Role of hysterolaparoscopy in the diagnosis and management of infertility

Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility.

Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation

PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.MATERIALS AND METHODS: From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.RESULTS: The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85–97) and 92 (range, 85–100) in Groups I and II, respectively, at the last follow up.CONCLUSION: Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

Nursing Students' Observation Experiences During Operations

PURPOSE: This study aimed to explore nursing students' experiences of observing surgeries in the operating room. METHODS: The data were collected through written scripts of nursing students who participated in the operating room practice. Data were analyzed via qualitative content analysis. RESULTS: Five themes emerged from the data: ‘preparing with the thrilled hearts toward unknown area’, ‘drawing back in front of the mirror of realities’, ‘becoming an audience at a lifesaving orchestra’, ‘reaching a tipping point of knowing’, and ‘redrawing the trajectory of dream to be a nurse. CONCLUSION: This study will prove helpful in describing their needs for systemic and emotional support. Findings indicated that major contributions of surgical observations to nursing students are more integrated understandings of nursing and the determinations of their career preferences.

Long-term outcomes of ligation of intersphincteric fistula tract for complex fistula-in-ano: modified operative procedure experience / Resultados em longo prazo da ligadura da fístula interesfincteriana no complexo das fístulas perianais: modificação técnica de procedimento cirúrgico

ABSTRACT Background: It is important but difficult to treat complex fistula-in-ano due to the high recurrent rate and following incontinence. Ligation of the intersphincteric fistula tract (LIFT), a novel surgical procedure with the advantage of avoiding anal incontinence, has a variable success rate of 57-94.4 %. Aim: To evaluate the long-term outcomes of modified LIFT operative procedure - ligation of intersphincteric fistula tract - to treat complex fistula-in-ano. Methods: Retrospective analysis of 62 cases of complex fistula-in-ano. The group was treated with the modified approach of LIFT (curved incision was made in the anal canal skin; purse-string suture was performed around the fistula; the residual fistulas were removed in a tunnel-based way) and had a follow-up time of more than one year. Patient´s preoperative general condition, postoperative efficacy and their anal function were compared. Results: The median age of the participants was 34, and 43 (69.4%) cases were male. Forty-one (66.1%) cases were of high transsphincteric fistula, four (6.5%) cases of high intrasphincter fistula, and 17 (27.4%) cases of anterior anal fistula in female. The median follow-up duration was 24.5 (range, 12-51) months. The success rate in the end of follow-up was 83.9% (52/62). The anorectal pressure and Cleveland Clinic Florida Fecal Incontinence (CCF-FI) evaluated three months before and after the operation did not find apparent changes. Conclusions: Compared with LIFT, the modified LIFT remarkably reduces postoperative failure and the recurrence rate of complex fistula with acceptable long-term outcomes.

RESUMO Racional: É importante, mas difícil de se tratar fístula anal complexa devido à alta taxa de recorrência e de incontinência pós-operatória. A ligadura do trajeto da fístula interesfincteriana (LIFT) - um novo procedimento cirúrgico com a vantagem de evitar a incontinência anal - tem taxa de sucesso variável entre 57-94,4%. Objetivo: Avaliar os resultados em longo prazo do procedimento cirúrgico LIFT modificado - ligadura do trato interesfincteriano com fístula - para tratar fístula complexa anal. Métodos: Análise retrospectiva de 62 casos de fístula complexa no ânus tratados com abordagem modificada de LIFT (incisão curva na pele do canal anal; sutura em bolsa realizada em torno da fístula; as fístulas residuais removidas em um túnel) e teve tempo de acompanhamento de mais de um ano. A condição geral pré-operatória dos pacientes, a eficácia pós-operatória e a função anal foram comparadas. Resultados: A mediana de idade dos participantes foi de 34 anos, e 43 (69,4%) dos casos eram de homens. Quarenta e um (66,1%) casos eram de fístula transesfincteriana alta, quatro (6,5%) de fístula intra-esfincteriana alta e 17 (27,4%) de fístula anal anterior em mulheres. A mediana da duração do acompanhamento foi de 24,5 meses (12-51). A taxa de sucesso no final do acompanhamento foi de 83,9% (52/62). A pressão anorretal e a Incontinência Fecal da Cleveland Clinic Florida (CCF-FI) avaliadas três meses antes e após a operação não encontraram alterações aparentes. Conclusões: Comparado com o LIFT, o LIFT modificado reduz notavelmente a falha pós-operatória e a taxa de recorrência de fístula complexa com resultados aceitáveis em longo prazo.

