group than those in the control group. After 6 months of treatment, we observed a significantly higher clinical efficiency in the treatment group than that in the control group (88.57% versus 68.57%, p=0.039). During the follow-up period, the pregnancy rate was 45.71% and 37.14% in the treatment group and control group, respectively, although the difference was not statistically significant (p=0.628). CONCLUSIONS: After surgical management of IUA, the integrated treatment combining a uterus stent placement and artificial cycle with Danshen injection and oral Chinese medicine can improve the condition of menstruation, and prevent and treat recurrence of IUA.

Research progress on the role of the Wnt signaling pathway in the development of intrauterine adhesions and its significance in treatment / 中华老年医学杂志

The Wnt signaling pathway also plays a role in fibrotic diseases of various tissues and organs, such as pulmonary fibrosis, liver fibrosis, renal fibrosis and skin fibrosis.Activation of the Wnt signaling pathway is related to the fibrosis of the endometrium and ectopic endometrial tissue, and it is a key component of the potential mechanisms for the development intrauterine adhesions.It could also be a target for treatment via promoting endometrial proliferation and angiogenesis and enhancing colony formation and self-renewal ability of endometrial stem cells.Wnt signaling pathways may regulate the complicated cross-talking networks and balance the dynamic processes of fibrogenesis and repair in intrauterine adhesions, thus potentially providing a new route for studying the pathological mechanisms of intrauterine adhesions and finding therapeutic targets.

Efficacy of Bushen Huoxue Decoction for Patients with Intra Uterine Adhesions After Trans Cervical Resection Adhesions Operation and Effect on Fibrotic Factors / 中国实验方剂学杂志

Objective:To discuss the efficacy of Bushen Huoxue decoction for recovery in patients with intra uterine adhesions （IUA） after trans cervical resection adhesions （TCRA） operation， and to investigate its effect on fibrosis factor. Method:The 110 patients were randomly divided into two groups by random number table （55 cases for control group and 55 cases for observation group）. The patients in both groups got TCRA， and after the operation， they got estradiol valerate tablets+progesterone capsules. The patients in control group additionally got Jinfengwan before meals， 10 g/time， 2 times/day. Patients in observation additionally got syndrome differentiation and treatment by Bushen Huoxuetang， 1 dose/day. The treatment course was 3 months in both groups， and 6 months' follow-up was recorded. Before and after treatment， menstrual volume， period and cycle were recorded. During the follow-up， pregnancy， ectopic pregnancy and abortion were also recorded. Endoscopy and vagina color Doppler ultrasound were conducted to detect endometrial thickness， uterine volume， resistance index （RI）， pulsation index （PI） and blood flow index （FI）. Scores of IUA and syndrome of kidney deficiency and blood stasis were graded. At the 6^th months after treatment， rate of intrauterine re-adhesion was recorded. Levels of transforming growth factor-<italic>β</italic>₁（TGF-<italic>β</italic>₁）， connective tissue growth factor （CTGF）， matrix metalloproteinase inhibitor-1 （TIMP-1）， platelet-derived growth factor （PDGF）， insulin-like growth factor-1 （IGF-1） and matrix metalloproteinase-9 （MMP-9） were detected， and safety was evaluated. Result:Total effective rate of clinical efficacy was 96.36% （53/55） in observation group， higher than 83.64% （46/55） in control group （<italic>χ</italic>²=4.959， <italic>P</italic><0.05）. Recovery rate of menstrual volume， period and cycle were 92.73% （51/55）， 90.91% （50/55）， and 94.55% （52/55） in observation group， higher than 72.73% （40/55）， 76.36% （42/55）， and 76.36% （42/55） in control group（<italic>χ</italic>²=7.698，<italic>χ</italic>²=4.245，<italic>χ</italic>²=7.313，<italic>P</italic><0.05， <italic>P</italic><0.01）. During the follow-up， rate of intrauterine re-adhesions was 23.64% （13/55） in observation group， lower than 43.64% （24/55） in control group （<italic>χ</italic>²=4.927，<italic>P</italic><0.05）. Pregnancy rate was 45.45% （25/55）， higher than 25.45% （14/55） in control group（<italic>χ</italic>²=4.807，<italic>P</italic><0.05）. Score of syndrome of kidney deficiency and blood stasis and IUA scores in observation group were lower than those in control group （<italic>P</italic><0.01）. Endometrial thickness， uterine volume， and FI were higher than those in control group （<italic>P</italic><0.01）. Levels of RI， PI， TGF-<italic>β</italic>₁， CTGF， PDGF， IGF-1 and TIMP-1 were lower than those in control group （<italic>P</italic><0.01）， while level of MMP-9 was higher than that in control group （<italic>P</italic><0.01）. No adverse reactions related to traditional Chinese medicine were found. Conclusion:Bushen Huoxue decoction can promote the recovery of menstruation， increase the thickness of endometrium， improve the blood circulation of uterus， regulate the expression of fibrogenic factors<italic> in vivo</italic>， prevent and treat intrauterine adhesions， reduce the rate of intrauterine re-adhesions， and improve the rate of pregnancy， with a good comprehensive effect and high safety for clinical use.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.