Intestinal derotation maneuver for resection of intestinal neoplasm near the ligament of Treitz / 中华普通外科杂志

Objective To study the the feasibility of intestinal derotation maneuver in the resection of gastrointestinal neoplam localized in the vicinity of the ligament of Treitz.Method Intestinal derotation maneuver was applied in all the 9 case of gastrointestinal neoplasms near the ligament of Treitz,from January 2014 to January 2016,at the Second Hospital of Jilin University.The clinical date were retrospectively analyzed.Results Intestinal derotation maneuver were applied without failure in all the nine patients,the mean operation time were (195 ± 50) min,and the mean intestinal derotation maneuver time were (19 ±5) min;No derotation procedure-related injury occured,and the mean estimated blood loss were (132 ±94) ml.Early postoperative ileus developed in one case and gastroparesis in two cases.All were recovered by conservative treatment.The follow-up period were 3-24 month,tumor recurrence occurred in two cases and one case died.One case lossed to follow-up after postoperative 3 month.Conclusion The present data suggest that clinical use of intestinal derotation maneuver was feasible for surgical management of gastrointestinal neoplasms near the ligament of Treitz.

Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

OBJECTIVES: Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate. METHODS: We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry. RESULTS: Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases. CONCLUSION: We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.

Laparoscopic management of borderline ovarian tumors; KBSMC experience / 대한산부인과학회지

OBJECTIVE: To evaluate feasibility and efficacy of laparoscopic management for borderline ovarian tumors. METHODS: From May 2005 to October 2007 in our institution, laparoscopic treatments were performed for 16 patients for borderline ovarian tumors. Through clinical records, the patients' age, parity, operating time, tumor diameter, length of hospital stay, change in hemoglobin level, intraoperative and postoperative complications, and recurrence were analyzed. RESULTS: The median age of the patients was 38 years (27-72 years), the median parity was 1 (0-3), and 6 patients were nulliparous., Eight patients were performed conservative surgery, and radical surgery was performed in the remainder. The median operating time was 90 minutes (50-305 minutes), the median hospital stay was 5 days (4-16 days), the median change of the hemoglobin level was 1.5 g/dL (0.2-4.5 g/dL), and the median diameter of the tumors was 8.5 cm. FIGO stage was Ia for 9 patients, Ib for 2, Ic for 4, and IIIc for the last one. Histopathological results showed mucinous tumor for 8 patients, serous tumor for 6, and mixed type and endometrioid tumor for each remaining. Laparoscopic pelvic and paraaortic lymphadenectomy were performed 4 patients. There was no upstaging by intraoperative cystic rupture. Neither laparoconversion nor intraoperative complication was noted. The median duration of follow-up was 20 months (3-53 months) and none showed recurrence. One of 8 patients who were treated conservatively obtained a baby by vaginal delivery in 32th postoperative month. CONCLUSION: This preliminary analysis demonstrated patients with borderline ovarian tumor can feasibly and efficiently undergo laparoscopic management.

Clinical Analysis of Non-blood Transfusion Management in our Emergency Department

PURPOSE: The number of patients who refuse blood transfusion is increasing for not only religious reasons but also non-religious reasons. The aim of this study is to analyze the effect of non-blood transfusion and to help the management of patients who want a non-blood transfusion. METHODS: We have studied on the case of 95 who refused blood transfusion. They visited the emergency department in Dong-A University Medical Center from November 2004 to July 2006, and these were reviewed retrospectively. We investigated sex, age, diagnosis, hemoglobin/hematocrit (Hb/Hct) level, the histories of transfusion. They were assigned to two groups according to the necessity of the blood transfusion. We analyzed differences in the average of Hb/Hct level, the histories of operation, numbers of nonblood transfusion, hospital stay, outcomes. RESULTS: The patients consisted of 40 males and 55 females. the most dominant ages of the patients were in the seventies (21 patients). A blood transfusion was considered to be necessary for 17 patients (17.9%). Nobody practically received a blood transfusion. Out of those 17 patients, the average of Hb/Hct level was 5.4 g/dL and 16.7% respectively. In addition, 9 patients (52.9%) were operated, 2 (11.8%) died, and all of the 17 patients recevied the non-blood transfusion. CONCLUSION: The treatment of patients who want non-blood transfusion management involves important medical considerations to decrease the risk of transfusion, to improve patient outcome. The development of appropriate non-blood transfusion strategies is increasingly important, and more studies are needed to define their role by controlled clinical trials.

Analysis of 52 eases of aged patients with acute cholecystitis treated with laparoscopie eholecystectomy / 中国基层医药

Objective To explore the clinical features and surgical management of aged patients with acute cholecystitis,and try to command the opportunity and procedure of laparoseopic cholecystectomy(LC)better.Meth- ods Clinical data of 52 aged cases with acute cholecystits undergone LC were analyzed retrospectively.Results All of the patients(within 48h of the acute attack)were successfully recovered without serious operative complications. Conclusion Aged acute cholecystitis progressed rapidly and its operative difficulty and risk were higher;only if more attention was paid to perioperative managements and operative time and technical skill were mastered,early LC for the patients was safe and feasible.Therefore.it should be recommended in the great majority of cases except the des- perate patients whose general condition was too poor to operate.

Change of the Tinnitus after Neurotological Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is a common and often very disturbing symptom. Current tinnitus treatment strategies emphasize multimodality therapy, including masking, pharmacological, and psychological treatment. In this study, we aimed to evaluate the change in the tinnitus symptoms following a neurotological surgery. SUBJECTS AND METHOD: A total of one hundred thirty one patients who visited the tinnitus clinic of Severance Hospital complaining of severe tinnitus between 1988 and 2002 were included in this study. They were all performed surgical procedures: there were 80 cases of chemical labyrinthectomy, 38 cases of cochlear implant, 11 cases of vestibular neurectomy, and 2 cases of cochlear neurectomy. RESULTS: Statistical analysis revealed a significant reduction in the tinnitus intensity: in cochlear implant, 82% were improved; in chemical labyrinthectomy, 44% were improved; in vestibular neurectomy, 91% were improved, and all cases of cochlear neurectomy were improved. CONCLUSION: Surgical procedures such as cochlear implant, chemical labyrinthectomy, vestibular neurectomy are effective modalities in the management of severe tinnitus within limited situation.

The Treatment of Renal Stag-horn Calculus by Lower Pole Incision Pyelocalycolithotomy / 中国医师杂志

Objective To evaluate the efficacy of lower pole incision pyelocalycolithotomy for the removal of complex stag-horn renal calculi. Methods The clinical data of 13 patients with complex stag-horn renal calculi underwent lower pole incision pyelocalycolithotomy were retrospectively analyzed. Results The renal pedicel blood flow did not be interrupted during operation. The mean operative time was 140 minutes, and the mean amount of blood loss during operation was 220ml. The size of the biggest removed stone was 7 2cm?4 1cm?3 5cm, and in one case the number of the removed stones amounted to 35 pieces. KUB plus IVP examination did not reveal the residual renal stone in all cases one month after operation. Conclusion The lower pole incision pyelocalycodithotomy have the advantages of simplicity, less bleeding,complete removal of calculus and preservation of renal function. It is one of effective operative procedures to treat big stag-horn renal calculi.